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Episode 10: Health risks of acid lowering medications

00:00:33 Glenn:       Welcome back again to Natural Health for People and Pets. My name's Glenn Cooke, I'm co-host of the show. I'm gonna pass you over to the brains trust of the show, Narelle Cooke.  

00:00:42 Narelle:       Hello everyone. So the last episode on histamine was really popular. I got a lot of feedback and messages from people who were wow, that explains my situation and they're gonna give it a go. Trying to follow a low histamine diet. So that's really encouraging.  

00:00:57 Glenn:        It is really encouraging. It's nice to hear that people are getting something out of any of the shows. I feel it's quite important that some of these episodes do a little bit of a deep dive into some of these topics, because the things that people talk about on the surface, they never really get a good look at what it is or what the ailment is that's affecting them or their dog. So it is nice for me to be able to listen to it extensively because I feel the only time that people really research something is when it's afflicting them when it's an ailment that they actually have. So I think sometimes being forewarned is helpful for them, because if they can see it occurring in a dog, doesn't mean they can diagnose it immediately, but they might have an idea of what it is and then be able to say to the doctor or the vet, this is what it could be.  

00:01:44 Narelle:       Absolutely, and today's episode which we'll get onto shortly, is really about that. Some people might hear that and go, oh, that's a bit, you know, whatever. But it's really important, which is why I am gonna talk about it today.  

00:01:58 Glenn:         And we have touched on it before, haven't we?

00:02:00 Narelle:        We have touched on it and I said I need to do a podcast about that, and so today's that day. But first …  

00:02:06    Glenn:         A big announcement. 

00:02:07 Narelle:       Well  I think it's super exciting, and I'm just really excited to share it with the listeners. In clinic I see a lot of patients for weight loss, it's probably one of the main conditions that I treat and support people with. But one of the negatives that I find in clinic is that most of my patients might see me on average every four weeks, which for most health conditions is okay. But when we are talking about weight loss, particularly if someone's got a lot of weight to lose, they need a much higher level of support. Ideally once a week or twice a week would be what I would prefer for them. But then it becomes prohibitive from a cost and time perspective. So what I've done now based on talking to patients and getting their feedback is I've created a highly structured 12 week course, all around weight loss and nutrition. The great thing about it is there'll be an online component where people will have lessons that they work through themselves. There'll be exercises and handouts that they do, but the beauty of it is, is there'll be a closed Facebook Group just for people who do the course. So they'll have access to me daily. 

00:03:19 Glenn:         Oh, like an internal support?  

00:03:21 Narelle:       Yeah, it'll be a support group, a Facebook support group, so people can check in every day, every week, whatever level of support they need, I'm there. So rather than waiting four weeks and falling off the wagon in between, or not knowing what foods to pick or all these questions that come up for people who are trying to lose weight and it's a new journey for them, I'll be there to support them in that group. I think that's gonna be a game changer for a lot of people. And the course is not just about eat this food and I've never been one for fad diets or crash diets. I don't want my clients to lose 15 kilos in four weeks because then I know they're doing something terribly wrong and they're just gonna rebound weight gain, or binge at the end of it.  

00:04:02 Narelle:        I'm all about sustainable, healthy choices. I'm not gonna go through all of the different topics for the 12 weeks, but a big part of it is mindset and setting yourself up to succeed. There'll be the facts about metabolism and energy and fat burning. I'm gonna dispel a lot of myths that persist about weight loss and fat burning so people can be crystal clear on what's right for their body. How to meal prep, how to create really nutritious meals at the right portion sizes for their body.  

00:04:34 Glenn:         So it's backed by science rather than just crude marketing.  

00:04:37 Narelle:       Yeah, it's just sustainable, healthy eating. Overweight and overeating, it's not just about being hungry, I mean that's just an outdated notion. It's about the emotional aspects, what's driving people to eat, and having a close support group can allow people to explore that a bit more. And within the course, you know, I'll be helping people to dig a bit deeper into what's driving their emotional eating, what's driving their cravings. And not just understanding that, but then what do you do about it? Like what's the practical steps if that is part of what is causing you to overeat and gain weight. Hmm.  

 00:05:12 Glenn:         Sounds good.  

00:05:13 Narelle:       I think that's gonna be amazing. That will be ready to go in January. Keep an eye out on social media on my website. I'm gonna talk about it more in the next podcast.  

00:05:22 Glenn:         Yeah, how would they find that? What's the address for people to go to if they're looking for that? 

00:05:26 Narelle:       Definitely the Natural Health for People and Pets Facebook page. Also on the Natural Health and Nutrition Facebook page. There'll be all of the information about the course content and the costs will be on my website, naturalhealthandnutrition.com.au.  

00:05:41 Glenn:         So you'll do announcements.  

00:05:42 Narelle:       Yeah, there'll be lots of announcements when that's ready to go. Watch this space and you know, New Year, New You.

00:05:48 Glenn:         That's good, get into it, y'all. Excellent. 

00:05:53 Narelle:       Getting onto today's topic, and again, this is something I see a lot of in clinic with my human patients, but it's also relevant to dogs. It's all about acid lowering medications. So people might be like, what's that?  

00:06:07 Glenn:         What's that got to do with me?  

