This article is a transcribed edited summary of a video Bob and Brad recorded in March of 2021. For the original video go to https://www.youtube.com/watch?v=LS8uzSBkPqE&t=18s
Brad: I'm Brad Heineck and I'm exactly one half of the Bob and Brad show. We have Chris the pharmacist here. We're excited to have him here. He did a lot of research and he just knows this information on this topic, which is heartburn, acid reflux and GERD capital G-E-R-D best relief options. Whether it's diet, over-the-counter or prescription meds, also known as PPI. I guess we're going to get into that. You need to know this information. If you have this or a family member it's going to be a complete education. You are going to feel so much better about how to deal with this. So, Chris, heartburn, acid reflux, GERD, or G-E-R-D. Are they all the same or is that three different diagnoses?
Chris: They're all the same. Basically, it is that awful feeling you get in your chest, you just feel like it's kind of burning. It just doesn't feel right. You're just uncomfortable, whether it's after you eat or maybe when you lay down at night. Your symptoms can come at different times of the day or at all times of the day. So, it just kind of depends on how severe your case is.
Brad: So from personal experience, I do want to say one thing, if you have not had acid reflux or this problem and you're getting chest pain, don't guess and think, “Oh, I've got heartburn,” because you could be having a heart attack. You've got to get in and get it checked out. Confirm what the problem is.
Chris: Yeah, you want to make sure that you have a professional look you over, because there are symptoms that are indiscernible to a doctor, even in an ER setting until they actually do blood work and look at your levels and all the things there.
Brad: So you're saying, they don't know what it is?
Chris: They don't know until they do some testing. So, sometimes people can have what they think is heartburn and it's actually a heart attack. Some people think they're having a heart attack and its only heartburn. So if it's an emergent situation, don't just guess “I'm going to take a couple of Tums and see what happens,” get it taken care of properly.
Brad: There's another diagnosis with similar symptoms which I have, it’s costochondritis, which, has to do with the ribs and the cartilage in your chest. But I know I get that pain in the chest area. I've gone to the emergency room three times. So I feel confident if I ever get it again that I know it's my costochondritis, but I'm thinking, boy I bet you heartburn is similar, because my mother had it in the same location.
Chris: It’s the same nerve plexus, from that standpoint. So yeah, it's nothing to mess around with guys. If you don't know, get it checked out by the pros. Those doctors are there to help you, and make sure. And if it is just heartburn, there's a lot of things that we can do to help treat people.
Brad: Yeah, that's the good news about this, the more educated you are, the more you can self-treat or work with your doctor and have a team effort that really does that prime way to work. So you feel part of the team. What are the stats as far as, is it just an older person thing or? When I was looking this up, there was a diagram and this really helped me. If you think of, here we've got the stomach, on the left, so the food goes down, goes over into the stomach, and then from there into the intestine, or the duodenum. So we've got the stomach. And here are the food's going down and there's a sphincter that keeps the food going one direction if everything is working right, and down in here, that's why I use red, we've got stomach acid, and evidently that's pretty potent.
Chris: Very potent, one molar, one molar hydrochloric acid.
Brad: Now we're talking chemistry, we've got a pharmacist. So if you compare that to other like acidic food, stomach acid is…
Chris: Much stronger. A tomato is not going to withstand that.
Brad: So we've got all this acid down here, which is healthy. We use it to digest, but we want to keep it there. So with GERD or acid reflux, somehow this stuff gets up and goes this way. And that burns, which is why you get the pain in the chest.
Chris: Yes. You're describing it really well.
Brad: I feel like that's my contribution to the this all.
Chris: That’s a definite improvement over my artwork, that's for sure. No two ways about it, but yes. When you get those symptoms, there's certain foods that can trigger it. In the old days, we used to tell people that, if you have reflux or GERD, you have to go to this bland diet where you're just eating like white bread and crackers and chicken noodle soup.
Brad: How about milk?
Chris: Milk actually is weakly acidic. And some people can actually get irritated by it. Not always. But that way of thinking is wrong. So that's the old news. The good news is, you can eat a lot, just about anything you want, minus garlic, tomatoes, citrusy fruits, onions, those types of things.
