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

Starting point is 00:00:00 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.

Starting point is 00:00:28 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

Starting point is 00:01:02 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

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Starting point is 00:02:37 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 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-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

Starting point is 00:03:32 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

Starting point is 00:04:13 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, in 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. That's pharmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter. If you've ever suffered from heartburn or reflux, this podcast should matter to you

Starting point is 00:04:51 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 Kenya 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,

Starting point is 00:05:17 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 Lapine again on The Doctor's Pharmacy talking about heartburn 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 and just sort of give us a little background on this problem because I think it's a big issue for people and it's, you know, 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

Starting point is 00:05:55 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. You know, 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.

Starting point is 00:06:42 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 what do doctors used to do? They used to cut the vagus nerve, and they used to do all kinds of surgeries for heartburn and reflux.

Starting point is 00:07:13 Oh, yeah. Treat 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 heartburn is usually a benign condition and it's oftentimes lifestyle related. And you can treat it, you know, periodically with, you know, as needed, you know, 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 say, 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,

Starting point is 00:07:57 you can actually do testing for gastrin levels. 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 acids. It produces a lot more gastrin what? We need to make more stomach acids. So it produces a lot more gastrin.

Starting point is 00:08:31 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 going to get withdrawal symptoms. Oh my gosh, 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.

Starting point is 00:08:46 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 drugs are like that too. A lot of the antidepressant and the anxiolytics, the same thing is your body gets into a different

Starting point is 00:09:04 state. And then if you go off of them too quickly or you're not being supervised, 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 become, you know, like I said, there's no money in dead 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 think of this this condition and um you know we we say it's it's uh too much stomach acid but uh you know 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. Like when I was in medical school,

Starting point is 00:09:54 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.

Starting point is 00:10:27 I can remember exactly when they first came out, there was a lot of warning and 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.

Starting point is 00:10:44 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 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. I mean, in traditional medicines, like, okay, you have heartburn, reflux, this is a chronic condition, take this drug. There's no thinking okay, you have heartburn, reflux, this is a chronic condition, take this drug. There's no thinking about why they have it. You know, they might be saying, oh, raise the head of your bed.

Starting point is 00:11:11 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 there's no real thinking about this being a solvable problem. Right. And sometimes there's things like a hiatal hernia or a structural problem, and you can get a surgical procedure to fix that.

Starting point is 00:11:31 But that's a very small group of people who have this. 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

Starting point is 00:11:56 side effects that we've now uncovered. So talk about some of the serious side effects that come as a consequence of these acid blocking drugs. And I'm just going to name the people know what they are. They're acid effects, Nexium, Protonix, Pep's Prevacid, Prilosec. These are the, did I forget any? There's a few more probably. I don't know how many of those all the time. But these are the common ones that people take.

Starting point is 00:12:14 You can get them 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 it's 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,

Starting point is 00:12:43 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, absolutely. And one of the things that's so striking to me is one of the most common side effects

Starting point is 00:12:59 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 truly and truly is. And they're not cheap. And the other thing, you know, I don't actually have a television set,

Starting point is 00:13:15 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, eaten a lot of, a lot of food and then they're having a sausage and the peppers. Oh, don't worry. Exactly. Take this drug. Exactly. So you can, 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.

Starting point is 00:13:51 Yeah, and literally, you know, there are some really good, you know, integrative and functional medicine gastrointestinal doctors 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 Pez candy. Oh, my God. And you go to them and you're going to get it. Well, you can get it now on your own.

Starting point is 00:14:11 You go to the grocery store. Yeah. 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 even be there. No, it's a serious trouble. Absolutely.

Starting point is 00:14:22 Exactly. So 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, uh, 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?

Starting point is 00:14:43 Well, the functional, you know, obviously, first 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, maybe foods that are citrus or tomato-based foods or spicy foods. So you want to sort of like, you know, eliminate some of the peppermint. Coffee, I hate to say. Yeah, coffee. Well, coffee, I think, in my opinion,

Starting point is 00:15:06 I've seen more people with gastritis, especially higher levels of coffee. And a lot of these medications or 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 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,

Starting point is 00:15:31 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 really, I think, the key thing and understanding that it's not an acid problem. It's really related to the balance of where the acid should be at the proper time.

Starting point is 00:16:02 Yeah. It's not as if you're overweight and you got a big gut. Yeah. You're pushing. Push things up. You're pregnant. You're pregnant. I mean, it's not as if you're overweight and you got a big gut. Yeah, you're pushing. Push things up. You're pregnant. You're pregnant. I mean, it's almost, I would say it's almost normal to have some heartburn when you're pregnant.

Starting point is 00:16:11 Because you've got this baby, this food baby, if you will, pushing up on the diaphragm. So there's a lot of things. 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 with food sensitivities, like gluten causing reflux. I see problems with zinc deficiency.

Starting point is 00:16:28 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. So 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.

Starting point is 00:16:49 And stomach ulcers are different than 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 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.

