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Letter
from Dr. Janson
Heartburn or GERD
Ask Dr. J
In the Health News
Recipe of the Month: Lentil-Lemon Soup
Dear Friends,
Although the focus on our personal health sometimes
seems trivial and self-centered in the light
of “larger” world events, it is important
to remember that each of us is as important
as the next, and taking care of ourselves is
part of taking care of the entire world community.
If we do our best to lead healthy, fulfilling,
caring, enriching lives, we will be setting
an example for those around us. It may appear
to be a small part to play, even trivial, but
each one of us moving in the right direction
moves the world in the right direction—and
that may be the best that we can do in creating
a harmonious, healthy, and spiritual world.
In attempting to achieve our own health, we
have to rely on ourselves. When I spoke last
year for an audience of insurance executives,
I remembered that many people think that they
buy health insurance from insurance companies.
But this is not the case. These companies sell
medical treatment insurance, to help after you
have a problem. And the government also only
finances medical treatment. People don’t
even get health from their doctors, as most
doctors focus almost exclusively on treatment
of diseases—to be fair, most people don’t
go to doctors until they have something that
they think needs treatment.
However, health is something that you can give
yourself. The way to do this is to take good
care of your lifestyle. You don’t need
to worry that you might have a genetic propensity
for a disease, because even if it were true,
you can’t do anything about that. Most
of the time genetics plays a small role in the
development of disease, while almost 90 percent
of the time lifestyle choices—such as diet,
exercise, stress management, participation in
cultural and spiritual activities, and fulfilling
relationships and work—are the major determinants
of long-term health.
For some people this seems like too much responsibility,
and they begin to feel guilty if they get ill,
which is not at all what I have in mind. I simply
mean that we have the opportunity to do much
about our health by choosing to do so, and thereby
influencing our children, family, friends, and
acquaintances. For example, recent reports confirm
that diet and exercise are the best and most
cost effective ways to reverse hypertension,
while another report shows that exercise reduces
breast cancer risk. Yet another study suggests
that simple, inexpensive vitamin supplements
may be the best way to prevent heart disease.
And another report shows that prolonged high
levels of sugar, a direct result of eating and
drinking sugary foods and beverages, can kill
pancreatic beta cells that produce insulin,
and thus may increase the risk of diabetes.
We all have the opportunity to create a healthier
world for ourselves and everyone else. But it
involves taking charge of our health habits
and our lives, and setting a good example for
those around us.
So many people have problems with acid indigestion
that it is almost considered a normal part of
living. However, it is not normal, just common.
It is related to dietary choices, among other
health habits. You might recognize this because
of the advertising on television, which often
juxtaposes ads for fatty, sugary, additive-laden
junk with ads for histamine antagonist drugs
(such as Pepcid and Axid) and acid-neutralizing
drugs (such as Tums and Rolaids).
Antacids are among the most popular drugs in
terms of sales, both by prescription and over
the counter. The symptom of heartburn, or a
burning sensation in the chest, is not necessarily
the result of too much acid. It may be that
the stomach lining is not resistant to the effects
of the acid, or that the acid rises into the
esophagus, which does not have a protective
mucosa.
This is called gastro-esophageal reflux disease
(GERD), associated with either hiatal hernia
or poor functioning of the esophageal sphincter.
Helicobacter pylori, a bacterium associated
with peptic ulcer disease, may not be related
to simple heartburn symptoms, but ulcers can
cause the same symptoms.
Symptoms of GERD are more frequent in obese
people, and are aggravated by food allergies,
or consumption of sugar, caffeine, and alcohol.
High dietary fiber seems to reduce the symptoms,
possibly by absorbing stomach acid, and helping
to push food through the digestive process.
Drinking adequate water is also important.
The stomach acid itself is not necessarily
the cause of the problem, as we all need acid
for proper digestion, and heartburn symptoms
also appear in people with low stomach acidity.
Counteracting the acid with drugs can lead to
poor digestion in addition to side effects.
A recent report shows that antioxidants are
more protective of the mucosal lining cells
than histamine-antagonist drugs. This suggests
that the condition is more complicated than
just too much acid. In that study, the researchers
used an antioxidant mixture, an antihistamine
drug, and a placebo. They found that the incidence
of esophageal ulcerations was 80 percent in
the placebo group, 60 percent in the drug group,
and only 27 percent in the antioxidant group.
The researchers suggested that oxygen free
radical damage was the major cause of ulcerations
in the esophagus, rather than gastric acid.
You should be aware that the same symptoms can
be caused by a gastric or duodenal ulcer, so
you should have a check-up if the symptoms are
severe or persistent.
My first recommendation is to eat a whole
foods diet, with lots of fiber, and lots of
vitamins and bioflavonoids for their antioxidant
value. Avoid salty foods, as salt can increase
the growth of H. pylori. In addition, drink
at least 6 to 8 glasses of water a day. Be sure
to drink either spring water or filtered water
rather than typical tap water (I recommend the
MultiPure solid carbon block filter system,
available from QCI Nutritionals at 888-922-4848,
or www.qcinutritionals.com).
Avoid caffeine, sugar, alcohol, and the vast
array of highly processed junk with hydrogenated
and reheated oils, artificial flavors, colors,
preservatives, and sweeteners. These are the
least nutritious components of the western diet.
Avoid sodas, which contain sugar and caffeine.
Try not to eat just before bedtime, and eat
smaller meals, as overeating can increase pressure
on the esophageal sphincter, leading to reflux.
Try to minimize the use of anti-inflammatory
drugs, such as aspirin and NSAIDS (including
Advil, Ibuprofen, Naprosyn, Celebrex). These
are common contributors to ulcers and bleeding.
Unless you have an ulcer diagnosed, it is probably
best not to take any antacid drugs.