00:06:09 Narelle:       That's right. But acid lowering medications are one of the most prescribed medications worldwide for people. And there's a lot of information coming out now that they're being overprescribed to people and they're being overprescribed to our pets as well.  

00:06:24 Glenn:         It's like Gaviscon, is it?  

00:06:26 Narelle:       Yeah, and I'll talk about a bit more about the different types of acid low medications as we go along, but the reason that I really want to touch on this is because I do see so many people on acid lowering meds and I'm talking for decades, and they've never once been told by their GP, or if it's a dog their vet, about the long-term negative health effects of staying on these medications. So that's what I wanna highlight to people today. And it's a sort of medication where, when people come to me with symptoms, how big a role is that medication playing in the symptoms you're presenting with, or in the development of new symptoms that we're seeing over time. But a big note that if you are on any acid lower medication, or if your dog is on acid lowering medication, absolutely do not stop your medication based on anything that you hear today in this podcast. I am providing you with information and I'm giving you a lot of things to think about in relation to the medication, but you must absolutely speak to your doctor, or speak to your vet before you make any changes to your medication.  

00:07:29 Narelle:       So I wanna be really clear about that.  

00:07:32 Glenn:         What's a precursor to put a dog on acid lowering medication? Like why do dogs usually get put on it?  

00:07:38 Narelle:       Well, let me just go through the process and then we'll get to dogs a little bit later.

00:07:43 Glenn:         Okay, yeah of course.  

00:07:44 Narelle:       To start with, let's put it in perspective about what they are and what they do and where they work in the body. So if we start with the esophagus, most people will know that that's the long flexible tube that connects our mouth to our stomach. But at the lower end of the esophagus, there's what's called a gastroesophageal junction and within that junction there's a sphincter muscle called the lower esophageal sphincter, which I'm gonna have trouble saying throughout the podcast. But that lower esophageal sphincter, which I might probably just call the sphincter, is designed to keep the stomach contents in place and to prevent reflux back up into the esophagus. That's why technically we can eat a meal and then do a handstand and all the food from our stomach doesn't come gushing back out of our mouths.  

00:08:28 Glenn:         Incredible by design. 

00:08:30 Narelle:       It is. I dunno why you'd wanna do that, but you can do that if you want to. But as humans, we can still vomit if we want to. So we can make ourselves vomit, or there are reflexes in the body that will trigger us to vomit. And this is something, I know nothing about horses, I'll admit that, but recently I learned that horses can't vomit.  

00:08:47 Glenn:          I didn't know that either.  

00:08:49 Narelle:        I was gonna say, how cool is that? But it's just really interesting and the reason for that is that their lower esophageal sphincter is so strong that once it closes, it's shut. Whereas for people, ours is relatively weak, which is why we can make ourselves vomit and food can pass back up. And in addition to horses, rabbits, rats and frogs can't vomit.  

00:09:10 Glenn:         What about cows?  

00:09:11 Narelle:        I don't know. They're the only ones I remember that can't vomit. But I don't know about cows. Why would you care about cows?  

 00:09:18 Glenn:         Well, they're just very similar in stature to a horse, I was just wondering if they have that same sort of physiology.  

00:09:25 Narelle:       Good question. If any of the listeners know if cows can vomit. Actually they regurgitate their food to keep chewing on it throughout the day, they're ruminants. So yeah, they swallow food, goes in the room and comes back up. That's why they ruminate. That's why we ruminate.  

00:09:41 Glenn:         Ah there you go, so cows can technically vomit.

00:09:44 Narelle:       Yeah I guess so If you think about the basic physiology. But coming back to humans, any incompetence of that sphincter between the esophagus and the stomach, that's what is considered the main underlying cause of acid reflux. So anything that compromises that is gonna make you more likely to get reflux. And then if we move on quickly to the acidic nature of the stomach environment, it's absolutely essential for us to be able to break down our food properly and to go onto the next stages of digestion and absorption. I mean, you think about dogs eating bones, if they don't have adequate gastric acid,  

00:10:20 Glenn:         They can't break it down. 

00:10:21 Narelle:       Yeah. Imagine a bone sitting heavy in their guts. And you think of all the rubbish foods and heavy foods that we eat as humans, if we don't have adequate gastric acid, it just sits there heavy like a lump fermenting.  

00:10:33 Glenn:       Okay. Fun fact, I think that since you've brought that up, that a dog's pH level is two points different in acidity than ours, isn't it? Because of the level of bacteria and like you said, bones that they consume and so forth. I think they have a higher level of acid in their stomach than human beings.  

00:10:54 Narelle:       There is some overlap in the levels of gastric pH with humans and dogs. Gastric pH varies depending on whether you're in a fed or a fasted state. So it's not that dogs are always two points lower on the acid scale per se, it can vary. Dogs have a range that they'll sit within, and we have a range and there is some overlap in that range. 

00:11:18 Glenn:       I don’t know what I was reading, I was glancing through something and it said that the reason they have the variance in pH is because of the quality and the quantities of foods that they eat, and that they have to have a tolerance for a higher level of bacteria than a human being could tolerate.  

00:11:34 Narelle:       Oh, absolutely. But all of those reasons are reasons why we need strong gastric acid as well. From an evolutionary perspective, they're eating large meals, if they're doing a kill.  

