Your doctor may not even be aware of the best non-drug treatment for heartburn

Step It Up

Heartburn? Acid reflux? General indigestion?

If you answered yes to any of those questions, you have two choices: over-the-counter antacids or prescription drugs.

Actually, there’s a third choice. And it’s inexpensive, safe, and drug-free. But most mainstream doctors don’t even know it exists.

Ups and downs

Getting from dyspepsia (indigestion, heartburn, etc.) to eupepsia (healthy digestion) is just a matter of stepping from one drug to another, according to a study from Radboud University in the Netherlands.

To assess cost-effectiveness of dyspepsia treatments, researchers designed a study in which more than 660 dyspepsia patients followed either a step-up regimen or a step-down regimen.

Those in the step-up group started with antacids, then, if results were inferior, stepped up to H2 antagonist drugs (such as Pepcid and Zantac), and then, if necessary, to proton pump inhibitors (PPIs, such as Nexium and Prilosec). The step-down group followed the opposite course: PPIs to H2s to antacids.

Results: After six months, both groups reported similar levels of dyspepsia control. And although initial relief was more rapid in the step-down group, treatment was just as effective but less expensive in the step-up group.

Step aside

The Radboud study notes that the percentages of adverse events in both groups were nearly identical (just under 30 percent), and were minor: constipation, diarrhea, and other dyspeptic symptoms. Too bad the researchers didn’t check C-diff levels.

C-diff (Clostridium difficile) is a bacterium that can trigger digestive inflammation and diarrhea so severe that some cases result in death. But gastric acid actually protects the stomach from C-diff. So when drugs are used to neutralize or suppress gastric acid, the stage is set for C-diff to flourish. (A 2006 study showed that PPI users were three times more likely to develop C-diff infections compared to subjects who didn’t use medication.)

Which brings us to the most important misconception about dyspepsia: Gastric acid isn’t the problem. You wouldn’t be able to digest food without it. Problems start when the acid finds its way to places it shouldn’t be.

Here’s how HSI Panelist Allan Spreen, M.D., explains it: “Reflux (or any of the other scary sounding names) is nothing more than acid slipping past the junction of the stomach and esophagus. The stomach is designed for it, the esophagus is not…hence a trap door (sphincter) at the intersection (called the GE, or GastroEsophageal junction) is set in place to keep the two areas separated.”

Dr. Spreen notes that when acid blockers reduce gastric acid, the body reacts in a logical way: It saves the energy required to protect the esophagus from acid, which actually weakens the GE sphincter. Dr Spreen: “This allows any remaining acid to sometimes slip past and irritate the esophagus. So, you take an antacid and you feel better, because you lessen even more what little acid remains that has been irritating your already sensitive esophagus. So look what’s happening – the short term ‘fix’ assures that the problem will continue (and even worsen).

“When the stomach is low on acid it tends to also be low on digestive enzymes. Believe it or not, the solution (along with acidophilus protection) is to ADD acid and digestive enzymes at the same time.”

Dr. Spreen describes this solution as “ridiculously simple and cheap.” You can find a detailed excerpt:encoded of his regimen in the e-Alert “Fire Down Below” (12/23/02). But be sure to talk to a doctor or health care professional before using acidophilus supplements to treat dyspepsia.

Prescription Medication Harmful To Seniors

Cold Beers

There’s no other way to put it: Far too many doctors are letting seniors down.

A new study from Duke University reveals disturbing evidence that more than 20 percent of all seniors who are prescribed drugs are receiving medications that are known to be harmful to older patients.

This lapse in “care-giving” is nothing less than shameful. But it serves as a stark warning: No one should meekly accept what a doctor prescribes. Ask questions. Research. Take control of your health care.

Slipping through the cracks

In the early 90s, Mark Beers, M.D., and several other specialists in geriatric drug therapy, developed a list of medications that were inappropriate for nursing home residents. The list – now known as the Beers List – was amended in 1997, and updated in 2003, and has become a well known tool for guiding doctors away from prescribing medications that may be harmful when taken by older patients.

In an interview with HealthDayNews, Dr. Kevin Schulman, a professor of internal medicine at Duke University and one of the authors of the study, said that even though someone over the age of 65 may be in good health, their kidneys don’t function as well as they did when they were younger. This is one of the primary reasons that some medications can be harmful. Antidepressants and muscle relaxants can put particular stress on the kidneys.

