Anti-inflamatory Meds Increase CV Risk in One Week

A study in the major cardiology journal, Circulation, shows a darker side of NSAIDs (anti-inflammatories like Celebrex, ibuprofen and naproxen) than once thought. We have known for some time of the increased risk of heart attack and sudden death with the use of NSAIDs but this recent study shows that the risk increases by 45% in ONE WEEK in patients with a cardiac history. 

It's a wonder how these medications are so easily accessible over-the-counter still while carrying this risk. For those who take them for 3 months, the risk of event goes up to 55%. Although effective in pain and inflammation relief the side effect risk is too great. Patients should opt for less risky alternatives like fish oil (2000-3000mg of EPA/DHA total daily) and turmeric (95% curcuminoids 400-500mg 1-2 twice daily) where the cardiac effects are actually beneficial as opposed to harmful!

The base of lowering inflammation must start with the diet as a treatment approach. Incorporating omega-3 fatty acids from cold-water fish, walnuts, ground flaxseed, a variety of fruits and veggies and spices like ginger and turmeric. Regular activity and stress management practices like breathing for relaxation daily will be helpful as well.

Approach to Reflux

The stomach needs acid to facilitate the breakdown of food, but also to provide protection for the rest of the digestive system by destroying harmful bacteria/yeast/parasites that are swallowed. Taking a proton pump inhibitor (ie. Nexium, Prevacid) for a long-time robs the digestive system of this and has been shown to increase the risk of fractures, B vitamin/magnesium/iron deficiency, colon infection, and leaky gut. The other problem with proton pump inhibitors (PPIs) is that the stomach never really stops wanting to make acid, so upon stopping the drug, there is an increased risk of high acid output. This acid output combined with the fact that proton pump inhibitors may weaken the lower esophageal sphincter (LES) is a recipe for heartburn and the feeling that the patient "needs" to restart the medication.

PPIs were developed for acute ulcer or gastritis: Take the medication for 4-6 weeks while implementing the lifestyle strategies that rid the root cause of the reflux: Food sensitivity, LES weakeners: nicotine, caffeine, peppermint, high fat, carbonation. Not likely spicy food. Also smaller meals, not eating before lying down). Then one stops the PPI and all is well. Unfortunately, we rarely focus on the root causes and implementing change and people stay on these drugs forever at the risk of complications.

For new cases, I rarely find a need to use PPIs if a focus on root causes is done. Treatment, if needed involves any one or combination of: Iberogast, probiotics, melatonin (good evidence, as it seems to stimulate closure of the LES at night-time), turmeric (good evidence for treating gastritis, if this seems to be present), working up or considering the elimination of food sensitivities (start with gluten and dairy) and adding digestive enzymes.

For those currently on PPIs for some time, it's often hard to stop cold turkey and sometimes hard to slowly wean. I typically discuss the root causes and how the digestive system works and explain this can be a long, but necessary process to get off PPIs. I usually start people on probiotics (20 billion colonies daily), melatonin (2.5 mg at bedtime, may need to increase especially if waking up with heartburn), Iberogast, and if sometimes additionally something with aloe, licorice and L-glutamine for digestive lining support and protection. I also consider food sensitivity elimination (if no testing, typically start with gluten for sure and often dairy, especially milk and ice cream). After 10 days I have them cut their PPI in half or take it every other day. Most are able to do this without symptoms. Over time, maybe every 1-2 weeks we try and space it out by a day more, eventually using it only as needed. Don't forget head position while sleeping, smaller meals, and avoidance of LES weakening foods and drugs.

More Calcium Does Not Stregthen Bones

A new study from the British Medical Journal in May 2011 shows us why we should stop looking at osteoporosis as a calcium thing. Over 60,000 women were followed for 19 years and their calcium intakes where assessed trying to determine the link between calcium intake and fracture prevention. There was a greater risk between low intake and those in the middle range, but there was no advantage to higher levels of calcium intake.

I continue to be concerned about the heavy focus on calcium supplementation from conventional healthcare providers. Most OB/GYNs and family docs are still telling folks to take 1200-1500mg of calcium supplements daily. The evidence is clearly pointing away from this.

