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Gastroesophageal Reflux Disease (GERD) – Acid Reflux – Treatment Options

Everyone today sees advertisements on Television and Radio for the treatment of Gerd. I find it interesting that one commercial will advertise foods or a restaurant that’s menu propagates GERD while the next commercial provides a medication to treat the symptoms of GERD.

GERD leads to the backward flow of the gastric contents from the stomach or esophagus into the esophagus or into the throat region. The contents could be undigested food particulate matter to liquid acid.

Symptoms can include: heartburn which sometimes can mimic a myocardial infarct (heart attack) TO regurgitation, silent or microscopic aspiration leading to the person coughing. This refluxing can lead to a set up for aspiration pneumonia.

Other complications include esophagitis which is an inflammation of the esophagus to chronic inflammation leading to cellular changes and the eventual possibility of developing cancer.

There is an anatomical flap of tissue that separates the stomach from the esophagus. This flap or sphincter of tissues is known as the Lower Esophageal Sphincter or LES. When this sphincter becomes incompetent due to a pressure change or a valve abnormality then fluids or particulate food matter will flow backwards into the esophagus or in the patient’s throat.

Patients that are Diabetic, Obese, Smokers and those whom have dietary choices can potentiate GERD. These patients are at higher risk.

Current treatments include the following:

  • Elevating the head of the bed by 30 degrees with pillows or a wedge or lift.
  • Eating small frequent meals and not eating late in the evening
  • Avoiding food or beverages that may provoke the reflux process
  • Weight loss and better control of Diabetes along with cessation of smoking
  • The use of proton pump inhibitors, antacids and Histamine 2 blockers

Now let us take a deeper dive into the convergence and divergence in treatment methods of traditional and non-traditional (Integrative and Functional Medicine) Medical practice.

In both traditional and Integrative and Functional Medicine practice it is important for everyone to chew their food more thoroughly to break down the food into small particles that can be digested.

The human body is an amazing machine. Along with chewing our salivary glands produce saliva that has many factors that assist in breaking down the food. These include: mucin, bicarbonate, prostaglandin E2, and various growth factors.

As the food moves into the stomach it is churned or mixed back and forth. Acid is needed to further breakdown the food into its basic nutrients. Other organs such as the pancreas and gallbladder release enzymes and bile to breakdown fats, proteins and carbohydrates into smaller structures that our body uses as building blocks.

So, what happens if a person takes a H2 blocker, Antacids, or proton pump inhibitors chronically. I myself took these medications every day for years due the stress of being an anesthesiologist.

Long term use of these medications show the following adverse outcomes:

Nutritional depletions in the following vitamins; B12, Folic Acid, Vitamin D, Calcium, Magnesium, Iron, Zinc and protein Beta Carotene. All of these elements are essential for our bodies normal physiological function. In their absence the bodies function will go off the track and we end up complaining of a variety of symptoms.

Increased risk of developing poor Kidney or Renal function leading to insufficiency.

Increased risk of developing Clostridium Difficile infection. This can be a devastating intestinal bowel infection leading to watery uncontrolled diarrhea.

Increased risk of osteoporosis and osteopenia and fractures.

Irritable bowel syndrome

Increased risk of community acquired pneumonia

Increased risk of respiratory illnesses along with asthma

Association of increased risk of Alzheimer’s

Many times, the GERD can be avoided. Integrative and Functional Medical Physicians will order extensive testing to elicit the root cause of the reflux. Sometimes just performing a food allergy test leads to the culprit.

I truly believe that H2 blockers, antacids and proton pump inhibitors have their place in treating patients. However, at some point these medications should be weaned.

Below is a step by step techniques that is used in the weening of PPI’s:

Remove all wheat from the diet. The human gut has no ability to break down gluten. Gluten will cause a rise in zonulin and thus enterocyte separation in all humans. Removing wheat will often resolve someone’s need for PPI.

Remove Dairy as much as possible. Especially milk, cream and ice cream. A little cheese a couple times per week may be tolerated but all other dairy is ideally removed.

Order a IgG & IgE food panel and remove inflammatory foods.  These foods need to be out of the diet for 2 weeks minimum before attempting PPI reduction.

