Thanksgiving Tips from Dr. Buckley
Following are some tips from Dr. Buckley to help reduce GERD symptoms:
Schedule an earlier meal. It's best not to eat late at night if you suffer from GERD.
Another good idea is to serve lighter appetizers. Fatty foods like chips, dips, and cheeses are slow to empty from the stomach and more likely to aggravate symptoms of GERD.
Dr. Buckley encourages sufferers to stay active. Stick with your exercise routine during the holidays, as weight loss can help alleviate GERD symptoms.
As always, lay off the Nicotine. Nicotine weakens the muscles within your food pipe that prevent back flow (reflux) of stomach contents.
Cut out the fruit juice. Citrus fruits and juices like grapefruit, orange and tomato, are acidic and can worsen GERD symptoms.
Be sure to season foods lightly. Spicy foods, as well as things like onions and garlic, often bother people with GERD and make heartburn worse.
Limit your drinks; whether wine at dinner or beer during the game, alcohol can worsen reflux.
Suggest not deep frying your turkey. Fried foods are known to exacerbate GERD symptoms.
Have smaller plates to use. Eating large meals can trigger symptoms, so try smaller meals spread throughout the day.
Substitute water for soda. Caffeinated and carbonated beverages are both notorious heartburn aggravators.
Be careful with the desserts. Chocolate might be your favorite, but it often bothers those with GERD.
Skip the after-dinner mint. Peppermint is another major heartburn irritant.
Slow down. Physical exertion after a meal can lead to reflux.
Stay upright! While the turkey might make you sleepy, fight the urge take a nap. Lying down within 3 hours after eating can cause GERD symptoms to flare up.
Talk to your doctor. An accurate diagnosis is the first step to receiving the most effective treatment.
Dr. Buckley stresses that GERD is a "disease" and it is important to understand that it's a mechanical problem/defect, not an acid problem. Heartburn that happens more than once a week, worsens, or continues over time may signal a more serious condition," said Dr. Buckley.
What are some common heartburn triggers we want to avoid?
For starters, if you know a certain food always gives you heartburn, it is best to avoid it.
There are certain foods or substances that actually relax the lower esophageal sphincter, the valve between the esophagus and the stomach, allowing for reflux. These are alcohol, tobacco, caffeine, and chocolate. In other words, all the really good stuff. Certain foods contain acid like citrus, sodas, and tomato-based products. Large and fatty meals tend to worsen acid reflux. This allows for slower transit of food through the stomach opening up the chance for reflux. Peppermint is a double-edged sword when it comes to the stomach. Peppermint tea, peppermint-oil capsules, and even peppermint candies are often used to settle upset stomachs—but these remedies can backfire on people with GERD. The soothing and numbing effect of menthol tends to relax the lower esophageal sphincter, which can cause stomach acids to drift up the esophagus more easily, aggravating heartburn. Finally, try to avoid lying down after a meal. Eating dinner at least 2-3 hours before bedtime can aid in a more restful sleep.
Certain types of exercise can also trigger GERD symptoms, mainly anything where you would be bending to increase pressure on the abdomen. Despite that, weight loss from exercise can really help heartburn, but it’s best not to work out on a full stomach.
Many different medications can also trigger heartburn or worsen it. Regular use of aspirin or ibuprofen tends to irritate the esophagus. Other culprits include many blood pressure medications, narcotic pain killers, and progesterone.
If you believe any of these triggers are causing your suffering please contact your doctor. Get educated. Get Evaluated. Get Treated.
Antacids, a Gateway Drug?
Are antacids the gateway drug to chronic PPI therapy?
Did you know that 1/3 of Americans suffer from heartburn at least once a month? Nearly every day 10% of Americans have acid reflux. With numbers like that, it’s probably safe to say you know someone with heartburn, even have a friend that carries over the counter antacids like TUMS, Rolaids or Pepcid, in their vehicle, purse or on their person at all times. Antacids are a reasonable and effective remedy for occasional heartburn, however, if you are consuming them daily, or multiple times throughout the day, perhaps it’s time to talk to a physician about other options. Antacids are the gateway drug. Antacids are non-addictive but if you become dependent on them to get through life, most likely there is a bigger problem and a need for further treatment. Perhaps your heartburn has progressed to true GERD (Gastro-Esophageal Reflux Disease). This is defined as persistent troublesome symptoms or actual damage to the esophagus. The most common first step is to begin a short term PPI regiment.
PPIs can be viewed as almost addictive. Not so much in the, I need my Nexium now, hunger for it way, but in that the body could develop temporary rebound acid production. This can lead to worsening stomach upset and symptoms from reflux.