This study actually showed that the highest levels of calcium intake (both food and supplements) had a 19% increased risk of hip fracture! So we need a better framework for thinking about the bones.

To view osteoporosis as a single nutrient deficiency is wrong. We need to start looking at osteoporosis as a manifesation of inflammation. A focus that needs to hone in on the foundation of health: whole foods nutrition, stress management and digestive health. A study in the early 2000's reported that pre-senile osteoporosis was gluten sensitivity until proven otherwise. For many of us, gluten is inflammatory, so this makes sense. Other aspects to focus on are hormone balance, general balance/core strength (the lower risk of fall = lower risk of fracture). Be certain to focus on lots of whole foods like vegetables, beans, lentils, non-breaded fish and regular exercise as the path to strong bones, not Caltrate.

The GladdMD Way

The premise of care at GladdMD is best explained in the analogy of the body as a house. No house can be relied upon for years without a solid foundation. That foundation is provided by optimal, whole foods nutrition, daily stress management including spirituality and a balanced digestive system. These form the goal of care for any and individual we care for and are concepts that every interaction should spend time focusing on. Certainly there are times when the roof may need to be replaced or other aspects of the house are not functioning as well as one would hope. In these instances, often manifested as symptoms affecting quality of life, we must help by providing some support beams in the way of hormones/supplements/meds (infrequently) that can help to stabilize the house (improve symptoms) while the patient works on the foundation issues that were likely a driving force for the issue(s) in the first place. 

We always spend the beginning of the first visit with the patient sharing their story, which is ultimately a focus on some of the root issues that got them here. Often the answer lies in a difficult upbringing, disasterous relationship or series of relationships, born via C-section and/or bottlefed, starting contraceptives, a series of antibiotics or chronic antibiotics or major stressful life event. This will help form the framework for providing the patient with tools for their toolbags to help them promote health and heal the foundation.

The other premise of care at GladdMD is to help understand a patient's desire and beliefs and to try and work within that framework. Alternative ideas are always open for discussion. Some clients do not want certain labs, do not want hormones or believe very strongly in a particular supplement they are taking. We know without a shadow of a doubt that we do not know everything and will never pretend to. We are very focused on providing evidence or a lack of evidence when appropriate.

If a patient swears by Brand New Juice X for joints or when they hold their left hand 60 degrees in the air on a rainy day they feel better, we simply say there is no strong evidence for it, but there is little to no risk so keep up the good work! On the other hand, when patients are paying several hundred dollars a month for a lot of supplements or doing live blood analysis or muscle testing, we are quick to point out the the data supporting these methods of care is very weak and non-reproducible and they need to know that. Again, if they choose to continue, that is their decision, discussing and helping them weigh risk and benefits is our role.

The approach to lifestyle change is based on motivational interviewing techniques. Some clients can be easily overwhelmed, so change starts by asking them what areas can they commit to changing. For many, we start with beverages. "Can you give up artificial sweeteners?" "What could you drink instead?" or start with one meal. "Are you willing to change your breakfasts to get started?" We find that easy recipes and quick stuff is very helpful. For example: club soda and 100% fruit juice instead of soda, making raw nuts trail mix for a snack, crockpot steelcut oats which can last a week, granola for a snack/breakfast while trying a non-dairy milk.

The care provided by GladdMD is done as a partnership with our clients. Unlike most healthcare experiences which have become like the military: I order this drug and demand you take or you will be labeled non-compliant. We are there to simply provide an educational and empowering framework from which our client can make a decision for themselves. This goes for everything. Often clients follow-up and are ashamed of not changing their diets or state they almost cancelled the appointment because they still drink pop everyday or still eat gluten when found to be sensitive. We'll respond by stating, "We are friends no matter what you do. These are your decisions. Now, what we can do is help you work toward your goals." If they understand the reasons they should avoid gluten, but are having a hard time, we'll ask what areas they are finding difficult. Often there are easy alternatives to help them over this hump. Making some small changes build confidence and confidence is king.

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