Starting point is 00:17:19 You can do it through antibody testing. Breath testing. And also breath testing, exactly. And if you have it, you treat it. It's 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. Yeah.

Starting point is 00:17:39 And for some people, it's not. So it's not like one- It's tricky. It's tricky. Exactly. It's tricky, but it's super common. I remember many patients I've had who had reflux, not ulcers, but who we find H. pylori and we treat it and they get better. Absolutely.

Starting point is 00:17:50 So I think you have to treat everybody as an individual and see, but this is a bacteria that people saw in the gut was lining these ulcers and doctors thought it was just incidental. Right. 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. He decided to drink a whole beaker of this bacteria, give himself an ulcer,

Starting point is 00:18:17 then have his partners scope him, and then take antibiotics, kill the bacteria, cure the ulcer, and ended 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 I said, not just caused by

Starting point is 00:18:36 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 and 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. It was a patient who came in to see me, and the patient's main symptoms was neuropathy. So neuropathy is painful nerve sensations, usually in the extremities, in the legs or the arms.

Starting point is 00:19:19 So the patient came in with neuropathy and was, I think, if remember correctly was being treated with gabapentin and uh 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, the fun part of this, because it's like solving a murder mystery. It's like, okay, who done it? 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.

Starting point is 00:20:02 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 up to the esophagus. And they're actually, that's like a low-hanging fruit. If I have anybody who'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.

Starting point is 00:20:31 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 don't 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.

Starting point is 00:20:59 Yeah. Like, and so if you shut down cholesterol production, you can't. I love cholesterol. Cholesterol is a great molecule. It is. Heart disease is not about cholesterol.

Starting point is 00:21:08 It's about inflammation. I tell patients, you want cholesterol. It's the building block of all your hormones and your myelin sheaths. But people need the right kind of cholesterol. Yeah. And they can get screwed up cholesterol. Yeah, right. There's nuances to it too.

Starting point is 00:21:20 But cholesterol is a good molecule in the body. It's the building block of lots of things. So he was on these two medications. And, you know, he was the kind of guy who was a hardworking 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?

Starting point is 00:21:41 They put him on a PPI. So then he came in to see me and he was having a lot of GI symptoms. He was having the 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. But you said it's super important. One of the main side effects of these drugs is they shut down B12 absorption because you need acid.

Starting point is 00:22:19 Exactly. You need acid. Yeah. So it shuts down B12 absorption. Yes. And what you're saying is this patient got B12 deficient because of the drug that caused the nerve damage because B12 was necessary for proper nerve function. Correct. Exactly. Exactly. And this was, I call this case, you know, atrogenica imperfecta. So it was doctor-induced illness. I mean, literally the doctors, by giving him the medications inappropriately, without thinking, actually caused the disease. Yeah. I mean, they're doing what they were trained to do, but we're not trained to think about

Starting point is 00:22:48 getting the root cause, which is what functional medicine is, is what we do here at the Ultra Wellness Center in Lenox, 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. And it breaks my heart because after doing this for 30 years and you've seen the same thing, you see so many patients get better from things that

Starting point is 00:23:14 traditional medicine just doesn't work with. And it's not that hard. Once you know what to do, it's like that joke of the guy who had an appendectomy and the doctor sent him a bill for $1,000. 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, $1, knowing that's what needs to be taken out, $999. So I think a 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

Starting point is 00:23:56 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 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.

Starting point is 00:24:17 So in addition, the patient also had prediabetes. 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 a 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.

Starting point is 00:24:53 He had lost weight. And then by six months, his neuropathy was gone. His heartburn reflux was gone and 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 or 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.

Starting point is 00:25:30 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 Mora, who wrote a nice ebook about heartburn and reflux, which patients can get. And it's 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 simple. And, and I think, you know, one of the key things is really having a good relationship

Starting point is 00:26:07 with a really good functional medicine nutritionist, not a dietician or not a, you know, a regularly trained nutritionist, because oftentimes their thinking is really skewed. You know, they're trained in hospital medicine and they're about calorie counting and taking Ensure and, you know, it's, it's really a functional mess in nutrition. Ensure, which is essentially high fructose corn syrup, casein from A1 cows, which is inflammatory, and refined omega-6 vegetable oils, which are super inflammatory. So it's not exactly a health food.

Starting point is 00:26:41 Yeah, there's some of these, you know, what do you call it, meal replacement things such as Ensure and such So it's not exactly health food. Yeah. There's some of these, these, these, you know, what do you call it? Meal, meal replacement things such as 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,

Starting point is 00:26:53 exactly. And, and, and as you say, you know, your food is information, you know, your food talks to your genes as Jeff Bland has always said,

Starting point is 00:27:01 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, you know, to some degree, you know a heartburn patient um does not need a big extensive workup there are some times when you may refer them and get an egd uh and make sure they don't have a hiatal hernia or make sure they don't have like that's an upper endoscopy scope down there and look around yeah do that um you can you know and then you you can um do uh

Starting point is 00:27:43 testing for stomach acid uh by gastrin levels. Oftentimes, I also combine that with antiparietal cell antibodies. And parietal 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 stomach acid producing cells. So that 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.