Add a probiotic to help stabilize the immune response. Higher doses if the patient has a long history of gut or autoimmune issues.

Below are natural treatments for GERD which include the following:

  •  Klaire Complete Powder
  •  Orthobiotic 100
  •  Orthobiotic 20
  •  DaVinci 50+ Mega
  •  EnteroMend
  •  GlutAloeMine
  •  Inflammacore

Sodium bicarb (Arm & Hammer baking soda) can be taken at bedtime to neutralize any pepsin in the esophagus. This is a good habit to employ throughout this process. Sodium bicarb is healthy for kidney function and actually protective. The amount of sodium is negligible and not a contraindication for hypertensive patient unless they are acutely sensitive to salt which is the vast minority of hypertensives.

Patients should commit to dietary changes and refrain from eating allergic foods. Avoiding alcohol is necessary along with modifying diet weight loss and other provocative causes such as stress , sleep and hormone evaluations.

Finally, patients can find relief from acid reflux disease by alternative methods such as the above. Patients can find an Integrative and Functional Medicine physician that can treat such diseases. The Center for Antiaging Aesthetic and Rejuvenation Medicine can assist in this and other medical issues.

Crohn’s Disease Explained – Treatment Options

This is a chronic inflammatory process which affects the small intestine. It mainly affects the last segment of the small intestine called the terminal ilium. However any part of the gastrointestinal tract can be involved.

A symptom complex can involve : diarrhea with or without pain, generalized abdominal pain along with weight loss. This is an extremely debilitating disease process. Many patients suffer from alternative or accessory organ inflammatory issues involving the kidneys in developing stone formation TO arthritis.

This chronic inflammation leads patients to suffer from continual intestinal fistula formation. Scarring can lead to bowel obstructions requiring the patient to present to the emergency room for a surgical bowel resection. Often times such patients have large resections of their small intestine that can develop post operative infections along with nutritional deficiencies.

Remember it is the small intestines function or job to absorb the nutrients, vitamins and minerals our body needs to maintain normal physiology. In the absence of sections of the small intestine these required nutrients the body requires can cause abnormalities in the patients body from functioning normally. Another wards the patients wounds may not be able to heal or the patient may not be able to fight off a smoldering infectious process.

The root cause or etiology of Crohn’s is thought to be auto-immune in nature. Thus patients whom develop Crohn’s disease often may have a co-existing auto-immune process such as arthritis.

Current treatments involve both medical and surgical options. This disease can be so debilitating that patients may have their entire small bowel removed. This can and is catastrophic.

Medications such as : anti-inflammatories, steroids, antibiotics, anti-diarrhea, immune suppressive drugs and modulation medications have been tried. However as stated above more than 2/3 of the patients require surgery and up to 10% will die form this disease.

Patients that develop diarrhea often develop several deficiencies in nutrients often leading to lacking the building blocks that their bodies need. These include : minerals, proteins, vitamins, fats and calories. For example many patients lack vitamin B,C and D.

Food allergy testing should be performed since there are elevated levels in blood markers showing an inflammatory process is present in the patients body.

Since these patients often are nutritionally depleted a broad spectrum vitamins, minerals should be replaced. These include : zinc, Vitamin B2,B6,B3, Vitamin D, Vitamin B12, omega 3 fatty acids and Vitamin C just to name a few.

Often chemotherapeutic agents ( like what is used in cancer) are used. These medications have many untoward side effects !!!!!

Alternative Integrative and Functional Medical Treatments involve : eliminating foods that are or show signs of causing or exacerbating the disease along with using several natural substances like : Enteromend, Moducare and Low Dose Naltrexone.

Enteromend is a compound made by Thorne Pharmaceuticals. It contains the following ingredients: Glutamine, Aloe, Curcumin ands Boswella. It functions in gastrointestinal repair, producing butyrate for healing the cells ( enterocytes), anti-inflammatory properties, mucous production to coat and cushion the cells for healing and producing fiber to give nutrition to the enterocytes.

Moducare is a plant sterol ( plant steroid ). It is natural and its has natural properties to affect the cells dealing with fighting infections. Specifically it affects the T-cells ( both T-1 and T-2) that work again in immune function.

