Letter from Dr. Janson
Heartburn or GERD
Ask Dr. J
In the Health News
Recipe of the Month: Lentil-Lemon Soup
Although the focus on our personal health sometimes seems
trivial and self-centered in the light of larger
world events, it is important to remember that each of us
is as important as the next, and taking care of ourselves
is part of taking care of the entire world community. If we
do our best to lead healthy, fulfilling, caring, enriching
lives, we will be setting an example for those around us.
It may appear to be a small part to play, even trivial, but
each one of us moving in the right direction moves the world
in the right directionand that may be the best that
we can do in creating a harmonious, healthy, and spiritual
In attempting to achieve our own health, we have to rely
on ourselves. When I spoke last year for an audience of insurance
executives, I remembered that many people think that they
buy health insurance from insurance companies. But this is
not the case. These companies sell medical treatment insurance,
to help after you have a problem. And the government also
only finances medical treatment. People dont even get
health from their doctors, as most doctors focus almost exclusively
on treatment of diseasesto be fair, most people dont
go to doctors until they have something that they think needs
However, health is something that you can give yourself.
The way to do this is to take good care of your lifestyle.
You dont need to worry that you might have a genetic
propensity for a disease, because even if it were true, you
cant do anything about that. Most of the time genetics
plays a small role in the development of disease, while almost
90 percent of the time lifestyle choicessuch as diet,
exercise, stress management, participation in cultural and
spiritual activities, and fulfilling relationships and workare
the major determinants of long-term health.
For some people this seems like too much responsibility,
and they begin to feel guilty if they get ill, which is not
at all what I have in mind. I simply mean that we have the
opportunity to do much about our health by choosing to do
so, and thereby influencing our children, family, friends,
and acquaintances. For example, recent reports confirm that
diet and exercise are the best and most cost effective ways
to reverse hypertension, while another report shows that exercise
reduces breast cancer risk. Yet another study suggests that
simple, inexpensive vitamin supplements may be the best way
to prevent heart disease. And another report shows that prolonged
high levels of sugar, a direct result of eating and drinking
sugary foods and beverages, can kill pancreatic beta cells
that produce insulin, and thus may increase the risk of diabetes.
We all have the opportunity to create a healthier world for
ourselves and everyone else. But it involves taking charge
of our health habits and our lives, and setting a good example
for those around us.
So many people have problems with acid indigestion that it
is almost considered a normal part of living. However, it
is not normal, just common. It is related to dietary choices,
among other health habits. You might recognize this because
of the advertising on television, which often juxtaposes ads
for fatty, sugary, additive-laden junk with ads for histamine
antagonist drugs (such as Pepcid and Axid) and acid-neutralizing
drugs (such as Tums and Rolaids).
Antacids are among the most popular drugs in terms of sales,
both by prescription and over the counter. The symptom of
heartburn, or a burning sensation in the chest, is not necessarily
the result of too much acid. It may be that the stomach lining
is not resistant to the effects of the acid, or that the acid
rises into the esophagus, which does not have a protective
This is called gastro-esophageal reflux disease (GERD), associated
with either hiatal hernia or poor functioning of the esophageal
sphincter. Helicobacter pylori, a bacterium associated with
peptic ulcer disease, may not be related to simple heartburn
symptoms, but ulcers can cause the same symptoms.
Symptoms of GERD are more frequent in obese people, and are
aggravated by food allergies, or consumption of sugar, caffeine,
and alcohol. High dietary fiber seems to reduce the symptoms,
possibly by absorbing stomach acid, and helping to push food
through the digestive process. Drinking adequate water is
The stomach acid itself is not necessarily the cause of the
problem, as we all need acid for proper digestion, and heartburn
symptoms also appear in people with low stomach acidity. Counteracting
the acid with drugs can lead to poor digestion in addition
to side effects.
A recent report shows that antioxidants are more protective
of the mucosal lining cells than histamine-antagonist drugs.
This suggests that the condition is more complicated than
just too much acid. In that study, the researchers used an
antioxidant mixture, an antihistamine drug, and a placebo.
They found that the incidence of esophageal ulcerations was
80 percent in the placebo group, 60 percent in the drug group,
and only 27 percent in the antioxidant group.
The researchers suggested that oxygen free radical damage
was the major cause of ulcerations in the esophagus, rather
than gastric acid. You should be aware that the same symptoms
can be caused by a gastric or duodenal ulcer, so you should
have a check-up if the symptoms are severe or persistent.
My first recommendation is to eat a whole foods diet,
with lots of fiber, and lots of vitamins and bioflavonoids
for their antioxidant value. Avoid salty foods, as salt can
increase the growth of H. pylori. In addition, drink at least
6 to 8 glasses of water a day. Be sure to drink either spring
water or filtered water rather than typical tap water (I recommend
the MultiPure solid carbon block filter system, available
from QCI Nutritionals at 888-922-4848, or www.qcinutritionals.com).
Avoid caffeine, sugar, alcohol, and the vast array of highly
processed junk with hydrogenated and reheated oils, artificial
flavors, colors, preservatives, and sweeteners. These are
the least nutritious components of the western diet. Avoid
sodas, which contain sugar and caffeine. Try not to eat just
before bedtime, and eat smaller meals, as overeating can increase
pressure on the esophageal sphincter, leading to reflux.
Try to minimize the use of anti-inflammatory drugs, such
as aspirin and NSAIDS (including Advil, Ibuprofen, Naprosyn,
Celebrex). These are common contributors to ulcers and bleeding.
Unless you have an ulcer diagnosed, it is probably best not
to take any antacid drugs.