Stressful lifestyles contribute to heartburn.
It has long been accepted that stress can lead
to ulcers, although it is not usually the only
cause. Do some form of meditation, relaxation,
yoga, or breathing exercises. While exercise
is an important part of overall health, do not
do aerobic exercise immediately after meals,
as that can worsen symptoms.
My first supplement recommendation for
acute heartburn and ulcer symptoms is a licorice
extract called DGL (deglycyrrhizinated licorice).
Chewing mixes it with saliva, forming a protective
coating of mucin for the lining tissues of the
esophagus and stomach. Chew 1 or 2 DGL tablets
before each meal, and at bedtime, or take them
as needed to relieve symptoms between meals.
The next important supplement is the amino
acid L-glutamine, the most abundant free amino
acid in the body. This is essential for the
health of the intestinal lining cells, and has
been shown to help heal ulcers and other bowel
inflammatory diseases. Typical doses are 1000
to 2000 mg twice a day, although sometimes higher
doses are beneficial.
Glutamine acts as an anti-inflammatory, but
it is also a precursor for the antioxidant glutathione.
As I mentioned, antioxidants protect against
free radical damage to the esophagus. Other
antioxidants that might help include vitamins
C and E, and bioflavonoids. N-acetyl cysteine
(NAC) contributes to glutathione production
and free radical control, and it can help heal
ulcers. The usual dose is 500 to 1000 mg twice
a day.
Additional valuable supplements include zinc,
which promotes healing, and carotenoids for
their antioxidant effects and benefits in healing
gastric erosions. Curcumin (from turmeric) is
an anti-inflammatory herb that also has excellent
antioxidant properties. Typical doses are 500
mg of standardized extract, 2 to 3 times a day.
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Q. I have been developing varicose veins as
I get older. Is there anything natural I can
do about them? I don’t want surgery.
A. Veins contain valves that control the direction
of blood flow, and with time they often get
damaged, leading to pooling of blood and bulging
veins. This can result from lack of exercise
(exercise helps propel the blood from the legs
back to the heart), and obesity, constipation,
long term standing or sitting, and pregnancy,
all of which put extra pressure on the valves.
It is important to do something for varicose
veins, because chronic venous insufficiency
with bulging veins can lead to blood clotting
(thrombosis) and inflammation. The calves and
feet can become swollen and painful.
Eating a high-fiber diet can relieve constipation
and bowel pressure, reducing stress on the venous
valves. This means lots of fresh vegetables,
fruits, whole grains (whole wheat, oatmeal,
brown rice, millet, and others), and legumes,
and avoidance of white flour, white rice, and
sugar. This diet is also rich in vitamins, minerals
and flavonoids.
Strengthening the connective tissue with vitamin
C and mixed bioflavonoids (1000 to 2000 mg daily)
is beneficial in preventing further damage to
the veins. Proanthocyanidins (100 mg), found
in grape seed and pine bark, are other flavonoids
that increase small blood vessel strength.
In addition, various herbs have been helpful
in managing vein problems. Horse chestnut extract
with 20 percent aescin relieves edema and improves
venous blood flow. The typical dose is 250 mg
twice a day of a standardized extract.
Another herb, butcher’s broom (100 mg
per day of a standardized extract), is also
effective in relieving symptoms of varicose
veins. As with horse chestnut, the active components
appear to be saponins, and the standardized
extracts contain known amounts of these substances.
Combinations of these herbs are available with
flavonoids, and often with gotu kola (Centella
asiatica), which helps restore venous connective
tissue.
•While obesity is related to the
risk of type II diabetes, it was thought that
only very obese people were at increased risk.
However, new research shows that diabetes is
more common in direct proportion to increased
body mass, meaning that at each level of increasing
obesity there is a higher incidence of diabetes.
(Hillier TA, Pedula KL.Characteristics of an
Adult Population With Newly Diagnosed Type 2
Diabetes. Diabetes Care 2001 Sep;24(9):1522-7)
Previously it was thought that you had to reach
a certain threshold of weight to increase your
risk, but that appears not to be the case. What
this means is that any weight you lose will
be helpful in lowering your risk.
•With age, genes change in their expression,
reflecting the deterioration associated with
the aging process. Restriction of caloric intake
in mice (and in other animals in previous studies)
can reverse or delay many of these genetic changes.
(Cao SX, Genomic profiling of short- and long-term
caloric restriction... Proc Natl Acad Sci U
S A 2001 Sep 11;98(19):10630-5) Lower calorie
intake reduces the expression of genes associated
with inflammation, stress proteins, and cancer
formation. In addition, calorie restriction
enhanced the ability of the liver to detoxify
harmful chemicals. Healthy diets are filling
because of the high fiber content, but they
also have a low caloric density.
•Breast feeding for at least six
months appears to help cognitive function in
infants at 13 months and at 5 years old. (Angelsen
NK, et al., Breast feeding and cognitive development
Arch Dis Child 2001 Sep;85(3):183-8) DHA (docosahexaenoic
acid), an essential fatty acid, is important
for neurological development. DHA from fish
oil can be added to an infant’s diet. (DHA
is also valuable for adults’ brain and
heart function.)
One of my favorite ethnic dishes is a simple
tasty soup. Sauté chopped onions and
celery (with some leaves for extra flavor) in
a small amount of olive oil and some added cumin.
Add green lentils with at least 4 times as much
water as beans, and make sure there is always
adequate water to make a soup (although if it
gets thick you can call it a stew). Add chopped
green chard or another green and simmer until
the lentils are done, which is usually about
45 minutes, but check them regularly, and stir
to avoid burning. Before serving, add fresh-squeezed
lemon juice to taste. Serve this with some whole
wheat bread or rice cakes, and a side of salad,
and you have a delicious, healthy meal.
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