Reprinted with permission from ExperienceLife.com

The prescriptions we take to regulate cholesterol, blood pressure and stomach acid are supposed to make us healthier. But could these medications be doing us more harm than good?

He had been a faculty member in three departments of a major university with an IQ north of 180. Over time, the professor lost the ability to recognize people he’d known closely for decades and to read more than a page of text at a time. He’d repeat the same thing over and over, not recalling he’d already said it. The diagnosis: rapidly progressive Alzheimer’s. When he went to his 50th college reunion, he wore a sign around his neck with his name and the statement, I have Alzheimer’s. Old friends needed an explanation for why he couldn’t recognize people he’d known for decades or repeated himself endlessly throughout the night.

His condition seemed hopeless when he applied to enter a clinical trial testing a new Alzheimer’s drug at Duke University.

Before he started the clinical trial, his wife took him off his cholesterol-lowering statin drug, simvastatin. By the time he got to Duke, he was no longer qualified to participate; he didn’t have Alzheimer’s, doctors said. Instead, he entered another study: The Statin Study Group, directed by University of California at San Diego (UCSD) physician and scientist Beatrice Golomb, MD, PhD. “There are people with extremely severe functional deficits caused by statin drugs,” Golomb says. Two years after he stopped taking simvastatin, the patient reported his recovery was complete. His mind was clear and he was back to reading three newspapers daily.

Statin’s side effects are rarely so severe, but they are far more common — and numerous — than generally thought. And statins aren’t the only popular drug with unpredictable side effects. Three common classes of prescription drugs in the United States — statins for reducing cholesterol, angiotensin II antagonists for lowering blood pressure, and proton pump inhibitors for reducing stomach acid — can all cause side effects worse than the problems they aim to treat. And the symptoms caused by one drug may necessitate the use of the others.

For large numbers of people with questionable risk factors, these drugs deliver little or no benefit, but that hasn’t stopped pharmaceutical manufacturers from aggressively marketing them as preventive treatments. Underlying their marketing strategy is a host of scientific studies that “exaggerate positive results and bury negative ones,” says Shannon Brownlee, author of Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer (Bloomsbury USA, 2007). “The science on which so much of prescribing is based is biased, shaky, over-marketed and misinterpreted. These are excellent drugs when used on the right people. The problem comes when they’re marketed to everyone on the planet. There’s benefit to a few people, but when you start giving them to everybody, they may do more harm than good.”

Cholesterol Conundrum

The rise in widespread use of statins coincided with lifestyle changes in post–World War II America. As the population gradually migrated to car-friendly suburbs and became increasingly sedentary, the food industry began filling supermarket shelves with more processed “convenience” foods packed with high-fructose corn syrup, trans fats and other pro-inflammatory ingredients. Before long, coronary heart disease (CHD) became a major cause of death.

At first, many experts attributed the problem to a single, simple cause: A high-fat diet thought to fuel high levels of a molecule called cholesterol in the blood. In optimum quantities, cholesterol is essential for cellular health, but in excess, the experts said, it coated and hardened the arteries, preventing blood from circulating and causing heart attacks and strokes.

That view has changed in recent years: The problem is not cholesterol, per se, but a low-density lipoprotein (LDL) that carries cholesterol through the blood and deposits it in arterial plaque, where it can do the most damage to the body. Also at fault are triglycerides, another type of fat circulating in the blood and coating arterial walls. (A protective cholesterol-carrying molecule, high-density lipoprotein, or HDL, lowers CHD risk.) Elevated levels of the offending molecules may not be a problem for the fit and healthy, but for those at risk due to obesity, diabetes, hypertension or smoking, they increase the likelihood of disease.

Scientists are beginning to revise the dietary factors once thought to underlie CHD. Instead of placing saturated fat at the root of the disease, some of the newest studies point to processed carbohydrates like white bread, sugar and rice, which are known to increase triglycerides and boost insulin production. The surging insulin causes diabetes and obesity, increasing inflammation along with the unfavorable LDL cholesterol known to damage arterial walls.

Despite an increasingly clear connection between diet and heart disease, pharmaceutical companies in the 1990s saw a burgeoning market for a class of drugs called statins, which block production of LDL in the liver, reducing its levels in the blood. And, by 1994, they had the research they needed to argue that these drugs could prevent heart disease.

