cure your heart burn, GERD and acid refulx today
Excerpts from HeartBurn Cured
Current Treatments

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Heartburn Symptons
Cause of Heartburn
Complications of Heartburn
Current Treatments

How This Book Will Help You
Who Should Read This Book?

Diet

Several books and web-based guides have been published offering dietary approaches to control heartburn. As far as I am concerned, few, if any of them are worth the cover price. As far as I am concerned, there is only one effecitve dietary plan and that is my glycemic index - based diet.

AstraZeneca, the pharmaceutical company that manufactures Nexium, an expensive prescription drug advertised for patients with chronic heartburn, promotes a meal plan “designed specifically to help you manage your GERD” that supplies over 275 grams of carbohydrates per day (you can find this meal plan on the Nexium website). For someone with chronic heartburn, that is a huge amount of carbohydrates to consume on a daily basis. Such a diet virtually ensures that heartburn sufferers will continue to consume more carbs than they can digest and absorb leading to a chain of events that can result in malabsorption, bacterial overgrowth and severe heartburn. This meal plan virtually assures that people susceptible to acid reflux will continue to require acid reducing drugs. I have come to understand that the only sound dietary advice for GERD is to ensure that our diet is balenced with our ability to absorbe the carbohydrates we consume preventing malabsorption. If AstraZeneca was to offer my glycemic index- based heartburn free diet plan on their web site I guarantee Nexium sales would drop dramatically.

Drugs

- Antacids

Antacids do exactly what their name implies: neutralize the acid in your stomach. Because antacids cause the pH in the stomach to rise to a more neutral pH, the digestive enzyme pepsin that breaks down protein no longer functions. Above a pH of 4, pepsin activity ceases or is dramatically hindered. Because stomach acid forms a barrier between intestinal microbes and your stomach, esophagus and lungs, the reduction of stomach acidity, which results from taking antacids, makes you more susceptible to infections.

- H2 Blockers

H2 blockers are one of the most commonly used medications for heartburn. Several H2 blockers are available over the counter (without a prescription). Tagamet (cimetidine), Pepcid (famotidine) and Zantac (ranitidine) were all used by me. These drugs block the normal production of hydrochloric acid by your stomach. The side effects for H2 blockers include constipation, diarrhea, headache, and in the case of cimetidine, breast enlargement, fatigue and impotence. Confusion and dizziness are side effects of the H2 blockers particularly in the elderly. The key message is that H2-blocker drugs, though widely promoted, are not indicated for long term use, have side effects, and inhibit stomach acid that is essential for normal digestion and protective against upper respiratory infection.

- Proton Pump Inhibitors

Proton Pump Inhibitors (PPIs), like H2 blockers, block your stomach's ability to produce acid. Drugs in this class include Prilosec (omeprazole), Nexium (esomeprazole), Zoton (lansoprazole), Pariet (rabeprazole) and Protium (pantoprazole). Proton pump inhibitors are generally considered more potent than H2 blockers at reducing stomach acid. The most common side effects of PPI drugs are headache, diarrhea, constipation, abdominal pain, nausea, and rash. Note that these drugs interact with other drugs, such as certain blood clotting, epilepsy and antifungal drugs and so can interfere with the action of those drugs. The long-term use of proton pump inhibitors can lead to stomach infections and, like H2 blockers, pose an increased risk for pneumonia because they significantly reduce the production of stomach acid.

- Pneumonia Risk from PPIs and H2 Antagonist Drugs

One of the increased health risks associated with the PPI and H2 Antagonist drugs is due to the dramatic reduction in the production of stomach acid. People taking acid reducing drugs have an increased risk of pneumonia as documented in a recent journal article from the Oct. 27, 2004 issue of the Journal of the American Medical Association. This study of more than 364,000 people led by Robert J.F. Laheij at the University Medical Center St. Radboud in Nijmegen, Netherlands, found the risk of pneumonia was almost double for people taking proton-pump inhibitors for prolonged periods. The risk was almost two-thirds higher for those taking histamine antagonists, compared to people not taking such drugs. According to Laheii, one reason long-term use of both classes of drugs can increase the risk of infection is that acid kills bacteria in the stomach. Lowering stomach acid lets more bacteria survive in the stomach (and presumably reflux into the lungs). Bacteria are normal inhabitants of our intestines and are essential for our survival. While these bacteria are, for the most part considered “friendly”, if they are allowed to move from the intestines into the stomach due to reducing stomach acidity, they are positioned to reflux into the esophagus and lungs where they can cause disease. That is what puts people on acid reducing medicines at risk for pneumonia.

- Prokinetic Agents

Prokinetic or promotility agents like Metoclopramide and Cisapride work by increasing LES strength and encouraging emptying of food from the stomach. Current prokinetic agents are not a reasonable first or second choice treatment because they have shown limited efficacy, and their side-effect profile outweighs their benefits. Side effects include nausea, diarrhea and nervous system effects. In the case of Cisapride, it was withdrawn from the market because there were 341 reports of heart rhythm abnormalities and 80 deaths. This information is published on the FDA.gov web site.

Surgery

In cases where therapy with histamine-2 blockers or proton pump inhibitors (PPIs) does not succeed in controlling symptoms, surgery is a third option elected by a surprising number of people. This surgery is also common in children with GERD. Surgery for GERD, such as Nissen Fundoplication (the preferred surgical method), improves the barrier between the esophagus and stomach to prevent gastric and duodenal contents from entering the esophagus. In the Nissen Fundoplication procedure (named after Rudolf Nissen) the surgeon pulls the stomach up and around the esophagus and then secures it around the esophagus. Antireflux surgery involves a risk of serious complications and even death.

A significant number of patients report new symptoms following fundoplication surgery. The symptoms include excessive gas, abdominal bloating, early satiety (feeling full after eating), inability to vomit, dysphagia (difficulty swallowing), diarrhea, epigastric (upper stomach) pain and the inability to belch. The quality of life can be significantly lower in patients with these symptoms and many require continued medical therapy after the operation.

Given what is known about the side effects of heartburn drugs and surgery, I would absolutely advise these treatments only as a last resort. After reading this book and implementing my heartburn-free low carb diet plan, the need for medication and surgery should be completely eliminated.

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