Getting To The Root Of And Getting Rid Of Heartburn And Reflux with Dr. Todd LePine

Coming up on this episode of the Doctor's Pharmacy.

Basically, the stomach is bathed in acid pretty much all the time, and you don't feel any pain when you have acid in your stomach, but you'll feel pain when the acid that's naturally there.

Goes in the wrong place. Hey everyone, it's Dr. Mark. My main goal with diet is to use food as medicine, but even when we eat super well, most of us are missing out on certain essential nutrients. Our soils have become depleted and our digestive tracts just aren't working so great. They're compromised by stress and toxins and they just can't absorb nutrients as efficiently as they should. And that's why I always use, and I recommend to my patients, a multivitamin mineral as nutritional insurance. It covers the basics for all our day-to-day body functions, all the things that we need that our food might be missing. But there are so many products out there I wouldn't go near because they contain artificial fillers or inactive ingredients and you have to be pretty picky. The one I trust and take myself is Athletic Greens. They use high quality, highly absorbable forms of vitamins and nutrients from real whole foods. Athletic Greens comes in a powder that tastes great and mixes easily with water or smoothies, and specifically supports my gut health, immunity, energy, and recovery. And it's not just vitamins and minerals. It has phytonutrient-rich superfoods and adaptogens and pre and probiotics and even digestive enzymes. I love that they add the digestive support in their powder since so much of our immune strength and overall wellness starts in the gut. It's really one supplement that covers so many bases, and you'd be hard-pressed to find something else in this comprehensive form in any single other product. I use Athletic Greens in the morning as part of my daily routine, and I love having it with me whenever I travel. I also love that it's diet-friendly, whether you're vegan, paleo, keto, dairy-free, or gluten-free. Right now, Athletic Greens is offering my audience a full-year supply of their Vitamin D3K2 liquid formula free with your first purchase. Now, these two nutrients are also so vital for a strong immune system and strong bones, and many of us are not getting enough of them. I use the Athletic Greens powder and their D3K2 formula to make sure I get extra nutrients that complement my diet. They're also going to give you five free travel packs as well. Just go to athleticgreens.com/hymen to get your free year's supply of vitamin D3 and K2 and five free travel packs with your first purchase. you'll get it delivered straight to your door and I promise you'll feel the difference Athletic Greens can make in your daily wellness routine. Again, that's athleticgreens.com/hymen. Now, so many of my patients ask me how I manage to work multiple jobs, travel frequently, well, not so much anymore, and spend time with my family and still focus on my health. I know it can seem hard to eat well when you've got a lot going on, but the trick is to never let yourself get into a food emergency and to stay stocked up with the right things to support your goals. So recently I discovered Paleo Valley Beef Sticks. I keep these beef sticks at home and at the office so I know that whenever I'm in a food emergency, I have a healthy and delicious option to keep me on track. It's no secret that I have high standards when it comes to what I put in my body and Paleo Valley Beef Sticks checks all the boxes. They're gluten-free, grain-free, dairy-free, soy-free and non-GMO. Plus, they use 100% grass-fed and grass-finished beef, which not only adds to the flavorful taste, but it also means they're free of any harmful antibiotics or hormones that you'll find in most meat. With grass-fed beef, you'll get more nutrients than you would with beef fed with grains, things like higher levels of omega-3 fats that help reduce inflammation, and more B vitamins and other antioxidants to support your body's converting food into energy. and also more of the fat soluble vitamins that are beneficial for a healthy heart. Plus, instead of being processed with chemicals and other questionable ingredients, these beef sticks are naturally fermented so you get gut friendly probiotics with every bite. How cool is that? Right now, Paleo Valley is offering my listeners 15% off your entire first order. Just go to paleovalley.com/steak forward slash hymen to check out all their clean paleo products and take advantage of this deal. That's paleovalley.com forward slash hymen. I definitely recommend stocking up on the grass-fed beef sticks to keep in your house and your car and in your office. It's one of my favorite tricks to staying healthy while on the go. All right, now let's get back to this week's episode of the doctor's Pharmacy. Welcome to the Doctor's Pharmacy. I'm Dr. Mark Hyman, and that's Pharmacy with an F-A-R-M-A-C-Y, a place for conversations that matter. And if you've ever suffered from heartburn or reflux, this podcast should matter to you because it's a special episode of the podcast called House Call, about how we deal with things differently in functional medicine. And today's guest is none other than Dr. Todd LePine, who's my colleague and good friend for over 25 years, both at Canyon Ranch and at the Ultra Wellness Center. He's a leading educator and doctor in the field of functional medicine, teaches all over the place, but mostly on Zoom now. And he is just one of those guys who is deeply thoughtful, understands things in ways that most people don't, and he's the doctor's doctor here. And I'm so excited to have Dr. Todd LePine again on the Doctor's Pharmacy talking about heartburn. So welcome, Todd.

