Don't be burned but heartburn meds

If you’re someone who takes medicine daily, any medicine, it’s important to step back and consider whether you still need to be taking it. I’d also brush up on the side effects. While I’d love doctors to focus on getting patients off unnecessary meds, let’s face it medicine is a business. But if you, or someone close to you, are one of the 15 million Americans who take a certain type of acid blockers, there are some serious side effects.

There is a class of acid blocking (“heartburn”) meds called PPIs. Examples of PPI’s are Prevacid, Nexium and Prilosec. The concerns about taking these meds long-term have been out there; however, almost daily I have a client in my office who feels they’re totally safe.

Whenever I see one of these meds in a new client’s chart I ask a few questions.

How long have you been taking this medication?

Have you tried going off of it?

What modifications do you make in your diet for your reflux or heartburn?

The answers are quite similar. Most clients have been on their acid blockers for a while- usually years. They haven’t tried to discontinue them and they “can eat anything on these meds so there’s no need to change their diets.” Sigh. It’s so backward. The meds are like pain killers; they aren’t improving the condition. And just because you “can eat anything” doesn’t mean you should.

Stomach acid has important functions. We need an acidic environment for maximum vitamin and mineral absorption. On PPIs you see more bone fractures because calcium absorption is compromised. There have been cardiac side effects researched as well. There is an increased heart attack risk on PPIs. There’s also less gut diversity or less “good” bacteria when there’s less acid. Our gut flora is connected to mood and food cravings. Stomach acid helps digestion and prevents infection.

These meds should be used short term or occasionally. If you are interested in going off of your PPIs, you need to wean yourself gradually you can have rebound symptoms. As you decrease your dose, address your diet. For starters, try decreasing alcohol, sugar and caffeine. You can try a spoonful of apple cider vinegar diluted with water before meals. I also like a probiotic, vitamin D and glutamine supplement to restore your gut health.

While I only focused on these acid-blocking medications, talk to your physician if you are interested in discontinuing a particular drug. And yes, there are certain cases where you absolutely need a particular med, even the acid blockers. More often than not, this isn’t the case.

Will this popular, healthy drink make you drunk?

If you’re not kombucha-conscious, kombucha is a fermented tea. It tastes tart and is slightly bubbly. It was been brewed and consumed for thousands of years. Kombucha is made using something called a SCOBY (which I thought was Scooby for the longest time) but stands for symbiotic culture of bacteria and yeast.  And this is what results in a finished beverage teeming with good bacteria and good yeast yum yum.

I’ll admit my bias; I love the stuff. I first enjoyed the gingerade from Synergy, love the blue green from BKkombucha, the cayenne Kombucha from Heathade and most recently fell in love with the milder kombuchas from Organic Avenue. Everyone at our office is dying to try Buchi’s sea buckthorn kombucha. Buchi- can you help us out?

I have always been aware kombucha contains trace amounts of alcohol. But while wine is generally 10 to 14 percent alcohol and spirits 40-something percent kombucha usually is .5 percent. So I was shocked when a client came in saying, “I had a few sips of kombucha and I felt something, was I drunk?” I hadn’t ever heard that, I thought about GT Dave the Synergy brand founder who drinks a gallon or two of kombucha a day “like it’s his job” oh wait, it is.

Back in 2010 there was a blip for the kombucha producers. Many kombuchas were pulled from the shelves. There was investigation into the alcohol content. The more sugar in kombucha the more alcohol it can ferment. Generally speaking the longer kombucha ferments, the more alcohol produced. Companies looked at their protocols to see how they could eliminate the alcohol without compromising the benefits. You can pasteurize and “solve” the problem but in order to have the probiotic benefits, kombucha needs to be raw/unpasteurized. Companies found ways to reformulate their brews, probably changing the SCOBY in order to control the alcohol content. Generally speaking unless in recovery/AA or pregnant continue to knock back kombucha.

Detractors will say “no real evidence” but as a superstar nutritionist (who has been at this for way longer than I have) said on a phone call last week “for many things in our field there will never be studies.” Kombucha is helpful for joint pain (contains building blocks for glucosamine) and helps with digestion (many clients report reflux improvements). Ironically, given the subject matter today, kombucha’s beneficial effect on the liver makes it an excellent hangover remedy.

So why did my client feel loopy? I dug around, spoke to some fermentation experts and there’s something I was unfamiliar with called histamine intolerance. Some people react to fermented foods with symptoms that mimic drunkenness as they lack an enzyme called DAO that breaks the histamine down. You can read more about histamine intolerance here.  There are digestive enzymes you can use if the thought of avoiding fermented foods (which help with mood and cravings not to mention immunity and more) worries you.  My only issue with kombucha is that Lindsay Lohan loves the stuff, ick. Are you a kombucha drinker? Do you make your own? Should I try? Do you have a favorite brand? Any kombucha concerns?

Coffee Talk: Is it good or bad and should you give it up?

