Episode 66 - GERD


Speaker 1: 00:00 This is Dr Chad Edwards and you’re listening to podcast number 66 of against the grain.

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Speaker 1: 00:58 What up? What up? This is the Super Tall Marshall Morris here with Dr. Chad Edwards, who believes that 80 percent of all medical recommendations are crap technically speaking here he is a board certified family physician. He served in the US army. He is the author of revolutionize your health with customized supplements and the founder of Revolution Health Dot Org and the against the grain podcast. Dr Edwards, what is up? How have you done? I am doing well. I’m glad to be here. I’m glad you’re here. Yeah, I’m glad to be talking about these crappy medical recommendations. Now based on one of your previous podcast episodes, you, uh, maybe it was even off air. You were telling me stay away from the Hmo, the insurance plans. And so I’ve done that. I’ve done that. Not that they’re bad in their own right, but maybe you said between the two in Hmo versus a ppo, you know, maybe look at the [inaudible] first, maybe look at it it, and, and in fairness, the, an Hmo health maintenance organization there, they tend to be, they tend to cost less.

Speaker 1: 02:03 And so it’s balancing cost versus freedom. You know, and if you’re William Wallace, you’re never going to sign up for a, for an Hmo. That’s just how it is. So you get a limited selection of physicians of providers and you go to your assigned doctor for everything. If you want to go to a nephrologist, you can’t do it unless you go through the gatekeeper, uh, your, your, uh, primary care physician and then they will refer you if so inclined and, or if they think it’s necessary. And I, I just, I’m not a big fan of that. I think patients have the right to go where they want, but I mean it’s a balance of cost. It’s a, it’s a balance of cost. It’s a given a take. And because I’m a diva, I went with a PPO. Hey, I get it. You’re like the king, the king.

Speaker 1: 02:46 That’s right. Okay. So Dr Edwards, every week we cover a really controversial topics, hot topics in the medical fields. What are we talking about this week? Yeah, we’re going to get straight into it because we’ve got a lot to go in a short period of time. It’s not gonna be a very long podcast, uh, but we got a lot to cover. So we’re going to talk about gerd, Gerd. Is that like g, R, R, R, R, r, r, d was kinda like, Kinda like gird your loins. Oh no, that’s not it at all. So it stands for, it’s g, e, r, d, gastroesophogeal reflux disease. Okay. So that’s also known as heartburn. Peptic ulcer disease. There are several different terms names that it has to break it. Break down the acronym for me, which each part, the of that means so of that Gerd, gastroesophogeal. So gastro means stomach esophageal beans to the esophagus and reflux disease.

Speaker 1: 03:38 So reflux is were junk from your stomach, comes up into your esophagus and you know, we’re, most people think that, oh, you got too much acid. And so it comes up into your esophagus that you know, the Cup runneth over, so to speak. And it comes up into the Esophagus, Burns your esophagus and it causes the symptoms. So that’s the, that’s the thought process. And so typically if you have those symptoms, you’ll go to your doctor. Well, you now they’ve got these medications over the counter, you can get Zantac and pepcid, which are what are called h two blockers and those are Histamines, uh, or anti anti histamines, but h two is a histamine and then you have another class of medications called Proton pump inhibitors, and in your stomach you’ve got these proton pumps that actually create hydrogen ions and we’ll make the hydrochloric acid that fills your stomach.

Speaker 1: 04:27 So you’ve got a Ph in your stomach of, around to, what is Ph? Uh, that’s, I don’t remember what it stands for, but it basically, it’s the, it’s the concentration of hydrogen ions and it basically determines the strength or weakness of an acid and a base. So a neutral solution in chemistry is a, has a ph of seven, so water with nothing in it. Distilled water has a Ph of seven, neutral. And that’s because it’s h, two o and the hydrogen ions in it and you know, those kinds of things. So it has a neutral ph. the human anatomy Ph is normally within seven point three, five to seven point four five. So it’s slightly basic compared to plane, straight old water. The hydrochloric acid is very high acid and [inaudible] acids are beneficial for certain things. Basis are beneficial for certain things, but the, the Ph in your stomach is around two, that means it’s it, it’s hydrochloric acid, you know, so it’s a very strong acid and it serves a purpose.

Speaker 1: 05:24 And we’ll talk a little bit about that in a second. So again, the thought is that you’ve got too much of this stuff that you’re stomach’s over producing it. So you’ve got gotTa, you know, at the bottom of the Esophagus, there’s this what’s called the lower esophageal sphincter or the les and the, the thought is that this thing will relax and allow all this acid in your stomach that’s too high to come up into your esophagus and gives you that burning sensation, that reflux. And so, you know, we’ll give you either those h two medications or the Ppis, the Proton pump inhibitors, uh, things like, um, oh, good grief. They all just slipped my brain like not Zantac, Malcolm, a index a lot would be one of them. Uh, oh, mep the SEC. Those kinds of things, those are there anything with a resolve that a’s all, that’s that.