Thank you, Mark.

All right, so let's get right into it. Tell us about how common heartburn is, what is it, what is reflux, and how is it different from heartburn? And it's sort of gives us a little background on this problem because I think it's a big issue for people and it's the source of a lot of suffering and it's also the source of billions of dollars in revenue for the drug companies because I think these drugs are the third category in terms of leading sales of all drugs after statin drugs and antidepressants.

Yeah, yeah. So I mean, I venture to say that most people have experienced heartburn. It's a very common condition. If you overeat, if you eat too late, if you eat certain foods, I've experienced heartburn. I'm actually very fortunate. I have a cast iron stomach. I can literally eat anything. I really can. Unlike my father.

But you can give yourself heartburn.

Yeah, absolutely. I can give myself. And I've experienced heartburn. So, I know what it's like. And for some people, it's a chronic problem. It's really something that they experience all the time. and the big thing about heartburn is that most of the time it's not about too much acid. That's sort of, I think, the take-home message for people. And I always tell people that your body needs and wants to have acid in the stomach. Acid helps you to break down your food. There's a rare condition which I learned about in medical school called Zollinger-Ellison syndrome. Remember that, Mark?

Oh, I do.

Yeah, right. Have you ever seen it? Have you ever seen it?

Only in the textbook.

Exactly. I think I've seen it once. So it's a condition in which your body actually produces too much acid. And they, you know, what did doctors used to do? They used to cut the vagus nerve and they used to do all kinds of surgeries for heartburn and reflux and all kinds of things.

Oh, yeah, they used to eat ulcers. They used to cut your nerve to your stomach. And then they realized it was a bacteria.

Yeah, exactly.

Right.

Yeah. So we'll talk about the bacteria causing some cases of heartburn. So in heartburn is this usually a benign condition and it's oftentimes lifestyle related. and you can treat it periodically as needed, baking soda or Alka-Seltzer or Tums if it's mild. But if you're having heartburn all the time, the first thing you need to do is saying, well, what's driving this? And again, it's not necessarily stomach acid. In fact, there are a fair number of people who actually have their heartburn because of lack of stomach acid. And you can actually do some testing for lack of stomach acid. If it's significant, you can actually do testing for gastrin levels. So, and I actually oftentimes will do this on my patients who are on the proton pump inhibitors. So gastrin is produced by the body to tell the body to produce more acid. So if you're taking these heartburn medications for a long period of time, and if you're escalating, you start on a low dose and you go to a moderate dose and you go to a high dose, you're really dropping your stomach acids. Your body says, hey, guess what? We need to make more stomach acid so it produces a lot more gastrin. And then what happens is because you have so much gastrin, you go off of the medication, your body now starts pumping out lots of acid, and then guess what? You're gonna get withdrawal symptoms.

Oh my God, Todd, this is the biggest scam ever. Exactly. Basically, they create a drug that makes you addicted to it. You treat a condition which is pretty benign. When you try to stop the drug, it come back with a vengeance. Yes. And so you get hooked on the drugs. Well, I have to take it because as soon as I stop it, I get worse.

And I get worse than I was before I took it. Yeah. And a lot of the psychiatric the psychiatric drugs are like that, too. A lot of the, a lot of the, the antidepressant and the anxiolytics, the same thing is your body gets into a different state, and then if you go off of them too quickly or you're not being supervised, you, you're, you get these rebound symptoms, and it's much, much worse. So these chronic conditions, like heartburn or depression or anxiety, when you use a pharmacologic approach, you know, it's like throwing gasoline on a fire. And you, and you become, you know.