00:11:46 Glenn:         A gorge. 

00:11:47 Narelle:       Yeah. They gorge and fast and the bacterial load is much higher for them so they do need that strong acid, which is why acid lowering meds in dogs can be quite detrimental. But we need that too. And because this is what I'm mainly seeing in clinic with patients, most of what I'll be talking about today is focusing on the use of acid lowering meds for reflux, because the theory behind that is that too much gastric acid comes back up into the esophagus, which is what creates the symptoms such as heartburn. But just to put it out there, there's also a school of thought that states that too little stomach acid can be a cause of acid reflux as well. A lot of people don't think of it that way, and to explain that a little bit further, that lower esophageal sphincter requires sufficient quantities of stomach acid to remain closed.  

00:12:35 Narelle:       So it's actually the acid building up in the gut that's like a trigger mechanism for that sphincter to go, okay, acid's building up, I need to shut tightly. So it shouldn't really matter if you have a lot of gastric acid because if your lower esophageal sphincter is working correctly, you shouldn't experience reflux in the first place. Which raises the question, why might that sphincter not shut properly? And towards the end, I'm gonna talk a lot about the diet and lifestyle influences on that. But just to give you a couple of examples now, peppermint can relax the sphincter muscles. So if someone has a big meal at night and then they have a cup of peppermint tea thinking they're doing the right thing by their digestion… 

00:13:24 Glenn:         You just make your sphincter sloppy.  

00:13:26 Narelle:       Yeah, you're just opening that sphincter. 

00:13:30 Glenn:         Oh good.  

00:13:31 Narelle:       It's not that that's gonna happen to everyone, but some people are more susceptible and sensitive to things.. So if that's you, having a cup of peppermint tea may not be the best choice.  

00:13:41 Glenn:         Right, or peppermint chewing gum.  

00:13:43 Narelle:       Yeah. Any mint peppermint can potentially relax that sphincter muscle, but other things like garlic and onion and fatty foods. Fatty foods are a double whammy because they can relax the sphincter muscle, but then they also slow down gastric emptying, which is like the rate at which food passes out of the stomach. If you can imagine the longer you have food sitting in the gut, one, you get a build up of volume if you keep eating, but you get a buildup of gasses as the food's broken down and fermented. So that causes an upward pressure on that sphincter, which can overwhelm it, causing it to open slightly. 

00:14:18 Glenn:         Okay, can I just insert something here? Just a question. Is it true that meat can sit undigested in the stomach for like months? Is that a fact? Or is that fiction?  

00:14:29 Narelle:       Those sort of facts? I don't just know off the top of my head, but for months I would say highly unlikely.

00:14:35 Glenn:         There's a lot of, I would call it an urban myth because it just seems so unlikely to me that you would eat a steak or something like that. It sounds like something somebody who would try and convince you not to eat meat would say that they can sit undigested in the stomach for months.  

00:14:49 Narelle:        I'm pretty sure there's a condition called gastroparesis. It's where some people do have a condition where they have really slowed and delayed gastric emptying. But to say months, I would say myth. Oh, imagine how uncomfortable that would be. 

00:15:03 Glenn:          We'll have to find out right. 

00:15:05 Narelle:        Google,  

00:15:05 Glenn:          We'll have to look into it unless … 

00:15:07 Narelle:        We've got some …

00:15:08 Glenn:          Got some people out there who've got medical … 

00:15:09 Narelle:        Professionals.  

00:15:10 Glenn:          Yeah, if anyone out there's got the facts around that, please … 

00:15:13 Narelle:        Let us know.  

00:15:14 Glenn:          Yeah, contact us on social media.  

00:15:16 Narelle:        But that's why obesity and pregnancy cause reflux, because you've got that upward pressure on that sphincter. But the problem is anything that slightly compromises that sphincter muscle and allows a tiny bit of acid through, it doesn't take much acid. I mean, acid's potent stuff. So even the tiniest bit is gonna cause symptoms and whether we call it heartburn or reflux or GERD or GORD, in Australia we call it GERD, Gastroesophageal Reflux Disease, because we spell esophagus with an E. In the States they’d call it GORD because they still spell esophagus with an O. Anyway, tomato, tomato.  

00:15:54 Glenn:           Literally.  

00:15:55 Narelle:         But it's painful and it's potentially dangerous, and the danger is that after prolonged exposure to the acid, and not just the acid, but we've got protein digesting enzymes in our stomach fluid, those cells of the lower esophagus undergo pre-cancerous changes, which can then develop into esophageal cancer. So it is really important that if you experience reflux that you treat it. It's just that the most common acid lowering meds come with a lot of negative side effects when they are used long term. And there's lots that people can do with their diet and their lifestyle to correct the problem without needing to take medications in the first place, so that's what I wanna really stress today. Don't just have a bit of heartburn and just start popping acid lowering meds. Think about your diet, think about your lifestyle, and we'll go through all of that in detail. So reflux is one of the main reasons for acid lowering meds, but the other one is peptic ulcer disease. That's where we get open sores or ulcers in the stomach or in the first part of the intestine, and people can get peptic ulcers from bacterial infection. The old school of thought was when you were stressed you'd get ulcers. But that's sort of a myth now. Or you know, that's sort of been dispelled.

