The IBS and GERD connection

The Cometa Wellness Center

Gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) are very common disorders in the general population. Symptoms of IBS are commonly encountered in GERD patients, and symptoms of GERD are not uncommon in IBS patients. "GERD and IBS may be two distinct manifestations of a similar underlying pathophysiologic process that can affect different levels of the gastrointestinal tract. ...the reason for the overlap observed between GERD and IBS remains to be elucidated..." I quote these words because I read them over and over again in the medical literature. The "overlap" observed between disease states in the human body will always be illusive in the medical paradigm where the body is broken down into parts! The specialization of medicine has made it very difficult for a person to be viewed by the doctor as a WHOLE person.  I quote the old adage...

                                        'View the forest not the trees'

The most important thing to remember when it comes to your digestion is that it is responsible for digesting your food! Gut mucosal integrity is essential for both competent digestion and the correct absorption of nutrients. Factors such as digestive enzymes, mucus, bacterial flora, and low pH (yes! an acidic environment!), are integral to mucosal integrity, health and function. Proton-pump inhibitors (i.e. the stomach acid-inhibitors such as Nexium, etc), NSAIDs (e.g. Motrin), steroids, antibiotics and poor dietary habits are examples of culprits that breakdown the first line defense against hypersensitivity to food proteins, as well as the aid we need in digestion and nutrient absorption.

What the current medical literature DOES NOT tell us about GERD

For those whom suffer from GERD, you should know there are no studies to document that GERD is an 'excess acid production' problem. The acid is simply stagnant with the food in your stomach (i.e. a delayed gastric emptying rate) and moving up into the esophagus rather than down from the stomach into the small intestine in a timely fashion. This is due to a breakdown in the functional gut mucosal integrity cited above. The fundamental abnormality in gastroesophageal reflux disease is exposure of the esophagus to acidic gastric contents, resulting in injury and/or symptoms.

As we understand GERD, there are now 2 known types of this disease. The most well established type is erosive esophagitis, (EE) where there is inflammation and the potential for Barrett's esophagus (i.e. esophageal cancer potential). This disease is correlated with regurgitant esophageal acid exposure, NOT excessive stomach acid production! There is also a second type of GERD, known as non-erosive reflux disease (NERD). This version of GERD is actually more predominant and accounts for over 50% of gastroesophageal reflux. Patients with NERD have typical reflux symptoms caused by the esophageal reflux of gastric contents but have no visible esophageal mucosal injury. This is in contrast to patients with erosive esophagitis and Barrett's esophagus, who have obvious esophageal mucosal injury on endoscopy.

IBS and GERD

It is the more common nonerosive gastroesophageal reflux disease (NERD), which frequently has features of irritable bowel syndrome (IBS). Irritable bowel symptoms are hence often associated with reflux symptoms, but not necessarily with acid exposure. Recent studies have demonstrated that GERD patients who also suffer from IBS-like symptoms perceive their GERD-related symptoms as more severe and are less likely to respond to anti-reflux treatment, as compared with those without IBS. The presence of both IBS and GERD in a patient is considered a likely explanation for "the failure" of proton pump inhibitors to treat GERD.

Although acid reflux gives rise to similar symptoms in both NERD and EE patients, the underlying mechanism of acid injury may be different. A breakdown in the mucosal integrity of the esophagus predominates in NERD and resembles the gut permeability disorder we reviewed in the June 23, 2010 blog, "Treat IBS Naturally and Effectively". Remember from this review that there are tight junctions between the cells that line the gut mucosa. These tightly adhered cells form the primary barrier between the external environment (e.g. our food) and the internal environment of our body. We now know from clinical research that "dilated intercellular spaces may be responsible for the enhanced perception of proximal acid reflux and that these dilated intercellular spaces are a feature of NERD patients, irrespective of esophageal acid exposure". These mucosal changes are considered an objective, structural marker of reflux symptoms. Through the food allergy response described under Food Intolerance in the June 23, 2010 blog, the food intolerant person slowly looses the tightly regulated mucosal immune response that protects them from untoward micro-inflammation. This leads to structural changes in gut mucosal integrity. This sounds an awful lot like the "dilated intercellular spaces" described in the medical literature that are now considered a structural marker of reflux, but NOT always related to esophageal acid exposure. The presence of IBS features in a large proportion of NERD patients reflects a high prevalence of visceral (i.e. gut) hypersensitivity that may aggravate acid reflux symptoms. Do you think there is a connection between food sensitivity/allergy, IBS and GERD pathophysiology? Of course!

Those nasty Proton-Pump Inhibitors!

GERD patients with a poor response to acid suppression treatment are seen a lot. Even double proton pump inhibitor dosing does not relieve symptoms in many patients with GERD. The literature clearly states that current definitions of acid reflux require review and the precise role of acid in NERD (type 2 GERD) needs further clarification.

