Well, welcome back to another episode of You're a Mom on Drugs.
My name is Josh Klaus.
And I'm Jennifer Seltzer.
And we are here to talk about all things drug related, usually the kind that you pop into your mouth, uh, that will help alleviate symptoms that you have in your body.
Um, my name is Josh, like I said before, and I've, uh, got a bachelor's degree in biology and a master's in public health.
And, uh, I'll let you say your credentials.
Okay.
And, uh, like I said, my name is Jennifer Seltzer and I have a bachelor's degree in pharmacy and also a doctoral degree in pharmacy as well too.
Yeah.
So all things drug related.
All, all things drug related.
So this is episode six.
Um, it's going to be the final one of the year.
And we've just so enjoyed y'all coming along with us.
And if you have any suggestions for the next year of episodes to do that, we would love to do them.
Um, the last one is going to be about indigestion and heartburn because we're right around the holiday times.
We're, um, especially as Americans, we'd love to gorge yourself with amazing food.
Um, and sometimes it can be a bit much.
Um, so if you ever basically get into that point where you are, uh, kind of feeling a bit bloated or you've got some acid reflux, uh, we're going to be able to provide you some helpful tools to be able to, uh, to get out of that.
Uh, so before we dive into the conditions that we're talking about today, I figured we'd give an overview of just general digestion.
I don't know if y'all think about what happens when you put food in your mouth and then, uh, the stuff that comes out the other end, but there's really only two pathways for food to go in and out.
One is in your mouth and the other one is out of your, your bottom.
Um, so when you put food inside of your mouth, um, you start to chew it or masticate it.
And there are these three salivary glands that basically start to break down your food.
The whole goal of digestion is to take that food that you're eating, whether it's a cookie or piece of chicken and to turn it into its prime components.
And there's four major components that your body loves to have broken down into.
We have carbohydrates, which are things like sugars and fibers.
We've got fats, which can be like oils or butter.
Um, and we're going to get those into lipid form.
Um, and then we have, uh, protein, which are usually big, long strings of these things called amino acids.
And we want to get those down to the smallest form of either amino acids or peptides.
Um, and then we also have nucleic acids, which makes up things like your DNA and your RNA, which are responsible of your cells, like, uh, producing more of themselves.
So you kind of want to think about these are like the resident Lego blocks of your body.
And then your body uses these Lego blocks to build these really cool structures inside of your body, like your hair or your bladder or whatever it is.
So let's say you eat a piece of chicken, you chew it.
It starts to dissolve in your mouth.
It turns into this thing called a bolus B O L U S, which is like this small ball that then goes down your esophagus, uh, via the epiglottis, which is this thing that differentiates between whether there's something should go to your lungs or, uh, to your.
Your stomach, um, your esophagus goes to your stomach.
You've probably had this experience when you've drank water before and you went down the quote unquote wrong tube.
That was because the epiglottis opened up the wrong way.
And it went to your lungs instead of your stomach, which causes you to go, and it's not a fun feeling.
So then down the esophagus, this chicken goes and it drops into your stomach.
Um, and that is basically the first step towards, uh, I would say second step towards digestion.
Your stomach is super acidic, meaning that it has an acid inside of it.
Now, a lot of people think acid, they think the James Bond movie, like, Oh, I'm getting acid poured on me.
I'm going to dissolve into my, just my bones.
But all an acid is in chemistry terms is something that donates, um, protons are usually hydrogen ions.
Remember hydrogen from chemistry class?
It's in the top left corner of the periodic table.
And all an acid is, is something that donates those things to a liquid or a solution.
And so the more hydrogen you have, the more acidic it is, but it's kind of weird because we use pH to signify acidity.
So actually the lower the pH, it is the more acidic it is.
And that's just because it's on a logarithmic scale.
If you remember that from math and it's actually like 10 to the negative something power.
So if you have a pH of, of one, for example, that is 10 to the minus one of the concentration of that hydrogen.
But if you have 10 to the minus seven, that's a pH of seven.
So 10 to the minus seven is less than 10 to the minus one.
Hence you have, I think that's a million times less hydrogen, cause it's also a factor of 10 scale.
I know just through a lot of math and numbers at you, but this stomach has, it's amazing.
It's got this mucosal lining that prevents the acid from dissolving the stomach itself.
So you have this amazingly acidic environment that's breaking down this food, breaks it down to its component parts, but it's not done yet.
It then goes to your small intestine.
Your small intestine has three sections to it.
And the first section of it is the duodenum and that basically secretes something we call a bicarbonate.
If you've ever taken Alka-Seltzer before it's something to neutralize the acid.
So your, your small intestine doesn't like acid.