The Scandinavian Simvastatin Survival Study, sponsored by pharmaceutical giant Merck, showed that the cholesterol-inhibiting drug, simvastatin (brand name: ZOCOR), could lower LDL levels by 25 to 35 percent and reduce myocardial infarction (heart attack) by 25 to 30 percent in those with normal cholesterol but who have other risk factors, like hypertension, smoking or diabetes.

With the advent of statins, our Big Mac nation was given license to stay the course: We kept consuming processed foods through the rollout of lovastatin, simvastatin and atorvastatin — otherwise known as Lipitor — which for many years has been the top-selling drug in the world. Just last year, rosuvastatin (brand name: Crestor) was approved as a preventive for healthy individuals with low cholesterol counts and no risk factor beyond an elevated level of C-reactive protein (CRP), a sign of inflammation in the body. Once prescribed statins, these people were advised to take them for life.

That’s when cardiologists and epidemiologists adept at reading statistics finally began breaking ranks. Their concerns about statins’ side effects were well placed. A study published in The Lancet in February 2010 showed statins could increase the risk of type 2 diabetes by 9 percent. Other recent studies have traced statins to headache, joint pain and abdominal pain, as well as linked the drugs to peripheral neuropathy, the sense of tingling and numbness or burning pain, often in arms and legs.

At UCSD, Golomb has been studying a series of lesser-known (but not less common) neuropsychiatric and cognitive side effects. Her interest began when, as a medical student in the late 1980s, she became aware of two studies linking cholesterol-lowering drugs to violent death. “In these studies, the decrease in death from heart disease was fully offset by increases in violent death from suicide, homicide and accident,” she says. Golomb’s neurobiology research told her the reports made sense. “Cholesterol is a very high fraction of the dry weight of the brain,” she says, and aids the function of neurotransmitters — the molecules of emotion and cognition that help the brain do its job. Force cholesterol levels down by artificial means, and brain infrastructure suffers. Her own paper on low cholesterol and violence was published in the Annals of Internal Medicine in 1998.

As word got out, Golomb’s lab received a steady stream of email from statin users with a wide range of problems neither reflected in the literature nor taken seriously by their doctors. The effects, documented in her multiyear study, include reduced energy and a lack of interest in activity, increased fatigue after exercise, erectile dysfunction, and a significant reduction in the ability to achieve orgasm. “Half the people who reported any symptom reported more than one,” Golomb adds.

This reflects what the evidence shows — a common mechanism based on statin disruption of the mitochondria, the energy-producing parts of cells. “We are conditioned to think of cholesterol as a nefarious substance that courses through the blood for the sole purpose of congealing in our arteries and causing cardiovascular disease, but there is a reason why evolution mandates that every cell in our body produces it, and that it circulate through our blood,” Golomb says.

So what’s a statin-taker to do? If you are experiencing troublesome side effects, but have heart disease or serious risk factors and can’t stop taking the drugs entirely, you may still want to consider taking a brief break from the med to see if it seems to be causing your symptoms. If so, you should ask your doctor to prescribe a different drug or lower your dose.

If you’ve been prescribed the drugs prophylactically, it may be time to talk with your doctor about getting off statins entirely. According to internist and clinical pharmacologist James M. Wright, MD, PhD, professor at the University of British Columbia, statins have no proven net health benefit as a preventive. As managing director and chair of the Therapeutics Initiative, a group that evaluates drug studies in Canada, Wright is an expert on meta-analyses — the large “studies of studies” — that take every last bit of data into account. His latest review of the data — and the most comprehensive to date — was published in the Therapeutics Letter in 2010: “Statins do not have a proven net health benefit in primary prevention populations,” he wrote, adding that the “claimed mortality benefit” for this group is “more likely a measure of bias than a real effect.”

The data is especially murky for people with elevated cholesterol but no other risk factors. “This is a gray area,” he notes. In short, there’s little credible evidence that attempting to lower a high cholesterol count with drugs is beneficial unless other risks are elevated as well.

Walter Willett, MD, chair of the department of nutrition at the Harvard School of Public Health, adds that even for those who need the drug, “statins only reduce risk of heart disease modestly, about 30 percent, and thus are not sufficient.” Lifestyle changes (see “Many Problems, One Cure,” page 65) are required to take patients the rest of the way. For many, making the right lifestyle changes is all that’s required.