Like I said, there's, there's no money in dead people. There's no money in healthy people, but there's a lot of money in sick people.

Yeah.

It was so funny. You know, I, I, I think of this condition and we say it's too much stomach acid, but in fact it's a lifestyle problem and there's many other factors and causes from a functional medicine perspective we look at. And we even come up with new names for conditions that are pretty benign like gastroesophageal reflux disease. That was a new thing. When I was in medical school, they didn't have that. It was called heartburn. And then they came up with this disease. because they found a drug to treat it. Now, I don't know about you, but we were in medical school probably about the same time, and these drugs came on the market. And I remember the drug reps would show up and say, look, these are very powerful drugs. No patient should take them for any longer than six weeks. They're used to treat ulcers. They're very effective, but they are dangerous to take long time because they suppress stomach acid, which has all sorts of adverse consequences. And then that just went to the wind, and now people are on them for decades.

Yeah, absolutely. I can remember exactly when they first came out, there was a lot of warning in short-term use. And what we also did is we used them in the hospital. People who are hospitalized, they can get a thing called stress ulcers. And that can then in turn lead to bleeding and aspiration pneumonia and a whole bunch of different things. And there were some early studies showing that it can decrease the risk of stress ulcers and aspiration pneumonia. So these were sort of high, high potential risk medications that should only be used for a defined period of time. And then it sort of went into this chronic long-term use because they figured, oh, we can make a lot of money on this. Yeah.

I mean, in traditional medicine, it's like, okay, you have heartburn reflux. This is a chronic condition. Take this drug. And there's no thinking about why they have it. You know, they might be saying, oh, raise the head of your bed. You know, you might say, don't eat certain foods, like spicy foods or fried foods or citrus or tomato-based foods. That can sometimes help. But, but there's no real thinking about this being a solvable problem.

Right.

And, and sometimes there's things like a hiatal hernia or a structural problem.

Right.

And you can get a surgical procedure to fix that. But that's a very small group of.

People who have this, right?

Exactly. So I think from a functional medicine perspective, we look at this very differently. We don't just say, oh, it's too much stomach acid, take this drug to suppress the acid, and you'll be fine. We go, wait a minute. First of all, there are many causes, and if you treat the cause, you don't have to worry about taking the drugs. And second, these drugs are not benign. I mean, it'd be one thing to say, oh, it's like vitamin C. Just take a little vitamin C. It's fine. these drugs have serious side effects that we've now uncovered. So talk about some of the serious side effects that come as a consequences of these acid blocking drugs. And I'm just gonna name the people who know what they are. Their acid effects, Nexium, Protonix, Pepcid, Prilosec, these are the, did I forget any? There's a few more, I don't know how many there are all the time. But these are the common ones that people take. You can get 'em over the counter at your drugstore.

And they're just, it's a free for all now. So tell us about why we should be concerned about these drugs. Right, so these medications actually have long term consequences. So this well known, now in the literature, and if doctors spend their time learning what's the latest literature is that they're associated long-term use with increase in food allergies, problems with vitamin and mineral absorption, specifically B12, problems with calcium so you can develop increased risk for osteoporosis. Absolutely. So they have long-term leaky gut is another thing that they tie in with. Absolutely.

Pneumonia.

Yeah, yep.

And one of the things that's so striking to me is one of the most common side effects is you develop irritable bowel and bacterial overgrowth.

Yeah.

So literally, you swap one GI problem for another GI problem. Exactly.

It's like adding gasoline to the fire. It really, it truly and truly is. And, and they're not cheap. And the other thing, you know, I don't, I don't actually have a television set, so I don't necessarily see ads unless I'm over at somebody's house or I'm in an airport watching TV, waiting for a flight. But they have ads where, you know, somebody is like, you know, overweight and they've just, you know, eating a lot of, a lot of food and then they're having hard time.

Have the sausage and the peppers. Oh, don't worry.

Exactly. Just take this drug. Exactly. So you can, and, and, right. And that's the mindset that people have, is that you just keep, keep doing.

What you're doing that's giving you the.