00:17:09 Narelle:       I think it was actually Australian scientists that found the connection between helicobacter pylori, which is a bacteria that resides in most people, like 75% of the world's population have h pylori in their system. It's just that for some people it takes off and can cause a lot of problems because the bacteria eats away at the lining of our digestive system. So, our body is amazing in design, because the stomach is so acidic it creates a really thick mucus layer that forms a barrier between our gut lining and the contents of the stomach. We don't actually eat away at our own stomach lining with our acid, but this bacteria eats away at that protective mucus layer so the acid can get to the gut lining and cause ulcers. And the other thing that's relevant to dogs as well, they don't actually get helicobacter pylori, like that same species of bacteria.  

00:18:05 Narelle:       They get lots of other helicobacter species, but not that particular one. But what's more relevant for dogs and people, is the long-term use of non-steroidal anti-inflammatory drugs. They also destroy that protective barrier lining and can lead to ulceration because of the acid getting into the mucus membrane. So as you mentioned earlier, one of the most main acid lowering meds that people would be familiar with are our antacids. They're the oldest of the meds and they reduce the stomach acid by temporarily neutralising the acid. They're those alkaline minerals such as magnesium or aluminum that you get in things like Gaviscon and Mylanta and the Rennies and Quickies. Quickies that's, I was trying to think of 00:18:54 Glenn:         It's like eating chalk basically.  

00:18:59 Narelle:       But that's how it neutralises the acid, and I knew someone years ago that would just pop Quickies, like lollies all day, every day, for how many years I don't know. But back then I didn't even know any of what I know now, so it didn't trigger any red flags. But now I'm cringing on the inside for that person. They're really common, people can just go and buy them from shops willy-nilly. Then you've got the next step up from that are called histamine type two blockers and that's very different from the histamine we were talking about last episode, but they work on certain receptors in our gut so we don't produce as much acid. And then finally the step up from that are our proton pump inhibitors. They're one of the main prescribed meds worldwide and it's quite scary.  

00:19:43 Narelle:       We've got these cells lining our guts called parietal cells, and in these little parietal cells there's a pump, and it pumps acid into our stomach. So the proton pump inhibitors inhibit the pump in that cell, so we don't produce as much acid. So it's all happening in our bodies. They're things like Nexium you would've heard of, that's like a major brand name for PPI’s, Naproxen. A lot of dogs will be put on Omeprazole, which is the chemical name. But people can get PPI’s by prescription only from their doctors, or their vets, or they can just go buy them over the counter. And that's pretty scary, because research has found, there's this connection that's shown between PPI use and negative health outcomes including an increased risk of premature death, and the risk of fatality increases with the duration of use.  

00:20:37 Narelle:       And it's even when people are taking those very low doses, you know like what you'd find in the Quickies for example. Where you can just pop down to the service station and get a pack of Quickies. So even at those very low doses, there's an increased risk of premature death. And the main cause is due to cardiovascular disease, chronic kidney disease, upper gastrointestinal cancer, so pretty nasty stuff. And that's because reducing our gastric acid has systemic effects throughout the whole body. 

00:21:08 Glenn:          It's supposed to be there, right?  

00:21:10 Narelle:        That's my whole point, we need acid.  

00:21:14 Glenn:          So you are saying that that's a science fact, that causes premature death. It's been proven?

00:21:23 Narelle:        Well, there are strong connections between increased risk of death and the long-term use of protein pump inhibitors. The research has shown that more than half the people taking PPI’s we're doing it without a true medical reason. So that's probably people who just pop down the shops and self-medicate long-term, without getting things checked out. And that it's actually that group that had the highest mortality rate because the official medical guidelines say that people should discontinue PPI’s after about anywhere from four to 12 weeks, so one to three months for most indications. There are small groups of people that have certain health conditions, that means they do need to be on PPI’s, for example, for life. People with conditions of connective tissue diseases, such as scleroderma, that's for some reason the first one that pops to mind.  

00:22:13 Narelle:         Scleroderma is a tightening of skin and connective tissues which can cause strictures in the esophagus, for example, so it's gonna compromise that sphincter, so they're always going to have the presence of acid, so to prevent them from getting esophageal cancer they need to be on PPI’s. But I had a patient who had been on a PPI for 30 years and it's one of those situations where the doctor just prescribed it and never really followed up, and he just assumed he needed to be on it. They're saying technically, one to three months is the guideline, and if you are just self diagnosing and self-treating, they say you shouldn't use it for more than two weeks. So if you're just going to the chemist and grabbing a box of Nexium, within two weeks you should be stopping using that to avoid problems. 

00:23:00 Narelle:          And the thing is with reflux, the PPI’s, are not addressing the underlying reason for your reflux. So even the medical literature is super clear that lifestyle measures, you know, dietary changes, stopping smoking, weight loss, all of those things can significantly reduce reflux and the risk of esophageal cancer without the need for medications. It's always stop and think about your diet and your lifestyle first before you start popping pills. I wanna go into a little bit more detail about just what damage they can do, and as with food we need acid to break down our food properly, but we also need adequate levels of acid in our guts and our dogs need adequate levels of acid in their guts to absorb nutrients, so all our vitamins and minerals. I'm just gonna touch on the top four that are impacted by PPI’s, for example.  