Brad: I’m dead in the water. I can’t eat grapefruit?
Chris: Well, if you have heartburn, no. But there's medicines, we're going to get to better living through chemistry shortly. It's one of those things that if we can avoid some of the foods that are triggers, we can kind of naturally bypass some of this. A lot of times, we may overeat, we have a high fatty meal. It's just, this little muscle the sphincter here, can get stretched and all of a sudden acid will just kind of leak right through it. And what do you do after dinner? You kind of lay around, you watch TV. I mean, you're not necessarily sitting with perfect posture. If you can sit upright after you eat for a good hour, this is going to help because gravity is going to keep things going down in the right direction. But if you're in the lazy boy and you're flipping through channels or you're reading a book, and your stomach is a little bulged because you maybe had the old 96er or something to that effect, you can get some seepage and you're going to get that heartburn.
Brad: 96er?
Chris: Did you ever see “The Great Outdoors” John candy movie? 96-ounce steak.
Brad: I don't get out much
Chris: A very big piece of meat.
Brad: I quit watching movies after 86. Anyways...
Chris: That's about when it was made.
Brad: I was on the borderline. So anyways also, so if you lay flat, you're even more prone.
Chris: More prone to probably suffering. And so there's things that people can use like bed wedges, prop their bed up. So there's a lot of non-drug things you can do but what it comes down to and really the title today is, the proton pump inhibitors have really revolutionized how we treat these types of acids.
Brad: Protons Pump Inhibitors. So they put up a pump in your system?
Chris: Basically the easiest way to think about how we make too much stomach acid. We have pumps and they're basically in the lining of our stomach and their actually what kicks out the stomach acid.
Brad: You don't mean... Surgically putting the pump in there. It’s not like the pump for morphine or anything. So the pump is just a natural thing that goes on.
Chris: No we're not pumping it in.
Brad: That was a little scary for me. You said the pump and I thought, what are we going to promote here?
Chris: There is no little robots in us or anything like that?
Brad: I thought they're going to put them in there. I didn’t know.
Chris: No, but ultimately it's what our stomachs do to break down food. So we need that. The business end in the stomach is the surface area, then it gets into some of the intestines, from there nutrients go into the body. I mean, that's the quick and dirty answer but the reality of it is, there’s a lot going on. For a lot of people that have reflux or even other stomach kind of conditions your body is making too much stomach acid and as a result, it's seeping out in the wrong direction, we're getting the heartburn, we're getting the discomfort. So if we take these types of medications like Omeprazole or pantoprazole, like Prilosec or Protonix these are drugs that suppress that acid pump. So your body doesn't make as much acid. Realistically, when you take a tablet within about 20 minutes of taking that, like with Omeprazole specifically, your stomach acid has been reduced by 80%. It’s very thorough.
Brad: So what about, I heard people take Tums, over-the-counter.
Chris: Yeah, that's a neutralizer, so it works differently. That's calcium carbonate. So if you've had acid in a little cup and you threw some Tums in there, it neutralizes it. So it's not as damaging. So that works a lot faster than say a proton pump inhibitor. It takes about five to seven days to notice a difference with the PPIs. If you have a lot of reflux and discomfort there's irritation going on and it takes time, it's just like any other wound at that point. So if the mucus is kind of irritated.
Brad: So the tissues in the throat or the esophagus are actually physically irritated with little lesions.
Chris: Irritated, correct. And there can be lesions, and if untreated, it can go to a myriad of very serious diseases, as bad as cancer. So yeah, you can get to ulceration and if ulcers are left untreated, it can become stomach cancer, esophageal cancer bleeding varices. There's a lot of things out there that you want to make sure you see your doctor and you get treatment for this.
Brad: So the first step I'm thinking, I don't want to take the pills, maybe diet. Like I know my mother, we had to take citrus out of her diet and it seemed to help. And actually she did get, she was taking, I don't remember. You remember?
Chris: Yep, she was on Ranitidine at one point, we switched and I think she’s on Omeprazole now.
Brad: I'm supposed to know that, it's my job. I got it written down.
Chris: That’s what you have me for.
Brad: Yeah, that's exactly right. So anyways, you may be able to modify it or maybe be able to control it by diet. If it's a mild case.