I am biased. When I read a study with conclusions in favor of something I like, I am sucked in. Headlines such as “good news for social drinkers”, “how cheese may save your life“ or “the benefits of being glued to your laptop” would get me to read and possibly hunt down and hug the author.  I know to then look at the sample size or research methods and while I don’t necessarily change my behaviors or recommendations, with the study du jour, I can certainly feel vindicated. So a couple of weeks, when I saw “Coffee may help lower depression risk” in the Wall Street Journal, though I’ve never been truly depressed, it felt like “score one for team coffee.”

Coffee can be confusing. It seems to be popular to part with coffee though most people, when pressed, wouldn’t have a good reason for that. In a recent post, one reader asked this question with their comment “It seems that for every article out there that says to go without coffee, there is another article praising the advantages of some caffeine. I don't go overboard, but I really do enjoy a small or medium cup of coffee every single morning. That is where it ends... please tell me what I would gain from giving this up (believe me, it is a point of contention in my household at the moment) Thanks!” Because I’m not convinced we must give it up, I’ll instead present the case for coffee and you decide where you stand.

 I started this with saying I’m biased on this subject and will start with coffee’s “perks”.  When someone criticizes your coffee tell him or her it:

• Is rich in antioxidants (with the “a” word possibly the most overused in nutrition land). Antioxidants prevent oxidation and oxidation leads to aging. This is the proposed mechanism for coffee decreasing a cognitive decline later in life.
• Reduces risk of Parkinson’s disease
• Reduces risk of diabetes
• Reduces the risk of cirrhosis of the liver (which to me means it sort of counteracts your PM glass of wine)
• Reduces the risk of gallstones (which are on the rise in the US) and kidney stones (do you know how painful kidney stones are?)
• Reduces the risk of Alzheimer’s
• Reduces the risk of asthma, caffeine in coffee is related to theophylline, an old asthma medication. Caffeine can open airways and improve asthma symptom.
• Makes you more alert and think better

And let’s be honest, coffee helps you “go”.

Coffee is also a nice little helper when it comes to endurance sports. Coffee can increase the time to exhaustion. Caffeine may alter the perception of how hard you are working. During testing, athletes were asked to judge their effort, which is referred to as the rating of perceived exertion (RPE). Some studies have yielded significantly lower RPE's when the athlete used caffeine. A little trick our runners and tri clients use is to decrease coffee the week prior to a race thereby increasing coffee’s effects on race day. A little caution to non-coffee people, coffee will not help you if you spend half the race in the porta potty. If you are unsure if you tolerate coffee, test it out on a day you have time to spare.

I do suggest being a coffee snob. Coffee is one of the heaviest chemically treated food commodities in the world. The most common chemical used in coffee production is synthetic petroleum based fertilizers that slowly destroy the soil's fertility and seep into local water supplies. It’s important to go organic which will ensure that you’re not drinking fertilizers or pesticides every morning. Other things to look for are shade-grown and fair-trade which guarantees safe growing practices and protection for the farmers using these superior methods. In NYC, I like Le Pain Quotidien’s coffee.

Though I could be the president of the coffee fan club, I’m not an advocate of unchecked caffeination. Two cups is the maximum coffee I’d suggest per day and for the record, like the commenter above, I’m generally a one-cup a day girl. Most afternoons are green tea with the occasional thoroughly enjoyed espresso.  I would cut your coffee consumption if you have palpitations or irregular heartbeats, severe PMS, insomnia, panic attacks or bladder problems. Speaking of sleep, a caffeine cut off is a good idea and I’d suggest 8 hours before bed or 3pm if you go to sleep at 11pm. It can take up to seven hours to metabolize caffeine.  The older we are, the longer it takes.  And if you are on birth control pills or estrogen, the half-life of caffeine may be doubled.  For the life of me, I’ve never been able to understand how some people can have coffee and fall right to sleep.

If there’s one group I worry about coffee with it’s women trying to conceive. There may be as much as a 30 percent increase in early miscarriage of normal pregnancies for women who drink one to two cups of coffee a day.  One study has shown this goes up to 40 percent with four cups.  There’s also concern about caffeine consumption while trying to conceive.  Some studies have shown infertility rates double for women who drink more than two and a half cups of coffee a day. Another “con” for coffee is that it is acidic and therefore not suggested for those with reflux either.

No coffee talk would be complete without mentioning what goes into coffee. While the coffee itself isn’t a problem, adding artificial sweeteners (the pink, blue or yellow) or too much sugar or agave is. I would also suggest organic milk of your choice (dairy, almond or coconut) and not a reduced-fat version. If it’s coffee with skim and Splenda or no coffee, I’m would advise no coffee. I have to run now, I smell that delicious aroma and hear the Capresso snorting (which means it’s done). Are you a coffee drinker? Are you concerned with seeking out organic coffee? Have you considered giving coffee up?

took this photo in the French Quarter, couldn't resist