The Duke team examined the outpatient prescription claims for more than 765,000 people aged 65 or older who had more than one prescription filled during 1999. Using the Beers List, the researchers produced this data:

* More than 20 percent of patients over the age of 65 may be taking inappropriate prescription drugs
* More than 15 percent of these patients received prescriptions for two or more of the drugs on the Beers List
* Four percent of the patients were prescribed three or more drugs on the list
* Psychotropic drugs (such as antidepressants) on the Beers List were prescribed the most, totaling more than 40 percent of the prescriptions
* Muscle relaxants on the Beers List were the second most commonly prescribed

Obviously, there are quite a few doctors out there who are asleep at the switch. And as a result, their patients may be suffering.

Adding up the danger

Kidney stress caused by drugs on the Beers List is by no means the only health problem older people face when filling prescriptions.

In the September 1999 HSI Members Alert, we told you how drugs can interfere with the absorption of nutrients. For instance, acid blockers (such as Prilosec and Nexium) have been shown to significantly decrease absorption of vitamin B-12; one of the primary vitamins needed to prevent anemia.

Other medications that are known to play a role in nutrient depletion are among the most frequently prescribed drugs on the market. Antibiotics, anti-depressants, anti-inflammatories, blood pressure medications, cholesterol-lowering drugs, estrogen, and tranquilizers can all strip valuable vitamins and minerals from the body. When two or more of these drugs are combined – especially in an older patient – the risk of developing anemia rises.

And that’s when things can get really complicated, because anemia dramatically increases mortality risk for patients with chronic health problems such as heart disease and cancer.

How much can you take?

The harm that a single drug may do – by stressing the kidneys and depleting nutrients – is small compared to the harm that can occur when several drugs are taken at the same time.

In the e-Alert “Iron in the Fire” (6/3/03), I told you about a study conducted by Medco Health Solutions, Inc. (a company that manages drug benefit plans). Researchers concluded with this shocking statistic: the average senior receives 25 prescriptions annually – a 100 percent jump from just five years ago!

As the over-medication of seniors grows at an alarming rate, we see two serious problems becoming even greater health threats: 1) the wider variety of drug intake creates conflicting side effects (and as we’ve seen before, many doctors treat drug side effects with additional drugs), and 2) these potent drug mixes rob patients of the very nutrients they need most when fighting an illness.

New coin

A few days ago I came across a word that was new to me: Polypharmacy. This is the practice of prescribing too many medications.

Along with polypharmacy I would coin this word: Negligentpharmacy; the practice of prescribing drugs that are known to be harmful to certain patients.

Unfortunately, many older people are victims of both polypharmacy and negligentpharmacy because too many doctors are not well trained or conscientious enough to know the harm that some drugs may cause. That’s why young and old patients alike have to be diligent whenever their doctor writes a prescription.

Ask questions. Research. Take control of your health care.

Vitamin B use among stroke victims

Vitamin B Use Among Stroke Victims

Second wind

You don’t always get a chance for a “do over.” But when researchers took a second look at a large study that examined vitamin B use among stroke victims, they found something important that was missed the first time.

And here’s the good news: The results of the follow up study offer victims of non-disabling strokes a course of action that may help prevent future strokes and cardiac events.

The middle way

The name of the study says it all: Vitamin Intervention for Stroke Prevention trial (VISP). When the VISP research was first reported last year, researchers found that high doses of vitamins B-6, B-12 and folic acid given to 3,680 patients who had experienced non-disabling strokes only moderately lowered homocysteine levels. (Homocysteine is an amino acid that promotes plaque buildup in blood vessels.) The conclusion: Risk of another “vascular event” remained the same.

But researchers at the Stroke Prevention and Atherosclerosis Research Centre (SPARC) in London, Ontario, analyzed the study and found several variables that may have skewed the results.

The SPARC team began by excluding subjects who started off the study with very high or very low levels of vitamin B-12 (which is known to reduce homocysteine). The idea was to remove two types of subjects: 1) Those who were already taking vitamin B-12 supplements, and 2) Those who likely had B-12 absorption problems (more on that in a moment).