Speaker 1: 06:17 Those are usually proton pump inhibitors, so those medicines will prevent those proton pumps from kicking out acid so it, it raises the Ph in your stomach and if you raise the Ph in your stomach and you don’t have as much acid in your stomach, then the cup no longer runneth over and so you don’t have anything going up into your lower esophageal sphincter and a present for prevents the symptoms. And there is good data. It’s all short term data, but there is good data on the use of those medications and some patients need them. There are certain conditions, you know, if you’ve got like Barrett’s Esophagus for example, you really probably need a medication like that because you’ve already got damaged to your esophagus and you need to prevent that. Um, you know, there may be from a functional medicine realm, there may be some benefit to some of the things that we’re going to talk about how to prevent needing one of those medications.

Speaker 1: 07:07 But, you know, um, my, this, the target audience for this podcast is that, that patient that gets either occasional heartburn has it all the time but has not yet been diagnosed with something like Barrett’s Esophagus and, you know, from a, from a safety perspective, I would encourage anyone that has reflux disease and has certain other conditions like a thing called dysphasia, dysphasia, meaning, uh, when you, when you eat food, gets stuck, you have difficulty with food going down and things like that. That could be a sign of other problems. It’s not just reflux, it could be a sign of other problems like achalasia where the esophagus has kind of constricted down there. There’s a number of different things that it could be. And in those cases I’ll generally recommend that someone get what’s called an egd or a soft Taco esophagogastroduodenoscopy where they go to a gastroenterologist, they put a tube down look and your stomach look at your esophagus.

Speaker 1: 08:00 They can take biopsies if necessary, uh, and then determine the scope of or the magnitude of your problem. So some patients need that. Certainly have your doctor evaluate you for something like that. And you know, if needed, get that test done, there is no harm in getting that test done. It’s very, very, very low risk. I’ve had it done myself. Painless procedure. It doesn’t sound painless. Well, I’ll be honest, I’m speaking on behalf of all of the listeners right now. That does not sound painless. Yeah. You go in, you get a little ivy, they put some medicine in your ivy and it’s night night you wake up and none the wiser. It’s painless, absolutely painless. Or at least you won’t remember it exactly. Oh yeah. It’s, it’s a, it’s not a big deal to get that procedure done. Okay. So. So why is Gerta hot topic though it get into that?

Speaker 1: 08:44 For me, I would argue that it’s not gerd itself. Well, one, it’s because of the crappy way that we eat. We eat too much. The kinds of foods that we eat and the whole host of things that it can. That is the way we eat causes. Now. It’s really the subject of another podcast to talk about all of the reasons behind why you get reflux, but there’s a number of reasons and the way our lifestyle and the way we eat, uh, is, is definitely plays a big role. There’s some question whether something like h Pylori, it’s an infection that you can get in your stomach. There’s a question if that contributes to it, uh, those kinds of things, but it’s really in the way that we treat gerd that I think is the hot topic. And so when you think that reflux, this heartburn is, is because of the Cup runneth though, run too much acid.

Speaker 1: 09:32 The Cup runneth over of acid and it goes up into your esophagus. Then it makes sense that we give you an acid blocking medication, like a PPI too much. Let’s give you something so that there’s less right now. Part of. I got to be honest, my, the reason that this became an issue for me is because when I was in residency, I started getting heartburn. I was, I remember going for a run and I was like, what the heck? I got this burning. What is that relatively young? I was not obese. I wasn’t even overweight. I was fairly fit. I was running, I was in the military and I started getting reflux, but I did have a lot of stress and stress is one of those things that can contribute to, to reflux. So I didn’t have a lot of the traditional risk factors at the time, but I started getting this reflux so I, I went short.

Speaker 1: 10:19 So that’s why I ended up getting an egd getting that test done. But I went on a couple of different medications trying to. I was as residency, traditional medical residency, uh, family medicine. And so, you know, we take medicine for our problems. And so that’s what I did and I ended up going on Omeprazole, took care of the problem that no big deal. But I remember at one point I started looking at the, at the list of potential problems and the risks of being on these medications. And I knew that those medications had never been studied long term. We don’t have longterm data. They weren’t intended for long term data. They were or longterm benefit. They were intended for short term, like eight weeks, and to my knowledge, and I’m not, I’m not saying this because I’ve looked at it and there may be some long term studies, uh, but to my knowledge, there are not longterm studies on the use of Proton pump inhibitors for any of these gastroesophogeal problems, but again, some patients need them, so I’m not telling you if you’re on it to just stop it and you know you need to do this with your doctor, but the, when you look at it, those medications over time can increase your risk of things like osteoporosis because they inhibit the absorption of things like magnesium and calcium.

Speaker 1: 11:32 You can get nutritional deficiencies because of these medications, but I’m going to go a step further. Acid in your stomach is essential for the and this gets into the real root of the problem. Acid in your stomach is essential for breaking down and digesting food. You need that stuff in order to break it down. Now there is a guy and his name eludes me. I think he’s at a Washington that has done longterm study since starting in 1976 long thousands of patients and they tested their stomach Ph and they found that patients with heartburn reflux, Gerd actually had too little stomach acid and not too much, so the problem isn’t too much acid. For many people, I would argue most, but for at least many. The problem isn’t too much stomach acid, stomach acid in the wrong place. It’s stomach acid in your esophagus, which isn’t supposed to be there.

