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- Welcome to the Natural Health for People in Pets podcast, a show that aims to empower you with the knowledge and tools needed to take control of your own health and wellbeing, as well as providing health promoting strategies for the dogs in your life. The world of health and nutrition can be overwhelming, so what better way to understand what works and what doesn't, what's evidence-based and what's not, then to hear it from someone in the know. So, please welcome your host of the show, accredited Naturopath and nutritionist Narelle Cook. - Welcome back again to Natural Health for people and pets. My name's Glenn Cook, I'm co-host of the show. I'm gonna pass you over to the Brains Trust of the show. Noelle Cook. - Hello everyone. So the last episode on histamine was really popular. I got a lot of feedback and messages from people who were like, wow, you know, that so explains my situation and they're gonna give it a go. Like trying to follow a low histamine diet. So that's really encouraging. - It is really encouraging. It's nice to hear that people are getting something out of any of the shows. Yeah, I feel it's quite important that some of these episodes do a little bit of a deep dive into some of these topics because the things that people talk about on the surface, but they never really get a good look at what it is or what the ailment is that's affecting them or their dog. So it is nice, it's nice for me to be able to listen to it extensively because I feel the only time that people really research something is when it's afflicting them when they're, it's something that's, mm, it's an ailment that they actually have. So I think sometimes it's forewarned is helpful for them because if they can see it, uh, occurring in a dog doesn't mean they can diagnose it immediately, but they might have an idea of what it is and then be able to say to the doctor or the vet, this is what it could be. - Absolutely. And today's episode, which we'll get onto shortly, is really about that this, you know, some people might hear the to and go, oh, that's a bit, you know, whatever. But, um, , but it's, it's really important, which is why I am gonna talk about it today. - Um, and we have touched on it before, haven't - We? We have touched on it and I said I need to do a podcast about that. Yes. And so today's that day. Mm-Hmm. But first - A big announcement. Well, - I think it's super exciting and I'm just really excited to share it with the listeners. So in clinic I see a lot of patients for weight loss. Mm-Hmm. . So it's probably one of the main conditions Yeah. I guess that I treat and support people with. But one of the negatives that I find in clinic is that most of my patients might see me on average every four weeks, which for most health conditions, you know, is okay. Mm-Hmm. . But when we are talking about weight loss, particularly if someone's got a lot of weight to lose, they need a much higher level of support. So, you know, ideally once a week or twice a week would be what I would prefer for them. But then it becomes prohibitive from a cost perspective and a time perspective. So what I've done now based on, you know, talking to patients and getting their feedback is I've created a highly structured 12 week course. Mm-Hmm. all around weight loss and nutrition. So the great thing about it is there'll be an online component where people will have lessons that they work through themselves. There'll be exercises and handouts that they do, but the beauty of it is, is there'll be a closed Facebook group just for people who do the course. So they'll have access to me daily, basically. - Oh, like an internal support? - Yeah. So it'll be a support group, a Facebook support group, so people can check in every day, every week, you know, is whatever level of support they need, I'm there. So rather than waiting four weeks and falling off the wagon in between, or not knowing what foods to pick or, you know, all these questions that come up for people who are trying to lose weight and it's a new journey for them, you know, I'll be there to support them in that group. So I think that's gonna be a game changer for a lot of people. Mm-Hmm. . And the course, it's not just about eat this food or, I've never been one for fad diets or crash diets. Like I don't want my clients to lose 15 kilos in four weeks because then I know they're doing something terribly wrong and they're just gonna rebound weight gain or binge at the end of it. Mm-Hmm. So, you know, I'm all about sustainable, healthy choices. So the course, I'm not gonna go through all of the different sort of topics for the 12 weeks, but it's a big part of, it's gonna be mindset and, you know, setting yourself up to succeed. Mm-Hmm. , yes. There'll be, you know, the facts about metabolism and energy and fat burning. So I'm gonna dispel a lot of myths that persist about weight loss and fat burning so people can be crystal clear on what's right for their body, how to meal prep, how to create really nutritious meals at the right portion sizes for their body. - So it's backed by science rather than just crude marketing. Yeah. - It's just sustainable, healthy eating. Mm-Hmm. But it's, you know, also looking at, I mean, overweight and overeating, it's not just about being hungry. I mean that's just an outdated notion. It's about the emotional aspects, you know, what's driving people to eat and having a close support group can allow people to explore that a bit more. And within the course, you know, I'll be helping people to dig a bit deeper into what's driving their emotional eating, what's driving their cravings. Mm-Hmm. . And not just understanding that, but then what do you do about it? Like what's the practical steps if that is part of what is causing you to overeat and gain weight. Hmm. - Sounds good. So - I think that's gonna be amazing. So that will be ready to go in January. Keep an eye out on social media on my website. I'm gonna talk about it more in the next podcast. - Yeah. How would they find that? What's the address for people to go to if they're looking for that? So - Definitely the natural health for people and pets Facebook page. Mm-Hmm. also on the natural health and nutrition Facebook page. There'll be all of the information about the course content and the costs will be on my website, natural health and nutrition.com au. - So you'll do announcements. Yeah, - There'll be lots of announcement when that's ready to go. Great. Watch this space and you know, new year, new - You. Oh yeah, . That's good. Get into it, y'all. Yeah, yeah. No, that's good. Excellent. So - Getting onto to today's topic. Mm-Hmm. And