This created a subgroup of more than 2,150 subjects with an average age of 66. And the results in this subgroup were dramatically different from the first group. When the data concerning ischemic stroke, coronary disease and death was analyzed, those who took the highest dosage of B-6, B-12 and folic acid reduced their risk of those conditions by more than 20 percent. The worst outcomes were seen in subjects who had the lowest intake of vitamin B-12.

Writing in the November 2005 issue of the journal Stroke, researchers noted that higher doses of B-12 and other treatments to lower homocysteine might be needed for some stroke patients in order to avoid further strokes and heart attacks.

Blocking the flow

Nowback to the B-12 absorption issue.

As we age we’re generally more likely to develop a B-12 deficiency because older people produce less of a protein known as intrinsic factor, which is essential for proper B-12 absorption. In addition, other factors can interfere with the assimilation of vitamins. In an HSI Members Alert we sent you in September 1999, we told you how pharmaceuticals sometimes hamper nutrient absorption from foods. For instance, acid blockers (such as Prilosec, Nexium, etc.) have been shown to significantly decrease absorption of – wouldn’t you know it? – vitamin B-12.

Fortunately, getting B-12 into your diet is easy, as long as you’re not a strict vegetarian. Meat, eggs and shellfish are the foods most abundant in B-12. So it’s no surprise that in addition to the elderly, B-12 deficiency is also a typical problem among vegetarians.

Send in the supplements

In addition to B-12, folate and vitamin B-6 also help metabolize homocysteine to keep levels down. These B vitamins are found in asparagus, lentils, chickpeas, most varieties of beans, and especially spinach and other leafy green vegetables. But as with B-12, the other Bs are not well absorbed, so a B complex supplement is often required to keep homocysteine levels in check.

HSI Panelist Allan Spreen, M.D., recommends folate supplements of 1.6 mg (1600 mcg) per day, and as much as 5 mg for those who want to address cardiovascular problems. Dr. Spreen points out that, “Folate isn’t effective in low doses except in a limited percentage of cases.” As for B-12, he recommends 1mg (1000 mcg) per day in sublingual form (dissolved under the tongue). And the form you choose is important too. Dr. Spreen: “Use methyl-B-12, instead of cyano- or hydroxo-B-12. It’s harder to find and more expensive, but worth every penny.”

In addition, Dr. Spreen suggests that to get the most out of folate, 100 mg per day of B-6 is also necessary, as well as 400-500 mg of magnesium per day (to make the B-6 more effective).

As I mentioned above, the SPARC team noted that other treatments beyond B vitamins may be needed to lower homocysteine levels. According to several studies, supplements of the antioxidant amino acid N-acetylcysteine (NAC) may also help bring those levels down.

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When drug treatments collide, patients suffer

Double Jeopardy

In addition to a long list of other side effects, your risk of upper gastrointestinal bleeding increases with the use of antidepressants – specifically, selective serotonin reuptake inhibitors (SSRIs) like Prozac. And as I first noted in an e-Alert seven years ago, elderly patients are most vulnerable to this risk.

Nowimagine what happens when nonsteroidal anti-inflammatory drugs (NSAIDs) are added to the mix.

Not good.

When treatments collide

In a meta-analysis reported late last year, Northwestern University researchers gathered data from four studies and found that SSRI use was twice as likely to cause bleeding in the upper gastrointestinal tract (esophagus, stomach, and upper small intestine). Results also showed that when SSRIs were combined with NSAIDs, upper gastrointestinal bleeding was six times more likely compared to subjects who took neither medication.

These results are particularly worrying for elderly patients. When these SSRIs and NSAIDs are combined (and they often are among the elderly), bleeding in the gastrointestinal tract contributes to anemia – a gateway to numerous health problems.

A new study reported this month in the Archives of General Psychiatry produced results similar to the Northwestern study.

Researchers at the Spanish Agency for Medicines and Healthcare Products collected drug use data from more than 1,300 patients with upper GI bleeding and about 10,000 healthy control subjects. Patients who combined SSRIs and NSAIDs were nearly five times more likely to develop GI bleeding compared to subjects who didn’t use the drugs.