Problem and take this to suppress the symptoms. You have, like, a little pill dispenser at McDonald's, you know? Yeah. And, and, and, and, and literally, I, you know, there, there are some really good, you know, Integrative and Functional Medicine Gastrointestinal Doctor, like Jerry Mullen, who we talked about, who's written a textbook on Integrative Gastroenterology. But most of the GI doctors, in my opinion, are handing out these acid-blocking medications pretty much like PezCure.

Oh my God. And you go to them and you're gonna get it.

Well, you can get it now on your own. You go to the grocery store. Yeah, but even at the higher. Yeah, they actually, you're right, because now they're actually at lower doses.

They're over the counter, which is, in my opinion, it really shouldn't be. No, it's a serious drug. Absolutely, exactly. There's all these consequences. so, so from a functional medicine perspective, one, you know, it's, it's not safe to take these medications long term.

No.

Two, you know, the problem isn't really dealt with. And three, there are better approaches to this. So what is the functional medicine view of reflux? What are the causes?

Well, the functional, you know, obviously, you first look at, look at the foods that you're eating because certain people will start reacting to certain foods. So for some people, it may be chocolate. it may be alcohol, may be foods that are citrus or tomato-based foods or spicy foods. So you want to sort of like, you know, eliminate some of the little peppermint.

Coffee, I hate to say.

Yeah, coffee. Well, coffee, I think, in my opinion, I've seen more people with gastritis, especially higher levels of coffee. And, you know, a lot of these medications or these, these foods can actually affect the lower esophageal sphincter tone, which is the muscle that keeps the stomach contents closed. So you want to have that. that muscle between the food pipe and the stomach be tight. And if you're overweight or if you have these certain foods which relax that muscle, then the stomach contents can go upward. And the lining of the esophagus is more sensitive to pain because basically the stomach is bathed in acid pretty much all the time. And you don't feel any pain when you have acid in your stomach, but you'll feel pain when the acid that's naturally there goes in the wrong place. Yes. Yeah. So that's, that's really the, I think the, the key thing and, and understanding that, that it's not an acid problem. It's really related to the balance of where the acid should be at the, at the proper. Yeah, it's not as if you're overweight.

And you got a big gut, you.

Know, that's, you're pushing, push things up. You're pregnant. You're pregnant. You know, it's, it's almost, I would say it's almost normal to have some heartburn when you're pregnant because you've got this, you get this, this, you know.

This baby, this food baby, if you will, you know, pushing up on the, on the diaphragm. So there's a lot of I see magnesium deficiency. I see problems with food sensitivities like gluten causing reflux. I see problems with zinc deficiency.

Zinc deficiency.

I see problems also with a bacteria that's common in ulcers, but I think also plays a role in some cases of heartburn and reflux called H. Pylori. Yeah, yeah, that's- Talk about what is this bug and why is it connected to these problems?

Well, it's really interesting. So H. Pylori, for a long time, we didn't really know what caused stomach ulcers. And stomach ulcers are different than heartburn. heartburn, but you can get similar symptoms to it. Stomach ulcers can cause bleeding and actually over time in some susceptible individuals, H. Pylori can actually cause gastric cancer. So not everybody who has H. Pylori actually has symptoms, but there are some individuals where it can. And it's probably related to a genetic component to it. And you can test for H. Pylori through stool testing, you can do it through antibody testing, breath testing. And also breath testing, exactly. And if you have it, you treat it as the best thing to do. And it's an interesting thing because there are some literature saying that in some individuals having H. Pylori can actually be protective against allergies and asthma. And for some people, it's not. So it's not like it's one. It's tricky. It's a trick.

Exactly. It's tricky, but it's super common. And I remember many patients I've had who've had reflux, not ulcers, but who we find H. Pylori and we treat it and they get better. Absolutely. So I think you have to treat everybody as an individual and see, but this is bacteria that people saw in the gut was lining these ulcers. And doctors thought it was just incidental, not relevant. But it turned out that this guy Barry Marshall, who was a doctor in Australia, said, maybe these are not just a coincidence or hanging around. Maybe they're the cause. And they thought he was a kook.

Exactly.

Kook. And so he decided to drink a whole beaker of this bacteria, give himself an ulcer, then have his partners scope him. and then take antibiotics, kill the bacteria, cure the ulcer, and end up winning the Nobel Prize.

Right.