again, this is something I see a lot of in clinic with my human patients, but it's also relevant to dogs. It's all about acid lowering medications. Right. So people might be like, what's that? What's - That got to do with me? - That's right. But acid lowering medications are one of the most prescribed medications worldwide for people. And there's a lot of information coming out now that they're being overprescribed to people and they're being overprescribed to our pets as well. - It's like gavascon, is it? Yeah. - Mm-Hmm. And I'll talk about a bit more about the different types of astara medications as we go along, but the reason that I really want to touch on this is because I do see so many people on acid lowering meds and I'm talking for decades, and they've never once been told by their GP or if it's a dog, their vet about the negative, like the long-term, negative health effects of, of staying on these medications. So that's what I wanna highlight to people today. And it's a sort of medication where when people come to me with symptoms, I'm like, how big a role is that medication playing in the symptoms you're presenting with or in the development of new symptoms that we're seeing over time. But a big note that if you are on any acid lower medication or if your dog is on acid lowering medication, absolutely do not stop your medication based on anything that you hear today in this podcast, I am providing you with information and I'm giving you a lot of things to think about in relation to the medication, but you must absolutely speak to your doctor or speak to your vet before you make any changes to your medication. Mm-Hmm. . So I wanna be really clear about that. What's - A precursor to put a dog on acid lowering medication? Like why do dogs usually get put on it? - Well, let me just sort of go through Mm-Hmm. The process and then we'll get to dogs Okay. - A little bit later. Yeah, of course. - To start with, let's put it in perspective about, you know, what they are and what they do and where they work in the body. So if we start with the esophagus, most people will know that that's the long flexible tube that connects our mouth to our stomach. Mm-Hmm. . But at the lower end of the esophagus, there's what's called a gastroesophageal junction. And within that junction there's a sphincter muscle called the lower esophageal sphincter, which I'm gonna have trouble saying throughout the podcast . But that lower esophageal sphincter, which I might probably just call the sphincter, is designed to keep the stomach contents in place and to prevent reflux back up into the esophagus. That's why, you know, technically we can eat a meal and then do a handstand and all the food from our stomach doesn't come gushing back out of our mouths. - Incredible by design. It - Is. I dunno why you'd wanna do that, but you can do that if you want to. But as humans, we can still vomit if we want to. So we can make ourselves vomit or you know, there are reflexes in the body that will trigger us to vomit. And this is something like, I know nothing about horses, I'll admit that, but recently I learned that horses can't vomit. - I didn't know that either. - I was gonna say, how cool is that? But it's just really interesting. And the reason for that is so their lower esophageal sphincter is so strong that once it closes like it's shun. Mm. Whereas for people, you know, ours is relatively weak, which is why we can, you know, make ourselves vomit and food can pass back up. Mm-Hmm. . And in addition to horses, rabbits, rats and frogs can't vomit. - What about cows? I - Don't know. They're the only ones I remember that can't vomit. But I, I don't know about cows. Why would you care about cows ? - Well, they're just very similar in stature to a horse. I was just wondering if they have that same sort of physiology. - Good question. If any of the listeners know if cows can vomit. Well actually cows, they regurgitate their food to keep chewing on it throughout the day. Like they're ruminants. So yeah, they swallow their food goes in the room and comes back up. They, that's why they ruminate. That's why we ruminate. Ah, - Yeah. There you go. So cows can technically vomit. Yeah, - I guess so. Yeah. If you think about the basic physiology, but coming back to humans, any incompetence of that sphincter between the esophagus and the stomach. So that's what's considered the main underlying cause of acid reflux. Mm-Hmm. So anything that compromises that is gonna make you more likely to get reflux. And then if we move on quickly to the stomach, so the acidic nature of the stomach environment, it's absolutely essential for us to be able to break down our food properly and to go onto the next stages of digestion and absorption. Mm-Hmm. , I mean, you think about dogs eating bones, if they don't have adequate gastric acid, - They can't break it down. Yeah. - Yeah. Imagine a bone sitting heavy in their guts. Mm-Hmm. And you think of all the rubbish foods and heavy foods that we eat as humans, if we don't have adequate gastric acid, it just sort of sits there heavy like a lump fermenting. - Okay. Fun fact, I think that since you've brought that up, that a dog's pH level is two points different in acidity than ours, isn't it? Because of the level of bacteria and like you said, bones that they consume and so forth. I think they have a higher percentage of, or higher level of acid in their stomach than human beings. - There is some overlap. Mm-Hmm. in the levels of gastric pH with humans and dogs. Gastric pH varies depending on whether you're in a fed or a fasted state. So it's not that dogs are always two points lower on the, the acid scale per se. It can vary. So dogs have a range that they'll sort of sit within and we have a range and there is some overlap in that range. And yeah, - I dunno what I was reading, I was glancing through something and it said that the reason they have the variance in pH is because of the quality and the quantities of foods that they eat and that they have to have a tolerance for a higher level of bacteria than what a human being could tolerate. - Oh, absolutely. But all of those reasons are reasons why we need strong gastric acid as well. Mm-Hmm. I mean, dogs do have a, from an evolutionary perspective, they're eating, you know, large meals, like if they're doing a kill - A gorge, - Yeah. They gorge and fast and the bacterial load is much higher for them. So they do need that strong acid, which is why acid lowering meds in dogs, you know, can be quite detrimental. Mm-Hmm. But we need that too. So most of what, and because this is what I'm mainly seeing clinic with patients, most of what I'll be talking about