Halting Hypertension

Similar criticisms have emerged regarding the conventional treatment of high blood pressure, the measurement indicating how hard circulating blood pushes against arterial walls. Pressure may rise and fall throughout the course of a normal day, but if it stays too high for too long, it damages blood vessels, the kidneys and the heart. Hypertension, while asymptomatic, is a major cause of heart failure, heart attack and stroke.

Anyone who’s been to a doctor knows that blood pressure consists of two separate readings — systolic pressure (the higher top number, measured as the heart is beating) and diastolic pressure (the lower bottom number measured between beats when the heart is at rest). It is the higher, systolic pressure that is most often used to determine risk.

For many years, physicians have treated even slightly high blood pressure with drugs that counteract the vessel-contracting hormone, angiotensin. First, the pharmaceutical industry introduced angiotensin-converting enzyme (ACE) inhibitors; later, when ACE inhibitors went off patent, drug companies began selling angiotensin II antagonists, also called angiotensin receptor blockers, or ARBs. But the data has not held up, says Wright, who also serves as coordinating editor of the Hypertension Group at The Cochrane Collaboration, whose systematic reviews of healthcare studies are considered the gold standard of evidence.

“Our job is to systematically review all the evidence related to blood pressure and hypertension, and what we are discovering is that the evidence for blood pressure treatment at more moderate levels is not as strong as we had previously thought,” he says. Indeed, while doctors routinely treat patients with mild to moderate systolic pressure of 140 to 160, it is only for those with moderate to severe hypertension — people with blood pressure over 160, the top 5 percent of the curve — that “we get a modest bang for our buck. Between 140 and 160 there is no good evidence that the benefits outweigh the harm,” he says.

Wright especially takes issue with marketing efforts to push ARBs rather than the less-expensive ACE inhibitors. The drug companies claim their studies showed better health outcomes with ARBs, he says, but recent research challenges that claim. A 2010 study published in The Lancet Oncology, for instance, reported an increase in cancer diagnoses among ARB users. Other side effects include headache, dizziness, lightheadedness, nasal congestion, back and leg pain, and diarrhea. And, while rare, side effects such as kidney failure, liver failure, allergic reaction, a drop in white blood cells and localized swelling of tissues (angioedema) can all be fatal.

The Acid Erasers

Another popular class of drug, generating more than $13 billion a year in the United States alone, is the proton pump inhibitor (PPI). These drugs reduce between 90 and 100 percent of acid in the gut by shutting down a system known as the proton pump.

The PPIs, including Prevacid, Nexium, Aciphex and Prilosec, originally were used to manage ulcers, a condition in which acid coursing over open stomach sores caused incapacitating pain. But research later confirmed that most ulcers are caused by the spiral bacteria Helicobacter pylori and could be effectively treated with a brief regimen of antibiotics. Use of PPIs then shifted to common conditions like ordinary heartburn (the burning sensation behind the breastbone) and the far more painful and persistent gastroesophageal reflux disease, or GERD (which results when muscles between the stomach and esophagus stay partly open, allowing stomach acid to leak up, or reflux, into the esophagus, causing pain).

PPIs can, in fact, effectively treat some noninfectious ulcers and severe cases of reflux, but it’s increasingly clear that long-term use can be dangerous, according to a series of studies published last year:

•  Research from the National Institutes of Health, published in Current Gastroenterology Reports, shows that long-term use of PPIs can limit the body’s absorption of essential nutrients, including calcium, magnesium, iron and vitamin B12, which require gastric acid to be absorbed. Risks include not just osteoporosis, but also anemia, fatigue, seizures and cardiac events.

•  The Annals of Internal Medicine reports that long-term use of proton pump inhibitors increases cardiovascular risk for those already suffering myocardial infarction or stroke.

•  The Archives of Internal Medicine reveals that PPIs substantially increase the risk of infection from a particularly hardy bacteria called Clostridium difficile. The study also linked long-term PPI usage with spine, lower arm and total fractures in postmenopausal women. Perhaps even more alarming was the finding that as many as 69 percent of people taking PPIs don’t need them to effectively treat their symptoms.

While almost no one should be using these drugs for years at a time, once someone has been taking them long enough, the habit can be hard to break. It’s been suggested that when patients stop PPIs, a rebound effect increases acid production for a while, causing painful reflux symptoms again. “People should hold out until the excess acid dissipates and the symptoms go away,” says pharmacologist Wright.

