Email: monica.rempen@gmail.com | Phone: 505-615-7972
DR. MONICA REMPEN - Doctor of Oriental Medicine
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Chronic Heartburn

11/17/2014

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Have you ever noticed just how often food related commercials are intermixed with commercials for heartburn medications? The take away being that you can continue eating as much of the foods that are likely causing your pain, as often as you would like, if you take some type of heartburn medication.

It seems that if we stay attuned to the general consensus, stomach acid is an unnecessary burden on the body and something that should be constantly tamed or neutralized. So, have another Tums or some more Prilosec and all will be well. 

In reality this couldn’t be farther from the truth. Stomach acid is a much needed and highly under appreciated part of our digestive system, crucial for the process of digesting and sterilizing everything we eat. The pH of the stomach should be quite acidic. The pH should be between 1 and 3 in the presence of food. The stomach is designed to handle that highly acidic environment without any discomfort or pain.

Now, if this is so, why do so many people have heartburn? The commercials might leave you thinking folks are producing too much acid! So, let’s look at the physiology.

The low pH in the stomach is the trigger for several processes in the digestive tract. First, the high acid levels stimulate the complete closing of the sphincter between the esophagus and the stomach.  This prevents refluxing food and gastric juices back into the esophagus where the acid would burn and damage tissue. The higher the acid content of the stomach the more tightly this is triggered to close. So, if the pH is higher than 3, which is more alkaline and less acidic, the sphincter may not close tightly and when you bend over or lay down heartburn is more likely. This is the most common cause of heartburn.

The low pH, highly acidic environment of the stomach also sterilizes the food we eat, killing bacteria, virus, and parasites. This prevents them from entering the small intestines where they would have a high likelihood of contributing to and causing health problems. It is estimated that 1/3 of the population of the US has chronic issues with parasites. It is well documented that a common issue with long term use of antacids and acid blockers is increased infections.  

So, what happens further down stream, through the rest of the digestive process? The pH of the food that moves from the stomach into the small intestines stimulates the release of bile, bicarbonate, and pancreatic enzymes into the small intestines. This neutralizes the acidic food and brings the pH of the small intestines near 7 (a neutral pH). This allows for normal healthy digestion of your food as it is processed through the rest of the small intestines. This also insures a healthy environment for the beneficial flora of the intestines.

So, what would happen if the pH of the stomach were only 5? This is still an acidic environment but the LES (lower esophageal sphincter, between the esophagus and stomach) may not close completely. Food or gastric juices may reflux back into the esophagus and at a pH of 5 this will still cause pain and damage tissue. This is not the only concern; the food moving into the small intestines will not be acidic enough to cause the release of bile, pancreatic enzymes, or bicarbonate. The pH of the small intestine will not neutralize and complete digestion of nutrients will not be efficient. Over time, repetition of this process will lead to nutritional deficiencies. The health of the beneficial flora will also be compromised. The nutrients that they create will over time become deficient. Harmful bacteria will have the opportunity to thrive in the small intestines. The aspect of the immune system that is dependent on the health of the flora will be weakened. Opportunistic infections will become more likely and overall health and vitality will decline.

With this, there is an increase in a vast number of health concerns that seem to have no connection to the digestive tract. Keep in mind we are now looking at the effect of nutrition deficiency and increased inflammation, not a lack of calories. So, the list of related health concerns is quite long and can include issues from body aches and pains, to insomnia, depression, anxiety, fatigue, headaches, and skin issues – including acne, hormone imbalances, auto immune issues, osteoporosis, arthritis, and more. And, of course, you may see the common GI relates symptoms, but you may not.   

Our acid blocking medications were never meant to be used long term. And, yes, at times they are absolutely necessary. It may be wise, however, to look for other solutions. Is stress too high? This can suppress digestive processes in most people. Are there foods in the diet that the body is reacting to? Eating foods that are inappropriate, whether because they are highly processed foods (which are not appropriate for anyone), or foods we are allergic or sensitive to, can cause chronic heartburn. Individualized food allergies or food sensitivities are common with many chronic health issues. We tend to think of certain foods as healthy, but they may not be for everyone. Often an elimination diet or simple testing will clarify issues. And, as we get older, production of stomach acid declines in most individuals; by the age of 50 stomach acid production may have declined by 50% or more. That, compounded with high stress, processed foods, and food sensitivities, is a great recipe for heartburn.  