today is focusing on the use of acid lau meds for reflux. Mm-Hmm. , because the theory behind that, you know, too much gastric acid, it comes back up into the esophagus, which is what creates the symptoms such as heartburn. But just to put it out there, there's also a school of thought that states that too little stomach acid can be a cause of acid reflux as well. Right. So a lot of people don't sort of think of it that way. And to explain that a little bit further, that lower esophageal sphincter, it requires sufficient quantities of stomach acid to remain closed. So it's actually the acid building up in the gut that's like a trigger mechanism for that sphincter to go, okay, acid's building up, I need to shut tightly. Mm-Hmm. . So it shouldn't really matter if you have a lot of gastric acid because if your lower esophageal sphincter is working correctly, they, you know, you shouldn't experience reflux in the first place. Mm-Hmm. , which raises the question, you know, why might that sphincter not shut properly? And towards the end, I'm gonna talk a lot about sort of diet and lifestyle influences on that. But just to give you a couple of examples now, like peppermint, peppermint can relax that sphincter, peppermint can relax the sphincter muscles. Okay. So if someone has a big meal at night and then they have a cup of peppermint tea thinking they're doing the right thing by their digestion, - You just make your sphincter sloppy. - You just, yeah. Mm-Hmm. you're just opening that sphincter and - . Oh good. - It's not that that's gonna happen to everyone, but you know, some people are more susceptible and sensitive to things. Yeah. So if that's you having a cup of peppermint tea may not be the best choice. Right. - Or peppermint chewing gum. - Yeah. Sort of any mint peppermint can potentially sort of relax that sphincter muscle. Yep. But other things like garlic and onion and fatty foods. So fatty foods are a double whammy because they can relax the sphincter muscle, but then they also slow down gastric emptying, which is like the rate at which food passes out of the stomach. Okay. So if you can imagine like the longer you have food sitting in the gut, one, you get a build up a volume if you keep eating, but you get a buildup of gases as the food's broken down and fermented. So that causes an upward pressure on that sphincter, which can overwhelm it, causing it to open slightly. Okay. - Can I just insert something here? Just a question. Mm-Hmm. , is it true that meat can sit undigested in the stomach for like months? Is that, is that a fact? Or is that fiction? - Those sort of facts? I don't just know off my head, top of my head, but for months I would say highly unlikely because - There's a lot of, I would call it a urban myth because it just seems so unlikely to me that you would eat a steak or something like that. It sounds like something somebody who would try and convince you not to eat meat would say that they can sit undigested in the stomach for months. - I'm pretty sure there's a condition called gastroparesis, whatever it's called. It's where like some people do have a condition where they have really slowed and delayed gastric emptying. But to say months, I would say myth. Yeah. Oh, imagine how uncomfortable that would - Be. We'll have to find out. Right. - Google, - We'll have to look into it unless - We've got some, - Got some people out there who've got medical - Professionals. - Yeah. If anyone out there's got the facts around that, please - Let us know. - Yeah. Contact us on social media. - But that's why obesity and pregnancy cause reflux because you know, you've got that, you know, upward pressure on that sphincter. But the problem is anything that slightly compromises that sphincter muscle and allows a tiny bit of acid through it doesn't take much acid. I mean, acid's potent stuff. So even the tiniest bit is gonna cause symptoms and you know, whether we call it heartburn or reflux or GERD or Gord, in Australia we call it gerd, gastroesophageal reflux disease because we spell esophagus with an E. Mm-Hmm. in the states that'd call it gourd because they still spell esophagus with an O. Okay. Anyway, tomato, tomato, mm. - Literally - . But it's painful and it's potentially dangerous. And the danger is that after prolonged exposure to the acid, and not just the acid, but we've got protein digesting enzymes in our stomach fluid, those cells of the lower esophagus undergo pre-cancerous changes. Mm-Hmm. , which can then develop into esophageal cancer. So it is really important that people, if you, you know, are experienced reflux that you treat it. It's just that the most common acid lowering meds come with a, you know, a lot of negative side effects when they use long term. And there's lots that people can do with their diet and their lifestyle to correct the problem without needing to take medications in the first place. So that's what I wanna really stress today. Like don't just have a bit of heartburn and just start popping acid lowering meds. Mm-Hmm. , think about your diet, think about your lifestyle, and yeah, we'll go through all of that in detail. So reflux, one of the main reasons for acid lary meds, but the other one is peptic ulcer disease. That's where we get open sores or ulcers in the stomach or in the first part of the intestine. And people can get peptic ulcers from bacterial infection. So, you know, the old schooler thought was, it was stress, like when you were stressed you'd get ulcers. Right. But that's sort of a myth now. Or you know, that's sort of been - Dispelled. - Dispelled. Mm-Hmm. , I think it was actually Australian scientists that found the connection between helicobacter pylori, which is a bacteria that resides in, you know, most people like 75% of the world's population have h pylori in their system. It's just that for some people it sort of takes off and can cause a lot of problems. Mm-Hmm. because the bacteria eats away at the lining of our digestive system. So, you know, our body in its amazing design, because the stomach is so acidic, it creates a really thick mucus layer that forms a barrier between our like gut lining and the contents of the stomach. So we don't actually eat away at our own stomach lining with our acid. Mm-Hmm. . But this bacteria eats away at that protective mucus layer so the acid can get to the gut lining and cause ulcers. And the other thing that's relevant to dogs as well, so with dogs, they don't actually get helicobacter pylori like that same species of bacteria. Mm-Hmm. , they get lots of other helicobacter species, but not that particular one. But what's so, what's more relevant for dogs is, and people, the use like the