Finally patents may require low dose naltrexone. This is a narcotic agonist antagonist. It is similar to naloxone which is used in narcotic overdoses. This medication has shown have great benefit not only in Crohn’s disease but other auto immune diseases. It not only assists as an anti inflammatory and pain killer but also as a “nerve cell modulator”

A Board Certified Integrative and Functional Medicine physician can and will treat patients with these natural supplements along with other alternatives.

Peptides and Your Health – What You Need To Know

Peptides have become the newest area of research for the enhancement in some healing processes. Patients are accepting new alternative modalities to assist themselves in various disease processes such as diabetes, erectile dysfunction and tendon and bone healing.

What are Peptides?

They are amino acids that are attached or hooked together into a chain. Just think of a bunch of box cars on a train track that are connected to each other as they travel along from one destination to another. They can be switched around into different positions which will have either no effect or a beneficial effect on the physiology of a patient. Each peptide has a determined amount of amino acids.

There are many peptides made within the human body. Most of these you have heard of and even know their functions. Here are some well known peptide hormones: Human Growth Hormone, Glucagon, Insulin, Ghrenlin, Oxytocin, Prolactin, and Thyroid Stimulating Hormone.

For instance Human Growth Hormone ( Somatotrophin ) has 191 amino acids. Its beneficial effects include: cell growth and cellular regeneration. It is produced in the anterior pituitary by somatotrophic cells where they are stored and secreted in a pulsatile manner.

Evolutionary scientific methods has shown that newer peptides are being used to impact the health and longevity of the patient especially with the repair of injuries.

Today we a discussing BCP-157.

This a a peptide consisting of 15 amino acids ( Gly-Glu-Pro-Pro-Pro-Gly-Lys-Ala-Asp-Asp-Ala-Gly-Leu-Val). It is a synthetic peptide that has been derived from Thymosin _Beta. Thus, it is not a naturally occurring peptide.

BCP-157 has been shown to have many effective benefits:

It has an anti-inflammatory effect by protecting the endothelial layer in tissues within the stomach and duodenum ( part of the small intestine). Thus, it maybe an alternative modality for the treatment of gastrointestinal ulcers.  Currently H2 ( Histamine 2 ) blockers and Proton Pump Inhibitors are being used for gastrointestinal inflammatory processes. However these drugs inhibit acid production which is needed to breakdown foods into their necessary nutrients for our bodies to maintain good health and to function at its optimum.

The protective effects of BCP -157 maybe interactive in many pathways including: prostaglandins, nitrous oxide, dopamine and the somatosensory nervous system.

This peptide has been shown to be a catalyst in wound healing such as in tendon repair injuries. Some individuals are now using BCP-157 to aid in sports related injuries and even post-surgical procedures for total knee replacement and rotator cuff repairs.

BCP-157 may have additional beneficial properties in angiogenesis. Angiogenesis is the formation of new blood vessels and the formation of  a new microvasculature structure to enhance blood flow.

Angiogenesis is needed in all wound repair. Additionally it may have an adjuvant benefit in patients with erectile dysfunction by creating new blood vessels and thus increasing flow in the penile tissue.

BCP-157 is used as a subcutaneous injection. The usual dosage is 200-400 ug/ day twice daily. It can be used for 2-4 weeks and maybe repeated if necessary.

In conclusion:

BCP-157 has been thought to aid in the following : Joint and Tendon, Bone Rejuvenation by accelerating fibroblast formation. It has a protective effect in the gastrointestinal tract from inflammatory processes that damages the tissue. This includes damage caused by non-steroidal drugs ( nsaids) such as Motrin, Naprosyn, for aspirin.

It also has been shown to have neuroprotection within the hippocampus of rats.

It must be noted that much of the research has been in the animal models. However, many individuals have acquired such peptides through physicians from FDA approved sterile compounding pharmacies that have been approved to make such peptides.

Patients individual physiology must be evaluated with the proper and thorough History and Physical along with obtaining a blood analysis by a Board Certified Integrative and Functional Medicine Physician. This should be done prior to even starting to use BCP 157 or other current peptides as a treatment modality.

Yale (Yoel) R Smith MD is Board Certified in anti-aging and regenerative medicine. Our practice will be investigating the use of these peptides on an individual per patient basis and will only obtain such peptides from the highest quality pharmacies.