So as soon as the stuff from the stomach, which we call CHYME, C-H-Y-M-E, which is the digested food, goes down into the small intestine.
And then it neutralizes the acid.
So then your small intestine can absorb the nutrients that you just digested from your stomach and put it into your bloodstream.
And your small intestine is so cool.
They have these like little finger like things called villi that essentially, if you ever think of like your bed sheets, like really crumpled up onto the bed,
you can like ball up your bed sheets on a bed.
But then when you stretch them out, they can cover the whole bed.
Your small intestine is like that.
It really compresses to increase surface area so that every little nook and cranny of your small intestine has a blood vessel associated with it that can take that nutrient and then bring it to the rest of your body.
Because guess what needs food?
Your brain, your heart, your liver, and it needs to get from your small intestine to the rest of your body, which is what your circulatory system is for, AKA your blood.
But then it's not done yet.
It then goes, passes all the way through to your large intestine.
And it's called large, not because it's longer.
It's actually just wider.
It's also called your colon.
And that is where water retention is happening because a lot of your contents inside of your stomach are very wet.
Your body likes to keep water.
So it actually will reabsorb some of the water from this process back into your body.
And as soon as that's done, whatever your body didn't use, whatever it considers as waste.
And actually a lot of that are dead red blood cells.
And anytime that you are excreting out of your, your, your, your behind, it's brown.
Yeah.
You're right.
I can say rectum.
My mom's given me permission to use the medical term and then it's brown because there's actually a lot of dead red blood cells because your red blood cells turn over like once every week.
And, uh, and then all of the remaining nutrients that you didn't like to process.
For some reason, some of those things are corn and peanuts, which have a hard time getting broken down by your body. If you've ever seen those in your, in your stool.
So that's just to break down a basic digestion of what normally happens when you take a piece of food and you put it inside of you.
Um, you essentially are your food, but the atoms and all the molecules that you eat eventually become a part of you.
So if you're, if you eat a solely chicken diet, you essentially are just a human chicken.
And don't forget to that, as far as eliminating waste, not only do you eliminate through your rectum, but you also, it's also in your urine as well as you.
So those are some of the waste from less stuff that you eat also gets eliminated from your urine.
Okay.
So both pathways, uh, that's really cool.
Um, so that's when things go really well.
And then you eat a piece of food, you're satisfied and you go on with the rest of your day.
But every now and then you'll get something go wrong and I'm going to let my mom kind of get into one of the first things that can go wrong, which is heartburn.
So mom, what is heartburn?
Well, Josh heartburn is it's actually a common gastrointestinal complaint.
So it's stomach and intestinal complaint.
So it's stomach and intestinal complaint, um, and it's defined as a burning sensation in the stomach or the lower chest that can extend up toward your neck and semblance every now and then it can also extend toward your back as well too.
So it's a higher kind of, you know, upper lower chest or higher kind of stomach kind of feeling.
It's a, you know, it's a burning sensation and it's.
And it's interestingly, it's a, it's a symptom of acid reflux.
So that means that there's the stomach contents are coming kind of up into your either esophagus or the upper part of your stomach area and stuff.
But interestingly, it's called heartburn because your esophagus with your, if you look at your anatomy, your esophagus is right behind your heart.
So if you've got this burning sensation and it's felt there, then it feels like your heart is burning, but it's not, you're actually your heart that's burning at that.
You know, most of the time, um, about 40% of the population can, um, experience heartburn intermittently.
Actually, you and I, we were looking at something up this morning and we read that about 60 million people in America can experience kind of this heartburn type feeling or reflux type stuff.
You know, at least once, you know, um, you know, and I think it was in a month or something or maybe one time, you know, in a year or whatever and stuff.
So, but anyway, that's a lot of people. So, um, if it's occasional heartburn that that burning type feeling, it's not a big problem.
It can be managed with lifestyle changes and non-prescription medications.
But if you have more frequent heartburn, then it could possibly indicate some more serious health problems.
And so it's going to, you're going to want to get examined, examined by a healthcare provider under those circumstances.
Um, so, um, would you like me to talk about kind of the pathophysiology behind heartburn at this point?
Or, okay, that would be great because I think for some people, it's also good to recognize, like, if you're just experiencing temporarily versus chronically.
And I think chronically would be described as how much two episodes a week or more than two episodes a week.
I think. Yes. So if you're having this, you know, once maybe after a big meal, it'd be something to keep in mind. Like, okay, maybe some of the lifestyle choices I can change or just realize that life isn't perfect.
And sometimes, you know, these things are going to happen. But, you know, when it does happen, we can talk about the path of pathophysiology and then we can talk about maybe some of the lifestyle choices that can tamper the, uh, the temporary heartburn and then versus the chronic one.
