Passing the acid test – Have you got acid reflux or GERD?

A lot of older people complain of ‘acid reflux’ or a burning in the chest, moving up to the throat. If they go to their GP they are likely to be diagnosed with GERD (Gastroesophageal reflux disease) and prescribed a drug known as a proton-pump inhibitor, or PPI, usually ending in ‘prazole’. These drugs are being handed out like Smarties for just about anyone who mentions the word ‘indigestion’ or ‘heartburn’. They are officially licensed for the treatment of ulcers and for gastroesophageal reflux disease or GERD.

PPI drugs work by suppressing the formation of stomach acid (betaine hydrochloride), which is absolutely vital for digesting protein into amino acids, killing off harmful bacteria in food, and absorbing vitamin B12. But, of course, they don’t address the underlying causes of indigestion or heartburn or GERD which, you may be surprised to hear, is not an excess of stomach acid.

Most people’s problem is caused by a weakness in the circular valve or muscle that separates the stomach from the oesophagus. It is called LES (lower (o)esophageal-stomach valve). In an extreme form this is called a hiatus hernia. As a consequence, acid, which is meant to be in the stomach, passes into the oesophagus. By simply suppressing all stomach acid formation you can get temporary relief but at some quite considerable cost. After all, the body doesn’t produce stomach acid for no reason. Taking an average of 1.5 PPI pills a day doubles the risk for B12 deficiency according to a study in the Journal of the American Medical Association. B12 absorption is dependent on adequate stomach acid and a lack of B12 is a major driver of dementia.

Most people who have GERD actually have a lack of stomach acid which is called betaine hydrochloride. How could this be if the drugs help? The issue is that if you are regurgitating stomach juices past the LES valve even the tiniest acid is going to produce symptoms. Killing off all stomach acid is like using a hammer to crack a nut, but actually doesn’t address the true cause at all.

Also, the less stomach acid you have, the less your body can kill off harmful bacteria, which then feed off undigested food and give you gas and bloating.

About a third of people over 60 have low stomach acid, while 40% of women over 80 produce no stomach acid at all. Stomach acid secretion declines about 20% per decade from age 30. The average 20 something year old produces 150mg per hour, while the average 60 something year old produces 50mg per hour. As a consequence, two in five people over 60 have insufficient B12 in their blood – not from dietary deficiency but from poor absorption caused by lack of stomach acid secretions. The fact that GERD almost only develops in older people illustrates that the problem isn’t caused by a lack of stomach acid – so taking antacids will never cure the problem. So what does? What makes the lower oesophageal-stomach (LES) valve weak?

If you eat too much this puts pressure on the valve as does being overweight (less space for the stomach). Also, if you eat too many carbs and sugary foods, which bacteria feed off – producing gas, that makes matters worse, too. High- protein foods such as meat require a greater release of stomach acid, so have smaller portions. High protein diets, for this reason, can be aggravating for some. So, too, can too much coffee and alcohol – both digestive irritants. We recommend max one coffee at the start of the day away from food if you have to and alcohol max one drink or none in the week. Also, don’t lie down after meals. Stay upright.

Dealing with this first stage, if you ate according to the low GL principles – explained in the Low GL domain – you deal with all these problems. If you took, with each main meal, a digestive support supplement that contains both digestive enzymes and beneficial bacteria you would take some strain off the stomach and help prevent the formation of gas and the pressure it delivers. Some also contain some glutamine, which helps keep the lining of the digestive tract healthy.

Allergies and intolerances

One common reason for heartburn is eating a food you are allergic to. Babies, when given milk too early, regurgitate it. This normal reflux is what the body does to get rid of something that doesn’t suit it. If you keep eating the wrong foods, this can weaken the circular muscle at the top of the stomach until some stomach acid enters the oesophagus, producing symptoms of heartburn. Other things that aggravate the digestive tract include alcohol, coffee and NSAID pain killers (eg aspirin and ibuprofen), and should be avoided if you have indigestion. But most important is to test for food allergies or intolerances. See www.yorktest.com.

