Archive for July, 2011

Heartburn and Statins – Do Statins Cause Acid Reflux?

There has been a lot of talk suggesting that statins (the popular class of cholesterol-lowering drugs) can be a cause of heartburn. It is listed on numerous websites as having the side effect of heartburn and this connection is also mentioned in several popular books on acid reflux. However, is there any evidence of this? Let’s find out!

Statins – What Are They?

The term statins simply refers to the class of medications that have become very popular around the world for their ability to reduce LDL cholesterol and inflammation in the body. The most popular statins include the brands Lipitor, Zycor, and Crestor (among others). Given the ubiquity of obesity, statins are among the most prescribed medications in the United States.

Statins and Heartburn – The Research

Despite the fact that statins are linked with heartburn anecdotally as well as listed on multiple third-party websites, the official NIH (National Institute of Health) page as well as the official site for Lipitor make no mention of acid reflux being a recognized side effect of statins. Now, this does not mean they aren’t recognized – it just is not documented.

I will say that of the listed side effects, other digestive issues such as upset stomach, constipation, or diarrhea are recognized as side effects of most statins (note that there are slight differences among each type of statin – but this is beyond the scope of this article). Additionally, unusual muscle function (cramping, involuntary contractions, fatigue) are also reported.

With that in mind, given that heartburn can be caused by irregular motility of the digestive tract, and that the usage of statins seems to cause irregular muscle activity, it would stand to reason that stains may indeed have acid reflux as a side effect.

Statins and Acid Reflux – What to Do

However, just because statins may have lead to heartburn does not mean that you should disregard your doctor’s advice if he (or she) prescribes them. Now, understand that I have very negative feelings about the chronic usage of prescription medication, but the facts are the facts: statins save lives.

Statins do not just make you more comfortable; there are dozens of very large studies which have reported that statins reduce not only cholesterol but also all-cause mortality (1, 2). There are many other studies that report the same thing: people who take statins just live longer.

The results surrounding statins are so good that some doctors have been even issuing them to those with low-risk for developing cardiac disease to help prevent cardiac disease from developing. It has become so wide spread that a recent Cochrane Review stated that while statins were beneficial, they did not recommend issuing them for low-risk patients (2).

The point is this – yes, statins may have side effects, but if you are a moderate or high-risk individual, they can save your life and help you live a lot longer. In regards to the development of acid reflux – you can talk to your doctor if you develop side effects, but personally I’d rather be alive with acid reflux than die prematurely without it. Interestingly though, a recent study reported that the use of statins was actually reported to reduce the risk of developing esophageal adenocarinoma (esophageal cancer) in those with Barrett’s Esophagus (a condition present in some with esophageal damage, particularly due to GERD) (3). Perhaps due to the anti-inflammatory properties of statins they can even reduce the damage done by acid reflux and be protective rather than destructive.

Statins and Acid Reflux – The Bottom Line

There are two important takeaways that you should get from this article. The first is that although statins may or may not cause heartburn, they do save lives and have been repeatedly shown to reduce all-cause mortality. The other thing to remember is that those who need cholesterol-lowering drugs and those who have acid reflux have a few common factors: obesity, smoking, and a poor diet.

Perhaps if you are on statin medications and are developing acid reflux, this may serve as a bit of a wake-up call. If you need to lose weight, quit smoking, or start following a smart acid reflux diet, those are things should be at the top of your priority list so that you can live a healthier and more satisfying life.

As always, everyone responds to medication differently. The decision to start or stop a medication should always be done under a doctor’s supervision. Statins do have some dangerous side effects, particularly related to liver and kidney dysfunction. Talk to your doctor about your medication if you have any concerns or side effects.

References

1. Baigent C., et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010 Nov 13;376(9753):1670-81.

2. Taylor F., et al. Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2011 Jan 19;(1):CD004816.

3. Nguyen DM, Richardson P, El-Serag HB. Medications (NSAIDs, statins, proton pump inhibitors) and the risk of esophageal adenocarcinoma in patients with Barrett’s esophagus. Gastroenterology. 2010 Jun;138(7):2260-6.

Iodine Supplements and Heartburn

As early as 1982, researchers have been able to demonstrate a solid link between acid reflux and hypothyroidism (1). It is theorized that hypothyroidism may effect the motility of the esophagus and reduce lower-esophageal sphincter pressure (1).

It is fairly safe to say that hypothyroidism and heartburn are related. However, is there anything we can do about this? Of course – and you are about to find out what!