Okay. So, and there are, I think Josh kind of alluded to this a little bit, but so, um, kind of like the stomach, the esophagus has defense mechanisms in place that protect it from the mucosa, mucosa getting damaged.
So the esophagus is also has a protective lining in it. And so it has what we call an anti-reflex barrier at the bottom, which we call the lower esophageal sphincter or LES.
And then there's also some other things that help to prevent, to, to keep acid or I'm sorry, to help, um, promote acid clearance from the esophagus. So things like what we call peristalsis.
So that's that movement of your food, you know, and it kind of does it in, um, kind of like an inchworm kind of thing. It's like it moves a little and then it stops and it moves a little and it keeps going down through your gastrointestinal tract.
And thank goodness you don't have to exert any effort.
No.
It's a thing about your muscles contracting, like when you have to lift something up, but your body does this automatically.
It does. Thank goodness.
The other thing, one of the other things is gravity. So just being upright, you know, you know, allows things to go down and then your blood supply in the esophagus as well too.
It helps to remove things like hydrogen and it provides bicarbonate and other nutrients.
And like Joshua talked about, hydrogen is going to be more acidic and so it can cause more damage, whereas bicarbonate is more neutralizing and it's going to be more protective.
So if you have a disruption in one of those protective mechanisms, either in that sphincter at the bottom or in any of the other types of things, the blood supply or if your peristaltic mechanism is not working correctly,
then you may end up with an increase in your esophagus of acid exposure because remember that the stomach contents is acidic.
And so your esophagus doesn't like that.
And so sometimes, you know, there's different ways that, you know, you again, that it can be damaged and stuff.
So but again, if you have more contact with your esophagus with the stomach content, then this is called reflux.
So that means that you can think about that. The content from your stomach is refluxing back up into the stomach because that valve at the bottom of your esophagus is keeping it from being there and stuff.
And so then if it's there, then it could cause some symptoms that may be uncomfortable.
We talked about the burning feeling in your chest.
You can have pain in your chest when you bend over or you lie down from this, the fact that this protective mechanism is not working.
Or you can even have a burning feeling in your throat or this this hot, sour or acidic taste in the back of your throat.
You can have some difficulty swallowing, belching or burping and feeling that bloating feeling as well.
So there's a lot of the symptoms that can go along with heartburn.
And we can all probably think of at least one time we've experienced this.
Yeah, absolutely. It makes me really grateful that that LES is there.
Because you often think like you forget what's in your body and the stuff that you're really happy is contained and where it is.
And when it comes back up, you're like, oh, my gosh, I didn't even know that was inside of me.
That's right. Because I mean, we all love to enjoy a good meal or a new food or whatever.
But there are there are certain things that that potentially can cause heartburn.
And I'll talk about foods in just a second.
But there's some there's some some conditions that can increase the chances of of developing heartburn.
One is pregnancy. It's going to be temporary, of course.
But as the baby grows, so and especially in the last few months of pregnancy,
that weight of the baby can push on the stomach and can cause that lower esophageal sphincter to not close properly.
So it's going to let the stomach contents rise, the stomach contents rise into the esophagus.
Another thing that can cause problems with that sphincter is a hiatal hernia.
And a hiatal hernia is when part of your stomach.
So there's a there's a layer of muscle that kind of separates, if I'm remembering correctly, anatomically,
it kind of is maybe it's between the stomach and the intestines.
Maybe I'm not exactly I cannot remember where the diaphragm is.
But what happens with maybe it's above the stomach.
That's probably where it is. So your stomach is so your stomach can push.
If there's a hole in that diaphragm, then that's part of your stomach can get through that hole in the diaphragm.
And then it can affect the closure of that sphincter at the bottom of your esophagus,
because you shouldn't have a hiatal hernia.
And so it usually requires surgery to have that fixed.
Another thing is gastroesophageal reflux disease.
So some people can have for a variety of reasons, can have that sphincter not work.
And so you've got this chronic regurgitation or reflux of the stomach contents into your into your esophagus.
And so it's called gastroesophageal reflux disease.
Some medications can cause heartburn, things like especially things like aspirin and the nonsteroidal anti inflammatory drugs like ibuprofen or naproxen.
Being overweight or obese can also cause problems with heartburn if you overeat.
We've all experienced that. And you're just like, oh, my gosh, why did I do that?
And that makes a lot of sense just because if you think about your stomach,
I think a lot of times it's you don't realize how small it is.
But I think it's been pictured as like the size of your fist.
And when you eat and consume things, it obviously expands to a certain amount because there's a certain stretchiness to it.
So obviously, your body can only handle so much food at a time.