Stomach ulcers

Another possible cause for digestive pain is the presence of stomach ulcers, often caused by infection with Helicobacter pylori. Other gut infections from bacteria, yeasts or parasites can cause digestive symptoms. If you have followed all the advice given here this is an avenue worth exploring, especially if your problems started after a trip abroad in a ‘high risk’ region.

Are you stomach acid deficient?

If you are older and suffering from GERD the chances are you are stomach acid deficient. The production of stomach acid, called betaine hydrochloride, is dependent on zinc and without enough of it you can’t break down proteins properly. Make sure you are supplementing 10 to 20mg a day. A good multivitamin/mineral taken twice a day could give you this but do check the label.

Some people lack stomach acid and benefit from supplementing betaine hydrochloride (called betaineHCl – betaine is also known as trimethylglycine or TMG). This usually comes in 300 or 600mg strength and relief for indigestion can be obtained with taking between 600mg to 3,000mg. However, you might want to do this under the guidance of a nutritional therapist.

Firstly, if you don’t need it, don’t take it. It could make you feel worse (eg burning sensation). Secondly, only ever take with a meal containing protein. Thirdly, never take it if you are on NSAID pain-killers such as aspirin or ibuprofen. These drugs can and do damage the gut and if you have any damage, or ulceration, taking betaineHCl will make you worse). However, if you suffer from continuous indigestion, bloating and other problems associated with lack of betaineHcl keep taking it, doubling the dose with each protein meal up to 3000mg, to see if you get relief. If you don’t, or get adverse symptoms, stopping taking it.

In summary, rather than suppressing the symptoms by taking antacids with considerable long-term adverse effects, try:

• Eating smaller meals, with a balance of 20% protein, 30% fat and 50% low GL carbohydrates, as in my low GL diet books and recipes.
• Test for and avoid food intolerant foods.
• Minimise use of coffee and alcohol
• Take a digestive support supplement that provides both beneficial bacteria and digestive enzymes, possibly also with glutamine, with each main meal.
• Control your weight
• Don’t lie down after eating.
• If you are still suffering do get checked for stomach ulcers, often caused by Helicobacter Pylori infection.
• If you’ve done all this and don’t have stomach ulcers, also try supplementing betaineHCL bearing in mind the cautions listed above

Further info

The fibre factor

Not all types of carbohydrate can be digested and broken down into glucose. Indigestible carbohydrate is called fibre. In recent years some kinds of starches, not previously classified as fibre, have been found to be resistant to digestion. They are called ‘resistant starches’ we spoke about in the last email.

Fibre is a natural constituent of a healthy diet high in fruits, vegetables, lentils, beans and wholegrains. If you eat such a diet you have less risk of bowel cancer, diabetes or diverticular disease, and are unlikely to suffer from constipation. Contrary to the popular image of fibre as mere ‘roughage’, it can actually absorb water. As it does so, it makes faecal matter bulkier, less dense and easier to pass along the digestive tract. This decreases the amount of time food waste spends inside the body and reduces the risk of infection or cell changes due to carcinogens that are produced when some foods, particularly meat, degrade. Bulkier faecal matter also means less chance of a blockage, or constipation.

There are many different kinds of fibre, some of which are proteins, not carbohydrates. Some fibre, such as that found in oats, is called ‘soluble fibre’ and combines with sugar molecules to slow down the absorption of carbohydrates. This type therefore helps to keep blood sugar levels balanced.

Some fibre is much more water-absorbent than other types. While wheat fibre, for example, swells to ten times its original volume in water, glucomannan fibre (from the Japanese konjac plant) swells to 100 times its volume in water. Highly absorbent types of fibre, by bulking up foods and slowing down the release of sugars, can help to control appetite and play a part in weight maintenance.

Watch this Film The Truth About Fibre to see how much water different forms of fibre absorb.

How Much Fibre do You Need?

The average daily intake of fibre in the UK and US is around 20g, which is less than half that of rural Africans who consume around 55g a day and suffer from few of the lower digestive diseases so common in the West. An ideal intake of fibre is not less than 35g a day. For example, if you have a cup of oats, an apple and a heaped tablespoon of seeds for breakfast this will provide 15g of fibre.