Starting point is 00:28:14 Also, betaine HCL is another thing that you can use to support stomach acid. Eventually, this is- So it's 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.

Starting point is 00:28:27 Exactly. But in the right patient, it can be very effective. 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 11 beta and TNF alpha, if you have those SNPs and you also have H. pylori, your body down-regulates stomach acid production. So chronic inflammation actually can, with H. pylori, can actually down-regulate stomach acid.

Starting point is 00:29:01 So basically we tell people the basic stuff, right? We 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 methemonic 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.

Starting point is 00:29:32 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 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

Starting point is 00:29:49 you really have to taper it down right yeah exactly that that that is definitely something that you do and you do that sort of slowly um you know if they're on like a you know 80 milligram dose you may actually then go to 80 one day 40 the 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 and then transition to an H2 blocker, add in some things like DGL and things to aloe for the, aloe and glutamine and 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 I'll measure gastrin

Starting point is 00:30:40 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 re-equilibrate. Yeah. So it's really powerful. So you can come out with your 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. Yeah.

Starting point is 00:31:01 And you mentioned a few of them, DGL, which is deglycerized licorice. Yep. use, it can be very, very helpful. And you mentioned a few of them, DGL, which is deglycerized licorice. And they're like chewable tablets that are like natural Tums that you can take before you eat. Very, very effective. And what you mentioned also is 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 of this, that, people do really, really well. It's one of those conditions that people just don't have to suffer from. But 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 pill so you'd avoid the symptoms. And that's just a dumb idea.

Starting point is 00:31:40 Yeah, symptom suppression. I mean, that's what that's what um sydney baker uh talked about for for years as the grandfather of functional medicine is most medicine nowadays is symptom suppression it's a blocker some type of blocker yeah an anti-hypertensive and anti-calcium channel blocker it's a blocking and you know when you really think about a systems biology um it's it's like having this big you know complicated machine You just sort of throw this wrench in it and you just stop it. And then what happens is all of a sudden it builds up and all of a sudden the conveyor belt, 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 medication was taken

Starting point is 00:32:26 off the market and was used- Like a 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. And heart attacks. Exactly. Strokes and heart attacks. So- It took it off the market.

Starting point is 00:32:41 It took off the market. And unfortunately, a lot of times when medications 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, you're not going to have problems. No. If you take PPIs for six to eight years, you're going to have problems. Right. for six to eight years, you're going to have problems. And I think that's really one of the areas where big pharma is really lax because we are not following up these patients long-term

Starting point is 00:33:12 on these very powerful medications. Yeah, and then the pH has to be right in your gut for the right bacteria. So if you shut off the acid and then you have no acid in your small intestine, you're going to get bad bugs growing in there. You're going to get yeast growing in there. So often I find myself having to deal with the consequences of the drugs

Starting point is 00:33:28 in repairing the gut. So not only do they have reflux, they end up having irritable 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 is a lot of, a good part of it is related to some of the side effects of the medications. Yeah. And what oftentimes happens in mainstream medicine now is that you have a side effect of medications. Doctor gives you another drug to counteract that side effect. So then you get this polypharmacy and that's a, that's a big dangerous thing, especially in the elderly.

Starting point is 00:34:09 Yeah. These patients come in and they're on, know tons of medications that one of the one of the things that's uh some of the geriatricians are doing now they're realizing this is they have these patients when they they saw like five doctors each doctor gave them two medications they're on 10 medications they're in the nursing home and they're like semi-comatose and almost you know uh uh uh on death's door yeah and they guess what they-comatose and almost on death's door. And they, guess what? They get them off of the medications and they wake up. Yeah. I once saw this patient.

Starting point is 00:34:32 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 um a disease which is easily treatable with functional medicine that uh avoids you having to take potentially very harmful drugs that uh requires a little bit of a different thinking and approach but that is available

Starting point is 00:34:58 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. 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.

Starting point is 00:35:21 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 what I say. What's your life's mission?

Starting point is 00:35:40 Really to end needless suffering through the power of functional medicine to get to the root cause of disease. Yeah, mental and physical suffering, emotional suffering, they all are tied in. There's the suffering that people have with pain. There's suffering with 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 healthy we don't really know we have a body yeah that's a beautiful thing it's like talking to you you know you'll breathe

Starting point is 00:36:09 you don't you don't have you know you're not wheezing you can move your body it doesn't hurt you go to bed and you actually sleep and amazing 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 like it's just there it just 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. Yeah, exactly.

Starting point is 00:36:35 Well, Todd, thank you so much for joining us on this special episode of House Call for the Doctors 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 here 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.

Starting point is 00:36:55 Tell us how you've struggled or not and how you've solved your issues with heartburn or anything else. And subscribe wherever you get your podcasts. 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.

Starting point is 00:37:15 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. Thank you.

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

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