It's mechanical. So if you're putting if you're eating really quickly or eating a lot of food in a single sitting and and remember the peristalsis like my mom talked about,
it's kind of a slow process. It's kind of like you're squeezing almost like icing out of like one of those.
What do you call them? Piping those piping tubes.
And so it's just going to take or even toothpaste is a great example of that, too.
And so it's going to take a certain amount of time for that that pace to come out of good to go from one place to another.
So while it's going from the stomach to the small intestine, there's going to be a lot of stuff filled inside of the stomach.
That acid and gas has to go somewhere.
And so the pressure of that inside of your stomach is like a balloon.
It's like a bag. And it's going to push back up into your esophagus because it's got to go somewhere.
And that's probably why you've burped as well, because the air has to go somewhere.
Right. And a lot of times, you know, burping doesn't just come from the lungs.
It comes from the stomach as well. And you can definitely sometimes smell that as well.
Yeah. Thank you, Josh, for that very graphic.
You're welcome. Indigestion.
Yes. There you go.
Also, too, another time you might feel heartburn is if you lie down too quickly after you eat.
You know, I thought this was kind of interesting, too.
If you're wearing tight clothes, really tight clothes, it can push on your stomach and affect that sphincter.
And so it can also cause heartburn.
That makes sense.
Smoking also can cause heartburn because what it does is it relaxes the lower esophageal sphincter pressure.
And so it's going to make it more flappy.
And so then more contents can get back up into the esophagus.
It also reduces saliva. And saliva helps to break down your food as well, too.
So if you bend over or lift heavy objects, especially after you've eaten, you know,
then you can increase intra abdominal pressure.
And if that exceeds the pressure in your in your lower esophageal sphincter,
then it can cause the contents of your stomach to be pushed back into your esophagus.
Also, too, if you eat too close to bedtime, I've done that.
You know, I love to have Froyo at night and chocolate chips.
That's right. And so, yeah, and stress as well, too.
So and some of the foods that can make heartburn worse, although it's not there's not definitive studies on this,
but there is definitely a list of things that may be associated with heartburn, such as high fat foods,
chocolate, alcohol, caffeinated beverages, peppermint or other mint flavorings,
carbonated beverages, acidic foods, spicy foods and onion and garlic.
And so basically, the bottom line is if you identify a particular food that seems to cause you more difficulty,
then that's the one you're going to probably want to eat in a more minimal amount or maybe avoid altogether.
Yeah. Nutrition is so hard and sometimes they can be more correlation than causatory.
Yeah, because it's interesting, because obviously these foods will have they're obviously made of different things.
And so they'll have different chemicals inside of them and they might trigger different things inside of your stomach when that happens.
I want to go back to talking about insets like the the anti-inflammatories and really kind of get to because a lot of people might have a headache
and they're like, well, I need to take my hyperpropan, but I don't want to get acid reflux or even a stomach ulcer.
And so it really has to do with dosage and really chronic uses of these drugs over time.
So the study that that my mom and I looked up about that is like if you viewed patients who took eight hundred milligrams,
which is essentially two tablets, sorry, four tablets of ibuprofen three times a day for six months, one.
That's a lot. Then that's a lot.
And that's one to four percent of those patients developed a stomach ulcer compared to the placebo or the control.
So. Essentially, if you're a chronic user of these, that's going to really contribute to the degradation of the mucosa lining of your stomach,
which is kind of how these ulcers form, because your stomach is just like covered in mucus, which is kind of weird to think.
But it's actually amazing because there's a super good lubricant so that that food can go down via gravity to the small intestine.
But also mucus is great for trapping bacteria and it won't allow them to colonize.
There's it's almost like a spider's web. It kind of goes, help me.
I'm in the mucus and and it can't do anything because bacteria love to hang out with each other.
Interesting. The one bacteria that has evolved a mechanism against this is something called H.
Polori or Helicobacter Polori, which basically will disrupt that mucosal lining.
And that's how the ulcers can form happens in about two odd.
No, no ulcers, no ulcers.
And that happens in about 15 percent of patients.
So, yeah, with insides, another way around that is to take acetaminophen or Tylenol if you have a headache, because that just acts at the brain center.
It has nothing to do with inflammation going on in your body, which deals with prostaglandins.
And those prostaglandins are the things that the insides act upon, which actually weirdly have a protective effect against acid reflux and ulcers,
even though they're associated with inflammatory processes in the body.
So, yeah, insides will inhibit prostaglandins. So again, you're going to inhibit that protective effect of prostaglandins.
Yeah. Thank you for clarifying that.
And yes, I just just want to let you know that I know sometimes it can it can seem like an either or do I take this?
Do I not? It really depends on how often you're taking the drug or how often or how much of it you're taking over a certain period of time.
That's going to contribute a risk factor.