Having appropriate levels of acid in the stomach is the healthiest situation of all. Eating high-fiber whole foods (such as beans, veggies and nuts), taking digestive enzymes and probiotic supplements, and decreasing chronic stress can all help to bring your gut back into balance.

Changing Course

If there’s any silver lining in this cloud of overmedication, it’s that Americans have been programmed to at least consider their risk factors for chronic disease. “We have this culture of ‘let’s catch it before it’s too late,’” says Brownlee. Unfortunately, she notes, rather than encourage people to make proactive adjustments in the way they eat, move and manage stress, the drug and medical industries have largely encouraged them to take medication. “What it has done is create a whole nation of perfectly well people who have been turned into patients,” she says. “Most of these people just have risk factors. They are not sick.”

But many doctors rely on pharmaceutical reps and materials for the latest information on treatment options. And they’re inundated with reports — that may or may not be credible — about the latest research. As Golomb notes, clinical studies designed to prove the efficacy of a certain drug have inherent limitations, particularly as it relates to examining safety.

“The people most likely to allow adverse effects to be identified, like the elderly or those on multiple drugs with health problems, are often excluded from participating in trials but not from receiving the drug in the real world,” Golomb says. “This occurs in part for sound reasons like minimizing risk to those in the study, but it also reduces the ability to identify an increase in problems if there is one. Because studies are designed in a way that obscures the harms associated with drugs, serious problems often show up only years after a drug has been fully approved by the FDA.”

So it’s up to doctors to practice some healthy skepticism when pharmaceutical reps promote studies heralding the next miracle drug, says Brownlee. “While physicians are now aware that the information they are getting from the drug industry is not unimpeachable, the bigger issue is that they often aren’t trained to tell good data from bad.”

And they should avoid continuing-education conferences paid for by the drug industry, she adds. “When gastroenterologists go to their annual meeting and there is a purple bus paid for by the maker of the purple pill, it is time to worry. One of the problems we have is that many physicians are not aware of the poor evidence for efficacy, and they also are not aware of side effects, because most of their information is not coming from unbiased sources. It is coming from the manufacturer, who has every reason to downplay the negative and emphasize
the positive.”

For patients seeking unbiased information, two credible resources are The Cochrane Collaboration (www.cochrane.org) and Clinical Evidence (clinicalevidence.bmj.com/ceweb/index.jsp), both of which feature summaries of valid pieces of research that provide important, relevant, more accessible information to patients and doctors.

At the very least, patients should ask their doctors to explain the pros and cons of every drug in a way they can understand, so patient and doctor can share the decision about treatment, says Brownlee. “If your primary-care doctor says, ‘I’m ever so busy, I’m not going to do that,’ you might need to find a new doctor who will help you be informed and who will share treatment decisions with you,” she says.

Patients must be “assertive, smart consumers” to make sure they are not being overmedicated or getting drugs they do not need, says Joseph T. Hanlon, PharmD, MS, professor of medicine in the University of Pittsburgh’s Division of Geriatrics and Department of Pharmacy and Therapeutics, and health scientist at the VA Pittsburgh Health Care System. “Make a list of every drug you are on and make sure you can answer five questions: What is it called? What are you taking it for? How and when are you taking it? What are the common side effects? And when will the treatment stop?” Hanlon says. “Medical schools don’t always do the best job of teaching prescribing. You are your own best advocate.”

Reprinted with permission from ExperienceLife.com.  Written by Pamela Weintraub, a features editor at Discover and author of Cure Unknown: Inside the Lyme Epidemic (St. Martin’s Press, 2008).

The majority of your diet should be plant based, so I always recommend that you eat your fruits and vegetables. Even though the health benefits of a diet rich in fruits and vegetables far outweigh the risks of pesticide exposure, I think it is important to be aware of the amount of pesticides that you may consume with them. So I always recommend buying organic produce if feasible. Not only is it smart to reduce your exposure to pesticides, but buying organic sends a message that you support environmentally friendly farming practices that minimize soil erosion, safeguard workers and protect water quality and wildlife.