Chris: You can, diet and exercise are huge.
Brad: Exercise has something to do with this?
Chris: Well, keeping a healthy body weight. Because, if we have too much body weight we're carrying around, the things that kind of keep everything in place kind of gets stretched and displaced. And then, all of a sudden, your stomach's not sitting quite right and then you can get reflux. So healthy body weight is important.
Brad: So, we work with our diet a little bit, and maybe it's not going well, and you talk to your doctor and it's like a time for meds. So this means we have to do prescription meds or is there over the counter meds?
Chris: No, many of these drugs are all over the counter as well. And so that's, one of the problems that we're facing in this country is, maybe the over utilization of some of these drugs. So we have to be careful with that. The reason that you see a lot of these packages over-the-counter, they're only for 14 days. We only want you to use it for two weeks. If your symptoms aren't gone, by that point, you should be discussing this with your doctor because we want to make sure that there isn’t something more serious going on that could be easily hidden by just simply taking months and months and months of over-the-counter proton pump inhibitors.
Brad: So, yeah, you're just kind of masking.
Chris: You can mask the symptoms. It could be a variety of different things. But I mean, worst case scenario is let's say you had some severe erosive esophagitis. I mean, that esophagus is just raw and irritated. Sometimes it can be to the point where they have to do special procedures or it could be triggering things like very bad disease states like cancer.
Brad: So at that point, if you've got that esophagitis, it's probably going to be painful to swallow.
Chris: It is, but some people are so tough. I mean, actually a buddy of mine's a gastroenterologist, it'd be fun to have him on here. But, a lot of these people just don't even recognize it and it almost speaks silent in some cases. Some people have tremendous pain. So it varies from person to person, condition to condition, and where along the GI track it is. So there's a lot of different things that go into these factors, but the medications that we use to help to try and cut down acid are game-changing. And so it can be life changing as a result of that. But, we still have to be judicious with it. There can be some consequences of over utilization of some of these medications as well.
Brad: You mean some side effects that take on other problems?
Chris: Yeah, so, you think about your stomach acid it's one of your best immune defenders. So I mean, it helps to protect you against things like pneumonia and other respiratory infections.
Brad: Because it goes up into the esophagus?
Chris: No, it's not even the esophagus, it could be on your food or whatever, but it's bacteria. And it can't stand up to that acid. Although we do have bacteria that do stand up to those acids too, we'll talk about.
Brad: There's good bacteria?
Chris: There's good bacteria, yep.
Brad: That's another video.
Chris: A couple of videos, probably. When we have people with symptoms, we have to treat them and we want to treat them and usually it takes about three months to get everything to heal up. And if you are three months and you're like, I feel great. I'm not having symptoms. At that point, your doctor may even suggest that maybe you can try and cut down or try and discontinue the product. But there's a double-edged sword with proton pump inhibitors specifically is that they can cause a rebound in your acid production for about 14 days after you discontinue a product. So depending upon the dose level that your doctor puts you on for your particular condition some people have to take it up to twice a day. Some people only take it once a day, usually like to half that dose for a couple of weeks and then stop it. And like I said, recognize that you will probably have a little bit of rebound reflux. So you have to kind of muscle through that or maybe use something like a Tums or maybe something like a Pepcid, which is an over-the-counter supplement to help to try and cut that down and bridge the gap.
Brad: I think once you see your doctor, hopefully you're listening to him, you got him as your quarterback or your coach. But if you're in that phase where I want to see if I can do this with over-the-counter meds, and you said they're typically 14 days, and then if that doesn't work then you better stop.
Chris: You should see your doctor after 14 days.
Brad: Is there an acceptable and wise way to go in to get an over-the-counter medication that you could suggest to people.
Chris: When people come and see me, we're going to talk, I'm going to try and get a gauge as to how long they've been suffering. What makes it worse? We're going to see if it's always after meals. Is it when they lay down at bedtime? Is it all day?
Brad: So you're saying like, if I'm a customer, I come in and have not seen my doctor, I could go ask the pharmacist, "I've got heartburn can you recommend anything?"