long-term use of non-steroidal anti-inflammatory drugs. So they also destroy that protective barrier lining and can, you know, lead to ulceration because of the acid getting into the mucus membrane. Mm-Hmm. . Okay. So as you mentioned earlier, like one of the most main acid lowering meds that people would be familiar with are our sort of antacids. So they're the oldest of the meds and they reduce the stomach acid by temporarily neutralizing the acid. So they're those alkaline minerals such as magnesium or aluminum that you get in things like gavascon and mylanta and the Remy and quickies. Quickies that's, I was trying to think of quickies and I couldn't, but it's like eating chalk basically. But that's how it neutralizes the acid. And I knew someone years ago that would just pop quickies, like lollies just all day every day for how many years? I don't know. Mm-Hmm. . But back then I didn't even know sort of any of what I know now, so it didn't trigger any red flags. But now I'm like cringing on the inside for that person. So they're really common, you know, people can just go and buy them from shops willy-nilly willy-nilly willy-nilly. Yep. Then you've got like the next step up from that are called histamine type two blockers. And that's very different from the histamine sort of, we were talking about last episode, but they work on certain receptors in our gut, so we, we don't produce as much acid. And then finally the step up from that are our proton pump inhibitors. So they're like one of the main prescribed meds worldwide and it's quite scary. So they inhibit, we've got these cells lining our guts called parietal cells, and in these little parietal cells there's a pump. Mm-Hmm. . And it pumps acid into our stomach. So the proton pump inhibitors inhibit the pump in that cell. So we don't produce as much acid. Goodness. So it's all happening in our bodies. So they're things like Nexium you would've heard of, that's a like a major brand name for PPIs, uh, naproxen, a lot of dogs will be put on Omeprazole is the chemical name. Mm-Hmm. . But people can get PPIs by prescription only from their doctors or their vets or they can just go buy them over the counter. And that's pretty scary, right? Because the research has found, like there's this connection now that's shown between PPI use and negative health outcomes including an increased risk of premature death and the risk of fatality increases with the duration of use. And it's even when people are taking those very low doses, you know, like what you'd find in the quickies for example. Mm-Hmm. where you can just pop down to the service station and get a pack of quickies. Yep. So even at those very low doses, there's a increased risk of premature death. And the main cause is that due to cardiovascular disease, chronic kidney disease, upper gastrointestinal cancer, so pretty nasty stuff. And that's all because of the way sort of reducing our gastric acid has systemic effects. Mm. You know, throughout the whole body and well, - It's supposed to be there. Right. - That's my whole point. We need acid. Mm. So by the end of this podcast. - So you are saying that that's a science fact that's fact-based, that causes premature death. It's been proven. Well, - There's strong connections between increased risk of death. Mm-Hmm. and the long-term use Mm-Hmm. of protein pump inhibitors. Yep. Like the research has shown that more than half the people taking PPIs, you know, we're doing it without a true medical reason. So that's probably people who just popping down the shops and self-medicating long-term. Mm-Hmm. without getting things checked out. And that it's actually that group that had the highest mortality rate because the official medical guidelines say that people should discontinue PPIs after about anywhere from four to 12 weeks. So one to three months. Mm-Hmm. is sort of for most indications, and there are small groups of people that have certain health conditions, that means they do need to be on PPIs, for example, for life. So people with conditions of connective tissue diseases. So scleroderma, that's for some reason the first one that pops to mind. So scleroderma is, you know, there's a tightening of skin and connective tissues which can cause strictures in the esophagus, for example. So it's gonna compromise that sphincter. So they're always going to have the presence of acid, so to prevent them from getting esophageal cancer. Mm-Hmm. , you know, they sort of need to be on PPIs. But I had a patient who had been on APPI for 30 years. Goodness. And you know, it's one of those situations where the doctor just prescribed it and never really followed up and he just assumed he needed to be on it. So, and they're saying technically, you know, one to three months is the guideline. Mm-Hmm. . And if you are just self diagnosing and self-treating, they say you shouldn't use it for more than two weeks. So if you're just going to the chemist and grabbing a box of nex VM within two weeks, you should be stopping using that Mm-Hmm. To avoid, you know, problems. And the thing is, with reflux, the PPIs, they're not addressing the underlying reason for your reflux. So even the medical literature is super clear that lifestyle measures, you know, dietary changes, stopping smoking, weight loss, all of those things can significantly reduce reflux and the risk of esophageal cancer without the need for medications. Mm-Hmm. . Yeah. You know, it's always stop and think about your diet and your lifestyle first before you start popping pills. So I wanna go into like a little bit more detail about just what damage they can do. And as with food, like we need acid to break down our food properly, but we also need adequate levels of acid in our guts. And our dogs need adequate levels of acid in their guts to absorb nutrients. Mm-Hmm. . So all our vitamins and minerals. So I'm just gonna touch on the top four that are impacted by PPIs, for example. So calcium, by lowering the stomach acid levels like our ability to digest calcium and absorb it, is significantly decreased. And that's whether it's calcium from food or calcium from supplements. And you know, once our blood calcium levels are low, the only way the body can correct that is to take it from the bones. So the longer you're on APPI, you know, the longer the body's low on calcium, the more calcium gets removed from our bone. Which ultimately leads to, you know, osteopenia, osteoporosis, bone fractures. And this is proven like studies have found a, a link between long-term PPI use and the increase in overall fracture risk. And just to put it in perspective, like one study, it was in an older population, so people over 50 years, they