Iodine Supplementation – A Possible Heartburn Remedy?

One of the biggest contributing factors to hypothyroidism (and as such, thyroid-related acid reflux) is inadequate iodine intake.

In response to a few studies demonstrating that high iodine intake leads to possible cancer and hypothyroidism, Iodine has received a particularly bad reputation lately.

However, you should know that this study did confirm that high iodine intakes may cause cancer or lead to hypothyroidism, the “excessive” group excreted a median of 651 micrograms per liter of urine (2). While, this may not seem like a lot, consider this:

• The average human excretes 1.5 liters of urine a day.

• The recommended daily allowance for iodine intake is 150 micrograms.

So, in order to be excreting (sans what their body was actually using) over 1,000 micrograms a day, the average person in the excessive group in this study was easily consuming an average 5 times the recommended daily allowance for iodine for a length of time.

As a result, the average person in a modernized nation is going to rarely be consuming those levels of iodine. This is much more typical of an eastern diet which includes a lot of seaweed and kelp. These plants contain extremely high levels of natural iodine not approached by any other food on the planet!

Now that we have got that out of the way, another study of a similar population confirmed that unusually low levels of iodine intake are associated with thyroid disease (3). We knew this all along, but it is good to see some positive research since the “high iodine” study.

The Dark Side of Sea Salt

Iodine intake has always been quite naturally low in the western diet. In order to combat this issue, most salts in the USA have been iodized. Since salt is used ubiquitously in cooking, it was thought that this would significantly reduce iodine deficiencies (and indeed it did).

The problem is now sea salt has begun replacing normal salt on many tables. For some reason sea salt is thought as some sort of health food because its natural, but the truth is it lacks iodine which is far more essential of a nutrient than any mystery minerals which might be found in sea salt.

Unless the package specifically says iodized, your sea salt has no significant levels of iodine. You can buy iodized sea salt online, but I have not seen it in the typical grocery store.

With this in mind, consider adding iodized salt to your acid reflux diet. If you cannot add salt to your diet to due to restrictions (such as edema or high blood pressure), consider an iodine supplement. A very small supplement of just 100-150 micrograms (micro, not milli) should be fine. Be careful, because many iodine supplements are 600+ micrograms, which is unsafe unless done under a doctor’s supervision (as a doctor can collect and monitor bloodwork and urinalyses).

Important: Do not take an iodine supplement if you are taking medication already for hyperthyroidism (overactive thyroid). If you already eat a iodine-rich diet (i.e. eastern diet rich in seaweed or kelp) do not use an iodine supplement.

Other Ways to Help Hypothyroidism

In addition to adding iodine to the diet, another great way to help get your thyroid back on track is to lose weight. I know a lot of people say that the reason they are fat is hypothyroidism, but the truth is that in most people the situation is reversed.

A small minority of the population has thyroid problems due to genetics, cancer, radiation exposure, or other illness. A vast majority of the population is experiencing poor thyroid function due to obesity. Obesity negatively impacts every body system, and the thyroid is no difference from this.

When you consider this, it is not surprising that diagnoses of thyroid disorders have exploded over the last 15 years and obesity has exploded over the last 20 years. This is not a coincidence.

The good news is that both heartburn and thyroid disorders often become milder (and frequently reverse) when you lose weight. This allows you to tackle acid reflux from two fronts through weight loss.

Medication

Of course, many will elect to go on medication for hypothyroidism if diagnosed. This is entirely up to you and your doctor. Many people report great improvements to their quality of life after starting this medication.

If you are experiencing symptoms of hypothyroidism such as brittle nails, dry skin, cold hands and feet, mental fatigue, and possibly even acid reflux, you will want to see your doctor and get some bloodwork done.

Hypothyroidism, Iodized Salt, and Acid Reflux Conclusion

Given that low iodine intake is related to hypothyroidism and hypothyroidism is related to acid reflux, I do not think it is too far of a stretch to consider iodized salt and iodine supplements to be good heartburn home remedies. If you prefer the flavor of sea salt, consider getting iodized sea salt, which is readily available online.

As always, talk to your doctor if you have any health concerns or are experiencing heartburn symptoms two times a week or more. If you need to lose weight, just remember that weight loss is tied to both reduced acid reflux and improved thyroid function!

References

1. Eastwood GL, Braverman LE, White EM, Vander Salm TJ. Reversal of lower esophageal sphincter hypotension and esophageal aperistalsis after treatment for hypothyroidism. J Clin Gastroenterol. 1982 Aug;4(4):307-10.