But sometimes organic produce may not be accessible or affordable. That’s why I love the EWG Shopper’s Guide Pesticide in Produce, because it helps consumers (like me) who are concerned about pesticides, make healthier choices, given their circumstances. It has 2 lists (the Dirty Dozen and the Clean Fifteen), and will help you determine which fruits and vegetables have the most pesticide residues and are the most important to buy organic. You can lower your pesticide intake substantially by avoiding the 12 most contaminated fruits and vegetables and eating the least contaminated produce. This essential Shopper’s Guide makes it easy to meet a goal of eating at least 7-9 servings of fruit and vegetables a day while reducing your exposure to pesticides.

Why should we be concerned about pesticides?

Pesticides are a public health problem and can be extremely toxic to human health and the environment. U.S. and international government agencies alike have linked pesticides to nervous system toxicity, cancer, hormone system disruption and IQ deficits among children. “Pesticides are toxic,” said Sonya Lunder, Senior Analyst at EWG. “They are designed to kill things and most are not good for you. The question is, how bad are they?”

Here are the 2 latest updated lists from the Shopper’s Guide

Dirty Dozen (Buy these organic)

1 Apples
2 Celery
3 Strawberries
4 Peaches
5 Spinach
6 Nectarines – imported
7 Grapes – imported
8 Sweet bell peppers
9 Potatoes
10 Blueberries – domestic
11 Lettuce
12 Kale/collard greens

Clean 15 (Lowest in Pesticide)

1 Onions
2 Sweet Corn
3 Pineapples
4 Avocado
5 Asparagus
6 Sweet peas
7 Mangoes
8 Eggplant
9 Cantaloupe – domestic
10 Kiwi
11 Cabbage
12 Watermelon
13 Sweet potatoes
14 Grapefruit
15 Mushrooms

Analysts at EWG synthesized data collected from the U.S. Department of Agriculture and the Food and Drug Administration from 2000 to 2009. Produce is ranked based on a composite score, equally weighing six factors that reflect how many pesticides was found in testing of on each type of the produce and at what levels. Most samples are washed and peeled prior to being tested, so the rankings reflect the amounts of the chemicals likely present on the food when is it eaten.

For a downloadable list of this Shopper’s Guide or an app, go to http://www.foodnews.org/walletguide.php.

Also check out a previous blog I wrote awhile ago on Pesticides on our food.

Eating is Big News

Eating right is certainly in the news these days. From the latest fads like “The South Beach Diet” to the front page image of the First Lady planting an organic vegetable garden on the White House lawn, Americans are beginning to pay closer attention to their eating habits. Staggering reports of the epidemic of obesity are flooding the scientific community and serve as fodder for TV shows like “The Biggest Loser.” One in five children in the U.S. are obese today. The “Healthy Schools Act” of 2007 has federally mandated guidelines to improve nutritional standards in schools in order to promote better food choices among students. Many states like New York have recently earmarked millions of dollars in state funds to boost school meal reimbursements. It is now well recognized that poor nutrition affects cardiovascular health and is linked to the rising rates of type 2 diabetes and cancer. But poor nutrition also directly affects the way our children learn.

Why we eat

While choosing what we eat is certainly critical to our cognitive health, a truly holistic understanding of eating goes much farther in considering how we eat, where we eat, when we eat and why we eat. So why do we eat?
I pose this question to children all the time and they giggle and stumble around for answers like “we eat so we can grow.” But we are not just machines requiring the right set of nutrients as basic fuel to keep going. We are living organisms not automobiles! In a recent workshop, I asked participants to describe the taste of a blueberry. No one could get far past the fact that they’re sweet and blue. While scientists may accurately analyze all the phyto-nutrients in a blueberry, this tells us very little about the actual experience of eating blueberries. Eating is a deeply personal encounter. It conveys something about ourselves at a particular moment in time. It feeds our memory and points directly to who we are, to our mood and temperament. Eating reflects our basic sanity because it is how we make contact with the world, how we exchange with the world. Our hunger to grow and know the world is not just physical but intellectual and spiritual. Eating is how we become the world.

The Good Earth

In Chinese medicine, the ‘spleen/stomach network’ is considered the center of our world. It corresponds to the ground we live on, the good earth, which supplies all that we need to grow. But the spleen is home to our thoughts as well. We gather information from the world in all different forms. As we take it in, it gets sorted, some is integrated into our being, and some is eliminated. This gathering, sorting, integrating and eliminating is a cognitive process. It represents how we learn. The health of our immune system (learning to identify the world), digestive system (learning to taste the world), and neurologic system (learning to perceive the world) are interconnected aspects of information processing. The body does not know these are separate systems. They only seem separate to us because there are immunologists, gastroenterologists, and neurologists. As a field of medicine we might more accurately describe this cognitive network as Neuro-immuno-gastroenterology.