found that the use of PPIs for more than a year was associated with a 44% increase in hip fracture risk. Okay. So, you know, this poor patient of mine who was on APPI for 30 years, like every day, it's just scary to think what's going on inside his body because of that. But if you are on APPI, and if you need to be on one, I do recommend, I mean always talk to your doctor, but you know, you'll probably need to supplement calcium, but you need to get the right form of supplement as well. So calcium citrate MM is the best option for a calcium supplement for people on an acid lowering medication because calcium citrate doesn't require an acidic environment to be absorbed. Calcium carbonate, which is the most common calcium you'll find in supplements. So you know your olins and things like that. So everything that doctors will recommend, it needs a lot of acid to be broken down and absorbed. Mm-Hmm. . Whereas calcium citrate doesn't. So make sure you pick the right form of calcium and remember that blood tests are not a good indicator of body calcium levels. So the levels of calcium in our blood are less than 1% of like our total body stores. And that's regardless of how much calcium you consume in the diet. So you can binge on cheese and milk and ice cream and yogurt for a month and get your blood tested. Or you can eat no calcium containing foods for a month and get your blood tested and it won't be impacted. And that's because our blood calcium levels need to remain within such a narrow window that it's really tightly regulated. So if you're eating too much, you'll just excrete more. And if you're not eating enough, the body's gonna take it from the bones. Mm. Blood calcium is really only an indicator of how well your body is regulating calcium levels. And that is the sole job of our parathyroid gland. So that gland, all it does is regulate calcium in the body. So if your calcium levels are outta whack on your blood test results, you'd wanna be sort of thinking about and talking to your doctor about potentially there's something going on with your parathyroid gland. Okay. So that's just something to think about. Iron. So iron is critical for so many different processes in our bodies that we need to feel good. You know, most people be aware that we need iron for the formation of red blood cells for oxygen transport. And like calcium iron absorption is significantly decreased when there's not enough gastric acid. Mm-Hmm. particularly non he mine. So we've got he mine, which comes from animal foods and it's called he mine because it comes from blood tissues that contain hemoglobin. Mm-Hmm. . Yep. Blood. And the non-heme iron comes from plant food. So with plant sources, the iron becomes bound to certain compounds in the plants like phytates, which inhibit absorption. So we need adequate acid to break down those inhibitory compounds to get the iron out. Mm-Hmm. . So symptoms of low iron, it could be fatigue, weakness, headaches. Dizziness, cold hands and feet, brittle nails. If you've got dry damaged hair or dry skin, any sort of swelling or soreness in the mouth or the tongue, that could all sort of relate back to an iron deficiency. Mm-Hmm. , the good thing is that iron on a blood test does give you a more accurate idea of what's actually going on. Mm-Hmm. . And like with calcium, there are certain forms of iron that if you're gonna supplement it better than others. So you know, your ferra grads, which is again, something a doctor will tend to recommend to people is rou sulfate. So that needs a lot of acid to be absorbed, whereas iron bisg glycinate doesn't need, you know, that acidic environment for absorption. So you wanna look for calcium citrate and iron bisg glycinate. Okay. Two more key nutrients that I wanna touch on. Mm-Hmm. magnesium necessary for hundreds and hundreds of reactions in the body, you know, to feel good. We need it for energy production, we need it for muscle function, for our nervous system. So it's really important for our moods. It lowers blood pressure, it reduces insulin resistance. So people who are struggling with weight, you know, magnesium is a really important part of what they might need to do. - You're big on magnesium, aren't you? - Uh, to me it's like, it's a non-negotiable. Like with all of my patients it doesn't, it feels like it doesn't matter what someone's seen me for. Like magnesium has a role. Mm-Hmm. , you know, even PMS symptoms, headaches, you name it, I love magnesium. And the thing is, three quarters of the population are not even meeting their minimum magnesium requirements for the day based on the guidelines. And then if you add an acid lowering medication on top of that, you know, they're getting even less. But like calcium. So blood levels of magnesium are not indicative of body stores because 99% of our magnesium is in our bone, our muscles and our soft tissues. Mm-Hmm. . Which, and not in our blood. So less than 1% is in our blood, which is available to be measured. So, you know, deficiencies of magnesium can often go undiagnosed and yeah. When people, you know, not eating enough magnesium and then they're on an acid lower meds so they're absorbing less magnesium and you know, you wonder why so many people are tired and depressed and anxious. I'm not saying it is a magnesium deficiency, but it certainly can be playing an important role. - So what should they be eating to keep up their magnesium stores to get it naturally? - I mean, just eating a wide range of fresh foods like you know, your green leafy vegetables, your nuts and seeds. Mm-Hmm. , they're all really good sources of magnesium. Mm-Hmm. B 12. You know, B 12 is necessary for red blood cell formation, neurological function. We need B 12 to metabolize our fats and our proteins properly. So in food B 12 is bound to protein. So in order to absorb B 12, we need acid to break down the protein so we can release the B 12. Which is why you tend to see B 12 deficiencies in elderly populations. Because as we age, we produce less stomach acid naturally, which is what we're doing artificially with the PPIs. Mm-Hmm. . And you know, one study showed that people who were taking PPIs, 75% of those people were deficient in B 12 compared to just 11% of people who weren't on APPI. So that's pretty significant. Uh, so if you are on APP, I definitely recommend supplementing for B 12 or getting injections. Mm-Hmm. . And again, there are different forms of B 12. I like the active form, which is a methylcobalamin is one of the active forms over the cyanocobalamin. So have a lookout for that. If you're buying something and you know, side effects associated with low B 12, fatigue, weakness, irritability, you