If you find you are often reaching for the antacids, it might be time to consider looking for the underlying cause and addressing that for long term health and happiness!

Best regards – Dr. Monica Rempen

References:
Textbook of Functional Medicine , Guyton's Textbook on Human Physiology, Robbins' text on Pathology
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Cold and Flu Season

4/28/2014

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In 1942, The American Medical Association stated, “The consumption of sugar and other relatively refined carbohydrates has become so great during recent years that is presents a serious obstacle to the improved nutrition of the general public.”

The average consumption of added sugars was estimated to be less than 5 teaspoons, this was less than 20 grams per day in the 1940’s.

Currently, Americans consume an average of about 22 teaspoons of added sugars per day (for reference: 24 teaspoons is ½ cup).  At 4 grams per teaspoon, this comes to about 88 grams of added sugars per day. 

A study recently published in the Journal of the American Medical Association concluded that sugar intake significantly contributes to poor health.

I have yet to have a conversation with a patient who doesn’t understand and  agree that excess sugar consumption will result in serious health concerns.  However, when we discuss the statistics on the amount of sugar consumed per year, they tend to believe the statistics reflect all of the other Americans; not themselves.

And who can blame them?  Who would sit down at breakfast, lunch, and dinner and shovel in more than 7 teaspoons of sugar at each meal?  You probably wouldn’t do that because you’d view it as horribly unhealthy, yet the average person does exactly that every day without realizing it! 

Following is a list of a few common processed food items, and their average levels of sugar from the US Department of Agriculture's Nutrient Database:

Plain bagel (1/2): 5.05 grams of sugar
Whole-wheat bread (one slice): 5.57 grams of sugar
Soda (12 ounce can): 38.97 grams of sugar
Pasta (2 ounces): 42 grams of sugar
Bowl of corn flakes: 6.11 grams of sugar
Fruit-flavored yogurt (6 ounces): 19 grams of sugar
Italian salad dressing (1 teaspoon): 8.85 grams of sugar
Granola bar: 21.8 grams of sugar

Added sweeteners:
Table sugar (per teaspoon): 4.7 grams of sugar
Maple syrup (per teaspoon): 2.8 grams
Honey (per teaspoon): 3.8 grams

Note: If you have one Super Big Gulp 32 ounce soda, you consume 128 grams (32 teaspoons, almost ¾ of a cup) of sugar in one beverage!

I hope this list helps put the issue in perspective so you see how quickly this can add up; two sodas and a granola bar and you are over the average.

Currently, the American Heart Association is recommending that women get no more than 6.5 teaspoons (26 grams) of added sugar per day, men get no more than 9.5 teaspoons (38 grams) of added sugar per day, and children should get no more than 2-3 teaspoons (8-12 grams) of added sugar per day. 

While I still view these recommendations as high, when you consider people often have other sources of naturally occurring sugar in their diet, it is a good start.

So, here we are at the beginning of Fall with the “holiday season” just around the corner: trips to the State Fair, candy from trick or treating, Thanksgiving, holiday parties, Christmas, New Year and then we’ll wrap it all up with Easter and chocolate bunnies.  This amounts to a much higher concentration of added sugars this time of year.

What does this all have to do with the Cold and Flu Season?  Studies have shown increases in blood sugar suppress immune function for upwards of 5 hours by 75% or more.  Sugar will actually displace the uptake of vitamin C at a cellular level, deplete essential nutrients like zinc and calcium which leave your immune system compromised and unable to fight efficiently.  Elevated blood sugar along with lower vitamin D3 stores due to less exposure to sunlight this time of year, and viruses being around a bit longer in cooler weather and we have a pretty good recipe for sick days.

So take a little time to evaluate your health concerns and commitments and may we all have a healthy happy rest of the year!!

Dr. Monica Rempen

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Chronic Emotional Stress

4/28/2014

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As I worked through my patient notes, “stress” seemed to be the word of the day!!

My clinical experience over the years has convinced me that there is no one factor more influential to your overall long-term health than chronic emotional stress and that is not to dismiss other factors as influential but if we are looking for the most impact.  Stress is the most impactful hands down.