2. Teng, W., et al. Effect of iodine intake on thyroid diseases in China. N Engl J Med. 2006 Jun 29;354(26):2783-93.

3. Yu, X., et al. A five-year follow-up study of goiter and thyroid nodules in three regions with different iodine intakes in China. J Endocrinol Invest. 2008 Mar;31(3):243-50.

Acid Reflux and Diabetes

Just recently in a very popular heartburn book, I read that diabetes was a major cause of acid reflux and that getting your blood sugar in check was a major step in controlling your acid reflux.

Up until that point in time, I had never come across any research or read any other reports that would indicate that this was true (or false), so I decided to look into whether or not there was any validity to this claim.

So are acid reflux and diabetes related? Additionally, do certain treatments have the side effect of acid reflux?

You are about to find out the answer to these questions as below I will be revealing what I found after digging in to the literature. I will start with laying out the research for both sides and then interpreting the validity of each study.

Support in Favor of a Positive Correlation Between Acid Reflux and Diabetes

The specific book I was reading referenced a study that looked at diabetic patients who used insulin therapy and those who did not. The researchers reported that those who used insulin therapy for their diabetes were more likely to GERD and esophageal damage from their reflux than those who did not use insulin therapy (1).

Additionally, I was able to find another study where researchers were able to demonstrate that the longer individuals were afflicted with diabetes, the likely they were to have GERD and other esophageal disorders (2).

Support Indicating No Relationship Between Heartburn and Diabetes

While the first two studies were interesting if nothing else, this is where the support for the link between diabetes and acid reflux ends.

By far the largest study I was able to find (looking at over 1,500 patients) reported that there was no difference in rates of acid reflux or instances of acid-related esophageal damage when comparing regular people with diabetes (3).

Another group of researchers reported they were unable to find any differences in GERD rates between different types of treatment protocols for diabetics, in direct opposition to study 1 (4).

Finally, one group of researchers even reported that those with the highest blood sugar levels (very poor glucose control) actually had much lower rates of acid reflux than those with slightly better glucose control (5).

Confounding Factors

There are a few confounding factors that should be made known about the particular pieces of research cited in this article. First off, the initial study reporting that people who use insulin as being much more likely to get heartburn was written in Russian; only the abstract (a brief summary) was available in English, which makes me curious as to how the author in the book I mentioned was able to interpret it (I am guessing they did not read the original piece).

The second study (in support of acid reflux and diabetes being linked) and fifth study (reporting that those with the highest blood sugar levels had less reflux) both used very small sample sizes, which could make their results be up to chance rather than reliable evidence.

The safest study is the third one referenced, which supports no difference between regular individuals and diabetics. This is simply because they had such a large sample size (over 1500 people) and adjusted for confounding factors and other risk factors.

Interpreting the Research – GERD and Diabetes

Based on what I have read of the research, right now there is simply no way you can say with complete certainty that diabetes or diabetic treatments are linked with acid reflux.

It is much more likely that the things which dispose individuals to type-2 diabetes (obesity and a high-carbohydrate diet) also dispose individuals to acid reflux. Obesity in particular is very strongly linked with acid reflux and diabetes.

Furthermore, another thing to consider is gastroparesis. With the translation of stomach paralysis, this may occur with nerve damage (particularly to the vagus nerve) and lead to acid reflux.

Patients with particularly severe cases of diabetes (particularly left untreated) may end up with vagus nerve damage and ultimately develop gastroparesis. This also helps explain the findings of study 1 and 2.

Study 1 was conducted in Russia; health care in Russia does not rank well on a world scale, which would make insulin-dependent diabetics more likely to develop gastroparesis.

Study 2 reported that longer-term diabetics often had worse acid reflux, which could be the result of nerve damage due to prolonged periods of elevated glucose levels.

Diabetes and Acid Reflux – Summary

According to our current set of research, well-managed diabetes is not likely to lead to acid reflux or heartburn. Obesity is one of the strongest risk factors for both diabetes and acid reflux, which is why the two may be correlated (but not necessarily directly related). Finally, prolonged periods of very poorly managed diabetes may result in gastroparesis, which can lead to acid reflux.

Individuals with diabetes and acid reflux should focus keeping their glucose levels at a healthy level and weight loss (should they be overweight or obese). An acid reflux diet should be secondary to managing glucose and weight loss.