A large salad containing crunchy vegetables, such as carrots, cabbage or broccoli pieces, may give you a further 15g. A meal based on beans, lentils or peas is likely to provide a further 15g.

Provided the right foods are eaten, 35g can easily be achieved without the need to add extra fibre. Professor of Nutrition, John Dickerson, from the University of Surrey, has stressed the danger of adding wheat bran to a nutrient poor diet. The reason for this is that wheat bran contains high levels of phytate, which reduces the absorption of essential minerals, including zinc. Overall, it is probably best to get a mixture of fibre from oats, lentils, beans, seeds, fruits and raw or lightly cooked vegetables. Much of the fibre in vegetables is destroyed by cooking, so vegetables are best eaten crunchy.

One way to get soluble fibres is to have a tablespoon of chia seeds a day. Another is to eat whole oat products. You can further up your soluble fibre intake by adding a teaspoon of oat bran to cereal. Soluble are also in vegetables, although somewhat destroyed by heat and hence prolonged coking. They behave quite differently to, for example, wheat fibre.

In summary:

• eat wholefoods – wholegrains, lentils, beans, nuts, seeds, fresh fruit and vegetables.
• Avoid refined, white, processed and overcooked foods.
• Eat vegetables every day raw or lightly cooked
• Eat resistant starch rich foods – Garlic, leeks and onions, asparagus, cashew nuts, raw oats, peas, beans and lentils
• Use xylitol or chicory root powder (inulin) as a sweetener
• Have a tablespoon of chia seeds (make sure to up your fluid intake as chia seeds are very absorbent!)
• Have whole oats, as is oat flakes and rough oatcakes
• Have a teaspoon or three capsules of Carboslow or PGX, or glucomannan, with a large glass of water, before one up to three meals a day (optional but good for both weight and appetite control and constipation).
• Exercise at least three times a week.
• Drink plenty of water – at least 1.5 litres a day.

Further info

Foods that feed your gut microbiome

Did you know that up to 2kg of your body weight is bacteria? The average person has about 130 different types of friendly bacteria, mainly resident in the digestive tract, and they are forever multiplying. There are about 100 trillion bacteria in your digestive tract, most of which are in the colon. That’s about ten times the total number of cells in your body, with a combined weight twice that of your brain. Every day you make quantities of bacteria and eliminate an equal amount in stools.

Not all of these bacteria are good for you, but, provided you have enough of the health-promoting bacteria, they act as your first line of defence against unfriendly bacteria and other disease- producing microbes, including viruses and fungi.

The good bacteria make some vitamins and digest fibre, allowing you to derive more nutrients from otherwise indigestible food, and also help to promote a healthy digestive environment. It is not just the quality but also the quantity of bacteria that makes a difference to your health.

We are, in fact, partly descended from bacteria. Within our body cells are organelles (or components), each with a specific function. Biologists now believe that the complex cells that make up our bodies may have developed from smaller microorganisms, such as bacteria, working together. Over time, this cooperation led to the development of the complex cells from which we are made; for example, the energy factories within our cells (called mitochondria) are derived from bacteria.

Like our fingerprints, our microbiome (the specific family of microorganisms found in our gut) is unique to each one of us and is comprised of a balance of different bacteria, some better for us than others. What exactly makes up a healthy microbiome is the subject of much research.

Some kinds of starch or carbohydrate are difficult to digest and act as fibre. These ‘resistant’ starches also feed gut bacteria and are thus called prebiotics because they can help healthy bacteria in the gut to grow. A classic prebiotic is FOS (fructo- oligosaccharides), which you might have seen in the list of ingredients of probiotic supplements. They are included to feed the bacteria when they hit fluids in your digestive tract. Another is inulin (containing fructans), derived from chicory root. Oats contains glucans, a similar molecule. Having a diet high in resistant starch is a good idea, and there are two ways to do this. The first is to eat foods that are naturally high in it.