Chris: Yep, and so we could see how long it’s been going on. If you’re like” Yeah, it's been like two months and I've been feeling horrible every time I eat. I just get this horrible pain up in my chest. It just doesn't feel right.” We can try a couple of different things, and then I would give them options. Pepcid is one, it's a little bit faster acting than the proton pump inhibitors but the proton pump inhibitors are more thorough and they're more effective.
Brad: You can get that over the counter?
Chris: Yeah, they're all over the counter. These are all over the counter at this point, this is my arena. We always say, "Hey, I'd like you to just try this for about two weeks. And if this isn't better, or if you see symptoms worsening while you're doing this, don't mess around with this and wait for something to happen in a positive direction. Talk to your doctor because you're going to need the help. We have to figure out what's going on directly.” And there's ton of incidences, where they go in and all of a sudden it was a big deal.
Brad: Do you have many people come in for advice like that?
Chris: Yeah, all the time. We want to talk to people. That's what we're there for. So hopefully we can give them some temporary help unless they need more thorough help from their doctors.
Brad: Which is something I didn't know. I don’t go to the pharmacy very often because I've been pretty healthy. I didn't know that you could go ask them questions. I just get a lot of my advice from Chris. I talk to him about something and he tells me. I remember I had a skin thing, I said, “I have to go to the doctor to get something for this.” And he gave me a little over-the-counter advice, I got it, it was gone, it's like, a pharmacist, they work. I mean, a pharmacist and a doctor really need to work hand in hand. But, you can eliminate doctor visits by doing some of it?
Chris: I don't think we can eliminate the doctor’s visits; we can help out when it's something simple.
Brad: Well, in my case, it was a simple thing. It's like, I don't want to go to a doctor because of a rash. I just need something to put on it. And you helped me. And like this topic of acid reflux, this could possibly stop a doctor visit.
Chris: Yeah, I think the use of over-the-counter medications, is very, very effective and I think it has its place in therapy. But again, we have to be careful because, if we're older, I mean, if they're a smokers, there's a lot of things that could be triggers that your doctor really needs to address these things. And long-term, as we age and we take these things for long, long periods of time, we found that there is a higher risk for osteoporosis. So you might want to maybe be taking a calcium supplement if you're on it, specifically calcium citrate versus calcium carbonate because the carbonate needs the acid to break down. So if you're reducing the acid environment you want to use something that's bioavailable.
Brad: These things overlap and we don't want to cause another problem.
Chris: Exactly. So, we have to be mindful, of other things, like I said, it's disease state management too. We can see, and if you're at higher risks of what they call Clostridium difficile which is another very bad intestinal bug, there is a correlation with long-term use of these medications. So we have to be really careful. And that's why your doctor has to be involved with your treatment plan. So coming in and seeing me is nice and I enjoy it, but a lot of times, we have to make sure we do the professional punt and hand it off to the pros. So whether it's your regular physician or a gastroenterologist, I mean these guys are the ones that really know and they'll turn you back to me and we'll talk about proton pump inhibitors at length. Particularly if you end up on a prescription to make sure you use it long enough, What's the best tapering strategy? And you should always, when you're talking with your doctors, figure out what's going to be the end game here. I mean, am I going to have to take this forever? And we're finding that about 27% of the people do. And your doctor has to mitigate those risks for you.
Brad: You're saying almost three-fourths of the people eventually can get off?
Chris: Yes, they can get off. So if they're eating well losing a little bit of weight, watching what they eat, minding the type of things that they eat.
Brad: Maybe get a wedge to sleep on.
Chris: Wedge to sleep on, smaller meals multiple times a day sometimes; grazing versus gorging kind of thing. So there's a lot of things that can be done that do not require medicine, but a lot of times they're there for you if you need it. But just realize that long-term use does have some consequences. So we have to be mindful of that. And you want to work with your doctor, to do the safest, most effective plan. See if there is an exit strategy for you. So we don't have to succumb to some of these risks that could be associated with long-term use of these medications. So I'm going to be very, very careful.
Brad: I'm feeling better already.
Chris: All right, well, there you go, no reflux for Brad.
Brad: Thank you for listening and watching. I know we'll be back with another exciting episode with Chris.
Chris: Have a good day guys.
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