So he changed the paradigm. He changed the paradigm because it used to be stress and emotional issues and all these things that cause ulcers, and now it's a bacteria. So I think we have to sort of understand that reflux is like you said, not just caused by food, but it can be caused by other factors, stress, being overweight, being pregnant, bacteria, food sensitivities, and I think it's a very specific method we use in functional medicine to help restore gut function. And I can't tell you how many people just completely get rid of heartburn reflux almost overnight by just understanding how to fix the problem. So what do we do in these patients? Give me a case of a patient you've had with reflux.

I have a great case. A patient came in to see me and the patient's main symptoms was neuropathy. so neuropathy is painful nerves Sensations in, usually in the extremities, in the legs or the, the arms. So the patient came in with neuropathy and was be, I think if I remember correctly, was being treated with gabapentin. And when I actually started diving into the history, which, you know, we, that's what, one of the things we do is we sort of play detective and ask a lot of questions and get the timeline of what started when and how and what were you doing and what were you taking, what were you eating and all that, all those kinds of things. And, uh, that's, to me, the fun part. part of this because it's like solving a murder mystery. It's like, okay, you know, who done it? You know, who did it?

And being a functional medicine doctor is.

Being a medical detective. Exactly, a medical detective. So in this particular case, the gentleman had high blood pressure and was on a medication called a calcium channel blocker. So that was the first thing in my mind. So for people that don't know about calcium channel blockers, they block calcium channels to lower blood pressure in the body. Well, another side effect is guess what? they lower esophageal sphincter tone. So there's a variety of different calcium channel blockers.

There's Norvasc and Diltiazem and Verapamil and such.

So relax that muscle that's keeping the food in your stomach and not going down. And they're actually, that's like a low hanging fruit. If I have anybody, anybody's on a calcium channel blocker and they have heartburn, I get them off the calcium channel blocker. Okay. So that was the first thing. And then he was also on a medication for high cholesterol. And that's another bugaboo of mine because the statin medications are actually associated with neuropathy. and you've got to treat about 500 patients with an elevated cholesterol to prevent one heart attack. So 499 patients benefit by the statins. And there's significant side effects in some people with- and the reason it causes this nerve damage is the nerve sheets.

Are covered by cholesterol.

Yeah.

Like, and so if you shut down cholesterol production, you can't- I love cholesterol.

Cholesterol's a great molecule. Heart disease is not about cholesterol, it's about inflammation. I tell patients, you want cholesterol, it's the building block of all your hormones and your myelin sheath.

But people need the right kind of cholesterol. Yeah.

And they can get screwed up. Yeah, right. There's a nuance. There's nuances to it, too. But. But cholesterol is, is a, is a good molecule in the body. It's a building block of lots of things. So. So he was on these, these two medications, and, you know, he was the kind of guy who was a hard-working guy. He would oftentimes skip lunch. He would then have late dinners, overeat because he was so hungry, and then he developed heartburn. So guess what the doctors did. They put him PPI. So then he came in to see me and he was having a lot of GI symptoms. He was having neuropathy symptoms. So I did a workup on him and I checked his vitamin B12. And in addition to his vitamin B12, I also checked methylmalonic acid, which is a precursor molecule that when you have B12 deficiency, you'll get elevations of methylmalonic acid even before you get B12 deficiency. And he had been on it so long that he actually had B12 deficiency. And guess what? No one ever checked his B12. yeah.

So he said it's super important. One of the main side effects of these drugs is they shut down B12 absorption because you need acid.

Exactly.

You need acid. Yeah. So that shuts down B12 absorption. Yes. And what you're saying is this patient got B12 deficient because of the drug.

Right.

It caused the nerve damage because B12.

Is necessary for proper nerve function. Correct. Exactly. Exactly. And this was, this was a, I called this case, you know, Atragenica Imperfecta. So it was doctor induced illness. I mean, literally the doctors, by giving.

Him the medications inappropriately.

Without thinking actually cause the disease. Yeah.

I mean, they're doing what they were trained to do, but we're not trained to think about getting the root cause, which is what functional medicine is, is what we do here at the Ultra Wellness Center in Linux, Massachusetts. And we do virtual consults. We could see people from anywhere. And we're just so grateful to be able to see people with these chronic problems to provide a pathway for getting better, which they've been struggling to find for often decades. Absolutely. You know, it breaks my heart because after doing this for 30 years and you've seen the same thing, you know, you see so many patients get better from things that traditional medicine just doesn't work with. And it's not that hard.

