Archive for the ‘Digestive’ Category

Proton Pump Inhibitors and Fracture Risk

Posted on: May 14th, 2011 by doctor No Comments

A recent article in the New York Times reports on research that links long-term Proton Pump Inhibitors (PPIs) with a 30% increased risk of bone fractures.  According to the article, the long-term use of PPIs may decrease absorption of calcium in the intestines.

PPIs reduce the acidity in the stomach in order to reduce symptoms of heartburn.  While this is an effective approach for reducing the burning pain caused by the regurgitation of stomach acid into the esophagus, lowered acidity in the stomach decreases the absorption of some nutrients – including calcium – and increases the chances of getting several types of infection including infections of the digestive tract and lung.

Some forms of calcium do not require stomach acid in order to be absorbed.  These forms include calcium citrate and calcium citrate/malate.  When taking PPIs or other antacid medicines, it is a good idea to supplement calcium intake with these forms of calcium especially if you are at increased risk of osteoporosis or of fracture.

The only drawback of calcium citrate and calcium citrate/malate is that these forms of calcium are very bulky – capsules usually contain only 150mg of calcium.  This means that the usually recommended dosage is 5 to 10 capsules per day.

Ensuring healthy vitamin D status is also very important for calcium absorption.

For more information on addressing osteoporosis, read my previous blog post on osteoporosis.

Other nutrients whose absorption can be decreased by acid lowering medications include magnesium and vitamin B-12.

Be well,

Richard Malik, ND

Natural Therapies for Breast Cancer

Posted on: January 3rd, 2010 by doctor No Comments
When considering natural therapies for breast cancer, it is important to understand what medical or research-based evidence exists that shows which natural therapies are effective and for what circumstances.  While there are many claims made on packages and the internet about herbal formulas, special diets, or new-fangled technologies, the evidence for natural therapies that work to cure breast cancer on their own is paltry, at best.
However, natural medicine truly shines in supporting oncology patients so they have the best results through surgery, radiation, and chemotherapy.  The options to reduce adverse effects, improve outcomes, and help cancer patients feel well are diverse.  When used in this way, the goal of natural medicine is to support conventional treatment approaches without interfering its effectiveness and to address concerns as they arise; natural treatments are tailored for each individual set of circumstances.  Here are some examples of my favorite approaches.
Glutamine is an amino acid (protein building block) that high doses helps to improve recovery from surgery and helps prevent nausea, ulcerative lesions in the mouth and digestive tract, and neurological toxicity from some chemotherapy drugs.
Ginger is an excellent and safe way for chemotherapy patients to prevent nausea.  Using capsules, liquid herbal extracts or even lollipops made by a compounding pharmacist are options that support easy compliance for the patient.
Doxirubicin is a common chemotherapy drug that is used to treat breast cancer.  However, one of the most serious adverse effects of doxirubicin is toxicity to the heart.  Coenzyme Q10 and L-carnitine are nutritional supplements that have been shown in medical research to reduce doxirubicin related heart damage without interfering with the drugs ability to kill breast cancer cells.
Another common concern for oncology patients is maintaining their immune function and white blood cell status.  Some approaches that are promising in this area include maitake mushroom extracts, ginseng (a popular Asian herb), ashwaganda (an herb from India), and vitamin E supplementation.
It is clear that natural therapies have a supportive role in cancer treatment.  But, if not used wisely, natural medicine can have negative effects.  For example, studies show that the herb curcumin (turmeric) can decrease the cell-killing effects of some chemotherapy drugs like cyclophosphamide and doxirubicin (both are used in breast cancer treatment).  Other dietary supplements that may reduce chemotherapy effectiveness include coenzyme Q10, glutathione, and cysteine.  The most effective and safest way of using natural therapies is to consult with your oncologist and work with a qualified professional.

Be Well,

Stomach Acid is Important

Posted on: September 7th, 2009 by doctor No Comments

The acid that is secreted by the parietal cells in the human stomach play a couple of very important roles.  First off, it helps to break down proteins so that nutrients are more available in the intestines and easily absorbed.  Stomach acid is important for calcium absorption, among other nutrients.

Stomach acid is also an important part of the immune system of the digestive tract.  Acid kills many of the organisms that we are commonly exposed to and helps to prevent infection.

Over the counter and prescription medications used to treat heartburn or GERD focus on reducing stomach acid production.  As I mentioned in the previous post, stomach acid is not the cause of heartburn – it is caused by a loose lower esophageal sphincter.