Stressful lifestyles contribute to heartburn. It has long
been accepted that stress can lead to ulcers, although it
is not usually the only cause. Do some form of meditation,
relaxation, yoga, or breathing exercises. While exercise is
an important part of overall health, do not do aerobic exercise
immediately after meals, as that can worsen symptoms.
My first supplement recommendation for acute heartburn
and ulcer symptoms is a licorice extract called DGL (deglycyrrhizinated
licorice). Chewing mixes it with saliva, forming a protective
coating of mucin for the lining tissues of the esophagus and
stomach. Chew 1 or 2 DGL tablets before each meal, and at
bedtime, or take them as needed to relieve symptoms between
The next important supplement is the amino acid L-glutamine,
the most abundant free amino acid in the body. This is essential
for the health of the intestinal lining cells, and has been
shown to help heal ulcers and other bowel inflammatory diseases.
Typical doses are 1000 to 2000 mg twice a day, although sometimes
higher doses are beneficial.
Glutamine acts as an anti-inflammatory, but it is also a
precursor for the antioxidant glutathione. As I mentioned,
antioxidants protect against free radical damage to the esophagus.
Other antioxidants that might help include vitamins C and
E, and bioflavonoids. N-acetyl cysteine (NAC) contributes
to glutathione production and free radical control, and it
can help heal ulcers. The usual dose is 500 to 1000 mg twice
Additional valuable supplements include zinc, which promotes
healing, and carotenoids for their antioxidant effects and
benefits in healing gastric erosions. Curcumin (from turmeric)
is an anti-inflammatory herb that also has excellent antioxidant
properties. Typical doses are 500 mg of standardized extract,
2 to 3 times a day.
Q. I have been developing varicose veins as I get older. Is
there anything natural I can do about them? I dont want
A. Veins contain valves that control the direction of blood
flow, and with time they often get damaged, leading to pooling
of blood and bulging veins. This can result from lack of exercise
(exercise helps propel the blood from the legs back to the
heart), and obesity, constipation, long term standing or sitting,
and pregnancy, all of which put extra pressure on the valves.
It is important to do something for varicose veins, because
chronic venous insufficiency with bulging veins can lead to
blood clotting (thrombosis) and inflammation. The calves and
feet can become swollen and painful.
Eating a high-fiber diet can relieve constipation and bowel
pressure, reducing stress on the venous valves. This means
lots of fresh vegetables, fruits, whole grains (whole wheat,
oatmeal, brown rice, millet, and others), and legumes, and
avoidance of white flour, white rice, and sugar. This diet
is also rich in vitamins, minerals and flavonoids.
Strengthening the connective tissue with vitamin C and mixed
bioflavonoids (1000 to 2000 mg daily) is beneficial in preventing
further damage to the veins. Proanthocyanidins (100 mg), found
in grape seed and pine bark, are other flavonoids that increase
small blood vessel strength.
In addition, various herbs have been helpful in managing
vein problems. Horse chestnut extract with 20 percent aescin
relieves edema and improves venous blood flow. The typical
dose is 250 mg twice a day of a standardized extract.
Another herb, butchers broom (100 mg per day of a standardized
extract), is also effective in relieving symptoms of varicose
veins. As with horse chestnut, the active components appear
to be saponins, and the standardized extracts contain known
amounts of these substances. Combinations of these herbs are
available with flavonoids, and often with gotu kola (Centella
asiatica), which helps restore venous connective tissue.
While obesity is related to the risk of type
II diabetes, it was thought that only very obese people were
at increased risk. However, new research shows that diabetes
is more common in direct proportion to increased body mass,
meaning that at each level of increasing obesity there is
a higher incidence of diabetes. (Hillier TA, Pedula KL.Characteristics
of an Adult Population With Newly Diagnosed Type 2 Diabetes.
Diabetes Care 2001 Sep;24(9):1522-7) Previously it was thought
that you had to reach a certain threshold of weight to increase
your risk, but that appears not to be the case. What this
means is that any weight you lose will be helpful in lowering
With age, genes change in their expression, reflecting
the deterioration associated with the aging process. Restriction
of caloric intake in mice (and in other animals in previous
studies) can reverse or delay many of these genetic changes.
(Cao SX, Genomic profiling of short- and long-term caloric
restriction... Proc Natl Acad Sci U S A 2001 Sep 11;98(19):10630-5)
Lower calorie intake reduces the expression of genes associated
with inflammation, stress proteins, and cancer formation.
In addition, calorie restriction enhanced the ability of the
liver to detoxify harmful chemicals. Healthy diets are filling
because of the high fiber content, but they also have a low
Breast feeding for at least six months appears
to help cognitive function in infants at 13 months and at
5 years old. (Angelsen NK, et al., Breast feeding and cognitive
development Arch Dis Child 2001 Sep;85(3):183-8) DHA (docosahexaenoic
acid), an essential fatty acid, is important for neurological
development. DHA from fish oil can be added to an infants
diet. (DHA is also valuable for adults brain and heart
One of my favorite ethnic dishes is a simple tasty soup. Sauté
chopped onions and celery (with some leaves for extra flavor)
in a small amount of olive oil and some added cumin. Add green
lentils with at least 4 times as much water as beans, and
make sure there is always adequate water to make a soup (although
if it gets thick you can call it a stew). Add chopped green
chard or another green and simmer until the lentils are done,
which is usually about 45 minutes, but check them regularly,
and stir to avoid burning. Before serving, add fresh-squeezed
lemon juice to taste. Serve this with some whole wheat bread
or rice cakes, and a side of salad, and you have a delicious,
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