But this study added an interesting wrinkle. Patients who used NSAIDs and SSRIs but didn’t use acid-suppressing agents were at NINE times greater risk compared to people who didn’t use those drugs. In their conclusions the authors write: “Use of acid- suppressing agents limits such increased risk.”

Ready for the kicker? The study was sponsored by AstraZeneca, the drug company that makes Nexium and Prilosec – two top selling acid-suppressing agents.

Gee – thanks for enlightening us, AZ! But before adding ANOTHER drug to an already disastrous cocktail, this would be an excellent time to address the key issues that are really at work here. (Hint: We’re not talking about a Prozac deficiency or an NSAID deficiency.)

Inflammation nation

For any patients – no matter their age – who are faced with the dual problems of depression and arthritis pain, I have three words: cod liver oil.

In the e-Alert “Tremors & Aftershocks” (10/18/04), I told you about research that shows how cod liver oil may reverse the actions of the enzymes that break down cartilage. In fact, studies suggest that taking cod liver oil might even prevent the development of arthritis.

And in the e-Alert “There Will Be Oil” (4/9/08), HSI Panelist Allan Spreen, M.D., had this to say, regarding a cod liver oil dosage of 10 grams daily: “Similar doses can be used on depression, bipolar disorder, high triglycerides, and other issues tied to inflammation besides arthritis. But it also requires (in my opinion) 400 iu of vitamin E mixed tocopherols twice/day, to stop the free radical formation that comes from even the ‘good’ polyunsaturated oils.”

And as I’ve noted in previous e-Alerts, there are several other nutrients that help keep depression in check. For instance, high levels of B vitamins (which include folate, a proven depression-fighter), magnesium, and omega-3 fatty acids have all been shown to help reduce symptoms of depression.

Dr. Spreen cautions that a high intake of cod liver oil may cause stomach upset in some patients, so a therapeutic dose may need to be adjusted – ideally under the guidance of a health care professional with a background in nutrition.

Biederman is undone – and no one is more deserving to have his life’s work refuted

Unringing the Bell

Biederman is undone.

And that’s truly great news.

Is it too extreme to call this guy a monster? I’ll let you decide.

Here’s a quick recap…

From the late 90s to about 2007, Harvard child psychiatrist Dr. Joseph Biederman conducted research that aggressively broadened the definition of bipolar disorder. According to PBS’ Frontline, there was a 4,000 percent increase in the number of children diagnosed as bipolar over the decade that Biederman and colleagues expanded the concept of the disorder.

Four THOUSAND percent.

And that research prompted a huge jump in the use of powerful (and potentially dangerous) antipsychotic medications for very young children.

A new study, published just last month, found that antipsychotic drugs prescribed for children between the ages of 2 to 5 doubled over the past decade. For that we can thank Biederman and his influential claim that mood swings in children as young as 2 can be diagnosed as bipolar.

Revolting, no? And all of that would be bad enough. But it gets much worse.

Two years ago, Senator Charles Grassley accused Biederman of failing to fully disclose payments from drug companies that make antipsychotic drugs.

According to the New York Times, Biederman accepted more than $1.6 million from drug companies between 2000 and 2007.

But, yeah, it gets even worse.

Court documents revealed that Biederman assured Johnson & Johnson executives that studies he was involved in would end up showing benefits of two different antipsychotic drugs made by J&J. At the time, Biederman was director of the Johnson & Johnson Center for Pediatric Psychopathology Research at Massachusetts General Hospital.

Bottom line: Biederman fattened his bank account nicely while his influence prompted unnecessary drug use in untold number of infants.

Sweet comeuppance

There was a time when Biederman’s influence seemed unstoppable.

In 2007, Dr. Lawrence Diller told the Boston Globe that colleagues in the child psychiatry field were afraid to speak out against Biederman.

Dr. Diller: “To politely challenge Biederman in public is to risk public retribution and ridicule from him and his team. Also academic researchers in child psychiatry risk losing their funding if they criticize this darling of the pharmaceutical industry…”

So it’s with the greatest pleasure that I share this with you today: Biederman is about to be undone.

The Diagnostic and Statistical Manual of Mental Disorders is psychiatry’s combination guidebook and encyclopedia. And it’s now being revised for a new edition.

According to the New York Times, this manual draws the line between normal and not normal, and provides psychiatrists with their primary guide for treating patients.