Industrially fed, Spiritually starved

If we take a minute to look at how we eat in America, we begin to see how it directly relates to the modern epidemics of childhood, obesity, allergies and ADHD. We eat as if we are in a race. This is the real purpose of “fast food.” It’s cheap and convenient just like a roadside gas station is for your car. But, again, we are living organisms not automobiles. The same kind of ‘assembly line mentality’ informs the way our children are force-fed information in school. We’ve been led to believe that education is a race and that the fastest child is the smartest. But in my 22 years as a developmental pediatrician watching children grow, this simply isn’t true. Sometimes the smartest kid turns out to be the one who took her time digesting the world. The current trends in standardized education have left us with a system that treats children as if they are USDA Grade A meat. The education of our children must be more than simply passing inspection! What’s more, when we are not given the time to digest the material, whether it is food or academics, it stagnates.

The Spiritual Deficit Disorder

Chinese medicine considers stagnation to be of grave significance. A healthy life is defined by the free flowing of qi; that which animates our life. Stagnation represents the accumulation of “stuff” that drags health down. It’s as if the body recognizes the need to SLOW DOWN in order to work on unfinished business even if it results in a pathological condition. This feeling of stagnation is not satisfying because things are simply not moving properly. The lack of movement is boring. Boredom leads to the need for distractions and so we try to spice up our lives. We try not to look at all that unfinished business accumulating within. This in turn makes us agitated. We try to get things moving; we try to shake up all that stagnation. This hyperactive state drives us to look for happiness somewhere else. TV ads capitalize on this, promising happiness with a “whopper” or a “happy meal.” This leads to infatuations, bizarre cravings, impulsive eating and binge-buying. We feel we deserve to be happy, we deserve that tub of ice cream for having had to work under these conditions. And when we can’t have what we think we deserve, we become hostile. Don’t take a piece of my pie.

This state of agitation, distractibility and impulsivity defines the Attention Deficit Disorder. It is said in the Chinese medicine classics that accumulation causes an inflamed state and this phlegm can “mist the mind.” We become confused, can’t think straight, and find it difficult to concentrate on one thing for very long. And so we take stimulants to try to wake ourselves up. Likewise, the same vicious cycle leads to the accumulation of phlegm in our bodies; our neuro-immuno-digestive system becomes confused, hostile, and inflamed. In my practice, I see a host of chronic health problems in children that can be traced back to the phlegm of stagnation: ear infections, asthma, obesity, colitis, and autoimmune disorders. These manifestations of chronic inflammation did not exist to such a degree one hundred years ago, or even fifty years ago. The inflamed state of autoimmunity is a spiritual crisis. When the mind-body remains in such a confused state, we no longer have time to recognize who we are. We are left with a Spiritual Deficit Disorder.

Taking time

Correcting this vicious cycle begins at birth. I work with many mothers on that first day, counseling them about breastfeeding or bottle-feeding. Right there in that moment is a real opportunity to learn how to learn, how to digest the world calmly, attentively, and with ease. Feeding a baby when she is crying is a common mistake. Moments of hunger are not necessarily a crime. Hunger is a way of waking up. We may naturally feel the urge to feed our child when he cries; feeding is a basic way we show our love. But it is vital to pause and consider the true reasons for eating. Babies feed much better when they are fully awake. They are less gassy and more likely to gain weight properly. They are actually learning to pay attention with their whole body-mind. This is a simple yet profound lesson for us all to live by. When you select information, whether food or academic, as a conscious process you are determining which aspects of the external environment you will allow inside your body to operate on an unconscious level. This is the meaning of “mindful eating”. We should take our lead from our babies. Whether we are stimulating our immune system, going to school, or sitting down at the dinner table as a family, taking time to digest is how we become truly sane in this world. Ultimately, taking time is the most alternative medicine. And taking time to digest the world is the ultimate spiritual practice.

Did you know the GI tract is 30 feet long? That’s a surface area the size of a doubles tennis court! Like our skin, it’s continually exposed to substances from the outside world. But unlike skin, it has an extremely thin lining providing the barrier between the internal body and the external world.