00:23:50 Narelle:       Calcium, by lowering the stomach acid levels our ability to digest calcium and absorb it, is significantly decreased, and that's whether it's calcium from food or calcium from supplements. And you know, once our blood calcium levels are low, the only way the body can correct that is to take it from the bones. So the longer you're on a PPI, the longer the body's low on calcium, the more calcium gets removed from our bones. Which ultimately leads to osteopenia, osteoporosis, bone fractures, and this is proven. Studies have found a link between long-term PPI use and the increase in overall fracture risk. And just to put it in perspective, one study in an older population, people over 50 years, found that the use of PPI’s for more than a year was associated with a 44% increase in hip fracture risk.  

00:24:44 Narelle:        So this poor patient of mine who was on a PPI for 30 years, every day, it's just scary to think what's going on inside his body because of that. But if you are on a PPI, and if you need to be on one, I do recommend always talking to your doctor. You'll probably need to supplement calcium, but you need to get the right form of supplement as well. So calcium citrate is the best option for a calcium supplement for people on an acid lowering medication, because calcium citrate doesn't require an acidic environment to be absorbed. Calcium carbonate, which is the most common calcium you'll find in supplements, like know your Ostelins and things like that. So everything that doctors will recommend, need a lot of acid to be broken down and absorbed. Whereas calcium citrate doesn't.  

00:25:29 Narelle:       So make sure you pick the right form of calcium and remember that blood tests are not a good indicator of body calcium levels. So the levels of calcium in our blood are less than 1% of our total body stores and that's regardless of how much calcium you consume in the diet. You can binge on cheese and milk and ice cream and yogurt for a month and get your blood tested or you can eat no calcium-containing foods for a month and get your blood tested and it won't be impacted. And that's because our blood calcium levels need to remain within such a narrow window that it's really tightly regulated. So if you're eating too much, you'll just excrete more and if you're not eating enough, the body's gonna take it from the bones. Blood calcium is really only an indicator of how well your body is regulating calcium levels.  

00:26:16 Narelle:       And that is the sole job of our parathyroid gland. All that does is regulate calcium in the body. So if your calcium levels are outta whack on your blood test results, you'd wanna be thinking about and talking to your doctor about potentially something going on with your parathyroid gland. So that's just something to think about. Iron is critical for so many different processes in our bodies that we need to feel good. You know, most people are aware that we need iron for the formation of red blood cells, for oxygen transport, and like calcium, iron absorption is significantly decreased when there's not enough gastric acid, particularly non-Hemin. So we've got Hemin, which comes from animal foods and it's called Hemin because it comes from blood tissues that contain hemoglobin. 

00:27:04 Narelle:       And the non-Hemin comes from plant food. So with plant sources, the iron becomes bound to certain compounds in the plants like phytates, which inhibit absorption. We need adequate acid to break down those inhibitory compounds to get the iron out. So symptoms of low iron could be fatigue, weakness, headaches, dizziness, cold hands and feet, brittle nails. If you've got dry damaged hair or dry skin, any sort of swelling or soreness in the mouth or the tongue, that could all sort of relate back to an iron deficiency. The good thing is that iron on a blood test does give you a more accurate idea of what's actually going on, and like with calcium, there are certain forms of iron that if you're gonna supplement some are better than others. So you know, your Ferrograds, which is again, something a doctor will tend to recommend to people is Ferrous Sulfate.  

00:27:53 Narelle:       So that needs a lot of acid to be absorbed, whereas Iron Bisglycinate doesn't need that acidic environment for absorption. So you wanna look for Calcium Citrate and Iron Bisglycinate. Two more key nutrients that I wanna touch on. Magnesium is necessary for hundreds and hundreds of reactions in the body, you know, to feel good. We need it for energy production, we need it for muscle function, for our nervous system. So it's really important for our moods. It lowers blood pressure, it reduces insulin resistance. So people who are struggling with weight, magnesium is a really important part of what they might need to do.  

00:28:33 Glenn:         You're big on magnesium, aren't you?  

00:28:35 Narelle:       To me it's a non-negotiable. Like with all of my patients it doesn't matter what someone's seen me for, magnesium has a role, even PMS symptoms, headaches, you name it, I love magnesium. And the thing is, three quarters of the population are not even meeting their minimum magnesium requirements for the day based on the guidelines. And then if you add an acid lowering medication on top of that, they're getting even less. But like calcium, blood levels of magnesium are not indicative of body stores, because 99% of our magnesium is in our bones, our muscles and our soft tissues which is available to be measured. So, deficiencies of magnesium can often go undiagnosed. When people are not eating enough magnesium and then they're on an acid lower meds they're absorbing less magnesium and you wonder why so many people are tired and depressed and anxious. I'm not saying it is a magnesium deficiency, but it certainly can be playing an important role.  

00:29:36 Glenn:          So what should they be eating to keep up their magnesium stores to get it naturally?  

