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Are Your Heartburn Medicines Damaging Your Kidneys and Brain?

Are Your Heartburn Medicines Damaging Your Kidneys and Brain?

May 23, 2021 by Dr Kar

Patient story:

A 59-year-old woman has diabetes for 20 years with early kidney damage, presently on insulin injections. She had an angioplasty nine years ago because of chest pain from blocked heart arteries. Besides insulin, she was taking Plavix (Clopidogrel) and Nexium (PPI). Plavix works on blood cells called platelets to prevent them from sticking together to cause excessive clotting. Given that she had an angioplasty, Plavix was essential for her.

She didn’t have stomach ulcers or acid reflux. Why was she on Nexium? She said her doctor had prescribed it, but she wasn’t sure why!

Long-term use of PPI without indications has serious consequences. 

Drugs like omeprazole, lansoprazole, pantoprazole are called Proton Pump Inhibitors. You may know them by their commercial names like Nexium, Omez etc.

Your doctor may have prescribed these medicines because you had heartburn. You had pain and discomfort or a burning sensation in the upper abdomen, sometimes described as “acidity” or “gastric trouble.”

PPIs work by blocking your stomach cells from making acid. 

But stomach acid is present for a reason!

Your stomach makes acid because it has essential functions. Hydrochloric acid produced in the stomach helps in protein digestion and in killing some of the bacteria present in food.

Though it is widely assumed that your reflux symptoms arise from high stomach acid, that is not always so! 

Harmful effects of PPI use

Studies have shown that between 25 to 70% of people using PPIs do so without a valid indication. In some countries, PPIs are available even without a prescription.  (1) Ref

Harmful effects of inappropriate PPI use

PPIs reduce the effectivity of Clopidogrel

Clopidogrel (Plavix) is used in after angina or angioplasty to prevent blood from clotting. A 2009 paper from the journal JAMA showed that the risk of an adverse outcome following an acute coronary event was much higher in those taking Clopidogrel and PPIs simultaneously than in those not taking PPIs with Clopidogrel. The PPIs reduced the beneficial effects of Clopidogrel. (2) Ref

What are the conditions when PPIs are indicated?

  1. Peptic ulcers
  2. As part of the treatment protocol for H Pylori infection
  3. Esophagitis
  4. Prevention of painkiller-induced ulcers.
  5. Zollinger Ellison syndrome 

What can you do if you have reflux?

  • Start with food. An elimination diet will take care of troublesome food.
  • Eat low carbohydrate food
  • Reduce your eating window. Your gut needs resting time. 
  • Early dinner. Don’t eat nearer to your bedtime.
  • Supplements like Melatonin 3 mg or Peppermint Oil may help.

What if you find it challenging to stop PPIs?

Talk to your doctor to find out if there are any alternatives.

Some of you are psychologically dependant on these medications, though you may not actually need them. Don’t stop them suddenly. There is a specific process of deprescribing PPIs.  (3) Ref

Going back to my patient at the beginning of this article……

It wasn’t difficult to stop her Nexium because she didn’t have any absolute indications. On the contrary, continuing PPIs could worsen her kidney function and increase her risk of heart disease.

Bottom Line:

Find out why you are on certain medications. If they are not mission-critical, talk to your doctor about reducing your medications and find out how to safely reduce meds. A deprescribing appointment should be a part of your medical program. 

References[+]

References
↑1 Ref
↑2 Ref
↑3 Ref

Filed Under: Deprescribing Medications, Gut Health, PPI

Bloating Remedies: Is Your Food Causing A Problem?

Bloating Remedies: Is Your Food Causing A Problem?

November 19, 2020 by Dr Kar

Bloating is a sense of fullness or “gassiness” or a feeling of distension of your stomach. You may or may not have an actual increase in the size of your abdomen.

The causes of bloating are many, ranging from food sensitivities to your medications to very serious conditions like ovarian cancer.

Where do you start?

In medical school, we were always taught that you should start with the basics- a good clinical history. Do you have only bloating? Or is it accompanied by belching (expulsion of excess gas from the mouth) or flatulence? Do you have stomach pain? Are your symptoms related to food intake? Do you feel bloated soon after eating food, or does it occur later? Do you feel bloated after a large meal? Do you devour your meals without chewing thoroughly? Any unintended weight-loss? Do you bleed when passing stools? (The last two should prompt you to visit your doctor immediately).

The first step in a thorough evaluation of bloating is a review of your food and drinks.

Which food are the typical offenders?

Food sensitivity. (Link) Do you know which food are troublesome for you? If you have never done a good elimination diet, then that is a great place to start.

Gut Symptoms Questionnaire

The commonest food sensitivities are to gluten, dairy, soy, corn, processed food. The simplest way to do an elimination diet is to stop eating the typical offenders for two weeks. Then you can reintroduce one food every three days and track your symptoms. The reintroduction phase is a vital piece in an elimination diet, but many of you miss that. Frequently your food sensitivity symptoms may have nothing to do with your gut. It may show up as headaches, brain fog, joint pain, skin rash etc.

Should you say goodbye to gluten?

Other common offenders:

Some of the following food may cause a problem as well:

  • Beans, legumes, onions
  • Caffeine
  • Lactose
  • Fructose
  • Artificial sweeteners like sorbitol, mannitol. (Including sugar-free chewing gums).
  • Carbonated drinks

Do you need a very restricted diet?