Toxins and food particles can easily pass through this wall into the bloodstream if the lining gets damaged causing systemic problems. Although the GI tract is thought of as our digestive system, it is also a major part of our immune system (it’s the largest immune organ in the body), a major part of our detoxification system and a sensory organ with it’s own nervous system. All the neurotransmitters found in the brain, are also found in the GI tract, hence the term “gut feelings.”

Given that the GI tract plays such a crucial role in so many areas of the body, it makes sense that correcting digestive problems and gastrointestinal dysfunction is key to health and vitality.

I have heard a lot about enzymes and digestion–how are they related?

The digestive process is dependent on the presence of enzymes, which allows our bodies to absorb the food we eat and use it for fuel. Enzymes are present in the digestive juices, where they help break down food into simpler components the body can use for energy.

Which enzymes aid in the digestion process?

The three main enzymes involved in digestion are amylase, protease and lipase–though there are many more enzymes involved in digestion. Digestion actually begins in the mouth where the amylase in saliva starts to break down starches and carbohydrates.

Protein digestion begins in the stomach where the acidic environment activates the protease enzymes to begin breaking down protein. Most proteins are ultimately broken down into amino acids, the building blocks of life.

Fat digestion accelerates in the second part of the small intestine with the help of the lipase enzymes, which break down fat into essential fatty acids. The lipase enzymes help in the absorption of the fat-soluble vitamins: A, D, E and K.

Other enzymes, such as sucrase, lactase and maltase, play the crucial role of breaking down simple sugars that are essential for energy production.

Is it true that bacteria are good for your digestive health?

Some bacteria are very important for your health– these beneficial bacteria are known as probiotics. Two important probiotics are Lactobacillus and Bifidobacterium. The health benefits of both of these probiotic bacteria are well studied and supplements are available which can help increase the presence of these beneficial bacteria in your intestines.

How often should I take probiotics?

The key with probiotics is to ensure that they get to the intestines where they can help support a healthy digestive tract. Often, probiotics do not survive the acidic environment in the stomach, so it is important to find a supplement that offers a patented delivery system designed specifically to deliver the bacteria to the intestine. Since probiotics do not permanently colonize in our bodies, it is important to regularly replenish the probiotics with food or supplements.

I know that fiber is important–what exactly does it do?

Fiber helps promote and maintain regularity and in addition is important for immune systems as well as cardiovascular health. Unfortunately, most Americans get only about half of the fiber they need each day. If you are one of those who fall short, consider supplementing your diet with additional fiber. You don’t need to suffer through the gritty fiber drink mixes that your grandmother used to use. There are more and more fiber powders that are palatable these days or if necessary, look for chewable tablets that provide supplemental fiber and taste a lot better.

A yoga practice combined with diet and lifestyle changes can strengthen and harmonize digestion and elimination to heal and reduce many GI complaints.

If you have chronic digestive problems, a short regular yoga practice, continued over a few months will certainly help to resolve the problem and keep your digestive system healthy and functioning smoothly. You will need a yoga instructor to ensure you receive the utmost benefits.

For lower abdominal problems like constipation or diarrhea, set up in the Supported Bridge Pose with the following items: a yoga bolster, a yoga block and a blanket (or some firm cushions) and a pile of books.

1. Set a yoga block or a 12-inch-high pile of books against a wall.
2. Place a bolster or firm cushions at right angles to the wall. The far end of the bolster should be about five feet away from the wall.
3. Begin by sitting in the middle of the bolster facing the wall. Then, lie back over the end of the bolster.
4. Now for the adjustment change the position of the bolster, or change your position on it so that your feet firmly contact the wall and your shoulders rest lightly on the floor.
5. Stay in the position and relax for 5-10 minutes, eyes closed.

Notice the shape of the posture, especially how the chest coils over the end of the bolster and how the shoulders rest only lightly on the floor. This restorative pose is restful and rejuvenates the whole system, including digestion.

Within the Chinese traditional medicine view, the gut is the center–the organizational nexus–of bodily life and social relations. The Chinese greeting, “Ni hao ma?” translates literally as “Have you eaten yet today?”. The industrialization of food production, along with the mechanization and acceleration of cooking and eating, have profoundly altered a primal pattern of behavior, interrupting ritual preparation and ceremonial meal times.