So, yeah. And along with the foods, too, like, you know, your body, you know what you're taking.
But again, it's really hard to isolate a certain food just because you eat so many at the same time.
It could be a combinatorial effect. It could be just one of them.
It could be none of them. So it's tough. But, you know, trying to make it clear.
Is it OK if I take this moment now to talk about indigestion as well, too?
Absolutely. Yeah. So we should move on and maybe differentiate between the two.
Yes. So so we talked about heartburn where you're going to feel the pain, maybe or maybe lower, lower chest, upper stomach.
Well, indigestion is going to be an uncomfortable or burning feeling in the upper part of the belly.
So it's like a little lower down. OK. So it's also that it's kind of it's got a medical term called dyspepsia.
So because, oh, Josh, you probably are better at because pepsin is is I think it's one of the digestive enzymes in the stomach and stuff.
So it's going to be responsible, I think, for degrading the proteins in your body.
So is the suffix that refers to condition.
Right. And this means broken. Yeah. You know, or something's wrong with it and stuff.
So any of our listeners wants to look that up, feel free and then leave it in the comments.
Yes, please. So so. So again, indigestion is going to be characterized by you're going to have a feeling of fullness after eating.
You may be you may feel like you get full faster. So you call that satiety or earlier satiety or feeling fuller.
You can have what we call epigastric pain. So it's that top of the stomach kind of pain or burning.
And so so it's a little it's located a little bit different area in your body and stuff.
So and again, the pathophysio or how that happens is is not as clearly known as the mechanisms for heartburn.
It may be due to delaying stomach emptying.
So then you're going to have more feeling of fullness or feeling like I'm not as hungry now anymore.
Or it could be that your intestines aren't moving as in the right, you know, that that natural flow with the peristalsis and stuff like that.
So and so and what I found as far as reading, as far as indigestion is concerned, is that sometimes it's more it's considered more of a symptom rather than a condition.
Whereas heartburn is a condition, then then indigestion or dyspepsia is more of a symptom going along with something else.
And so some of the causes associated with indigestion are that you could have increased nerve sensitivity in your in your in your stomach area or food sensitivity.
You could have it could be due to the meal that you ate.
Maybe you ate it too fast. Maybe you ate a food that you that you didn't like as much or whatever.
Maybe it could be again acid reflux or that gastro esophageal reflux disease can also be associated with indigestion.
Ulcers also can cause you to feel that way.
And a lot of and like I mentioned, I think I think that we can clarify this.
But from what I remember learning in school, primarily the ulcers that happen in the duodenum part of the small intestine were associated with helicobacter pylori.
I'm thinking gastric ulcers were not as affected by the bacteria, but I maybe that there may be new data on that.
So we'll have to verify that. OK. Yeah.
If you've got slow stomach emptying or medications, there are some medications that can affect your gastrointestinal motility.
And so if they're slowing it down, that can also contribute to that as well, too.
Other things that can cause indigestion are if you have too much alcohol or caffeine.
If you eat too much or too fast, fatty, spicy or acidic foods and stress and anxiety.
So you can see some similarities between heartburn and indigestion as far as some symptoms as well as some causes as well, too.
It's interesting because I think maybe the overall feeling that people would have, I think people know what a burn feels like and then just know what feeling full.
Right. Right. So I bet there is an overlap.
And I wonder if it could be a chicken or egg thing of like if you have indigestion, then that's the feeling of being full.
Right. Which is like your stomach really expanding.
Right. And that's going to push some of that acid up into your esophagus.
Right. So like you kind of have this combinatorial effect.
Actually, actually, that's a great segue into some of the symptoms associated with indigestion, because heartburn can be a symptom of indigestion for that very, very same reason.
You can have some nausea associated with it again, bloating, the belching or burping.
Sometimes you can actually vomit with indigestion again.
And then all those things that we talked about being feeling full or or or feeling like you've eaten enough, maybe faster, quicker than you normally do and stuff.
Let me let me point out a couple of things as far as heartburn or indigestion that you should be aware of.
So a lot of us have had to treat that ourselves and we can handle it.
And we'll talk a little bit in a little bit about the medications that are available to end in the lifestyle changes that are available to hopefully manage that.
But there are a couple of conditions that you are symptoms that you want to be aware of that would make you think I need to see somebody maybe sooner rather than later.
And one of the big things is that because indigestion and heartburn happen in the heart area, sometimes it can mimic a heart attack.
And so that's that's serious. And so if you have this kind of burning pain in either your upper stomach or lower chest and it doesn't go away with taking something like an antacid or you have things like sweating or pain that goes down your arms or feeling.
You know, dizzy or lightheaded or you have a feel that you feel like your chest is kind of squeezing.