know, tingling and numbness in the hands and feet, burning feet, you may not realize they get clients with burning feet. So, you know, we always think about B 12 there, mood changes, depression, cognitive changes, you know, things like memory loss, dementia, poor coordination. So I always think without elderly population, you keep hearing like when they stumble and fall or if they lose their memory or they get dementia, it's like, oh, that's just normal. It's just a natural part of aging. But when you look at some of the symptoms of nutrient deficiencies Mm-Hmm. , you know, I think how much is it is it's tied into that. And if we just supported our elderly people with the nutrients they needed and that they weren't getting, because for example, they've got less stomach acid, how much better off they would potentially be. Mm-Hmm. That's four key nutrients that can significantly impact how someone feels on a day-to-day basis. Mm-Hmm. So that's really important to look at. And the other big thing that affects people on PPIs is infection. So remember our stomach acid is our first line of defense against pathogens coming into our bodies. So when we've got less acid, it sort of just opens the door for infection to sort of take hold and grow and remember. So I always love this when I remember to think about it. Like, we're like donuts. Our bodies are like donuts. Okay. - That's interesting. So, - So remember we've got a tube, like a single tube that goes from our mouth to our anus. Mm-Hmm. . And technically everything in that tube is exposed to the external world. So that's not actually inside our body. So when food's sitting in our stomach, it's not in our bodies, it's, it's in a tube that's running through our body. So it's like sticking your finger through the hole in a donut. That's the same concept of our bodies. Mm-Hmm. . So it's not until food's broken down and absorbed and assimilated sort of into the cells and the tissues that it's part of, it's in us. Mm-Hmm. . But I always love that concept of thinking we are just like, we are just flesh around a hollow tube like donut. Like you've just got the donut around the Yep. Whole - . Okay. - But that's the reason I bring that up is it just highlights how important it is that we do things that support our mucus membranes. Mm-Hmm. . Because that is the external world - Invading our internal world. - Yes. Mm. So, you know, zinc, vitamin A, vitamin C, we've spoken about that in previous shows. So people with PPIs are at increased risk for pneumonia and other upper respiratory tract infections. You know, just due to that increased bacterial colonization. People who use PPIs are gonna be at increased risk of enteric infections. Same with dogs I should say as well. So they're infections of the intestinal tract. So you might get increased diarrhea, you know, any abdominal discomfort, nausea, vomiting, you know, a classic one there is clostridium difficile or c diff, which is a common trigger for diarrhea. There's gonna be an increased risk of small intestinal bacterial overgrowth. So cy, which is becoming more and more prevalent in people and dogs. Mm-Hmm. these days. So, you know, just by lowering gastric acid, all of these things can, you know, suddenly what - Cy small intestine, - Small intestinal bacterial overgrowth. Mm-Hmm. . So it's bacterial growing where it shouldn't be growing. Not good, not good. You know, by changing the gastric pH, it can have a huge impact on the absorption of other medications and drugs. So make sure you're having conversations with your vet or your doctor. Mm-Hmm. about that. So you might be, 'cause a lot of drugs are manufactured around a certain gastric pH. So once that varies, you might be getting more or less of the drug than you need. Mm-Hmm. . So that's, that could have serious consequences depending on the person and the drug and what it's treating. Okay. Getting back to dogs, like I said, PPIs are known to be overprescribed in human populations, but the literature is also stating that they're way overprescribed in veterinary medicine as well. And there's tons of research around the use in humans. There's not so much research around the use in animals and dogs. Mm-Hmm. . But again, because of the similarities between the two, they can sort of - Coincide, - We'll just translate one mm-Hmm. finding, you know, from humans to dogs, dogs to humans, things like that. Okay. And you know, just reading recently about like through the medical literature, particularly the animal literature on this, there's a lot of reports now challenging sort of the clinical practice of administering acid lowering medications just for routine things like, you know, gastritis or pancreatitis. Um, which just comes back to your original question at the start of the show. So vets will often just prescribe for, like I said, gastritis, pancreatitis, liver disease, kidney disease, just as sort of a go-to when that may not be indicated. Right. And particularly due to the long-term side effects. So diarrhea is probably the most common, you know, adverse side effect associated with PPI use in dogs and as with humans. So PPIs are often given to animals to allow that gastric mucosa to heal. So remember if we've got acid eating through into our gut lining, the best way to allow that to heal is to reduce the acid. Mm-Hmm. . So the tissues can heal. But a big reason that the gut lining gets damaged in dogs is through the long-term use of nonsteroidal anti-inflammatory drugs. So, you know, a dog gets put on an nsaid if it's long-term, they might then get put on a, you know, PPI to help mitigate the damage or to heal the damage. But then, you know, I was reading a paper that said, because PPIs increase intestinal dysbiosis, remember when you've got a more alkaline gut, that's like a perfect breeding ground for bacteria. So by creating like this dysbiosis, it actually then increases the risk even more of getting damaged by the non-steroidal anti-inflammatory drugs. Hmm. So you end up with this vicious cycle of, you know, you give one, you get this thing and then you give another drug to treat that. But then that triggers that and yeah, it's sort - Of, it's like the, the children's song. I knew an old lady who swallowed a fly, gosh, - I haven't heard that for decades. Mm. So do you wanna share it with people in case they don't know? - I knew an old lady who swallowed a fly. I dunno why she'll probably die. I knew an old lady who swallowed a spider that wriggled and wiggled and tickled inside her because - I can't remember the words. - . Yeah. I can't remember , I can't remember. But the whole story is, the reason why she kept swallowing all these animals is