Is treating your acid reflux increasing your risk of dementia?

Prilosec, omeprazole, Nexium, and other proton pump inhibitors (PPIs) suppress stomach acid, reduce symptoms associated with esophageal reflux and peptic ulcer disease, and assist in ulcer healing; short term (days to weeks) use for diagnosis and treatment often makes sense.  However, that pesky stomach acid also happens to be a key component of a healthy metabolism, so it shouldn’t surprise us that suppressing it long term may have side effects.  Weigh the pros and cons of PPIs carefully with your physician and explore the alternatives.

• Benefits of PPIs:  Prilosec and other PPIs ease the discomfort of gastroesophageal reflux (GERD) and may reduce the risk of esophageal cancer in patients with Barrett’s esophagus, which is a serious complication of GERD.
• Potential harms from long-term use of PPIs:  The downside of chronic use of PPIs include dementia [1]; stroke and heart attack [6]; kidney disease [2]; infections including pneumonia and C difficile diarrhea [3]; low magnesium and B 12 levels [5]; altered gut microorganisms [4]; stomach cancer [7]; and broken bones [3]. 

My recommendation:
Carefully consider the risks from this group of medications when deciding whether to take them for more than a few weeks.  Schedule a visit with your physician to discuss the risks and benefits as well as alternatives.  For most GERD sufferers there are some fundamental lifestyle steps that can both reduce symptoms and risks – including risk of esophageal cancer – while minimizing medications: avoid sugars and starches; increase intake of high fiber foods such as vegetables; get daily exercise; eat probiotic foods such as fresh sauerkraut, kefir and yogurt; and reduce weight around the middle.  Some traditional folk remedies can also be effective. 

 

If you decide to tackle GERD head on, and eliminating medications is a reasonable option, it’s important to taper PPIs rather than stopping them cold turkey, coordinating with your physician as you do this.  As well as reducing or eliminating the need for PPIs and feeling better, you will enjoy the added benefit of improved blood pressure, cholesterol, and cancer risk!

 

Miles Hassell MD 

[1]Gomm, W. et al. JAMA Neurol2016;73(4):410-6

[2]Lazarus, B. et al. JAMA Intern Med 2016 Feb;176(2):238-46

[3]Schoenfeld, A.J. and Grady, D. JAMA Intern Med 2016;176(2):172-4

[4]Jackson, M.A. et al. Gut 2016;65:749–56

[5]Laine, L. and Nagar, A. Am J Gastroenterol 2016 Jul;111(7):913-5

[6]Shah, N.H. et al. PLoS One 2015 Jun 10;10(6):e0124653

[7]Tran-Duy, A. et al. Clin Gastroenterol Hepatol 2016 Dec;14(12):1706-19 e5

Osteoarthritis: Keep your joints in good shape – avoid sugar, watch your waist, and stay active

Healthy joints are critical to enjoying life as we get older.  Three important steps we can take to prevent painful osteoarthritis of the hips, knees, thumbs, spine, and shoulders are:

1. Reducing excess waistline and weight
2. Avoiding added sweetening and refined grains (especially white flour and white rice)
3. Staying active 

These choices protect the joints from excessive mechanical forces while also improving the ability of the joint to repair itself.  Too much weight around the middle combined with excess sugar and refined grains plus too little activity create a cascade of metabolic effects that accelerate wear and tear on joints. [1]  They start to hurt, and next thing you know your doctor is talking about joint replacement.

So, take action as soon as you get the first hint that you are developing “metabolic syndrome,” a condition notable for three or more of the following:

1. Fasting blood sugar greater than 100 or being treated for high blood sugar
2. Waistline greater than 35 inches for women and 40 inches for men; less for small framed people
3. Blood pressure greater than 135/85 or being treated for high blood pressure
4. Triglycerides greater than 150 mg/dl
5. HDL cholesterol lower than 40 mg/dl for men and 50 mg/dl for women

Once “end-stage” osteoarthritis of a joint is diagnosed, is it too late for lifestyle choices to make a difference?  We’re glad you asked.  Even in the case of “end-stage” or “bone-on-bone” joints facing replacement surgery, we have seen dramatic improvement in joint pain when overall health is improved.  (Some nutritional supplements that can occasionally help with osteoarthritis are worth considering and can be discussed during a consultation.)