Latest Information About Cardiovascular Disease

Cardiovascular Disease is the leading cause of death in the United States and most likely is the same in developed countries. These include coronary heart disease and myocardial infarcts.

There are many factors that precipitate coronary artery disease. These include: Diabetes, Obesity, Hypertension, Lipid abnormalities, and Smoking. The common denominator to all of these if from Inflammation.

As a former Cardiac Anesthesiologist, one wonders the following:

Firstly, what is the single underlying trigger that causes millions of individuals to undergo extensive cardiovascular work-ups.

These patients often require interventional cardiologists to place stents and / or cardiovascular surgeons to perform elective or emergency on – pump (using the bypass machine) OR off-pump coronary artery bypass grafts in those patients that are not candidates for the cardiologist to stent because of technical difficulties or the instability of the patient.

Many require long post-operative rehabilitation along with prescriptions for platelet altering medications that are used to maintain patency (the opening) of those vessels that were either stented or bypassed.

The use of both pharmacologic and natural supplements has been shown to alleviate such risk factors and improve outcomes in cardiovascular disease states.

For many years both those in medicine and in the public, we have been told that cholesterol was the trigger in initiating the domino effect which causes coronary artery disease and acute myocardial infarcts. This is still the current belief in traditional medicine and most physicians believe this to me true. That is why they look at cholesterol.

Cholesterol is a precursor to all hormones that are needed for normal physiology of the patient’s body to function.  As you can see by the illustration of the diagram below without cholesterol your body cannot make efficient amounts or quantities of the proper hormones to enable you to function properly. Therefore, one must have the proper amount of cholesterol in one’s diet. Eliminating it would cause detrimental effects with many patients complaining that they do not feel good or well. Everyone has a different physiology!

Over the last couple of years research has shown that elevated Sugar is the root cause of inflammation leading to the blood vessels or vasculature to lay down plaque in the blood vessels.

These elevations in blood sugar sets up the inflammatory response causing the vascular endothelial bed to develop structural damage. Over time these vessels become more inflamed and additional plaque builds in the vessels until the vessel becomes blocked or occluded. Additionally, unstable lesions (lipid (fat) laden liquid filled molecules) can rupture through the endothelial cells into the lumen (the opening) in the vessel leading to an acute coronary event.

In Functional Medicine we look deeper into specific testing to determine the patients risk of having a cardiac insult. While cholesterol, LDL, Triglycerides and HDL are ordered by most traditional medical practitioners we also look other biological markers that are more important in determining the risk of an event.  Yes, LDL is important, however our laboratory evaluations are more specific. These include: C-Reactive Protein ( CRP), Oxidized- LDL, LDL particle number and size, Small Dense LDL, along with HGB- A1C.

If a patient has dangerously high abnormal numbers we often will perform a deeper dive ordering a Coronary Artery Calcium score (CAC) and even a PULS test to determine if an unstable cardiac lesion can and will rupture leading to a myocardial infarct and even death. These patients would be referred immediately to their cardiologist for immediate invasive evaluation by cardiac catheterization. Thus, prevention of a catastrophic event rather than the after effect of the event.

Have you ever wondered why in traditional medicine a patient could be taking 2-4 medications just to control their blood pressure? It is because some patients do or do not possess the genes to convert the drug into its active form or the gene may not work properly. In Integrative and Functional Medicine there are ways to detect if the patient has a GENE SNP (SNIP) which is the reason why so many of these pharmacologic agents do not work. Often times many of these medications can be withdrawn slowly and replaced by either no medications or a medication along with a natural supplement that has the same benefits without the side effects.

So how does one provide prevention? By altering one’s life style, diet, exercise, proper sleep quality and quantity along with the use of pharmacologic’s and natural supplements, one can slow down or decrease further damage to the blood vessels.

Life style changes include our diet. Changing from highly processed foods which is in the standard American diet,( loaded with carbohydrates ( sugar) and preservatives ) TO  a diet which is higher  in good quality vegetables and meats, fish and poultry  that can provide significant weight loss and a better physiology. Additionally, trans fats seen in many foods can increase all lipids and lead to damage to the blood vessels leading to a coronary insult.

