The Myth of a Pill for Every Ill

Having recently had the honor of speaking with Jack Lalanne, truly a pioneer in wise lifestyle choices with a life-long focus on fitness and nutrition, he made an intriguing statement that he had lived long enough, recently celebrating his 96th birthday, to have those who initially called him a quack and charlatan for his emphasis on regular physical activity and wise nutritional choices including the use of supplements to now acknowledge his innovative wisdom. Clearly, Jack is a man whose emphasis on lifestyle rather than unnecessary medication was years ahead of its time.
Several years ago the debacle of Vioxx and Celebrex, acclaimed initially to be miracle drugs for pain relievers and then linked to tens of thousands of heart attacks and other adverse effects, prompted a mainstream press to focus on an under appreciated concept. The New York Times and other consumer press began to initiate the conversation of “risk to benefit ratio.” That is, consumers were informed they had an obligation to assess the potential benefits of using a medication (or any remedy for that matter) to the possible risks to their well-being.
We all learned that a leading cardiologist, Cleveland Clinic’s Eric Topol, MD, had refused to prescribe Vioxx for his patients who had a risk of heart disease because he knew the research confirmed the risks outweighed the benefits for those with arthritic pain who had heart disease. Truly, that was a paradigm shift for many Americans. We all see, read, and hear the ads touting the benefits of prescription drugs but it as important if not more important to assess the potential risks in order to make an informed decision if the medication is right for you.
It is tragic the mainstream press continues to ignore the concept of “drug induced nutrient depletion.” Pioneering pharmacists including Ross Pelton, RPh and Jim LaValle, RPh produced books and databases to educate professionals and consumers that drug side effects are often linked to the nutrients depleted or impaired by the consumption of medications. For example, beta carotene, vitamin B6, folic acid, vitamin C, vitamin D, calcium, magnesium, potassium, selenium, and zinc are depleted by the use of steroid medications. Proton pump inhibitors such as Protonix and Nexium deplete the body of beta carotene, vitamin B1 and B12, folic acid, calcium, and zinc. Clearly, nutrient depletion is a risk of medication not often taken into account when making a decision to use that prescription.
A new paradigm shift appears to be making its way into the mainstream lexicon. In July 2010 the Annals of Internal Medicine printed a discussion of the over-diagnosis and over-treatment of prostate cancer. It is becoming increasingly clear that those who ignore the advice of Stanford University researchers who term routine PSA screening as “clinically useless” and the continued screening and treatment of men after age 70 for non-aggressive prostate cancer are not helping men to live longer and live better. USA Today in an article printed October 25, 2010 entitled “Don’t stretch your hand for the pills” continues along these lines stating “not every illness requires a trip to the doctor and some ailments can be prevented altogether.” That is a huge mind-set shift for the generations of Americans culturally conditioned since the 1950s that “there was a pill for every ill.”
For example, some of the most commonly used over-the-counter medications and prescription drugs in the U.S. are used for heartburn. Heartburn can be related in many cases to the lifestyle choices we make each day.  The work of Denis Burkitt, MD, pioneering British researcher who focused on indigenous cultures that failed to get many diseases industrial cultures acquired from processed foods.  This was also pointed out by Neal Barnard, MD in his book “The Power of your Plate” that Americans fail to eat the amount of fiber and balance of insoluble to soluble fiber humans evolved eating. British epidemiologists have pointed out that man evolved eating 100 grams of fiber daily. When society shifted to industry and city-living from farming, fiber consumption dropped to 50 grams daily. It is estimated that Americans get 10-20 grams of fiber daily eating the typical Western diet. The lack of fiber is linked to heartburn and reflux, constipation, hemorrhoids, and varicose veins to name but a few conditions. Couple that with Americans who often carry too much weight and often around their mid-section, routinely eating overgenerous portions, and eating up until bed-time and we have a recipe for many Americans to have symptoms of heartburn.