Consistent with the physiological importance of stomach acid, recent medical research indicates that medications that lower stomach acidity are associated with an increased risk of infection (gastrointestinal and pneumonia!) and osteoporosis.  Another of the known adverse effects of these medications is hair loss – treated naturopathically with specific nutrients.

The natural treatment of GERD involves identification and avoidance of aggravating foods and herbal and nutritional recommendations that soothe and protect the esophagus while improving gastrointestinal function.  Discontinuance of acid lowering medication and WITHOUT GERD symptoms is a real possibility for many patients.

Be Well,


RSS makes it easy to subscribe to the Simply Well blog – just add the feed address (feed:// to your RSS reader (your email program) and get updates automatically.

Hollywood and the Hyperacidic Stomach

Posted on: September 6th, 2009 by doctor No Comments

Tonight I saw the movie Julie & Julia. Eric, Julie’s husband, explains that he has a hyperacidic stomach while taking some Tums. Zollinger-Ellison Syndrome is a rare but serious medical condition that is caused by a hormone secreting tumor that triggers secretion of damaging amounts of stomach acid . Eric instead probably had recurrent heartburn, or GERD.

GERD is NOT caused by too much stomach acid; it’s caused by a loose valve that seperates the bottom of the esophagus from the stomach. This valve is called the lower esophageal sphincter (LES). Certain foods commonly cause the LES to relax and are triggers for GERD symptoms: fatty foods, alcohol, caffeine, onions, garlic, mint, and tomatoes to name a few.

So, heartburn is not caused by too much stomach acid. It is caused when the contents of an appropriately acidic stomach move into the esophagus.

In an upcoming post, I’ll discuss surprising adverse effect from acid reducing medications.

Be well,

RSS makes it easy to subscribe to the Simply Well blog – just add the feed address (feed:// to your RSS reader (your email program) and get updates automatically.

Endoscopy for Heartburn: New Recommendations

Posted on: January 11th, 2009 by doctor No Comments

The American Gastroenterological Association (AGA) produced clinical guidelines for the management of Gastro-Esophageal Reflux Disease (GERD) in October of 2008 that advise against using endoscopy for the screening of patients with GERD.

The Bottom Line:

If you have GERD and your symptoms are addressed with treatment recommendations, an endoscopy is not helpful in improving health outcomes.  If symptoms persist in spite of treatment, an endoscopy or further testing may be a good idea.  In this case, you should speak to your doctor.  Fortunately, most people’s symptoms are relieved with medical or natural therapies.

Hypothyroidism: Many Symptoms, One Disease

Posted on: January 1st, 2009 by doctor No Comments

If you have been experiencing persistent fatigue or sadness, it may be more complicated than simply shifting your attitude or pulling yourself up by your bootstraps.  Fatigue and depression (and many other problems) may be signs of a physical medical condition: hypothyroidism – a decrease in the function of the thyroid gland that results in lower levels of thyroid hormone throughout the body.  It may even be possible to have low thyroid function while blood test interpretations say that all is normal.

Thyroid hormone is produced by the thyroid gland; a subtle butterfly shaped gland found in the neck below the Adam’s apple and on either side of the trachea.  Thyroid hormone is important to many parts of the body.  It sends a message to cells in the body to increase activity, function, and energy consumption.  The more thyroid hormone that is present, the faster body systems and organs will run.  It is possible to have too much (hyperthyroidism) or too little thyroid hormone (hypothyroidism).

Effects of Low Thyroid Function:

The symptoms of low thyroid function are diverse and vary considerably from person to person.  The manifestations of hypothyroidism can be vague or subtle, slowly getting worse over months or years.  Patients with hypothyroidism often experience some of the following symptoms: fatigue, depression, poor memory, unclear thinking, low body temperature, cold hands and feet, sensitivity to cold, dry skin, constipation, frequent infections, weight gain, premenstrual syndrome, or hoarseness.

Having hypothyroidism is also associated with several medical conditions; low thyroid function can cause or contribute to infertility, menstrual irregularities, elevated cholesterol levels, atherosclerosis, heart disease, anemia, and carpel tunnel syndrome.

Diagnosis and Treatment:

Thyroid function is first assessed by checking a hormone that tells the thyroid gland to make more hormone, thyroid stimulating hormone or TSH.  Elevated TSH levels are a sign of low thyroid function while low TSH levels are indicative of hyperthyroidism.