An example of these lifestyle choices at work is one of our patients who at 75 had previously had one knee replacement surgery and was scheduled to have the other replaced.  He decided to try a non-surgical path and reduced his intake of sugar and other refined foods.  With his healthier diet and resulting weight loss,

• he was able to reverse his type 2 diabetes,
• his blood pressure (BP) improved and he was able to stop his BP medications,
• his knee stopped hurting, and he felt better than he had for decades.

Five years later he still has his original knee and still needs no blood pressure or diabetes medications!

 

My recommendation:
If you have the metabolic syndrome, reverse it using the 14-step Risk Reduction Action Plan on pages 59-92 of Good Food, Great Medicine (3rd edition).  Target the following lifestyle choices to get a jump start:

1. Reduce excess waistline and weight (see page 60-61).
2. Avoid added sweeteners and refined grains (see pages 42-46 and 73-77).
3. Keep active.  You’ll also find tips for daily exercise on pages 50-55, especially the tips for arthritic joints like trekking poles on page 53. 

Miles Hassell MD

[1] Courties, A. et al. Osteoarthritis Cartilage doi: 10.1016/j.joca.2015.05.016

Extra-virgin olive oil appears to lower cancer risk substantially

There are plenty of good reasons to use extra-virgin olive oil as your main kitchen oil, and one of the lesser known ones is a reduced risk of cancer of all causes.  In Mediterranean countries where olive oil is used generously and frequently, cancer is less common, and it doesn’t appear to be a coincidence.  A review of 19 observational studies following about 37,000 people found a consistent relationship between olive oil use and cancer incidence: a 34% lower risk of any cancer in those who used the most olive oil!  (The benefit was strongest for breast and colon cancers.)  We are not aware of any data suggesting comparable benefit for other vegetable oils. [1]

 

My recommendation:

Use extra-virgin olive oil as your main kitchen oil and avoid hydrogenated oils and highly-processed vegetable oils.  For more information on the health benefits of olive oil and why we should avoid highly-processed oils see pages 26, and 47-48 in Good Food, Great Medicine (3^rd edition).  You’ll also find tips for choosing an extra-virgin olive oil on page 115 and about 100 recipes to get you started. 

Miles Hassell MD

 

[1] Psaltopoulou, T. et al. Lipids in Health and Disease 2011;10:127

Can drinking alcohol help prevent and treat type 2 diabetes?

It is commonly believed that drinking alcohol will worsen blood sugar control in type 2 diabetes but the evidence shows otherwise.   In an analysis of the available randomized studies that compared patients with diabetes who drank alcohol with those that did not, alcohol was found to make no difference to blood sugar control [1].  Furthermore, there are important potential benefits for moderate alcohol intake (up to one drink daily) in patients with type 2 diabetes:

§  Better sleep and improved markers of cardio-metabolic risk control, especially with red wine [2]

§  Less risk of death from any cause [3]

§  Less heart disease and stroke [3]

§  Less risk of kidney disease [4]

In addition, for people without type 2 diabetes, moderate alcohol consumption significantly reduced the risk of developing diabetes [5] and has anti-inflammatory benefits. [6]

My recommendation:

For those who can avoid drinking to excess, with or without type 2 diabetes, one 5-ounce serving of red wine with a meal remains a reasonable choice. For more information on alcohol and health, see Good Food, Great Medicine (3^rd edition) page 39.

Miles Hassell MD

 

[1] Hirst, J.A. et al. Diabet Med 2016; doi:10.1111/DME.13259

[2] Gepner, Y. et al. Ann Intern Med 2015;163:569-79

[3] Blomster, J.I. et al. Diabetes Care 2014;37:1353-59

[4] Dunkler, D. et al. JAMA Intern Med 2013;173:1682-92 (ONTARGET)

[5] Huang, J. et al. J Diabetes Investig 2016;doi:10.1111/jdi 12537

[6] Mathews, M.J. et al. NutritionJournal 2015;14:1-12