because she swallowed one. So she thought, well now that I've swallowed one, I have to swallow another to get that one. To get that one. So then she swallowed a spider to catch the fly. She swallowed a bird to catch the spider, swallowed a cat to catch the bird, swallowed a dog to catch the cat. And it just kept going on and on and on until eventually she died. Yeah. Because she swallowed a horse, I think in the end. And I mean, it's a ridiculous song, but it just went to show that she swallowed a fly. She could've just stopped at that. But yeah, she just kept going on and on and on and on. And that's like, I hear some people with medications that are quite the same and same thing with dogs, you know, like they, oh, I'm going back and I'm getting this and I'm getting that. And mm-Hmm. I guess, you know, you're right. Sometimes people are very quick to just jump on the pharmaceutical bandwagon sometimes. And I, I know they're necessary when they're necessary. Mm-Hmm. You know, like you've never said, don't use pharmaceuticals and never, you know, you are a scientist after all. I think what I've heard you mention to people is understand what and why you are using it. And it should be for a limited time only. Well, - Whether it's for a limited time depends on the condition and the drug. That's true. But always my point is always don't just make that, you know, unless it's obviously you indicated, you know, our diet and our lifestyles can fix a whole lot of health problems before you reach for pills long term. Yeah. And I think I've seen a T-shirt talking about taking one thing and then another thing, there's a T-shirt, you know, um, I started with this drug then I, I can't remember how it all goes. But then, you know, you had to take another drug to counteract the side effects of the first drug and then you needed a third drug to counteract the side effects of the second drug. And there's this whole thing about it. Mm-Hmm. But talking about, you know, being on medications and stop your medications. So, you know, I was quite clear, don't just stop medications and it's particularly relevant to PPIs because what happens is you get this rebound acid hyper secretion. What that means is if you just stopped APPI cold Turkey, you get an increase in gastric acid secretion that's even worse than it was in the beginning that made you take the drug in the first place. Mm-Hmm. . And the reason that this happens is because when we suppress those parietal cells in our gut lining and our body starts producing less acid, that's a red flag. Like that's an alarm to the body that things aren't working the way it should. So it starts like it upregulates those parietal cells. Mm-Hmm. , you know, with the aim of producing more acid. 'cause the body's like, oh, you know what's going on? These cells aren't doing their jobs. They better make some more of them. And then, you know, it makes more, but then those new cells get suppressed by the medication. And so when you stop the medication, suddenly you've got far more acid producing cells than you would've normally. And suddenly they're free and they're like, wow, awesome. Like, we are free to do what I want. Let's just start pumping out that acid again. Mm-Hmm. . So you've got more cells that are suddenly producing more acid. So yeah, you're gonna get this massive sort of rebound acid secretion, which is gonna hurt. But the thing is, you know, the body does self-regulate and then it quickly realizes, okay, you know, now there's too much acid. Let's down-regulate those cells and find a sort of a balance. But you know, that might take a week or two. And in the interim people are like suffering from all this acid. So they're like, oh, I must have really needed to be on that medication because look how bad it is when I'm not. But that's just a short, short term phase that the body's trying to find its natural balance again. So, you know, coming off PPIs, people should always wean Mm-Hmm. off. And again, always talk to your doctor before you start making any changes to your medication. But you know, you, if you're on a higher dose, you might start by lowering your dose every day and then when you get to the lowest dose of a tablet, you might take it every second day and then every third day. So the body can gradually find that balance again without that shock and that sort of wave of acid being produced, but in constant consult with your doctor. Yeah, absolutely. And there are things you can do naturally. So I might be working with a patient that's working with their GP to come off medication, but you know, I can quite safely support them naturally to minimize any rebound acid hyper secretion as well as minimizing symptoms and healing the tissues and things like that. So maybe we'll get into what that looks like. So if we think about food foods that can aggravate symptoms like chocolate caffeinated beverages, alcohol, you know, alcohol's gonna weaken that sphincter or relax it. We've mentioned peppermint, fatty foods, fried foods, tomato-based sauces, you know, like a really rich lasagna or bolognese can aggravate onions and spicy foods. Any carbonated beverages, again, that's gonna sort of fill up that space and put upward pressure. So you need to avoid eating a lot of food, particularly late at night when you're sort of just sitting or you're sort of lying back, which can create upward pressure ensuring you're getting adequate fiber. So increasing your fruits and veggies, you know, that's gonna help to increase gastric motility, which keeps food moving through your system at a better rate. So it's not sitting there fermenting and heavy in your gut producing gas. I'm not one for food combining these days, but if someone's really sensitive to reflux, I might say to them, look, let's just trial a period where you don't eat heavy proteins with, you know, rapidly absorbed carbs so you wouldn't have a steak with a fruit salad. It's important that your water intake's good, but you don't wanna drink a lot with meals. So you need to drink a lot throughout the day so you're not constipated. And again, that can sort of slow down gastric motility, but you don't wanna drink masses with your food because then you're diluting those gastric acids that you need to adequately break down food. And particularly like alkalizing waters, like I'm all for alkaline water, but it may not like drinking, you know, massive glass of alkaline water with a heavy meat meal for example may not be ideal. And you know, fluids fill up that gastric space a lot quicker too. Putting upward pressure, particularly carbonated drinks. 