Speaker 1: 12:27 So then it begs the question, how did it get there? Well, if you don’t have enough stomach acid, then that food that it’s supposed to digest doesn’t get digested appropriately. You’re not triggering the biochemical processes to allow the pylorus, which is, you know, thinking about the lower esophageal sphincter between the esophagus and the stomach. That’s the entry valve. Well then you also have the entrance entrance entry door. You also have an exit door and that’s the pyloric sphincter at the other end of the stomach. And if you don’t get the right bio, mechanical biomechanical messengers, then you don’t trigger the opening of the pylorus. And so that sphincter doesn’t open appropriately, you don’t get the gastric motility that causes the food to go out and into the small intestine so you can absorb it. There are also a whole host of other potential problems, things like small intestinal bacterial overgrowth, a where we have an imbalance of bacteria in the small intestine.

Speaker 1: 13:18 There’s a number of gut problems which is beyond the scope of this podcast, uh, to get to the answer of what is it that’s going on? So, approaching gerd from a functional medicine perspective, you have to look at the overall gut health of the patient. Most of these patients need probiotics, a, they change your diet. There’s a whole host of things. Things like start with the Paleo Diet, um, you know, which is meats, vegetables, nuts and seeds, some fruit, no grains, no legumes, no dairy. I’m starting with that. Some patients need a specific carbohydrate diet or would call a gaps diet. Uh, some people need low fodmap diet. Again, beyond the scope of this podcast today, but there’s a whole host of nutritional things that we may need to look at. A, if you’re obese, if you’ve got too much, uh, abdominal fat, you know that beer belly, if you’ve got that, you’ve got too much pressure in your stomach and it’s pushing food up that can increase your risk.

Speaker 1: 14:11 There’s a whole bunch of things that can increase your risk of this, but again, the problem isn’t too much stomach acid. The problem for most people, the problem is too much stomach acid in the wrong place, so we’ve got to do everything we can to optimize the function of the stomach and part of that is can actually be giving hydrochloric acid to patients and there’s a supplement that I use that has good digestive enzymes and sometimes I’ll use a separate digestive enzymes and hydrochloric acid and some patients will actually use it as basically a reflux medication. So this is against the grain because it’s completely contrary to why you have reflux. And the therapy for this is going the absolute opposite direction. We’re not blocking stomach acid, we’re enhancing stomach acid and what we find is that patients do better and many times they can go on stomach acid.

Speaker 1: 15:06 They can often come off of it, whereas if you’re on a proton pump inhibitor, not only do you go on the medication, you develop a tolerance and dependence because when you come off of that medication, now you get this reflux that’s almost worse than you would have had a patient this week that he was on reflux medication to treat some unrelated thing and he turns around and tries to come off the medication and now he’s got. Now he’s got symptoms that he didn’t have before because he’s quote hooked on the medication. Not Psychologically, but physiologically. His body’s hooked on it. So the fix for this is give hydrochloric acid, optimize the gut function, probiotics, number of things like that. And I’ve got a protocol, A. I’ve got it on my, I think I got on my website for how you can take this hydrochloric acid and there’s a, um, there’s a test that we can do in our clinic.

Speaker 1: 15:55 It’s called the Heidelberg capsule and we can actually measure the Ph in your stomach. And you swallow this capsule and it tells us what your Ph is. And we give this a bicarb stuff to neutralize the stomach acid and then watch how your stomach actually [inaudible] and you’ll see the Ph just decline as you develop new stomach acid. If you can’t do that appropriately, then you’ve got a gut function problem and we can address that by a number of different ways. So we’re actually evaluating and we can get black and white. Here is your problem. So we can do that test in the clinic. What’s that name of that test? One more time. The Heidelberg. And it was developed in Heidelberg, Germany. Uh, so the Heidelberg capsule test. So I had

Speaker 3: 16:36 no idea that gerd might actually be because of too little stomach acid, um, but, but rather stomach acid in the wrong place. So you’re maybe a, and again, this is probably better for another episode, but um, but in fact maybe too much food it, which is pushing the acid up into the, up into the esophagus. Right. Um, and so the reason that there is too much food is you don’t have enough stomach acid in the first place. Try to break down the food. That’s right. Okay. Exactly. Boom, so this is, this is another, this is another podcast episode that I feel is kind of maybe going to kickoff a sub series here. Um, last episode we got into cholesterol this episode we’re talking about Gerd and maybe some of the other things that associate with that. So stay tuned to some of the upcoming episodes. This is going to be great. We’re going to get into a couple series here, parallel series going on, but Dr. Edwards, thank you so much. We’re getting into Gerd.

Speaker 1: 17:38 Yeah,

Speaker 3: 17:41 thanks Marshall. I appreciate you. Absolutely. Talk to you guys next time. Thanks for listening to this week’s podcast with Dr Chad and in next week

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