Why Stomach Acid Actually Prevents Heartburn

GERD (gastroesophageal reflux disease), or heartburn as it's commonly known, is the most common digestive disorder in the United States; approximately 10-20% of Americans experience symptoms at least once a week.  Conventional treatment is to take antacids.... chances are you've probably used these drugs at one time or another.  Tums, Zantac, Pepcid... ring any bells?  Or if you're really serious about your heartburn, maybe prescription Nexium?  Drug stores sell these things like candy.  Literally.  Tums is placed right next to the candy and gum in the checkout area, and for the first ten or so years of my life, I thought it was candy.  On the prescription side, Nexium was the number two best selling prescription drug on the market in 2006, just behind Lipitor (don't even get me started), bringing in $5.1 billion.  People generally find heartburn relief in these medications, so all is well right?  Not quite.

Although this topic may seem tame, there is more than you know going on behind the scenes.  I recently read a fantastic set of articles by Chris Kresser about the physiology and treatment of GERD that brought this to my attention.  It's a long six-part series, something I probably wouldn't have made time for if not for the combination of my iPhone and a boring afternoon class.  Since I will be summarizing a large amount of material here and simplifying some of the concepts, it would be unrealistic for me to cite all of my claims like Chris did.  So if you don't believe me, just refer to the link above.

For starters, let's talk about what exactly GERD is.  Out of Taber's Medical Dictionary, GERD is:  "A common condition in which acid from the stomach flows back into the esophagus, causing discomfort and, in some instances, damage to the esophageal lining."  You see, there is a one-way door between the esophagus and the stomach called the lower esophageal sphincter.  In digestion, food moves through this door to the stomach, and when everything is functioning correctly, nothing comes back up.  In GERD, small amounts of stomach acid are able to creep up into the esophagus, causing burning and damage to the wall of the esophagus, which can lead to a number of problems including esophageal cancer if left untreated.

Poking Fun at the Lipid Hypothesis

Quick one today about saturated fat and cholesterol.  If you haven't noticed, I really get my jollies off by poking fun at the lipid hypothesis.

Ancel Keys, the man largely responsible for convincing everyone that saturated fat clogs your arteries and gives you heart disease, published a few observational studies on the subject in the 1950's.  While his data showed a clear association between a high fat intake and increased risk of heart disease, the studies were extremely flawed.  Keys essentially cherry-picked the data from certain countries that would support his idea.  See this for a full explanation.

So, I thought I would share with you today some other, more convincing data on saturated fat consumption and heart disease death risk.  The following tables were assembled by Dr. Malcolm Kendrick, using the 1998 data from the World Health Organization.  He sorted through all of the data on European countries and found the seven countries with the lowest consumption of saturated fat, along with the seven countries with the highest consumption of saturated fat, and compared their death rates from heart disease. 

Here are the seven countries consuming the least saturated fat:

And here is the data on the seven consuming the most saturated fat:

At first glance, you may do a double take.  But your eyes are not deceiving you... the countries consuming more saturated fat are suffering fewer deaths from heart disease.  The country consuming the most saturated fat, France, consumes approximately three times more than the country at the opposite end of the spectrum, Georgia, but at least six times more Georgians die of heart disease.  These numbers are not made up guys.  This is real.  In fact, every single one of the seven countries with the lowest saturated fat consumption has significantly higher rates of heart disease than every single one of the seven countries with the highest saturated fat consumption.  Now, explain to me again how saturated fat causes heart disease...

Grass-Fed Beef vs. Grain-Fed Beef

The popularity of grass-fed beef has been on the rise lately, thanks in large part to the various pieces of media that are exposing the horrors of conventional meat production.  In my case, it was the film Food Inc. and Michael Pollan's outstanding book The Omnivore's Dilemma that brought the issue to my attention.  For those of you who don't know what I'm talking about when I say "grass-fed beef", here's a brief explanation:  Cattle have evolved over time to eat grass.  They get all the nutrition they need from grass alone.  However, in modern beef production, cattle are fed a diet of mostly corn and other grains, which can cause all sorts of health problems, but it fattens them much more quickly and increases production.  While this allows farmers to produce more beef faster, the whole process is extremely wasteful and destructive to the environment.  And although the price on the beef you see in the supermarket is affordable, this does not in any way reflect the true cost of that beef.  When you factor in all the corn grown specifically to raise the cattle, the antibiotics needed to keep them in decent health, and the environmental problems, just to name a few of the costs, the actual price of that beef looks a little different.  The only reason it's available to consumers at such a low price is because of government subsidies.  As a result of all of this, an increasing number of people are opting to seek out grass-fed beef, meaning that the cows only eat grass and are allowed to graze in fields as they please.  This type of beef production is healthier for the cattle, better for the environment, and is a much lower-input process overall.  In addition to the philosophical reasons to choose grass-fed beef, though, there are a number of nutritional benefits as well, and that will be my main focus for today.

Do Cholesterol-Lowering Drugs Save Lives?

If you read my last post about cholesterol-lowering drugs, then you understand some of the problems that can arise from their use.  Statins can produce some nasty side effects.  But side effects aside, statins save lives right?  I mean, doctors prescribe them to just about everyone, they must be effective.  Not quite... the story is not as simple as it may seem.