'cause you've got the extra bubbles in the gas, you can google lists of foods that are more likely to trigger reflux and have a look at those. If we move on to like lifestyle stress, like, you know I've mentioned numerous times how stress shuts down digestion because you know, diverts blood away from the digestive tract into the extremities so we can do the whole fight or flight thing. So that can compromise digestion and you know, gastric motility, losing body weight to relieve that upward pressure. Consuming smaller meals. So people who do intermittent fasting where they might have like one massive meal or two massive meals a day, that might make some people more prone to reflux symptoms. So keep that in mind. Simple things like if you do have to eat late at night because of, you know, that's life for you and you go to bed, you know, with a heavy sort of stomach of food, you might need to put an extra pillow sort of under your head to sort of elevate the esophagus. Mm-Hmm. if the food doesn't come back up so readily smoking, like it's a known risk factor for gut issues and reflux. I mean acupuncturist, people may not realize acupuncture can be great for increasing gastric peristalsis, increasing gastric emptying and improving the tone of that lower esophageal sphincter. Mm-Hmm , there are things that everyone can do like those food and lifestyle. Yeah, of course. So, you know, have a think about that. But then if you need a higher level of support, certain supplements. So you know, there are supplements that are great for providing immediate relief. So if you're prone to reflux or you know you're gonna have a heavy meal, you might take some of these as a preventative or for relief afterwards. So your demulcent herbs, things like licorice, slippery elm always seems to pop up. Yeah. You love that. Your slippery elm slippery elm's great. Mm-Hmm. For dogs and people. Marshmallow root great for dogs and people, all of these are great for dogs and people. So they form like a coating of the mucus membranes, which is protective and healing. Mm-Hmm. and nutritive as well. We wanna reduce any inflammation of the esophagus and you know, the mucosal tissue, so again licorice, but I always look for a particular type of licorice. It's a deglycerized licorice so it, it's not gonna impact on blood pressure, but it's called gut guard and it's very healing and restorative to the mucus membranes and anti-inflammatory herbs like meadowsweet. So you can even just get a meadowsweet herbal tea and drink, you know, a few cups of that between meals throughout the day. Zinc, but again, particularly zinc carine as the form of zinc is particularly indicated for mucosal healing and repair. Turmeric or you curcumin, I always look for like a clinically trialed one, such as like the C three complex or the meriva or the BCM 95. You've got your glutamines golden seal. Again, any of those mucus membrane restoratives, like, you know, vitamin A, vitamin C. Um, a really important for some patients with sort of who experience reflux, it could just be a hypersensitive reaction. So it's like some people with IBS symptoms, it's not that there's anything going wrong, it's just that they're particularly like, they're hypersensitive to the feeling. Mm-Hmm. . So it feels uncomfortable. So some people with gore, it's not that there's anything going wrong, there's just a heightened sensitivity of anything sort of happening there. And that's often a stress response. So for those people, you know, we may look at dealing with adaptogens and vines to sort of calm that stress response. So things like with thania or ashwagandha, it's known as well. Passion flower skullcap are all great herbs. People might think about meditation and yoga and breathing exercises to sort of calm that sympathetic nervous system dominant response. Things that you can do to improve that lower esophageal tone in a mild bitters like globe artichoke, you know, I love globe artichoke for digestion for people spas, lytics like Kamar can help tone and just sort of keep everything calm and soothing. What else can people do? Digestive enzymes. If we did a whole show on digestive enzymes, so again, by breaking down our food more fully, it's gonna pass through the system more quickly. So they're not gonna sit there and ferment and you know, get gaseous. Mm-Hmm. prokinetics, which are things that sort of help prevent reflux by keeping motility improved. So again, the gut guard, licorice and ginger are great in that way. Mm-Hmm. . And then elimination diet. If someone does all of that and you know, if they wanna sort of an extra step, I usually suggest that they trial like a two week elimination diet. So I'd give them a list of foods that are most likely to trigger reflux. They keep a symptom diary for two weeks, you know, what they eat, how they felt. And then, you know, at the end of the two weeks most people feel significantly better and pretty much have no symptoms. And then we just start to slowly reintroduce foods that they really like. Mm-Hmm. . And just trying to find that balance in that threshold. - So a good recommendation would be that they make time to talk to you. - That would absolutely be the best approach to speak to a natural healthcare professional. Yep. In conjunction with their medical doctor. Mm-Hmm. or their vet. Mm-Hmm. because I like, I don't treat reflux in dogs, but I, you know, I treat a lot of gut issues and dogs on PPIs. Yep. And you know, there are things you need to be cautious of and things that you can do though to support both people and pets who are on acid lowering medications. So, I mean, that's a lot of information. If people have any questions about the show or what we've spoken about today, jump onto the Facebook page. Natural Health for People and Pets. Yep. If you wanna know more about me and my services, jump onto my website, natural health and nutrition.com au. And you can email me at noelle at natural health and nutrition.com au. And there's an email through my website too. So if you just find my website, you'll find me. Yep. - And get ready for some courses coming your way from nelle. - Yeah. So remember on the 20th of February, 2021, I'll be in Canberra doing a full day nutrition seminar just for dogs. Mm-Hmm. . Which is gonna be super exciting. So all that information's on my website and yeah, if you wanna make changes to your body and your health and your weight, stay tuned for January for the 12 week course that you can be part of. Brilliant. Super excited. So thank you everyone. - Okay. Goodbye everyone. - Bye.

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Natural Health for People and Pets Podcast

Episode 10: Health risks of acid lowering medications

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