You may have heard of a low FODMAPs diet, a no-gluten diet, or the Specific Carbohydrate Diet. Which one is right for you? 

While there are no simple answers, you can use the scoring in this quiz to provide clarity. If your symptom score is very high, you may need a more restricted diet like the low FODMAPs diet. However, most people do quite well by eliminating the major ones like gluten, dairy and processed food.

Are you an “early bloater” or a “late bloater”?

Early Bloater. You are an “early bloater” if you experience bloating in less than half an hour after eating food. One of the commonest causes of early bloating is gastroparesis in people with diabetes. 

Gastroparesis means partial paralysis of the stomach. The commonest cause is nerve damage from diabetes. However, other possible factors are medicines like tricyclic antidepressants, L-dopa, and narcotics. SLE and scleroderma, Parkinson’s disease and post-viral infection, stomach outlet obstructions are additional causes. You will need to consult a specialist physician to rule out many of these causes.

Late Bloater: You are a “late bloater” if you have bloating after half an hour or longer post-meal.” Late bloating” is more common. Some of the causes are food sensitivities(particularly gluten sensitivity), SIBO (Small Intestinal Bacterial Overgrowth), Celiac Disease or IBS (Irritable Bowel Syndrome).links

SIBO: Normally, gut bacteria reside in the large bowel. In SIBO, abnormal numbers and types of gut bacteria are present in the small bowel, leading to bloating, diarrhea, nausea etc.

Are you a “constipated bloater”?

If you have constipation along with bloating, additional causes have to be excluded. Is it primarily constipation? Do you have stomach pain? Constipation, with bloating and stomach pain, may indicate a diagnosis of IBS-C. 

Additional causes of constipation are pelvic floor dysfunction and hypothyroidism.

Additional causes of bloating:

OSA treatment: 

Obstructive Sleep Apnoea(OSA) is a condition where you periodically stop breathing when asleep. It is a potentially serious condition because OSA is related to a higher risk of heart disease, high blood pressure, stroke, heart rhythm abnormalities etc. One treatment of OSA is using a C-PAP device. Some people find that they end up swallowing a lot of air (aerophagy) in the initial days of using a C-PAP device. Aerophagy can sometimes lead to bloating.

Medications: (1) Ref

  • Aspirin.
  • Antacids.
  • Diarrhea medicines, such as Imodium, Kaopectate, and Lomotil.
  • Opioid pain medicines.
  • Fibre supplements and bulking agents, like Metamucil, Isapgol.
  • Iron pills.
  • Metformin

Ovarian cancer

Ovarian cancer is the most serious of women’s cancers. It is often detected late because some of the symptoms are non-specific. Bloating and feeling full maybe some of the earliest symptoms of this cancer. (Usually, there is no vaginal bleeding in ovarian cancer).

Warnings:

If you have bleeding with stools or unintended weight loss, please meet your doctor immediately to rule out potentially serious disease. If you are a woman, please talk to your doctor about screening for ovarian cancer.

Summary

  • The first step to dealing with your bloating is to figure out your food sensitivities by doing an Elimination Diet. 
  • What should you eliminate? Check your score here.
  • Often your doctor cannot do a detailed food assessment in a time-constrained clinic consultation. Here is where you can help your physician by finding out your bothersome food.
  • Are any of your medications or supplements causing a problem?
  • Please meet your doctor if your symptoms are not relieved in a reasonable time. 

References[+]

References
↑1 Ref

Filed Under: "Leaky Gut", Celiac Disease, Gluten Sensitivity, Gut Health, Irritable Bowel Syndrome (IBS), Non-celiac Gluten Sensitivity

Should You Stop Eating Gluten?

Should You Stop Eating Gluten?

November 21, 2019 by Dr Kar

(An earlier version was posted in April 2019. Updated November 2019)

What Is Gluten?

Gluten is a family of proteins found in grains like wheat, spelt, rye and barley. It consists of two main proteins, glutenin and gliadin. Gluten is the component of grains that helps them bind together, like when you roll out a roti (Indian flatbread) or while making bread.

Gluten-containing food are

  • Roti made with wheat (Atta, maida)
  • Bread
  • Biscuits
  • Cakes
  • Semolina (Sooji)
  • Pasta
  • Couscous
  • Oats
  • Tabbouleh
  • Many processed food contains gluten …..hidden gluten. These may not be obvious sources but relevant nonetheless. Commonest are soups, and sauces, gravy thickeners in restaurants, the coating (breading) in chicken nuggets, and Indian-Chinese food from your neighbourhood pushcart. (Which possibly contains MSG too!)

What Is Non-Celiac Gluten Sensitivity (NCGS)?

Non-celiac gluten sensitivity (NCGS) is a condition where you have abnormal symptoms within a few hours or days of eating gluten-containing food, but you do not have Celiac Disease or wheat allergy. (1) Ref. Your symptoms go away when you stop eating gluten-containing food, but they recur within hours or days of eating gluten again.

[Read more…]

References[+]

References
↑1 Ref

Filed Under: Celiac Disease, Gut Health, Non-celiac Gluten Sensitivity

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  • Revenge Of The Deprived Calorie: Is Fasting Another Low-Calorie Diet?
  • Are Your Heartburn Medicines Damaging Your Kidneys and Brain?
  • Are Nutrient Deficiencies Affecting Your Thyroid Function?
  • Recovery From Covid 19:The Problem Of Long Covid
  • Bloating Remedies: Is Your Food Causing A Problem?

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