 

These include:

Jerusalem artichokes Garlic, leeks and onions – in that order Asparagus Cashew nuts

Oats, uncooked Chicory Green bananas, raw Peas, beans and lentils

The second way to increase your intake of resistant starch is to cook a carb and cool it, then to eat it cold or reheated. Oats naturally have ten times more resistant starch raw than cooked, but if you make porridge and cool it, you recreate resistant starch. Or take a small cup of oats and mix with a dessertspoon of chia seeds and some plant milk and leave it to soak overnight for an oat & chia porridge, topped with berries and yoghurt.

The same is true with potatoes, rice and pasta. If you steam new potatoes, then cool them, to make a potato salad, you significantly increase the level of resistant starch. You can do the same thing with rice and pasta, but its best to start with a long- grain brown rice or wholegrain pasta, which is naturally high in resistant starch; for example, you could make a pasta salad or a cold rice pudding using dried Montmorency cherries instead of raisins, and oat milk instead of cow’s milk, if you are dairy sensitive.

Even though the sugar in bananas is fast- releasing, hence they are high GL, the same is not true for a green banana eaten raw. Cut a green banana into thirds then put a third, plus some frozen blueberries, in your breakfast smoothie mix in the morning.

Further info

Six steps to digestive health

Underlying most digestive disorders is disruption of the fundamental cornerstones of a healthy gut – good digestion, a diverse and healthy gut microbiota, good gut wall integrity, an absence of gut inflammation and food intolerances and good elimination.

Most digestive problems are a consequence of one or more of the following issues:

• poor digestion (irritation, intoxication, lack of enzymes, lack of stomach acid)
• poor absorption (increased gut permeability)
• poor protection (dysbiosis, over inflammation, food intolerances)
• poor elimination (clogged up colon, liver detoxification problems)

Read the Report Six Steps to Digestive Health in your Library to find out which apply to you and make changes to transform your digestion.

Further info

Improving your HEALTHY GUT starts today

In the weeks that follow, starting now, we’re going to guide you in taking simple steps to improve your gut health.

A healthy gut is essential for a healthy brain. In recent years it has become established that there are many ways in which the gut communicates with the brain, and vice versa. This includes:

• the production of neurotransmitters in the gut
• the gut’s ability to absorb critical brain-friendly nutrients such as vitamin B12
• its role in controlling inflammation and eliminating potential brain-damaging toxins
• the role of the gut microbiome – the balance of trillions of bacteria that populate our gut.

Two gut-related predictors of Alzheimer’s – periodontal disease and lack of stomach secretions required for vitamin B12 absorption – illustrate this microbiome-gut-brain connection.

Decreasing production of stomach acid, required for vitamin B12 absorption, is a common occurrence in those over age 50. Two in five people over 61 have low blood levels of B12. Gastritis, irritable bowel syndrome (IBS), gut infections such as H.pylori, long term use of PPI (proton pump inhibitors) antacids and antibiotics have all been implicated or associated or with increased risk of cognitive decline and dementia.

The intestinal gut barrier functions much like the blood-brain barrier, ideally allowing nutrients to pass while rejecting toxins and ant-nutrients. The integrity of the gut barrier is affected by alcohol, gliadin in wheat, a lack of antioxidants and anti-inflammatory omega-3 fats which influence the microbiota. Gut inflammation may play a role in cognitive decline.

The role of the microbiome in the gut affecting cognition is a new frontier for research. While there is little clinical trial evidence yet there is a growing body of evidence that restoring gut health and eating a digestion friendly diet is correlated with and likely to be beneficial for protecting your future cognition.

Further info

Your Antioxidant domain – how have you progressed?

Congratulations! You have finished a month focussing on increasing your antioxidant intake in your diet and achieving a more stable blood sugar balance – which will have knock on positive effects on your energy levels and weight control.

Now is the time to find out how much impact it has had. To see how much reduction you’ve achieved in your Dementia Risk Index, click the button below to complete only the ‘antioxidant’ related questions. This will show you, specifically, what level of improvement you’ve made over these past 4 weeks, what effect that has on your ‘antioxidant’ domain score, and your overall Dementia Risk Index.