Additionally, Americans’ diets are often carbohydrate rich and protein poor. If we fail to get normal amounts of protein each time we eat, the stomach acid production triggered by eating lacks the substrate on which to work. A local medical doctor whose practice focuses on lifestyle medicine states many patients who suffer from heartburn no longer do so when they try to achieve 0.8-1.0 gram of protein/2 pounds of body weight.
The natural health literature is replete with science that there are alternatives to medications that suppress stomach acid production. Andrew Weil, MD recently stated “I have no experience using orange peel extract (d-limonene) for heartburn so I checked with Tieraona Low Dog, M.D., director of the Fellowship at the Arizona Center for Integrative Medicine, and an authority on botanical medicine. She told me that she does recommend d-limonene for treatment of heartburn and has found it very effective. Dr. Low Dog said that d-limonene stimulates esophageal peristalsis, helping move acid and liquids back into the stomach. She recommends buying it as orange peel extract in 1,000 mg doses (standardized to d-limonene 97-99%) and taking it once a day every other day for a total of 10 doses over 20 days. After that, take it as needed.”
Renowned naturopathic physician Mary Bove, MD teaches patients about making lifestyle changes along with natural remedies that may include a form of licorice herb known as DGL. “The use of deglycyrrhizinated licorice (DGL) before meals will soothe and heal the esophageal tissue, thereby decreasing inflammation and ulceration. This form of licorice is safe for people with high blood pressure to use. A standard dose would be 350 milligrams (mg) to 1,000 mg three times per day with meals.” Dr. Bove speaks that there is no magic bullet for those who suffer from heartburn and reflux but there are lifestyle changes that do help. “Improving digestion in the stomach to strengthen and support the esophageal valve, HCL secretion and stomach-emptying is the first priority. Bitter herbal tinctures such as chamomile (Matricaria recutita L.), meadowsweet (Filipendula ulmaria), barberry (Berheris vulgaris) or common dandelion root (Taraxacum officinale) taken in the form of 1/2 teaspoon in a little water before meals is one way to improve digestion. Dietary modifications that can help people with GERD include avoiding fatty foods, processed flour and grain products, coffee, tomato products, chocolate, citrus juices, large meals and over-drinking with meals. Food sensitivities, intolerances or allergies can also be underlying causes of reflux disease, so it is important to identify, if they are part of the picture.”
Dr. Bove and many other integrative practitioners point out the symptoms of too much stomach acid are those of too little stomach acid. Taking over-the-counter acid suppressing medications or even prescription medication such as the proton pump inhibitors can worsen the situation if the symptoms are the result of too little stomach acid.  Integrative physicians such as Jonathan Wright, MD have long used the Heidelberg gastrogram as a non-invasive science-based tool to measure the stomach acid as well as other factors such as stomach emptying time. Dr. Wright recently wrote an excellent book on this very topic published by Praktikos Books entitled “Your Stomach: what is making you miserable and what to do about it.”
The potential risks of long-term use of these medications are just now emerging. The Wall Street Journal had a special section devoted to heartburn printed in 2006. It mentioned University of PA research regarding the dangers of bone thinning with the use of acid suppressing medications. It also mentioned the long-term increased risk of esophageal cancer if these medications are used routinely. The British Medical Journal published research that there was an 80% increase in respiratory infections with the long-term use of acid suppressing drugs. According to a report published in U.S. News, “One study found a 74 percent increase in risk of infection with a harmful intestinal bacteria called Clostridium difficile for those taking a daily prescription-strength PPI, while another found a 25 percent increased risk of fractures in postmenopausal women who used PPI’s.”
Stomach acid is critical for digestion and maintaining a balance of flora in the gut for good health. Yet, ads routinely demonize stomach acid as the enemy to be suppressed at any cost. That is a risky concept for those who want to maintain good digestive and immune health.   Perhaps the mantra for Americans in the year 2010 should be “It’s your lifestyle. Make wiser choices and you may no longer suffer from symptoms of chronic disease.”
Deborah Ray, M.T. (ASCP)