00:29:41 Narelle:        Just eating a wide range of fresh foods like, your green leafy vegetables, your nuts and seeds. They're all really good sources of magnesium. B12 is necessary for red blood cell formation, neurological function. We need B12 to metabolise our fats and our proteins properly. In food, B12 is bound to protein, so in order to absorb B12 we need acid to break down the protein so we can release the B12. Which is why you tend to see B12 deficiencies in elderly populations, because as we age, we produce less stomach acid naturally, which is what we're doing artificially with the PPI’s, and one study showed that people who were taking PPI’ s, 75% of those people were deficient in B12 compared to just 11% of people who weren't on a PPI.  

00:30:30 Narelle:         That's pretty significant. So if you are on a PPI I definitely recommend supplementing B12 or getting injections. And again, there are different forms of B12. I like the active form which is a Methylcobalamin, which is one of the active forms over the Cyanocobalamin, so have a lookout for that. Some side effects associated with low B12 are fatigue, weakness, irritability, tingling and numbness in the hands and feet, and burning feet. You may not realise but I get clients with burning feet, so we always think about B12 there. Mood changes, depression, cognitive changes, things like memory loss, dementia, poor coordination. I always think with our elderly population, if they stumble and fall, or if they lose their memory, or they get dementia, it's like, oh, that's just normal.  

00:31:18 Narelle:       It's just a natural part of aging. But when you look at some of the symptoms of nutrient deficiencies, I think how much is tied into that. And if we just supported our elderly with the nutrients they needed that they weren't getting, because for example, they've got less stomach acid, how much better off they would potentially be. That's four key nutrients that can significantly impact how someone feels on a day-to-day basis. So that's really important to look at. And the other big thing that affects people on PPI’s is infection. Remember our stomach acid is our first line of defense against pathogens coming into our bodies, so when we've got less acid, it just opens the door for infection to take hold and grow. I always love this when I remember to think about it. We're like donuts. 

00:32:09 Glenn:         That's interesting.

00:32:12 Narelle:        So we've got a single tube that goes from our mouth to our anus. and technically everything in that tube is exposed to the external world. So that's not actually inside our body. So when food's sitting in our stomach, it's not in our bodies, it's in a tube that's running through our body. It's like sticking your finger through the hole in a donut. That's the same concept of our bodies. So it's not until food's broken down and absorbed and assimilated into the cells and the tissues that it's part of us. But I always love that concept of thinking we are just flesh around a hollow tube like a donut.

00:32:49 Glenn:          Okay.  

00:32:50 Narelle:        But the reason I bring that up, is it just highlights how important it is that we do things that support our mucus membranes, because that is the external world  

00:33:00 Glenn:          Invading our internal world.  

00:33:02 Narelle:        Yes. So, you know, zinc, vitamin A, vitamin C, we've spoken about that in previous shows. People with PPI’s are at increased risk for pneumonia and other upper respiratory tract infections just due to that increased bacterial colonisation. People who use PPI’s are gonna be at increased risk of enteric infections, same with dogs I should say as well. So they're infections of the intestinal tract, so you might get increased diarrhea, any abdominal discomfort, nausea, vomiting. A classic one there is Clostridium Difficile or C. diff, which is a common trigger for diarrhea. There's gonna be an increased risk of small intestinal bacterial overgrowth. So SIBO, which is becoming more and more prevalent in people and dogs these days.  

00:33:50 Glenn:         What’s SIBO?

00:33:51 Narelle:       Small intestinal bacterial overgrowth. It's bacteria growing where it shouldn't be growing. You know, by changing the gastric pH, it can have a huge impact on the absorption of other medications and drugs. So make sure you're having conversations with your vet or your doctor about that. A lot of drugs are manufactured around a certain gastric pH, so once that varies, you might be getting more or less of the drug than you need. That could have serious consequences depending on the person and the drug and what it's treating. Getting back to dogs, PPI’s are known to be overprescribed in human populations, but the literature is also stating that they're way overprescribed in veterinary medicine as well. And there's tons of research around the use in humans, there's not so much research around the use in animals and dogs. but again, because of the similarities between the two, they can sort of 

00:34:49 Glenn:         Coincide …  

00:34:50 Narelle:       Well, just translate one finding, from humans to dogs, dogs to humans, things like that. And just reading through medical literature, particularly the animal literature on this, there's a lot of reports now challenging the clinical practice of administering acid lowering medications just for routine things like gastritis or pancreatitis, which just comes back to your original question at the start of the show. Vets will often just prescribe for, gastritis, pancreatitis, liver disease, kidney disease, just as sort of a go-to when that may not be indicated. And particularly due to the long-term side effects, so diarrhea is probably the most common adverse side effect associated with PPI use in dogs. And as with humans  PPI’s are often given to animals to allow that gastric mucosa to heal.  

00:35:43 Narelle:       Remember if we've got acid eating through into our gut lining, the best way to allow that to heal is to reduce the acid so the tissues can heal. But a big reason that the gut lining gets damaged in dogs is through the long-term use of nonsteroidal anti-inflammatory drugs. A dog gets put on an NSAID if it's long-term, they might then get put on a PPI to help mitigate the damage or to heal the damage. But then, I was reading a paper that said, because PPI’s increase intestinal dysbiosis, remember when you've got a more alkaline gut, that's a perfect breeding ground for bacteria. So by creating dysbiosis, it actually then increases the risk even more of getting damaged by the non-steroidal anti-inflammatory drugs. So you end up with this vicious cycle of, you know, you give one you get this thing, and then you give another drug to treat that. But then that triggers that.  