You will then be asked to choose the next domain you’d like to focus on for the next 4 weeks. Note: if you got distracted and didn’t make many changes such that ‘antioxidant’ is still in your top two weakest domains you can choose to focus on this again with more resolve.

Further info

Go nuts for zinc, selenium and magnesium

Antioxidants aren’t only vitamins. The essential minerals magnesium, zinc and selenium are vital antioxidant team players too.

Magnesium is one of the most commonly deficient minerals which, in modern day diets, falls along way short of what our ancestors ate. It’s found in greens, nuts, seeds and beans. Pumpkin seeds are a really good source. We are meant to get 375mg a day. The average woman in the UK gets 217mg. Men achieve 272mg. That means that four in ten women don’t achieve the recommended intake for magnesium. Our Palaeolithic ancestors, by comparison, consumed close to 500mg a day (about double what most of us achieve from our diet today). Their calcium intake was also less than ours today resulting in a big increase in the calcium: magnesium ratio, further inhibiting magnesium utilisation. Calcium, as a result of high dairy product consumption, is one of the few minerals that the average person eats more of than needed.

Of the body’s 25g of magnesium, 95 per cent is found within mitochondria, the energy factories within cells. It helps to mop up oxidants and reduce inflammation.

Magnesium deficiency is known to promote inflammation,

A reasonable quality multivitamin and mineral might give you 100mg of magnesium but you still need to eat greens, nuts, seeds and beans almost every day.

Zinc is vital for all growth, hence is found in the ‘seeds’ of plants – be it a nut, seed, bean or pea. These are the same foods rich in magnesium. But it’s also contained in eggs, fish, milk and meat. Zinc is vital for over 200 of the body’s known enzymes, especially in relation to healthy immune function, growth, repair and protein utilisation. Zinc is used up at a faster rate when there is an ongoing active inflammatory disease such as arthritis. Theoretically, then, it is necessary to have adequate zinc for cartilage repair, proper immune and inflammatory responses and warding off viruses and other  infections. Aim for a total of 20mg a day.

Most people achieve less than 10mg a day from food, so supplementing 10mg in a multivitamin makes a lot of sense.

Selenium is a tiny mineral with a big kick. It works together with glutathione as a dynamic duo in the critical antioxidant enzyme called glutathione peroxidase, sometimes abbreviated to GPX. It is a trace element, which means you need very little. The amount that you need on a daily basis is probably 50μg, up to 200 μg when under viral attack. It’s also one of the most toxic minerals. You certainly don’t want more than 500μg. Taking in 100μgin total would ensure you’re at an optimum level.

Selenium is rich in seafood, which includes both fish and seaweed, and also seeds and nuts. However, it is hard to know, or even guarantee, how much you’re getting. I generally assume you’ll eat at least 50μg from a wholefood and seafood diet, so supplement an additional 30μg to 50μg. You’ll find it included in both multivitamins and antioxidant supplements antioxidant supplement, so do check to avoid overdose. It may be that 200μg for short term use, only during an acute infection, has additional benefit but, without further studies, it is hard to know. Selenium is one mineral you don’t want to take too much of. It becomes toxic certainly above 500μg causing nausea, vomiting and nail discoloration.

Further info

The best oils for salads and cooking

Depending on what oil you use for cold use, such as salad dressings, or for cooking such as steam-frying, sautéing or frying, you can increase your intake of helpful antioxidants or harmful antioxidants.

Read the Report Which are the Best Oils? in the Cognition Library.

You’ll discover that when you cook with an oil you want to – a) use a close to saturated fat which is close to solid at room temperature and b) never go above the ‘smoke point’. That’s when you’re really generating oxidants. Some oils have a higher smoke point than others.

Then there are oils that contain polyphenols and are positively good for your brain. One hero oil is virgin cold-pressed, preferably organic, olive oil. The good stuff is for cold use only as its almost a medicine for your brain and body, reducing inflammaging. But how do know which oil is the best? Read the report and all will be revealed.

Further info

Protect yourself from pollution

There are two sides to nutrition – one is your intake of nutrients, such as antioxidants. The other is your intake of antinutrients, such as oxidants.