The list of health concerns related to stress is extensive:  (This is a partial list.)
skin disorders, eczema, psoriasis, rashes, unexplained itchy skin, asthma, muscle control, muscle tension, diabetese, subluxations, decreased pain tolerance, infertility, hypertension, chest pain, heart attack, stroke, arteriosclerosis, headaches, weight gain, weight loss, stomach aches, ulcers, nausea, vomiting, diarrhea, constipation, ulcerative colitis, diverticulitis, autoimmune disorders, infections, cancer, MS, IBS, allergies, emotional disorders including anxiety, depression, mood swings, PTSD, anger, increase aggression, decreased cooperation,  damage to brain tissue especially in the hippocampus, a part of the limbic system which impacts memory, moods, and actually manages the chemistry that decreases the stress response. 


It is estimated more than 70 percent of all doctors visits are in some way stress related. 

OSHA estimates over 3 billion dollars in stress related costs in the work place every year.

Wow!! When people say “This stress is killing me!”,  it's quite literal.

So let's take another look at all of this and what's really happening in the body.

Imagine a tiger comes running out of the forest.  Your adrenal glands, tiny little glands that sit on top of your kidneys, release adrenaline then a few minutes later corticosteroids (cortisol).  This event affects the function of every cell in your body.  What follows is increased breath rate, increased heart rate, increased blood sugar, increased blood pressure.  This is needed to insure we get oxygen rich and nutrient rich blood to the brain and muscles necessary fight like a warrior or run like the wind.

At the same time, other hormones are suppressing and postponing all other vital processes like growth and repair, reproduction, digestive function, immune function, etc. The body is decreasing blood flow to all systems not immediately needed.  And there we are, we’re in a full blown adrenaline rush / stress response.

And this is a normal healthy response to this type of stress.

The problem is that most people in our culture today are not running from a tiger. Too many are in a state of chronic stress and our bodies do not know the difference.  Imagine what happens when all of those effects are happening everyday, and all day long.  We respond with the same chemistry regardless of the stimulus.  If you look again at the list of disorders and the explanation of what is happening in the body, perhaps the disorders caused by chronic stress do make sense.

While most people dislike feeling stressed.  I have found that few recognize the price the body pays for every moment you feel anxious, tense, frustrated, and angry.  While these are normal human emotions, the danger lies in experiencing these emotions on a chronic basis.  And, that's exactly what many of us are suffering from in today's hectic world.  Though it may not be to the same extent as if they were to be face to face with that tiger, there is no question that sympathetic nervous system increases its output whenever you feel stressed. 

Emotional stress always equals increased output by the sympathetic nervous system which always equals accelerated aging and breakdown of your tissues.
So remember: Stress equals rapid aging!


So what are things you can do:
Begin to recognize those thoughts that pass through your mind that cause you stress and begin to interrupt them. Many need an example here: so imagine being in traffic in Albuquerque and someone cuts you off (not hard to imagine!).  There is a quick stress response (adrenaline), but for many there is a stream of thoughts that follow; “That so and so and such and such….” resulting in a cortisol release.  Many people are not aware of these thoughts.  The adrenaline response could be cleared rather quickly, but the chemical response to the thoughts resulting in the cortisol release, complicates the situation and all to often the adrenaline and cortisol are still surging often hours later.  And remember, this is the response of many to any stress related situation – an argument, taking a comment personally, pressure from work, etc.  Though anger, frustration, and anxiousness can all help to fuel personal growth and character development, if left unchecked the resulting damage to the body can be vast.


Consider doing something that brings you joy everyday, exercising regularly,   finding a way to work through those things from the past that are still affecting you today, and making sure you're getting the nutrients needed for a healthy nervous system

Your nutritional status can make all the difference between being able to handle a certain amount of stress without breaking down quickly vs. quickly suffering health problems at the point in time when faced with stress.

Don't make the mistake that many health conscious people make and fret over the percentages of carbs, protein, fat, raw food, and cooked food in your diet while neglecting the emotional stressors in your life.

Yes, eating fresh, nutrient-dense foods is good for your health.
But eating fresh, nutrient-dense foods while feeling emotionally balanced and at peace is even better.


So, please, make a commitment to LAUGH and APPRECIATE something EVERYDAY!!

And remember, your smile is a gift to the world!

Share it!!

Dr. Monica Rempen
Doctor of Oriental Medicine
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