00:36:37 Glenn:          It's like the children's song, I knew an old lady who swallowed a fly.

00:36:42 Narelle:        Gosh, I haven't heard that for decades.. So do you wanna share it with people in case they don't know?  

00:36:48 Glenn:          I knew an old lady who swallowed a fly. I dunno why, she'll probably die. I knew an old lady who swallowed a spider that wriggled and wiggled and tickled inside her …

00:37:00 Narelle:         I can't remember the words.  

00:37:01 Glenn:          Yeah, I can't remember. But the reason why she kept swallowing all these animals is because she swallowed one. So she thought, well now that I've swallowed one, I have to swallow another to get that one. So then she swallowed a spider to catch the fly. She swallowed a bird to catch the spider, swallowed a cat to catch the bird, swallowed a dog to catch the cat. And it just kept going on and on and on until eventually she died, because she swallowed a horse, I think in the end. And I mean, it's a ridiculous song, but it just went to show that she swallowed a fly, she could've just stopped at that. But she just kept going on and on and on and on. And I hear some people with medications that are quite the same, and same thing with dogs. Sometimes people are very quick to just jump on the pharmaceutical bandwagon sometimes, and I know they're necessary when they're necessary. You know you've never said, don't use pharmaceuticals, you are a scientist after all. I think what I've heard you mention to people is to understand what and why you are using it. And it should be for a limited time only. Well,  

00:38:12 Narelle:       Well, whether it's for a limited time depends on the condition and the drug. But my point is our diet and our lifestyles can fix a whole lot of health problems before you reach for pills long term. I think I've seen a T-shirt talking about taking one thing and then having to take another drug to counteract the side effects of the first drug and then you needed a third drug to counteract the side effects of the second drug. But talking about being on medications and stopping your medications. I was quite clear, don't just stop medications and it's particularly relevant to PPI’s because what happens is you get this rebound acid hypersecretion.  

00:39:03 Narelle:       What that means is if you just stopped a PPI cold turkey, you get an increase in gastric acid secretion that's even worse than it was in the beginning that made you take the drug in the first place. And the reason that this happens is because when we suppress those parietal cells in our gut lining and our body starts producing less acid, that's a red flag. That's an alarm to the body that things aren't working the way it should so it upregulates those parietal cells, with the aim of producing more acid because the body's like, these cells aren't doing their jobs, they better make some more but then those new cells get suppressed by the medication. And so when you stop the medication, suddenly you've got far more acid producing cells than you would have normally.  

00:39:50 Narelle:       And suddenly they just start pumping out acid again. So you've got more cells that are suddenly producing more acid and get this massive rebound acid secretion, which is gonna hurt. But the thing is, the body does self-regulate and then it quickly realises that now there's too much acid, let's down-regulate those cells and find a balance. But that might take a week or two and in the interim, people are suffering from all this acid. So they're like, oh, I must have really needed to be on that medication because look how bad it is when I'm not. But that's just a short term phase that the body's trying to find its natural balance again.  

00:40:32 Narelle:       So coming off PPI’s, people should always wean off. And again, always talk to your doctor before you start making any changes to your medication. But you know, if you're on a higher dose, you might start by lowering your dose every day and then when you get to the lowest dose of a tablet, you might take it every second day and then every third day. So the body can gradually find that balance again without that shock and that wave of acid being produced, but in constant consultation with your doctor. And there are things you can do naturally. I might be working with a patient that's working with their GP to come off medication, but I can quite safely support them naturally to minimise any rebound acid hypersecretion as well as minimising symptoms and healing the tissues.

00:41:16 Narelle:       So maybe we'll get into what that looks like. If we think about  foods that can aggravate symptoms, like chocolate, caffeinated beverages, and alcohol. Alcohol's gonna weaken that sphincter or relax it. We've mentioned peppermint, fatty foods, fried foods, tomato-based sauces, you know, like a really rich lasagna or bolognese can aggravate, onions and spicy foods. Any carbonated beverages, again, that's gonna fill up that space and put upward pressure. So you need to avoid eating a lot of food, particularly late at night when you're just sitting or you're lying back, which can create upward pressure. Ensuring you're getting adequate fibre, so increasing your fruits and veggies, that's gonna help to increase gastric motility, which keeps food moving through your system at a better rate. So it's not sitting there fermenting and heavy in your gut producing gas.  