Smoking is a good example – it uses up vitamin C at a rate of something like 25mg per cigarette smoked. Smoking is a choice but breathing in exhaust fumes, if you live in a city or industrial area, or live with a smoker, is hard to avoid completely. That is why the incidence of many diseases, especially those of the lungs, is higher in cities than in the countryside.

So, how can you protect yourself from pollution? There are a few ways, depending on where you live and what you do.

Firstly, it is best to exercise away from (busy) roads. So, when you go for a walk or a jog go to a park or make a trip to the country once a week and have a long walk. If you go shopping on the high street, don’t do it in rush hour. If you have flexibility in the time you travel, avoid rush hour if you’re driving. City dwellers need more vitamin C.

Exercise actually uses up antioxidants. That’s why a lot of long distance runners get worse colds. It also makes them more susceptible to COVID-19 unless they increase their intake of vitamin C and other antioxidants. The more energy you’re expending the more antioxidants you need. By the way, a Montmorency cherry drink, made with a pure concentrate called Cherry Active, has been shown to speed up recovery and muscle stiffness after exercise. It’s a superb antioxidant with one shot equal to a hundred carrots for its ORAC (oxygen radical absorption capacity) score.

Plan trips where you spend some time in unpolluted air, perhaps with trips to the seaside or the mountains of natural places. ‘Earthing’ is an antioxidant. That’s right. We accumulate electrical charge as a consequence of making energy, and discharge when standing on the earth or swimming in a lake or the sea. So get your shoes off and stand, sit or walk on the earth barefoot whenever you can. Growing your own veg, and doing some gardening barefoot is a lovely way to ‘earth’.

If you do suffer from asthma or breathing difficulties, consider getting an ioniser. This ‘sucks’ small particulates from the air which would otherwise get into your lungs.

Learn deeper breathing techniques, as taught in yoga, or practiced in t’ai chi. When you work through the ACTIVE BODY domain we’ll go into this in more detail.

These are a few simple steps you can take to help reduce your total pollution load.

Further info

The truth about antioxidant supplements

There’s a big misunderstanding about vitamin supplements by many medical authorities and researchers. They think of vitamins like drugs and ask questions such as ‘will vitamin C or vitamin E supplements improve cognition or reduce dementia risk?’ This fits in very well with the much worshipped ‘double blind randomised placebo controlled trial’ giving half the ‘subjects’ in a study a dummy pill and the other half the vitamin or drug. There’s nothing ‘wrong’ with this and, in the case if vitamin C and E, there is some evidence of benefit.

These kind of studies cost millions and since vitamins are unpatentable, who pays for them? Governments put up almost no money for such prevention research, so very few studies get carried out. A number of key vitamins, as measured in food and in the blood, do correlate with decreased risk. These include vitamin C , both in food and supplements and vitamin E in supplements. Vitamin E has been found to be beneficial in mild to moderate AD by slowing the decline of cognition. A study supplementing vitamin E and selenium was not found to be protective. Nacetyl cysteine, the precursor of glutathione, Co-enzymeQ10 and resveratrol, found in red grapes, is also neuroprotective.

Do you remember this film ‘‘Keeping Your Brain Young with Antioxidants’? Watch it here. It shows that antioxidants are team players. Much like dementia prevention is a combination of the 8 domains which all influence each other, antioxidants are part of a network keeping you healthy.

It doesn’t really make a lot of sense to give one without the others. All those listed above – vitamin C, E, glutathione and N-acetyl cysteine, CoenzymeQ10 and resveratrol – work together as you’ll see in the film.

There are many other team player ‘cousins’, from B vitamins to minerals such as magnesium, zinc and selenium.

The first step is to eat ‘whole’ foods, and seafood, that are more likely to contain these kinds of nutrients but, as you have learnt with vitamin C, just eating whole foods doesn’t guarantee you are achieving optimum nutrition.

Most nutritional therapists supplement extra vitamin C and some supplement an all-round antioxidant supplement providing the nutrients listed above. There’s very good logic, and supporting evidence to do this, especially if you’re over 50 years old, even if there isn’t that definitive ‘randomised placebo controlled trial’ yet.

Further info