You can actually have pain in your jaw as well, too.
Those all shoulders as well, too, things that are just different than it being localized right into your kind of stomach or abdomen area.
Then you're going to want to get help pretty much right away because that potentially could be a heart attack.
And so you want to be, you know, checked out for that, you know, pretty quickly.
Other things that can go along with either heartburn or indigestion that would make you want to get to see a health care provider about it sooner rather than later or if you have difficulty swallowing, if you have pain with your swallowing, if you had an upper gastrointestinal bleed.
So if you vomited blood or if you have blood that passes through your rectum, you want to if you have some unexplained weight loss or if you actually feel a mass somewhere like in your, you know, maybe your neck area or something that's not there normally, you could have they they can have.
And they could indicate things like it could be things like gastroesophageal reflux disease.
It could be you could have a narrowing of the esophagus and it could be an ulcer or and as I was as Josh and I were talking before we started with this this podcast.
If you allow your esophagus to be exposed to acid over and over again, like with gastroesophageal reflux disease, and you don't do anything to manage that your esophagus being exposed to acid over time can increase your chances of developing gas esophageal cancer.
So it's something that you want to make sure that you've got under control.
So yeah, I think that's really good. So two things to clarify there. One on the first that cancer part is like talking about the mechanism there.
You have to remember what cancer is. Cancer is actually the disease of your own cells, your cells actually mutating to the point where they lose their ability to act like normal cell because most cells basically kind of live right next to each other.
They divide and they basically as soon as they run into their neighbor, they stop dividing.
But cancer soon is essentially we just divide uncontrollably.
And so this happens due to DNA mutations inside of these cells.
So the more cells you destroy, the more times these cells need to be replaced.
And every time they get replaced, they have to replicate, which introduces a chance for the error, which is why you normally see cancer in older people just because their cells have had to replicate more times and there's more chance for error every now and then you'll get some childhood cases.
But that's just kind of the law of probability. So the number of times that you can reduce damage to any part of your body for replication, the lower your odds will be for cancer.
Also, in terms of these, these are chronic conditions, you know, so keep in mind, you know, the heart attack is definitely not chronic. It's right then and there.
So if you're experiencing those other symptoms other than the pain in the chest, pain rating down the arm and the jaw, etc.
Then you're waiting, you know, that shortness of breath is another one as well to sign of a deeper problem.
And then the cancer and the GERD, those are definitely more things that you'll notice maybe over a weeks to months period.
And so for those atypical symptoms, if you go to see your health care provider, they would do some diagnostic tests to try to figure out what's going on.
And that would be doing some blood work. They may do something that we call an upper endoscopy.
Maybe some of you have had to have that where they're going to give you some medication to allow you to relax.
And then they'll put a tube down your throat to be able to look into your stomach to see whether or not you've got an ulcer in your esophagus to see if you've got some acid damage or whatever, you know, as far as that's concerned.
And sometimes you might need some imaging studies, you know, radiology imaging studies to look for things as well, too.
But that's really beyond our scope. We really I mean, but that those will be the things that you could expect if you went to see your health care provider, if you were having some atypical symptoms that lasted over time.
Yeah, unfortunately, getting that deep into the body means you have to probe pretty deep. So it's almost like worse than going to the dentist.
So but luckily, they'll they'll give you stuff to relax and, you know, it's better to know what you've got than to not know.
Right. Because some things can be treated and you prevent even a more serious condition.
Yeah. Well, speaking of treatment, let's talk about things that we can do to treat at home.
I think one of the things that I struggle with personally is when I experience indigestion, I often think, well, I need to take, you know, Pepto Bismol or I need to take an acid because it's really just the acid that's causing my indigestion when it really could just be that.
I'm too full and I've eaten way too much and actually putting in an acid might actually make that worse because if I don't have enough acid, then it won't be able to digest my food as readily.
So I'm hoping that you can go through some of these treatment options for these different conditions and maybe let people know, you know, which which which ones work well for different conditions and which ones don't work as well so that they can have a pretty good guide when they experience these conditions.
Well, we're going to start, first of all, with lifestyle modifications. So again, this is like no drugs. So what do I do to keep from having heartburn or indigestion if I happen to be someone that gets it, you know, once a month or whatever, or I see a pattern developing and stuff as far as that's concerned.
If you happen to have a few, you're carrying a few extra pounds along with you, trying to lose some weight can help to reduce heartburn belching or burping and regurgitating your contents, your stomach contents back up into your esophagus.
You want to try to avoid eating within two to three hours of bedtime if that seems to be the time when you have most of your problems.
Interestingly, sleeping on your left side, I thought this was really interesting. Somehow the way your anatomy is set up, it can help with your digestion and removing acid from the stomach and the esophagus more quickly.
