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Americans are using more and more medications. As a physician who prescribes these medications, I am greatly relieved to finally have alternatives to offer my patients.
This past week (May 2014), the Centers for Disease Control published the results of a study showing that the proportion of Americans on at least one prescription medication has increased from 39% to 48% in the last 15 years. A quarter of all children are also using prescription medication. And each patient is on an increasing number of medications. The total number of prescriptions in the United States increased by 39% between 1990 and 2009, while the population only grew by 9%.
Most people I meet dislike taking pills. As their physician, I worry about unexpected side effects and interactions between drugs. I would much rather take people off medications. Using the tools I learned training as a functional medicine physician, I take the approach of reversing chronic illness in my patients, so that they will no longer need the medications previously prescribed.
Here are three main reasons to get off medications, or avoid using them entirely:
- Symptoms indicate a deeper imbalance — masking them won't make you healthy, it will just give you temporary relief, or improve your numbers
- Medications have side effects, some of which only appear after prolonged use
- You gain a sense of confidence in your body when you can deal with discomfort without the use of chemicals
You can learn ways to avoid prescription and over-the-counter medications. In future posts, I will address pills for high blood pressure, high cholesterol, diabetes and prediabetes, acute and chronic pain, allergies and asthma, infertility, depression, anxiety, and insomnia.
If your doctor has prescribed anti-epileptic drugs, antipsychotics, disease-modifying anti-rheumatic drugs, immunosuppressants, migraine medications, thyroid supplements, drugs for osteoporosis, or a number of others, getting off medications will usually mean finding a local functional medicine provider who can unravel the source of your problem and see how else it can be addressed. You can find one on the website of the Institute for Functional Medicine.
Let's start with heartburn.
Many people use medication for heartburn daily or intermittently. Most of these are available over the counter. One can buy antacid chewable tablets like Tums, or histamine-2 receptor blockers like Tagamet, Pepcid, and Zantac (also called cimetidine, famotidine, and ranitidine, respectively). The strongest antacids are the proton pump inhibitors (PPIs), Prilosec, Nexium, Prevacid, and others, also called omeprazole, pantoprazole, aripiprazole, and so on. As I was writing this article, I got a call from a pharmaceutical representative wanting to fax me information on a new PPI. Interesting coincidence!
Why would you want to avoid these medications?
PPIs eliminate the stomach acid that we need to digest food and absorb nutrients, including vitamin B12, iron, folate, zinc, magnesium, calcium, vitamin A, vitamin D, and amino acids. PPIs were initially approved for a genetic condition called Zollinger-Ellison syndrome, which causes the release of massive amounts of acid and eventually results in recurrent multiple ulcerations of the gastrointestinal tract. When PPIs were first used for regular peptic ulcers, physicians were cautioned to discontinue use after 6-8 weeks and instructed that they only worked for ulcers and not for heartburn. Then gradually more and more patients found themselves on extended courses of PPIs, for an ever-expanding list of symptoms. However, humans have not, in the meantime, found a new way to digest food! Studies show that the chronic use of H2-blockers and PPIs are correlated with vitamin B12 deficiency, and also with increased incidence of food allergies (improperly digested food can lead to allergies).
What's more, the use of these medications in infants has increased dramatically in recent years, in spite of the fact that studies show no efficacy over placebo. A certain amount of spit up (quite a bit, in fact) and fussiness is normal for babies, so it's hard to tell if there is a problem on your hands. But even studies that try to define "normal" found that "abnormal" babies rarely benefit from medications. If antacids increase the risk of food allergies (a problem that can be deadly!) and vitamin/nutrient deficiencies, shouldn't we require excellent proof that they work? Medical care is still very much affected by the placebo effect (in this case, placebo effect via the caregiver, which is much stronger than you would think — younger children have the highest rates of placebo response). This is fine as long as the intervention is benign, but a serious problem when there is a significant potential downside.
One interesting issue is that these medications do not actually block refluxing stomach contents. Patients continue to have reflux, but they can't feel it anymore. If you have Barrett's esophagus (a precancerous condition caused by reflux), your doctor will prescribe PPIs, but the evidence that they work to prevent progression to esophageal cancer is not very good. It is based on observational studies and not placebo-controlled studies. I think it would be best to figure out the underlying cause for reflux and reverse the condition.
Here you want to exercise caution: there are certain specific medical conditions, such as gastritis or esophageal stricture, that require the use of acid blockers, at least temporarily. Before you stop using these medications, consult with your doctor to make sure there isn't an important reason you must continue them.
The first step, whether you are on medication or not, is to change your diet. You need to change the types of food you eat, the total number of calories, and the spacing between meals.
Gluten-containing foods and dairy are very common causes of heartburn. This can happen even if the heartburn is not actually connected in time with the consumption of gluten or dairy products. So the first step is to remove them from your diet for 6 weeks.
Another cause is the condition called SIBO (Small Intestinal Bacterial Overgrowth), a well-described but often overlooked condition. It responds to a very precise diet called the low FODMAP diet. Details are freely available online.
Eating large meals causes reflux by simple mechanical upward pressure. The solution is to eat until you are 80% full, and then stop. Try that for 6 weeks, see how you like it. Some people get a sense of freedom from this approach. They feel lighter, gain energy, and save on food costs!
Finally, space out your meals. If you have a diagnosed peptic ulcer, this may not work as well, so ask your doctor. However, we have been told that the normal eating pattern should be to eat something every 2-3 hours, which means 3 meals and 2 snacks, in order to avoid becoming overly hungry before the next meal and overeating as a result. But this is true only if you're eating or drinking sweet foods (including juices) or refined carbohydrates. If you eat a meal with 15g of protein (and almost every meal should have this much — more for taller people), and also include a cup or so of fresh fruit and vegetables and some healthy fats (from nuts, avocado, olives, coconut), and thus crowd out starchy carbohydrates and added sugars, then you will not be hungry for several hours. You need 3 hours for the body's mechanism for moving food along down the intestine to kick in. Digestion then proceeds much more efficiently. A 12-hour overnight fast provides additional benefits.
There's more you can do to improve digestion: remember that this is a bodily function that is suppressed by stress. Eating on the run, in cars, in conflict situations, while reading upsetting emails or watching distressing news — these activities are not conducive to digestion. The food will sit there, gas may accumulate, and you won't feel good! Too much fat in a meal can also have this effect. The solution is to plan a balanced meal, to stop for a moment (just a minute or two) before you start chewing and take a few deep breaths, to savor the sight of the food, to think about where it came from, and to feel gratitude for those who grew and harvested it and those who prepared it (hopefully someone who cares about you!). Put down your fork or spoon between bites; enjoy chewing; notice the flavors. We know the nutrients will be better assimilated. Health has been defined by Dr. Joel Fuhrman as calories divided by nutrients. You really want to make the most of the nutrients on your plate and the pleasure of the experience.