Yeah.

Once you, you know, once you know what to do, it's like that joke of the, the guy who had an appendectomy and the doctor sent him a bill for a thousand dollars. And the guy goes, wow, that's such an expensive operation for such a simple thing to take my appendix out. It's a lot of money for just taking out my appendix. He's like, you're right. And he sent him a new bill. He says, taking out your appendix, one dollar. knowing that's what needs to be taken out, $999. That's right. So I think little functional medicine is like that. It's like you look like a genius, but it's just the right roadmap. And the truth is the body is not organized like we thought it was according to all these organs and diseases. It's organized according to systems, and the body is one integrated dynamic system, and everything's connected. And so functional medicine really helps us to navigate using that map we call the matrix. And it's, it's so satisfying for us as doctors because we can start to treat people with problems that are often intractable and frustrating and yet have simple solutions.

Exactly. And going back to that particular patient, so in addition, the patient also had pre-diabetes, so he was overweight and he worked with me, he worked with a nutritionist, we changed his blood pressure medication, so his lower esophageal sphincter started to work. I'm trying to remember, I think I actually decreased his statin medication, put him on coenzyme Q10, which also is in vitamin that gets depleted by taking the statin medications and then put them on some vitamin B12. And within probably three months, his neuropathy symptoms was about 50% better. He had lost weight. And then by six months, his neuropathy was gone. His heartburn reflux was gone. He had lost 25 to 30 pounds and his pre-diabetes was no longer there.

So it's so simple sometimes. And I've seen case after case, sometimes it's just getting off of gluten dairy, sometimes it's just cleaning up their diet a little bit, sometimes it's giving a little extra magnesium or sometimes it's treating the H. Pylori or treating the bacterial yeast overgrowth in their gut. These things really can have a huge impact. I wrote a textbook chapter years ago for a functional medicine integrated medicine textbook on reflux, and I was just amazed to see the literature, what you could do. and all the treatments that are available from a functional medicine perspective that really work.

Yep, absolutely. There's a really good, as a nutritionist, I know Katie Morra who wrote a nice e-book about heartburn and reflux, which patients can get. And it's a sort of a simple guide that you can give to your patients to help them do it on their own. Because a lot of these things are really sort of, once you know what to do, you can really make interventions so, so, so simple. and, and I think, you know, one of the key things is really having a good relationship with a really good functional medicine, nutritionist, not a dietician or not a, you know, regularly trained nutritionist, because oftentimes their thinking is really skewed. I, you know, they're trained in hospital medicine, and they're about calorie counting and taking Nsure. And, you know, it's, it's really a functional mess. Nutritionist is real, which is essentially high fructose corn syrup.

Casein from A2 A1 cows, which is inflammatory and refined Omega-6 vegetable oils, which are super inflammatory. So, yeah, it's not exactly a health food.

Yeah, there's some of these, these, you know, what do you call meal? Meal replacement things, uh, such as, uh, insurance, such are really not necessarily the best way to be getting your calories. It's the last thing I'd be giving a sick person. Yeah. Yeah, exactly. And, and, and as you say, you know, your food food is information. Your food talks to your genes, as Jeff Bland has always said, and getting real food into your body and taking out the bad stuff, the fake food, the toxic food, the Franken food is so important. So, so important.

So, what kind of workup would you do for a patient with reflux to see what was going on from a functional medicine perspective?

Well, to some degree, a heartburn patient does not need a big extensive workup. times when you may refer them and get an EGD and make sure they don't have a hiatal hernia or make sure they don't have, like, that's an upper endoscopy.

Upper endoscopy.

Yeah, they look at a scope down there and look around. Yeah, do that. You can, you know, and then you, you can do testing for stomach acid by gastrin levels. Oftentimes I also combine that with antiparital cell antibodies. And parital cells are the cells in the body that make stomach acid. And there are some people that will actually have autoimmunity so that their body is attacking the pro, the stomach acid producing cells so that they're, they're not actually having enough stomach acid. So sometimes stomach acid support can be really helpful things such as apple cider vinegar, which is a simple sort of home remedy. I've had patients do very well with that. Also, betaine HCL is another thing that you can use to support stomach acid. Eventually, the sort of almost counterintuitive, you're.