References

1. Fedorchenko IuN, Korneeva NV. Influence of the insulin therapy on the course of gastroesophageal reflux disease with type 2 diabetes. Eksp Klin Gastroenterol. 2010;(11):35-9.

2. Kinekawa, F., et al. Esophageal function worsens with long duration of diabetes. J Gastroenterol. 2008;43(5):338-44

3. Holub JL, Silberg DG, Michaels LC, Williams JL, Morris CD, Eisen G. Acid-related upper endoscopy findings in patients with diabetes versus non-diabetic patients. Dig Dis Sci. 2010 Oct;55(10):2853-9.

4. Horikawa, A., et al. Prevalence of GORD (gastro-oesophageal reflux disease) in Type 2 diabetes and a comparison of clinical profiles between diabetic patients with and without GORD. Diabet Med. 2009 Mar;26(3):228-33.

5. Lauffer A, Forcelini CM, Ruas LO, Madalosso CA, Fornari F. Gastroesophageal Reflux Disease is Inversely Related with Glycemic Control in Morbidly Obese Patients. Obes Surg. 2011 Jul;21(7):864-70.

Health Benefits of Pineapple and Bromelain

In addition to being downright delicious, pineapple is one of the greatest foods you can add to your acid reflux diet plan.

Below, you are going to discover some of hidden health benefits of pineapple and find out why it is one of the best heartburn remedies for some heartburn sufferers.

Pineapple – A Tropical Fruit With a Powerful Enzyme

Pineapple has high concentrations of a specific enzyme (enzymes are catalysts that make reactions easier to happen) known as bromelain. Bromelain in particular belongs to a class of enzymes known as proteases. Hang with me for a second, because it will all be clear below.

Proteases such as bromelain have the specific ability to make protein easier to digest. This has two benefits for people suffering from heartburn (and any other digestive problem).

The first health benefit of pineapple (and bromelain) is that improvements in digestion are correlated with improvements in acid reflux. Bromelain and pineapple will allow you to digest your food better, which in turn means you will be a little (or a lot, depending on the person) to get acid reflux.

The Second Surprising Benefit of Pineapple

The second benefit of pineapple is specific to people who use any sort of acid-reducer or buffer, such as a proton-pump inhibitor, H2 blocker, or simple antacid. These drugs are often designed to bring the pH of the stomach up to a 4 or higher.

While bring the pH of the stomach up reduces heartburn symptoms, it also has an unintended side effect. Pepsin, a human enzyme responsible for expediting protein digestion and breakdown, is dependent upon low pH levels to be active. So while acid reflux improves as we raise the pH of the stomach, our abilities to digest food decrease.

The deactivation of is the primary mechanism why acid reflux medications have stomach ache, sour stomach, and constipation.

So where does pineapple fit into all of this? Bromelain is a protease which helps break down protein. While not a complete replacement for pepsin, it may help improve protein digestion, which is likely impaired via the use of acid-reducers.

Other Health Benefits of Pineapple

While unrelated to heartburn, another reported benefit of pineapple and bromelain is that bromelain acts as an anti-inflammatory. A recent study has reported that there is a physiological basis for this, and bromelain may indeed reduce inflammation (1).

This of course is not a preponderance of evidence, so take it with a grain of salt. Different things effect different people differently, so you will have to see just how it works for yourself.

Be sure to stick to fresh or frozen pineapple; avoid canned, jarred, dried, or cooked fruit as bromelain may be destroyed in the heating process, and the added sugar in these preparation methods makes them unhealthy and removes any potential health benefit (sugar leads to poor digestion and promotes inflammation).

Health Benefits of Pineapple and Its Effect on Heartburn Conclusion

There is decent evidence that pineapple and bromelain may improve digestion, reduce inflammation, and help reduce acid reflux. Many different people swear that adding fresh pineapple or bromelain supplements (which are available online for a very low price) to their protein-rich meals significantly reduces acid reflux and improves their digestion.

Of course, if you are allergic to pineapple, you do not want to add this to your diet or take a bromelain supplement with your biggest meal of the day.

While most people will be safe eating adding quantities of fresh pineapple (avoid the canned stuff – the added sugar makes it worthless), check with your doctor before starting a bromelain supplement as some people may be sensitive to high levels of this enzyme, particularly those with other chronic conditions such as heart disease or those that take other medications.

References

1. Fitzhugh DJ, Shan S, Dewhirst MW, Hale LP. Bromelain treatment decreases neutrophil migration to sites of inflammation. Clin Immunol. 2008 Jul;128(1):66-74