Can Pharmaceuticals Make Us Fat?

Posted: Thursday, March 10, 2011

Part one of a two part series

In a word, yes.  Anti-depressants, contraceptive pills, even anti-diabetic medicines.  But I’m going to pick on one of my least favorite, very popular prescriptions: proton pump inhibitors (PPIs), such as Prilosec, Prevacid, Nexium, Protonix and numerous others.

Overweight Americans will often additionally suffer from projections that they must eat like pigs, all the time.  Many overweight people in my practice do not chronically over-eat.  Obviously, all overweight people have stored more calories than necessary, but let’s not assume it’s because they are lazy or gluttonous. In order for the food we eat to satisfy, and provide adequate nourishment, it must be properly digested.  All food, in particular protein, absolutely requires stomach acid to break it down into micro-nutrients that can be absorbed into the blood stream, and then transported across the cell membrane into the trillions of cells in your body.  Eventually, all food turns into raw material for energy production within the cells, inside tiny organelles called mitochondria, which produce the basic unit of energy, ATP (adenosine triphosphate).  Ideally, whatever is not usefully broken down for ATP production, is eliminated.  If our digestion is compromised, however, food is not managed optimally, and calories get stored without giving any satisfaction.  That’s when fat happens.

Besides inhibiting proper digestion, PPIs have been affiliated with hip fracture (they inhibit mineral absorption), low magnesium status (potentially causing cardiac arrythmias, seizures and severe muscle spasms), the two main forms of anemia from poor iron and B-vitamin absorption, slow gallbladder function, increased risk of serious infections such as Clostridium difficile and various agents of pneumonia, and the list goes on.  PPIs are given as a treatment for heartburn, even though the problem is not stomach acid per se.  We absolutely, critically, need our stomach acid.  We mammals were designed to tolerate a very low pH in the stomach after eating (a pH of 1 to 2, which is about the same as vinegar or lemon juice).  The actual problem in heartburn, or GERD (gastro esophageal reflux disease), is often a sliding hiatal hernia, which inhibits optimal function of the valve designed to prevent reflux of stomach contents.  The tube that connects your mouth to your stomach is the esophagus.  The esophagus passes through a hole in the round muscular diaphragm which separates your heart and lungs (thorax) from your digestive organs (abdomen).  Often, particularly with overweight or sedentary folks (though skinny people can get hernia-induced heartburn too) the stomach gets pressed up against the diaphgram and the lower esophageal valve (LES) gets stuck in the hole in the diaphgram, so the valve doesn’t work right.  The “fix” is not to block your stomach acid.  Stomach acid is not only essential for proper digestion, it’s also one of the most important early mitigators of preventing disease going deeper into the body.  This is why PPIs are affiliated with more pneumonia and serious intestinal infections: the stomach acid not only breaks down proteins, it also sterilizes all the potential pathogens that could come down the pike.

If you want to get the maximum value out of your food, so you can eat less but still feel completely satisfied, here are some tips to improve digestion.

1.    I know you’ve heard this before, but it is SO important that it bears repeating: CHEW, CHEW, CHEW. This means both slowly and thoroughly. To be totally graphic about it, you want anything you swallow to be a soupy consistency. Especially meat. For starters, digestion starts in the mouth. There are thousands of tiny neuro-receptors in the mouth that send messages to the brain about what is about to come down the pike. These messages “prep” the entire digestive system to gear up for the meal or snack that’s on the way. Fatty foods will trigger the liver to produce extra bile, and cause the gallbladder to contract. The gallbladder is a handy little sack that hangs just under the liver, collecting an extra repository of bile in case you have a Mac-attack. Bile is extremely potent stuff (so precious to the body that 95% is recycled — the other 5% is responsible for the wonderful deep brown color of a healthy bowel movement). Bile is the main agent for digesting fat. But I’m getting a little ahead of myself. Back to the mouth. Unlike cows, birds and certain lizards, we mere humans do NOT have small sharp objects in our stomachs to help pulverize food into smaller morsels. We have those small sharp objects in our mouths — they are called teeth. Please USE your teeth to grind and pulverize every mouthful of food. Then, you mix the thoroughly pulverized food with as much saliva as you can muster without drooling.  Saliva is loaded with amylase, the starch-digesting enzyme. You want that saliva-drenched, well-chewed food, to head down the esophagus and into the stomach where the next phase of good digestion occurs.

2.    There’s a helpful and entertaining book by Jonathan Wright MD called “You NEED Your Stomach Acid”. Stomach acid serves three critical functions. It sterilizes food, it breaks down protein into amino acids which can then be absorbed into the blood stream, and it provokes the pancreas to dump “neutralizing” bicarbonate of soda into the upper small intestine to allow the absorption of nutrients into the blood stream.  If you suffer from heartburn, you need to repair the sphincter between the end of the esophagus and the stomach. If you have gastric ulcers, you need to heal the lining of the stomach so that it can again accommodate the acid levels required for proper digestion. Folks chronically popping antacids eventually impair their digestion, which leads to poor nutrient absorption, which ultimately leads to malnutrition including protein, mineral and vitamin deficiencies — despite plenty of calories.


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