00:42:05 Narelle:       I'm not one for food combining these days, but if someone's really sensitive to reflux, I might say to them, look, let's just trial a period where you don't eat heavy proteins with rapidly absorbed carbs, so you wouldn't have a steak with a fruit salad. It's important that your water intake's good, but you don't wanna drink a lot with meals. So you need to drink a lot throughout the day so you're not constipated. And again, that can slow down gastric motility, but you don't wanna drink masses with your food because then you're diluting those gastric acids that you need to adequately break down food. And particularly alkalising waters, I'm all for alkaline water, but drinking a massive glass of alkaline water with a heavy meat meal for example may not be ideal. And you know, fluids fill up that gastric space a lot quicker too … 

00:42:53 Narelle:       Putting upward pressure, particularly carbonated drinks, because you've got the extra bubbles in the gas. You can Google lists of foods that are more likely to trigger reflux and have a look at those. If we move on to lifestyle stress, you know I've mentioned numerous times how stress shuts down digestion because blood diverts away from the digestive tract into the extremities so we can do the whole fight or flight thing, that can compromise digestion. And you know, gastric motility, losing body weight to relieve that upward pressure, consuming smaller meals. People who do intermittent fasting where they might have one massive meal or two massive meals a day, that might make some people more prone to reflux symptoms. Keep that in mind. Simple things like if you do have to eat late at night you might need to put an extra pillow sort of under your head to sort of elevate the esophagus  if the food doesn't come back up so readily.  

00:43:49 Narelle:       Smoking is a known risk factor for gut issues and reflux. People may not realise acupuncture can be great for increasing gastric peristalsis, increasing gastric emptying and improving the tone of that lower esophageal sphincter. There are things that everyone can do about food and lifestyle, have a think about that. But then if you need a higher level of support, certain supplements, there are supplements that are great for providing immediate relief. If you're prone to reflux or you know you're gonna have a heavy meal, you might take some of these as a preventative, or for relief afterwards. Your demulcent herbs, things like licorice, slippery elm always seems to pop up. 

00:44:36 Narelle:       Slippery elm's great for dogs and people. Marshmallow root is great for dogs and people, all of these are great for dogs and people.They form a coating of the mucus membranes, which is protective and healing and nutritive as well. We wanna reduce any inflammation of the esophagus and the mucosal tissue, so again licorice, but I always look for a particular type of licorice. It's a deglycerised licorice so it's not gonna impact on blood pressure, but it's called gut guard and it's very healing and restorative to the mucus membranes and anti-inflammatory herbs like Meadowsweet. You can even just get a Meadowsweet herbal tea and drink a few cups of that between meals throughout the day. Zinc, but again, particularly Zinc Carnosine as the form of zinc is particularly indicated for mucosal healing and repair. Turmeric or you curcumin, I always look for a clinically trialed one, such as the C3 complex or the Meriva or the BCM95.  

00:45:36 Narelle:       You've got your glutamines, Goldenseal. Again, any of those mucus membrane restoratives, like vitamin A, vitamin C are really important. For some patients who experience reflux, it could just be a hypersensitive reaction. It's like some people with IBS symptoms, it's not that there's anything going wrong, it's just that they're hypersensitive to the feeling, it feels uncomfortable. Some people with GORD, it's not that there's anything going wrong, there's just a heightened sensitivity to anything happening there. And that's often a stress response, so for those people, we may look at dealing with adaptogens and nervines to calm that stress response, so things with Withania, or Ashwagandha it's known as well. Passion Flower and Skullcap are all great herbs. People might think about meditation and yoga and breathing exercises to calm that sympathetic nervous system dominant response.  

00:46:34 Narelle:       Things that you can do to improve that lower esophageal tone, in a mild bitters like globe artichoke. I love globe artichoke for digestion for people. Spasmolytics like Kamar can help tone and just keep everything calm and soothing. What else can people do? Digestive enzymes, we did a whole show on digestive enzymes, so again, by breaking down our food more fully, it's gonna pass through the system more quickly. So they're not gonna sit there and ferment and get gaseous. Prokinetics, which are things that help prevent reflux by keeping motility improved. So again, the gut guard, licorice and ginger are great in that way. And then elimination diet. If someone does all of that and they want to take an extra step, I usually suggest that they trial a two week elimination diet. I'd give them a list of foods that are most likely to trigger reflux. They keep a symptom diary for two weeks, you know, what they eat, how they felt. And then at the end of the two weeks most people feel significantly better and pretty much have no symptoms. And then we just start to slowly reintroduce foods that they really like, and just try to find that balance in that threshold.  

00:47:38 Glenn:        So a good recommendation would be that they make time to talk to you.  

00:47:42 Narelle:       That would absolutely be the best approach to speak to a natural healthcare professional, in conjunction with their medical doctor, or their vet. I don't treat reflux in dogs, but I treat a lot of gut issues and dogs on PPI’s. And you know, there are things you need to be cautious of and things that you can do to support both people and pets who are on acid lowering medications. I mean, that's a lot of information. If people have any questions about the show or what we've spoken about today, jump onto the Facebook page. Natural Health for People and Pets. If you wanna know more about me and my services, jump onto my website, naturalhealthandnutrition.com.au. And you can email me at narelle@naturalhealthandnutrition.com.au. And there's an email through my website too. So if you just find my website, you'll find me. 

00:48:28 Glenn:         And get ready for some courses coming your way from Narelle.  

00:48:31 Narelle:       Yeah. So remember on the 20th of February, 2021, I'll be in Canberra doing a full day nutrition seminar just for dogs which is gonna be super exciting. So all that information's on my website and yeah, if you wanna make changes to your body and your health and your weight, stay tuned for January for the 12 week course that you can be part of. So thank you everyone.  

00:48:54 Glenn:          Okay. Goodbye everyone.  

00:48:55 Narelle:         Bye. 

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