Giving stomach acid support to people who are traditionally thought to have too much stomach acid.

Yes, absolutely. Yes.

Yeah, it is counterintuitive. Exactly.

But in the right patient, it can be very yeah, exactly. And the other thing, Mark, which is, this is really interesting, and this ties in back in with H. Pylori is that there are some genetic SNPs with the interleukin 1 beta and TNF alpha. If you have those SNPs and you also have H. Pylori, your body downregulates stomach acid production. So chronic inflammation actually can with H pylori can actually down regulate stomach acid.

So basically we tell people the basic stuff, right? We look at, we look at, we might look at stool testing, food allergy testing, we might look at H pylori, we'll look at their vitamin levels, zinc, which gets malabsorbed magnesium, we'll look at their B12 levels or methionine acid. So we'll get a really good sense of what's going on with this patient like you did with yours. And then we'll give them some basic lifestyle recommendations, which are not uncommon even in traditional medicine, right? Avoid fried foods, spicy foods, tomato-based foods, citrus foods, too much coffee, chocolate, certain spicy foods. So all that can be helpful for some patients. We'll tell them to stop smoking, we'll tell them to stop eating late, we'll tell them to raise the head of their bed. All that's great advice. But to get to the root cause, we have to deal with these other factors. And often you can't just stop the acid blocking medication because you'll get this rebound effect that we talked about.

You really have to taper it down, right? Yeah, exactly. That is definitely something that you do and you do that sort of slowly. you know, if they're on like a, you know, 80 milligram dose, you may actually then go to 81 day, 40 the next day and then gradually decrease it. And then as you do that, you can then go to a lower, maybe an H2 blocker. Yeah. And then transition to an H2 blocker, add in some things like DGL.

Yeah.

And things to aloe for the, uh, an aloe glutamine and, uh, glutagenics I oftentimes will use in patients. to help with the stomach lining. And patients, if they do it slowly, they oftentimes can get off of the proton pump inhibitors. Again, if they have, and one of the things I actually will do is, is I'll measure gastrin levels. And if they have very high levels of gastrin, then I know it's going to be a slow process because it takes a while for the body to reacquaint. Yeah.

So it's really powerful. So you can come off these medications off and cut it by. you know, the dose by half once a week over a period of weeks. And you're right, in addition to just stopping the drugs and the dietary things and lifestyle factors, there's a number of products we use that can be very, very helpful. And you mentioned a few of them, DGL, which is deglycerozied licorice. And they're like chewable tablets that are like natural Tums that you can take before you eat. Very, very effective. And you mentioned also as a combination of glutamine, aloe and licorice, which also can be extremely helpful. You can take it as a powder before you eat every day. and I find when I do that, and maybe a few other supplements that sometimes are effective or magnesium, a little this, that people do really, really well. It's one of those conditions that people just don't have to suffer from. They do have to make the dietary and lifestyle changes. It's not just go about eating your sausage and peppers and deep fried food and take your pills so you avoid the symptoms.

And that's just a dumb idea. Yeah. Symptom suppression. I mean, that's what, that's what Sydney Baker talked about for, for years as the, sort of the grandfather. of functional medicine is most medicine nowadays is symptom suppression. It's a blocker, some type of blocker, an anti-hypertensive, an anti-calcium channel blocker. It's a blocking. And, you know, when you really think about systems biology, it's like having this big, you know, complicated machine. You just sort of throw this wrench in it. Yeah. And you just stop it. And then what happens is all of a sudden, you know, it builds up and all of a sudden, you know, the, you know, the conveyor belt, you know, all the stuff starts backing up. and that's what happens when you have these very powerful interventions in very complex systems in the body. We saw that with Vioxx. Vioxx is a classic case where Vioxx was a medication was taken off the market and it was huge.

Super duper Advil.

Yeah, super duper Advil and it worked really well, but in the process of blocking the prostaglandins, we actually caused people to have strokes. There are some people that- Exactly. Strokes and heart attacks.

It took it off the market.