When looking at the statin drug clinical trials, it's important to keep a few things in mind.  Firstly, and most importantly... total mortality is more important than heart disease mortality.  If a drug prevents you from dying of heart disease but doesn't affect your chances of dying in general, then that drug is not worth taking.  What's most important is whether or not the drug will extend your life.  Secondly, you must consider that different groups of people may respond differently to the drug.  Women, middle-aged men, the elderly, and those with preexisting heart disease may all respond differently to treatment. 

I'd like to begin by talking about women... both because I like women, and because they don't respond well to statins.  Although many statin studies notoriously neglect to reveal the all-cause death data for women, there are a few studies that do.  Check out the Scandinavian Simvastatin Survivial Study (4S), which was one of the most positive trials to date.  The big pharma folks must have been partying it up when this one came out.  This was a secondary prevention trial, meaning that participants all had pre-existing heart disease (previous heart attack or angina).  For future reference, a primary prevention trial would be an experiment in which the participants did not have pre-existing heart disease.  So, half of them took simvastatin and half of them took a placebo.  The results were great across the board: heart attack numbers were reduced, along with deaths from heart disease and all-cause mortality.  But there was one group that clearly didn't benefit:  women.  Over the duration of the 5.4 years of the trial, 27 (6.6%) of the women taking the statin died, while only 25 (6%) of the women taking the placebo died.  So despite the rest of the data, which was very supportive of statins, there was actually a slight increased risk of death in women from taking the statin.  As you'll soon see, this finding is consistent throughout all of the statin trials, yet it is completely ignored by mainstream medicine.  These drugs simply don't work for women.

The Potential Dangers of Cholesterol-Lowering Drugs

In recent years, the prescription of statin drugs to reduce cholesterol has soared through the roof.  You've heard of them:  Lipitor (atorvastatin), Crestor (rosuvastatin), Zocor (simvastatin), and the like. The supposed benefits of these drugs, as your doctor will tell you, is that they'll reduce your cholesterol levels, hence lowering your risk of heart disease.  I'm sure you all know by now how I feel about lowering cholesterol levels (see this)... but that's beside the point in today's discussion.  I will just say that statin drugs' effectiveness may have been a bit overstated.  Today, though, I'd like to focus on the dangers, or side effects, one may encounter in taking statins.

First, just a little information about how statin drugs work in the body.  Their main function is to block an enzyme called HMG CoA Reductase.  This is one of the enzymes that is involved in making cholesterol in the liver.  So through blocking this pathway, the drug has inhibited the body's ability to make cholesterol molecules.  As a result, your blood cholesterol level goes down, your doctor is happy, and you're happy.  We've finally won the battle against cholesterol!  Yeah... except cholesterol is needed in the body for all sorts of vital processes, like hormone production, vitamin D synthesis, cell membrane structure, and brain function, just to name a few.  Hopefully by the end of this, you'll realize how ridiculous it is to think that blocking an important biochemical pathway like this one is a good idea.

Why Low-Carb Diets Work

NOTE: This post is outdated.  I no longer believe everything I have written in this article.  I'll keep it up regardless, but it does not accurately reflect my current thinking.

Although it may seem counter-intuitive, a diet low in carbohydrates, which by definition is also higher in fat, may be the most effective way to lose weight.  I remember when I first heard of the Atkins Diet back in high school, when I saw my friend's father take the cheese off of a piece of pizza and throw away the bread.  Surely you can't lose weight by eating fatty cheese and throwing out the low-fat bread!  But while it made little sense to me at the time, low-carbohydrate diets really do work, and the science supporting this concept is just about indisputable.

Firstly, I would like to state that in weight-loss, what most people are concerned about is losing fat, as opposed to just weight in general.  Fat is the enemy, not muscle; we want to keep our muscle.  As a result, I'll be discussing how the fat tissue is regulated in the body.  In order to understand how low-carb diets help you lose fat, it is important to understand the function of two key enzymes that regulate the fat tissue:  lipoprotein lipase (LPL) and hormone-sensitive lipase (HSL).  The activity of both of these enzymes is controlled by the hormone insulin, which is secreted in response to carbohydrate consumption.  I'm going to get into some biochemistry here... I like biochemistry because, since most people don't understand it, I can make it look like I really know what I'm talking about, even though in reality I'm just making up words and hoping I don't get caught.  Seriously though, it's important to understand a little basic biochemistry in order to truly understand how a low-carb diet burns fat like nothing else.

Why Low-Calorie, Low-Fat Diets Don't Work

NOTE: This post is outdated.  I no longer believe everything I have written in this article.  I'll keep it up regardless, but it does not accurately reflect my current thinking. 

Losing weight isn't easy.  Just ask your neighborhood middle-aged yo-yo dieter.  It's hard to get the weight off, and it's even harder to keep it off.  But the problem, in my opinion, does not lie in a lack of motivation or drive to make a successful lifestyle change.  The problem is that the vast majority of dieters are going about it the wrong way.  The media loves to promote this simple calories in, calories out model of weight loss, and while calories certainly do count for something, there's much more to the story.  What the calories in, calories out concept fails to account for is what your body actually does with the calories it receives, and it turns out that is a vitally important concept in weight loss. 

First off, let's discuss what happens when you try to lose weight by simply eating less (also known as starving yourself).  You start off with all the motivation in the world, probably counting calories and planning out all of your meals.  Let's say you aim to eat 1500 calories a day, and your body wants to burn 2500.  At this rate, according to the simple math of the calories in, calories out model, you should be losing about 2 pounds per week.  And indeed, you'll probably lose a few pounds in the first few weeks on a diet like this.  But you're setting yourself up for failure in the long-term.  Here's why.