As is commonly assumed, but rarely acknowledged, good feeling, both toward oneself and others, as well as a sense of optimism and clarity, are affected by and dependent upon good digestion, with its consequent feelings of hardiness, contentment, and conviviality. The opposite, indigestion, induces a plethora of discomforts: bloating, heartburn, cramps, irritability, lethargy, and melancholy.

The source of indigestion lies in the disruption of the Digestive Network, governed by the Stomach and Spleen. This network is responsible for the processing of food and nutrients that form the basis of the body constituents — Qi, Moisture and Blood. It is also responsible for distributing these constituents, upward and downward through the abdominal region, and outwardly to the four limbs. When these essential activities are impeded by over-consumption of food, or weakened by under-nutrition, the vigorous, rhythmic, contractile waves of the gut become deranged. This leads to inefficient transformation, diminished absorption, the formation of gas, and the retention of undigested material.

These conditions lead to the syndrome of Qi Stagnation and Food Accumulation, producing symptoms of lingering hunger and uneasiness after eating, distention and aching of the abdomen, belching and flatulence, heartburn and reflux, irregular bowel movements, and a loss of the ability to discriminate between unreasonable cravings and true hunger. Indulging cravings, as well as eating too quickly or too much, leads to fleeting relief and persistent discontent, while satisfying true hunger produces deep feelings of pleasure, affirming the soundness of the body’s instinctual intelligence. Chinese herbs as well as acupuncture can increase the efficiency of the digestive system, which in turn enriches vitality and resilience.

The 4R Program to promote gastrointestinal health, developed by Jeffrey Bland, Ph.D., and his associates at the Functional Medicine Institute, is an extremely effective way to address and treat gastrointestinal dysfunctions and promote gastrointestinal health. It is a simple four-step program, and it is what I use with my patients:

The program simplifies the complex interactions in gastrointestinal health by asking four questions:

1. What needs to be REMOVED?
2. What needs to be REPLACED?
3. Does one need to RE-INOCULATE with probiotics?
4. Does the intestinal lining need to be REPAIRED?

Step 1: Remove

• Toxins in food
• Gastric irritants (e.g., caffeine, alcohol, and non-steroidal anti-inflammatory drugs)
• Food allergies, sensitivities, or reactions
• Chronic low-grade infections in the gut (e.g., yeast and parasites)

Step 2: Replace

• Stomach acid (or stimulate stomach acid with bitters)
• Digestive enzymes

Step 3: Reinoculate

• Restore beneficial bacteria to reestablish a healthy balance of microflora in the gut.

Step 4: Repair

• Provide nutrients to heal the gut wall or lining.
• Support the immune functioning of the gut.

Digestive problems are probably the commonest problems I see in my practice. In addition, many of the patients who presented to me with other symptoms, from fatigue to allergies to arthritis, often the primary issue is faulty digestion. Most of these patients didn’t even realize that they had a faulty digestive system. They had become used to having mild indigestion or bloating or gas and thought it was a normal part of aging.

I believe that digestion is one of the most important functions for health. A well functioning digestive system will energize you, help your immune system and generally prevent all sorts of diseases. It will make you feel more vital.

So in almost all of my patients I always look to see if the digestive system is working well. It makes sense, because if you’re not digesting and or absorbing the food you eat, your nutritional needs will not be met.

I see many patients who are taking hundreds of dollars worth of supplements, which probably aren’t being absorbed properly because of a poorly functioning digestive system.

In Chinese medicine as well, the digestive function or the spleen function or earth element is at the center. When this is off balance, the whole system becomes imbalanced.

Here are 10 simple tips to help with digestion:

1. Chew your food well.
2. Sit down and relax while you eat. Eating in a rush and under stress is not healthy and may lead to digestive problems.
3. Make eating a mindful experience
4. Eat natural, whole, unrefined, unprocessed, high quality foods.
5. Eat when you’re hungry and stop when you are 80% full.
6. Eat organic and preferably local foods whenever possible.
7. Try resting your digestive system for at least 10 hours at night. eg if you eat breakfast a 7:00 am, try not to eat anything after 9:00 PM.
8. Try doing an Elimination diet for 1-2 weeks from time to time, where you eliminate all refined sugar, processed foods, alcohol, gluten and dairy. Notice how your digestion usually improves.
9. If possible have something bitter before your meal, it stimulates your body’s own digestive juices and therefore helps digestion. Eg arugula or dandelion root.
10. Try taking a good probiotic formula