So you can elevate the head of your bed. And this is actually not sleeping on more pillows because that motion could actually cause you to kind of crunch over and kind of block your stomach and increase stomach pressure.
So it's more like putting blocks under your bed, you know, and so you actually raise the head of your bed, you know, if you have one of those cool beds that you can like raise from the back.
Yes, which those are a sweet number. We can do a little admin. No, not really. Sponsor us please.
No. Yeah. And quitting smoking because there's a lot of reasons to quit smoking. I apologize if you love smoking, but there really are a lot of reasons to quit smoking.
I don't apologize at all.
Avoiding trigger foods. If eating curry just does you a number, then you might have to give it up. So I'm not picking on curry loving people, but it could be or it could be.
Oh, my gosh. You know, in South Texas, we're talking about all the spices in Tex-Mex food and stuff. So that would, you know, that is the problem.
Then you want to deal with red pepper. Yeah, I find it's interesting because I wonder if it's actually I have no answer to this.
I'm just spinning off the top of my head. I often wonder if we often blame the foods that we love for causing these things because we love them so much.
So we actually eat more of them like no one blames broccoli for indigestion. Right.
It's like, but they blame ice cream or cookies or curry because it's delicious.
And so you eat more of it because you're getting all that amazing dopamine hit to it.
So I just I often think that honestly, eating a little less, especially as you get older, like when you're a kid, I'm sure everybody remembers when you were a kid, you could just eat anything.
And you don't think you ever got indigestion. But as you get older, these mechanisms, this peristalsis, this pathway of digestion slows down just because your body ages and it doesn't work as efficiently.
So you kind of have to adjust your lifestyle to your biology, which is so hard to do. And it's accepting the fact that you are aging and that is a tough thing to do.
But your body will thank you. And unfortunately, if you're not going to exercise or change your sleep habits or quit smoking, then it's just going to get worse.
I mean, exercise and sleep and reducing stress can help, but it's not going to make you 13 again.
It's only going to make your current situation just a little bit better.
If you do know that you have some trigger foods that really like every time you eat it, you're like as much as I love this, it makes me feel crummy afterwards.
Then you're probably going to want to avoid those foods or eat, like Josh said, a little bit less, you know, have a taste and stuff.
You want to avoid overeating. That is especially as you get older.
It's just it's just not worth it. It's just not worth it because then you feel miserable for the rest of the day or the night or whatever.
So, you know, try to eat less, you know, set a set a limit and also eating more slowly.
My husband and I, we were like snarf through dinner and we're like, oh, my gosh, why do I feel so bad?
So it's like put your fork down, you know, eat with a fork instead of your hands, you know, and stuff.
So you've got to like, you know, control, you know, how fast you eat.
And that is so hard. I don't know why there is that sense of like, I have to eat this immediately.
Like I do the same exact thing, whereas like if I don't eat this quick, it's just going to not be delicious anymore.
Yeah. But if I just took a break and like ask somebody a question, if I'm eating with somebody or just, you know, just sat and like, wow, I'm really enjoying this meal.
And but there's something about it. You just want to keep going. Yeah. Just consuming it all. Yeah.
And this this also is interesting to wear loose fitting clothes.
I mean, if you're going out and you want you're wanting to look good and, you know, slim line and, you know, make, you know, contour, you know, fitting clothes, don't go eat, you know, or eat very little, you know, and so.
So wear a trash bag. There you go. Yeah.
You can expand to it. Yeah.
So so those are your lifestyle modification things to think about as far as helping with indigestion and heartburn.
But if you do get heartburn or indigestion, there are a couple of non prescription over the counter medications that are typically used to manage.
The first is going to be in acids and acids are going to be your things like maylocks or mylanta.
A lot of times they're liquid. They can be chewable tablets as well, too.
And they neutralize the acid that's in your stomach.
They are not actually very much systemically absorbed.
They kind of act locally.
The deal with in acids is that usually you have to take either a fair amount of it, like 30 mls of of mylanta or a couple of tablespoons.
And you have to usually use it fairly frequently.
So that would be really hard for me because mylanta or maylocks liquid is so thick and stuff.
It almost makes me gag. But that's me.
You know, and stuff. But some people can handle it and stuff.
And so it's definitely, you know, a definitely a treatment you can use.
How often do you have to do it during this period?
Like you said, you said you have to drink it a lot.
So, for example, if you were taking.
Gavis, which is a combination of aluminum hydroxide and magnesium carbonate, that's another thing I should mention that most of the in acids contain aluminum products,
calcium products or magnesium products and stuff.
And I think we should. I think people, when immediately when they hear metals, they immediately think like heavy metal poisoning and things like that.