The predominant medical view is that in the absence of elevated TSH, hypothyroidism cannot be diagnosed.  However, the possibility of hypothyroidism that is not detected by current lab tests and current standards does exist.  The standards for normal thyroid function have changed over the years and some endocrinologists believe that current standards miss many patients suffering from low thyroid function.  

The easiest treatment for hypothyroidism is supplementation with synthetic or animal derived thyroid hormone.  Improvement in symptoms usually takes as little as a few days or as long as six months.  However, excessive thyroid hormone replacement can cause high levels of thyroid in the body – hyperthyroidism – and result in anxiety, insomnia, palpitations, chest tightness, diarrhea, and osteoporosis.  So, thyroid hormone should be used carefully and with medical supervision – appropriate diagnosis and monitoring are important.

Addressing the Cause:

Iodine used to be a common cause of hypothyroidism.  Today, in our society iodine deficiency is rare.  Conversely, very high doses of iodine can cause hypothyroidism in as short as a few weeks and long term high daily intake seems to increase the risk of hypothyroidism over the years.

In today’s medical practice, hypothyroidism is most commonly caused by one of two issues: 1) an auto-immune attack on the thyroid gland; or 2) the thyroid gland puttering out – not functioning as well as is should or used to.  In either case, supplementation with thyroid hormone is helpful.

While the medical literature states that the causes of both types of hypothyroidism are unknown, there are numerous drugs and chemicals that are definitively known to cause auto-immunity or to hamper thyroid function.  Some of these substances include: food coloring; mercury; numerous solvents; and even some prescription drugs.  Some chemicals contribute to low thyroid hormone levels by increasing the liver’s breakdown of thyroid hormone.

Avoidance of these harmful substances and enhancing the body’s ability to get rid of them can be helpful.  Selenium (200 mcg daily); zinc (15 mg daily); iron (18 mg daily in absence of high iron levels); and the amino acid cysteine help the body make thyroid hormone and convert it to its most active form.  Cysteine is also important anti-oxidant that helps the body handle toxic chemicals and heavy metals.

Other supportive natural therapies include the far eastern Indian herbs ashwaganda and bacopa which support thyroid function and the action of thyroid hormone throughout the body.  Some patients benefit from supplementation with food grade thyroid gland products that supplement thyroid hormone levels.

While hypothyroidism can sneak up on people, accurate diagnosis and treatment often helps to relieve the symptoms and provides dramatic improvement quality of life.

Safe Constipation Treatment – Avoid Stimulating Laxatives

Posted on: November 8th, 2008 by doctor No Comments

Many folks use stimulating laxatives like senna, cascara, rhubarb, aloe leaf and other herbs that contain anthraquinone glycosides to deal with chronic constipation. Anthraquinone glycosides irritate the lining of the gastrointestinal tract to encourage intestinal activity and contractions called peristalsis. Long-term use of these substances causes discoloration of the intestinal mucous membranes and, more importantly, dependence on them for bowel movements.







Many herbal supplements and natural healthcare practitioners recommend them. This is a poor or lazy way of addressing constipation.

So what should someone with chronic constipation do? There are many approaches for identifying the cause and treating chronic constipation that are far more gentle and safe for long-term use but just as effective as stimulating laxatives. These include identifying hidden or subtle medical conditions that are causing or contributing to constipation; identifying foods and lifestyle habits that cause or contribute; and careful treatment with nutrients to address symptoms.

To get most of the details, please listen to my recent podcast on constipation.

Be Well,


Vitamin K, Osteoporosis & Liver Cancer

Posted on: November 2nd, 2008 by doctor No Comments

While several research studies (1, 2, 3) show that very high-dose supplementation with vitamin K2 can be very helpful for IMPROVING bone mineral density in women with osteoporosis, another recent study exploring the same treatment has found dramatic reduction in liver cancer in patients that are at high risk for liver cancer.  Other studies show improved outcomes in liver cancer patients taking vitamin 

Vitamin K2, unlike other forms of vitamin K, is non-toxic.

The possibility exists that vitamin K recommended daily allowances are adequate for preventing coagulation problems (one of vitamin K’s jobs is to support blood clotting) but not high enough for healthy bones.  I think it is interesting that the daily recommended allowance of vitamin K is only less than 120 micrograms per day while one cup of chopped kale has over 500 micrograms.

Kale, broccoli, swiss chard, and parsley are the best dietary sources of vitamin K and are also rich in calcium!

For more information on Vitamin K and Osteoporosis, please take a look at my articles and podcasts on the subjects.

Be well,


Go to top