It took it off the market and they, unfortunately, you know, a lot of times when medication go on the market, they're studied for a relatively short period of time. And what happens when you take the PPIs for a long period of time? If you study the PPIs for six to eight weeks, they're not gonna have problems. No. If you take PPIs for six to eight years, you're gonna have problems. Right. And I think that's really one of the areas where big pharma is really lacks because we are not following up these patients long term on these very powerful medications.

And then the pH has to be right in your gut for the right bacteria. So if you're shut off the acid and then you have no acid in your small intestine, you're gonna get bad bugs growing in there, you're gonna get yeast growing in there. So often I find myself having to deal with the consequences of the drugs in repairing the gut. So not only do they have reflux, but they end up having your little bowel and SIBO and SIFO, which are these bacterial and yeast overgrowth in the gut.

And so you have to fix all that too. So you have to do a cleanup crew after they get on these drugs for a long time. Exactly. We're fixing the iatrogenic induced illness. I mean, when you really think about it, there's a lot of the stuff that we see nowadays A lot of a good part of it is related to some of the side effects of the medications. And what oftentimes happens in mainstream medicine now is that you have a side effect of medications. The doctor gives you another drug to counteract that side effect. So then you get this polypharmacy and that's a big dangerous thing, especially in the elderly. These patients come in and they're on tons of medications. One of the things that some of the geriatricians are doing now, they're realizing this, is they have these patients when they saw like five doctors, each doctor gave them two medications. on 10 medications. They're in the nursing home and they're like semi-comatose and almost, you know, on death's door. And they guess what? They get them off of the medications. They wake up.

I once saw this patient, I did a house call on this woman and she was on 22 different medications. It was just unbelievable.

Right.

Unbelievable.

Right.

So I think this is really a great case of, a disease which is easily treatable with functional medicine that avoids you having to take potentially very harmful drugs that requires a little bit of a different thinking and approach, but that is available pretty easily. And I've written a lot about this, not only the textbook chapter, but I've written a lot of blogs. You can go to drhyman.com and search for reflux or heartburn on the search box, and you'll find a bunch of articles sort of detailing some of these ideas in functional medicine. But I just want to emphasize for people who are suffering from this, a lot of this you can fix your own. You don't need to see the doctor, just follow these guidelines. But if you do, you know, we're at the Ultra Wellness Center here in Lenox, Massachusetts. We've been dealing with this stuff for decades and collectively you probably have over 60 or 70 years of experience in functional medicine between all of us practicing here. And we can really help people remotely through Zoom consultations, wherever you are in the world, and we really would love you to not suffer. And I think that's really one of those, what's your what's your life's mission? Really to end needless suffering through the power of functional medicine to get to the root cause of disease.

Yeah, yeah, mental and physical suffering, emotional suffering, you know, they all are tied in. You know, there's the suffering that people have with pain and they're suffering with, you know, their day-to-day existence. And when you see enough people, it really is, you're absolutely right, it's all about helping people to be alive and well. And when we're healthy, we don't really know we have a body. that's a beautiful thing. She's talking to you. You'll breathe, you don't have, you're not wheezing, you can move your body, it doesn't hurt, you go to bed and you actually sleep and you move your bowels and you don't think about it. It's just like when everything's working, you literally don't know you have a body.

It's just there, it just works. It's true. What is functional medicine? It's the path to figuring out how to get to know you don't have a body. I love that. Thank you so much for joining us on this special episode of House Call for the Doctor's Pharmacy. again, if you've been suffering from challenges with digestion and reflux and heartburn or you know anybody, please direct them our way. The Ultra Wellness Center in Lenox, we take care of people from all over the world and do it all virtually now. If you want to come in, we're happy to see you, but you don't have to. Please share this podcast with your friends and family on social media. Leave a comment, tell us how you've struggled or not and how you solve your issues with heartburn or anything else. And subscribe wherever you get podcast and we'll see you next time on the Doctor's Pharmacy.

Great. Thank you, Mark.

Hi, everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed.

Healthcare practitioner, and can help you make changes, especially when it comes to your health. Don't forget, there's a way to listen completely ad free. With Hyman Plus on Apple Podcasts, you can enjoy every episode without any breaks. Just open Apple Podcasts and tap try free to start your seven day free trial.