It is not all about the numbers. Many physicians look at the laboratory values of patients and although they may be in the normal ranges, the patients complain that they do not feel well. We have to listen to our patients and many times we do not.

Exercise both aerobic and strength training should be performed at least 5 days a week for 60 minutes. Changes in body composition can have dramatic effects on the abnormal lipid profile and better these numbers and the patient’s physiology.

Supplements such as omega 3 fatty acids have been shown to reduce sudden cardiac death by many different physiological pathways. Additionally, kyolic garlic also has a huge impact on reversing abnormal lipids and has beneficial effects on cardiovascular disease states. These two supplements are just two that are natural and have limited if any negative side effect on the human physiology.

For a more in depth understanding of your own individual physiology, to hopefully reverse or slow the disease state the cookie cutter approach of using medications is obsolete. You as the patient should partner with a Board Certified Integrative or Functional Medicine Physician to help you with longevity and prevention of disease.  For more information please make and enhancement by scheduling an appointment with our office.

Erectile Dysfunction Information

Erectile Dysfunction or E.D. is more commonly referred to as Impotence. Studies performed at a major Medical Center revealed that millions of males ranging from their second decade and upwards suffer from E.D.

Erectile Dysfunction is a form of sexual dysfunction whereby there is the inability to maintain an erection long and firm enough for sexual intercourse. E.D. is considered present if the erection difficulties are present for a prolonged and sustained period of time.

When poor blood flow to the copora canvenosa (two formal chambers of the penis) is insufficient then E.D. can and will occur.

There are many causes for Erectile Dysfunction. Many of these works together to limit the adequacy of erectile function. Such causes include in general: psychological as well as physiological stress that is placed on the body.

However, the most common cause for E.D. is due to inadequate flow from plaque within the vasculature and or restricted blood flow from other causes. This is seen in many cardiovascular disease states like Diabetes.

Hormonal production of Testosterone and other precursor hormones decrease over time. Stress and lack of proper sleep have huge impacts on hormones like Cortisol. This hormone has an inverse effect upon many hormones such as Testosterone and Melatonin. Elevated levels of Cortisol cause damage to hormonal cascade leading to decreases in Testosterone.  Along with the aging process other factors impact Hormonal balance.

Ordering blood testing of a complete hormonal picture one can assist in the physiological correction of hormones specifically Testosterone which will have a positive impact on longevity and correcting E.D.

Alcohol consumption is another factor that can inhibit erectile function by decreasing blood flow to the penis along with decreasing testosterone, libido and can also impact flow of blood to the nerves that supply all tissues and organs. The use of Alcohol can also impact negatively psychological problems.

The obesity rate has exploded throughout the U.S. along with those individuals that have limited exercise and physical activity. There is a direct correlation with Diabetes and cardiovascular disease disorders impacting sexual performance.

Men whom smoke have an association of poor penile blood flow. Moreover, oxidative stress leads to a myriad of problems physiologically with the production of free radicals that damage at the cellular level.

Patients they have sleep apnea and poor sleep behavior lead to insufficient oxygen absorption and consumption causing poor nutrient supply to all tissues including to the penis.

All forms of physiological and psychological stressors on the body can impact on obtaining and maintaining an erection. Additionally, medications lead to side effects causing impotence.

Metabolic Syndrome (MetS): consists of elevated fasting blood sugar, hypertension, hypertriglycemia, increased waist circumference and a decreased HDL. As stated previously this syndrome promotes cardiovascular diseases, diabetes, kidney failure along with poor vascular blood flow and erectile dysfunction.

Erectile Dysfunction treatment has been effective with the use of phosphodiesterase-5-inhibitors such as: Viagra, Cialis, and Levitra. There is a success rate of 80%with such medications. However, such medications have many side effects which can and do acerbate many of the cardiovascular medications that male patients are using.

Gainswave is a non-invasive technique that treats E.D. at the origin. Using low frequency ultrasound waves creates better blood flow, invigorates the growth of growth factors and rejuvenates penile vasculature for a sustained erection. This treatment technique leads to enhanced sexual performance for the individual and his partner.

Under the direction of Yale (Yoel) R Smith, M.D. patients can receive this treatment modality along with others along with obtaining blood levels of hormones to assist in correcting Erectile Dysfunction.