A Columbia University psychiatry professor told the Times, “Anything you put in that book, any little change you make, has huge implications not only for psychiatry but for pharmaceutical marketing.”

The new edition is not yet completed, but the Times reports that the definition of bipolar disorder in children will be significantly changed. And that change will sharply reduce the use of antipsychotic medications for the very young.

According to one psychiatrist: “The treatment of bipolar disorder is meds first, meds second and meds third.” But if children are diagnosed instead with a behavior disorder, then the primary treatment is behavioral treatment before drugs are considered.

It’s a sad day for Johnson & Johnson and other companies that make antipsychotic drugs. And it’s a sad day for Biederman and his undone influence.

But it’s an excellent day for the kids.

To Your Good Health,

Aspirin Therapy may Raise the Risk of Pancreatic Cancer in Women

Hungry Heart

If you’re a woman who takes a daily aspirin to help prevent heart attacks, you might have gotten a jolt earlier this week when major newspapers and TV networks reported that aspirin therapy raises the risk of pancreatic cancer in women.

As usual, the headlines and 20-second health briefs managed to emphasize the frightening aspect of the reported study without delving into the details that bring this news down to earth.

Does daily aspirin therapy really cause pancreatic cancer? Probably not. But that doesn’t mean that aspirin therapy comes without other health risks.

Researchers at Brigham and Women’s Hospital (BWH) reviewed data collected over 18 years for more than 88,000 women from the BWH Nurses’ Health Study. Announcing their findings earlier this week at a meeting sponsored by the American Association for Cancer Research, the BWH team reported that the long-term use of aspirin may increase the risk of pancreatic cancer in women.

And that was the gist of the information you were left with if you caught the news while getting ready for work or if you only had a moment to glance at the headlines.

In fact, only 161 of the 88,000 women developed pancreatic cancer. But the fact that pancreatic cancer risk increased by more than 85 percent among women who reported taking two 325 mg aspirin tablets every day over many years, was significant enough to establish a clear association.

At a news conference, BWH researchers said they were surprised by their results. They also cautioned that based on this single study, women should not stop taking aspirin to help prevent heart attacks because the long range heart-protective benefits outweigh the relatively low possibility of risking pancreatic cancer.

I’m sure that one of the reasons their results were unexpected was that one year ago, a similar study came up with the exact opposite conclusion. In the 2002 research, seven years of data from the Iowa Women’s Health Study showed that among more than 28,000 postmenopausal women, the risk of pancreatic cancer DROPPED by over 40 percent in subjects who used aspirin therapy. And the cancer risk was lowest among women who took aspirin most often.

In addition to all its previous good press as a heart health superstar, for some time, aspirin has been regarded as a possible cancer-fighter. Aspirin is a non-steroidal anti-inflammatory drug (NSAID), and NSAIDs have been shown to block Cox-2 enzymes that trigger the type of inflammation thought to be responsible for the creation of blood vessels that feed cancer cells and the promotion of cancer cell division.

But of course, there’s a down side. As we’ve discussed in other e-Alerts and Members Alerts, all NSAIDs, including aspirin and ibuprofen, have been shown to contribute to liver and kidney impairment, as well as gastrointestinal conditions such as bleeding and ulcers. Add to that a study late last year that associated NSAIDs with an increased risk of hypertension in women, and you have an over-the-counter medication that carries almost as many unhealthy side effects as some prescription drugs.

Orange you glad I said banana?

In the e-Alert “Pain Takes a Holiday” (9/8/03) I told you about a 15-month study of almost 2,000 subjects that showed how those whose diets included the highest fruit intake had more than 70 percent reduced risk of heart attack and other cardiac problems compared with those who ate the least amount of fruit. On average, for every additional piece of fruit consumed each day, subjects showed a 10 percent reduction in coronary risk.

And vegetable intake produced a similar effect. Subjects who consumed vegetables three or more times each week had approximately 70 percent lower heart attack risk than those who ate no vegetables at all.

With this in mind, researchers developed a supplement called TheaChol, a formulation that delivers 375 mg of different tea flavonoids; that’s the equivalent of 25 to 57 cups of tea. You can find out more about TheaChol at northstarvitamins.com.

What we know

To Your Good Health,
Jenny Thompson
Health Sciences Institute