If using the drugs for short period of time it may not be problematic, but they tend to breed dependency, say experts, leading patients to take them for far longer than the recommended 8 to 12 weeks; some stay on them for life.
Hospitals have been known to start patients on P.P.I.’s as a matter of routine, to prevent stress ulcers, then discharging them with instructions to continue the medication at home. P.P.I.s can be safe when used according to the prescribed indication of up to six months for maintenance, though many physicians prescribe it for longer.
“Studies have shown that once you’re on them, it’s hard to stop taking them,” said Dr. Shoshana J. Herzig of Beth Israel Deaconess Medical Center in Boston. “It’s almost like an addiction.” P.P.I.’s work by blocking the production of acid in the stomach, but the body reacts by overcompensating and, she said, “revving up production” of acid-making cells. “You get excess growth of those cells in the stomach, so when you unblock production, you have more of the acid-making machinery,” she said.
With this in mind it is important to remember PPIs do not cure GERD, they don’t prevent the progression of GERD, they don’t prevent Barrett’s esophagus nor can they prevent or decrease the likelihood of cancer. PPIs only control symptoms.
--Tripp Buckley, MD
If you enjoyed this week's Blog, we think you would enjoy last week's Blog: If PPIs are so great, why....
If PPIs are so great, why...
First off, let me say that PPIs (Prilosec, Nexium, Protonix, Prevacid, Aciphex, Dexilant, etc.)have revolutionized the way we treat and prevent many gastrointestinal disorders. Primary among them- peptic ulcer disease (gastric and duodenal ulcers), erosive esophagitis, and H. pylori infections. Here are the FDA approved indications for PPIs:
- Healing of erosive esophagitis (EE)
- Maintenance of healed EE
- Short-term treatment of gastroesophageal reflux disease (GERD)
- Risk reduction for gastric ulcer (GU) associated with nonsteroidal anti-inflammatory drugs (NSAIDs) • Helicobacter pylori(H. pylori) eradication to reduce the risk of duodenal ulcer (DU) recurrence, in combination with antibiotics
- Pathological hypersecretory conditions, including Zollinger-Ellison (ZE) syndrome
- Short-term treatment and maintenance of DUs
Most experts agree that PPIs are grossly over prescribed and managed poorly once they are. Optimizing medical therapy for GERD is a complex issue that challenges even the most well-practiced providers. Additionally, this is doubly true when patients are self-managing their GERD with PPIs or H2 blockers. While PPIs have improved the symptomatic treatment of GERD and other disorders described above, they are not without their side effects. Hopefully this will stir some debate.
If PPIs are so great, why…
- has esophageal adenocarcinoma increased by 600% since 1975?
- do 30-40% of patients have breakthrough symptoms?
- has the FDA issued 3 safety communications concerning long-term use?
- have recent studies implicated PPI use with increased risk of cardiovascular events (stroke and heart attack) and significantly decreased survival?
- do patients progress at alarming rates from simple GERD to Barrett’s esophagus (considered a pre-cancerous condition) despite PPI use?
- did a recent study in nearly 10,000 patients find higher rates of esophageal cancer in Barrett’s patients when they took PPIs as prescribed vs patients who took less or none?
- have recent studies linked PPI use to higher rates of community acquired pneumonia?
- is there not a single health benefit to PPI use
Please click here to learn more about the complications of GERD.
Here is what the Harvard Medical School Health Letter says about PPIs-
“PPIs are the most potent inhibitors of stomach acid available, and they’re a welcome addition to the medical armamentarium. But every pill — indeed, every medical intervention — is a risk-benefit balancing act. The PPI-clopidogrel interaction seems to be less important than once feared, but there are other reasons to be cautious about PPIs. You don’t need to take a PPI for the incidental case of heartburn. If you have a prescription, the reasons for it should be reviewed periodically to make sure they’re still valid; it’s common for people to take medications far longer than is necessary, and that is particularly true of the PPIs.”
The bottom line is that PPI use in patients with GERD should be viewed as such:
- They can help heal erosive esophagitis in the short-term, BUT they only function to decrease acid; there are many other harmful components of refluxed contents from the stomach.
- They treat a symptom, heartburn, BUT they do not treat the D (Disease) in GERD.
- They do NOT stop progression of disease to Barrett’s esophagus and/or esophageal cancer because they do NOT stop gastro-esophageal reflux.
Think about this if you are on long-term therapy.
Tripp Buckley, MD
Welcome to my blog
Welcome to my blog! Within this regularly updated feature of my website, I will provide visitors with practice news and specials, as well as information regarding the most recent technological advances and new treatments in GERD and other reflux related diseases.
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