Yes, proton-pump inhibitors may wipe out GERD symptoms, by taking away the acid production naturally found in the stomach. Yes, they also reduce esophageal exposure to acid and consequently reduce the incidence of Barrett's esophagus. But, would it not be better to keep Mother Nature's plan, and allow the acid to reside in the stomach? Would it not make more sense to help the acid do its job in a timely fashion, by facilitating digestion and the normal propulsive forward motion of food through the digestive tract? Let's look at what we do when we inhibit stomach acid production. By inhibiting acid production, we are:

• 1. Inhibiting the first line defense our body has to kill pathologic bacteria that has entered the stomach from the mouth.
• 2. Inhibiting the production of enzymes that are low-pH (acid) dependent in the stomach and small intestine.
• 3. Inhibiting the essential breakdown of food in the stomach before it continues into the small intestine.
• 4. Likely reducing the ability of the lower esophageal sphincter (thought to be acid sensitive for its closure) to close and hence increasing reflux!

Note, that by taking Nexium-like drugs, one is not only is often UNABLE to address NERD, BUT is also breaking down the first line defense to disease in the gut! Does any of this sound like a good idea? NO!

Natural Approach towards GERD for disease cure, not symptom suppression!

Integral to most of the GI support programs I have successfully implemented in my medical practice, is the recognition and treatment of food intolerance. The loss of food tolerance leads to hypersensitivity. Such food hypersensitivity can lead to an array of gastrointestinal disorders. The many causes of food intolerance are still a quandary to conventional medicine. This is not the case for those of us that implement natural medicine. One very common type of food intolerance is food allergy and/or sensitivity. Whether it be GERD, IBS, Colitis, Gastritis, Peptic Ulcer Disease (PUD), or any combination of the above, the identification of food allergy in that patient is imperative. Food allergy and sensitivity testing is available at The Cometa Wellness Center. One does not need to be a patient with Dr. Cometa to take advantage of this very useful testing available at the Center. Call the Center at 410-296-6100 if you would like to be tested.
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Stay tuned to The Cometa Wellness Center blog with drcometablog.com to learn how correct nutritional and herbal support can enhance your Gut Integrity and Digestion/Nutrient Absorption.

Ariane Cometa MD, the holistic doc
The Cometa Wellness Center Pharmacy

The Connection between Osteoporosis and Atherosclerosis: Calcified Bones NOT Arteries

The Cometa Wellness Center
Have you ever wondered why so many aging people have calcified plaque in their arteries and yet walk around with brittle bones that are markedly depleted of calcium? Vitamin K2 is the link between these diseases. Vitamin K2 will be discussed shortly.

                                      Healthy Bone Turn-over

Bone is a dynamic, living tissue that is continuously remodeled. As old bone is resorbed by osteoclasts (cells that break bone down), the "old and stressed" bone is replaced with healthy new bone by osteoblasts (new bone cells). DO WE WANT TO INHIBIT RESORPTION? Of course not. Say "NO!" to Fosemax! Why? I will tell you why.

Bisphosphonate drugs (e.g. Fosemax and Actonel) increase the Bone Mineral Density (BMD) of the bones at the expense of our bone quality. Such drugs reduce the activity of osteoclasts through cell death. These drugs act as an osteoclast poison. This is how the drugs slow resorption of bone. In addition, they do not increase the activity of osteoblasts (new bone cell growth). As a result, these drugs maintain "older" bone with poorer architectural quality. As old bone is NOT torn down and the osteoblasts continue to build new bone, the bone is more brittle, therefore the QUALITY of the bone will naturally be diminished and weaker.

 Medical research documents that WE WANT Bone Quality, not just Quantity:
1. JAMA Commentary article, March 26, 2008; "In an effort to prevent fractures, do we pay too much attention to BMD (quantity) at the exclusion of what improves the vitality or quality of bones?"

2. JAMA 1998 article; "The antifracture benefit of bisphosphonates in women with low bone mass but without prevalent fracture must be judged to be small".

3. NIH in 2001 defines bone strength as a combination of BMD and "bone quality". "Bone quality is a vague entity and BMD is widely over emphasized".

Bisphosphonates may increase BMD, but at what expense? The answer is in the value of Vitamin K2 and Strontium. Let's start with Vitamin K2.

                                               The Vitamin K's

•  1929, Danish Nutritionist discovers Vitamin K1
• "K" for koagulationsvitamin
• "The clotting vitamin".
• In the 1970's, the discovery of many non-clotting Vitamin K2 dependent proteins were found ubiquitously in the body, including the bones and the vessels.

                                                  Vitamin K2
                                      How is Vitamin K2 different?

•  Menatetrenone is Vitamin K2, not Vitamin K1.
• Vitamin K2 is deficient in the American diet, with only tiny quantities available in goose liver, butter and egg yolks.
• Vitamin K1 conversion to Vitamin K2 does occur minimally in our bodies. Plus, this conversion slows down with age.
• Vitamin K2 is a GREAT bone builder.
• Clinical trials have shown that Vitamin K2 provides bone protection beyond the BMD numbers.

There are many Vitamin K2 dependent proteins. Vitamin K2 activates important proteins in the body. Osteocalcin is one of these very important proteins. This protein binds calcium (once activated by Vitamin K2). Calcium from all over the body is then transported from the bloodstream into the bone matrix. Sounds pretty important to me! Vitamin K2 is nature's calcium chelator!

Over the last decade, randomized, controlled human, animal and in-vitro studies have consistently demonstrated that K2 supplementation protects bone health.

• Deposits bone into the bone matrix.
• Prevents prostaglandin E2 (PGE2) mediated calcium loss AND PGE2 production.
• Reduces osteoclast (cells that break bone down) formation from stem cells (but does not poison osteoclasts).
• Promotes osteoblast (new bone cells) maturation and activity through effects on gene expression.

                                BMD does not equal Bone Quality

• Vitamin K2 increases strength, improves the structure and boosts the mineral content of bone.
•  It does this while it maintains or improves BMD.
• Women's risk of fracture slashed with Vitamin K2 is comparable to bisphosphonates.

                              Bridging the vessels and the bones

Have you ever wondered why so many aging people have calcified plaque in their arteries and yet walk around with brittle bones that are markedly depleted of calcium? Vitamin K2 is the link between these diseases. Vitamin K2 deficiency is an epidemic in the country as is Vitamin D deficiency. Vitamin K2 availablity decreases with aging. As a result... osteocalcin is not able to bind calcium and transport it to the bone matrix. This is one reason why calcium accumulates in the arterial wall. But there is more to the story....read on!

                                       From Bones to Vessels

In Vitamin K2 deficiency, not also is the important Vitamin K-dependent protein, osteocalcin, underactive, BUT so is another important Vitamin K2 protein called Matrix G1a protein. This essential K2 dependent protein is an inhibitor of arterial calcification. So, in addition to ineffective transport of calcium into the bone matrix, we cannot prevent or inhibit arterial calcification. Youch! What do we end up with?

                                          Calcified Vessels!

 Increasing evidence reveals that the Vitamin K-dependent calcification process is ubiquitous. Therefore in Vitamin K deficiency... we literally ossify the plaque of our arterial wall rather than our bone matrix!

                              How do we find Vitamin K2?

Vitamin K2 is rich in the Japanese diet. Natto is a traditional Japanese food. It is a fermented soy condiment. Vitamin K2 is extracted from Natto and is purified of all it's soy content and grown through fermentation with the probiotic Bacillus, natto. It is very biologically active. Natto is the richest known food source for Vitamin K2. Eastern regions of Japan eat a lot more Natto. Research has demonstrated that these women, who eat more Natto, have far fewer fractures than their western neighbors. Pure Natto resources can be found in Japanese groceries. Since Natto is not available in your local grocery store, and we do not live in Japan, let's talk about Vitamin K2 supplementation.

                                        Vitamin K2 Dosage

• Vitamin K2 30-45 mg daily in divided doses with meals.
• Pure Natto resources found in Japanese groceries.

There are many reasons to address this problem naturally. The most important reason is that by naturally correcting your bone metabolism issue, you have corrected the problem. Of course the correct diet and weight bearing activity program are integral to the bone health program recommended below.

Let Nature and Lifestyle improve Bone strength. Nature addresses the age-related decline in bone formation.
                                                             
                                              Lifestyle

• A diet high in lots of fresh vegetables and lean meats is great for bone formation.
• The diet should be low in sugar, soda, caffeine and NO SMOKING. These ALL leach out important nutrients or worse, poison the bone cells (osteoblasts).
• Exercise: Power walking and using light 2 pound weights in the hands when you walk can be very helpful. Try to do this 30 minutes, 3-5 times a week. Exercise helps us with Proprioception, which helps with balance, coordination, mobility and strength.

                               Natural supplements for Bone Health
                                 You must not be on Coumadin to follow this program.
          Available at The Cometa Wellness Center Pharmacy

• Peak K2, 15 mg/capsule. Take 1 capsule twice daily with meals
• Vitamin D3 such as Vitamin D3 1000 IU or 5000 IU. Take 1 capsule daily with a meal.
• Well-balanced Bone mineral supplement such as Osteosheath, 2 capsules twice daily with meals.
• Treatment can be safely started while on your Osteoporosis medication.

Also, for those of you who have Osteoporosis, please add Strontium. We will review the value of Strontium and Vitamin D3 in the reversal of Osteoporosis in upcoming blogs.

• Strontium, take 2 in the AM 1 hour before all medication, supplements and food.

Doctor's message:

I have been 100% successful in reversing early bone loss AND Osteoporosis with the above recommendations. Please consider how important your bone health is for longevity and quality of life as we age, and keep those bones "truckin".

Ariane Cometa MD, the holistic doc