So can we I think we should mention that it's not like you're just taking aluminum.
There are aluminum compounds that they're aluminum attached to.
So when they enter into your body, they will, you know, the aluminum will detach from the main compound and act upon it.
But that aluminum will hopefully will get excreted as waste.
And hopefully, if you're not taking a lot, it won't accumulate a lot in your body.
Correct. Right. Because let's take, for example, aluminum hydroxide.
When you take it, it's going to neutralize the hydrochloride or that acid in your stomach.
It forms an aluminum salts with chloride and then it creates water.
So because it's a chemical reaction, if you remember back to those, remember, we all had to take chemistry at one point.
You know, and stuff, all those chemical reactions, we had to write out and that's reassuring.
So it's nice because I think a lot of people think they put aluminum in their body and the aluminum stays.
But actually, the aluminum combines with the chlorine, which makes the aluminum chloride, which is a salt.
And it remains as that. And because it's a salt, it's probably water soluble.
And it also has a higher pH.
And so it's going to help your pH go up and neutralize your your hydrogen, your those hydrogen acids.
And it'll probably get excreted by urine at some point because it's water soluble. Right. OK, cool.
So that so so that was that's important to know as far as what is in those antacids.
But so, again, primarily the salts that are in and acids are magnesium, aluminum, calcium, carbonate or sodium carbonate.
And aluminum and magnesium come in a couple of different salt forms.
But when you're talking about the dose of these antacids, like I said,
you have to take a fair amount of it. So, for example, so they come they can come in chewable tablets or they come in a liquid.
If you take the tablets, you're looking at chewing two to four tablets four times daily.
So, you know, that's a lot and stuff. But if you're not feeling well, then you're probably going to do it.
But those tablets can taste kind of chalky and stuff and all.
And so, I mean, it's it's a it's patient preference, really, and stuff.
And the liquid form of it, you're you're thinking of taking anywhere from one to two tablespoons four times a day as well.
OK, wow. So this is really more of the indigestion indigestion heartburn doesn't go away.
Right. Yeah. And you're like, OK, I got to take this and get it away.
So you have to be pretty consistent with taking these over maybe an eight hour period.
And maybe one dose will do it for you. You know, it's you know, it just depends, you know, and stuff.
Yeah. So another thing that can be used if you if you're like, well, you just you just kind of all that stuff.
You just told me about the anesthetics. Maybe I'm not going to try that.
But please, it is an option and it does work.
And it's it's it it can be it give you immediate relief, but maybe some patients it doesn't work as well.
So you can also use bismuth sub salicylate, which is also known as Pepto bismol.
Pepto bismol has protective effects on your stomach mucosa, and it has some weak antacid properties.
There's some other things that Pepto bismol does as well, which are beyond the scope of this particular talk.
So you don't want to use Pepto bismol in younger kids and teens because it has an aspirin like component in it.
And aspirin in kids and every parent knows this rule in young kids and teens.
They're not supposed to use aspirin in kids because if they've got any chickenpox or flu like symptoms, things with a fever,
it in rare instances, it can cause a condition called Rye syndrome.
And Rye syndrome is an encephalopathy or a swelling of the brain.
And it doesn't have a mechanism, the mechanism is not well known,
but there just happens to be this association with using aspirin type products and developing this in kids who are sick.
So you want you instead of using Pepto bismol in kids, you're going to probably want to use it.
And the kids that develop indigestion, it's just that's really I didn't even address that really here because it's not really it's not really common.
You know, and again, if the kiddo is doing that, is it having having those types of symptoms?
I'd sure want to go to my pediatrician and find out what's going on.
Absolutely. And it might even be lifestyle choices that the child might be a little bit overweight and that might be causing that and or not getting enough sleep and things like that.
That's well said. So with Pepto bismol, they obviously have a different mechanism, but is the the outcome the same with that in an acid?
Like, would you take them for similar reasons?
Like if I was feeling heartburn or indigestion, I would I would take Pepto bismol or an acid for a similar goal.
So. I didn't really see any comparative data looking at Pepto bismol and an acids from just my just my clinical.
Thought on that would be that, yes, they can both help with heartburn or indigestion,
but in acids have a direct neutralizing effect on the acid component and and Pepto bismol is more of a protecting the mucus lining of the stomach and the esophagus.
So I think it's going to be patient specific. Maybe Pepto bismol works great for you when you have heartburn or indigestion, but maybe it wouldn't work great for me.
So it's certainly something you could try to see if maybe you have a lighter case of indigestion or heartburn, whether it works.
But I might be more likely to pick any an acid over Pepto bismol.
But again, I don't have any real strong data to definitively say that.
Yeah, it's interesting. Yeah, with some of these different mechanisms, they obviously yield different results.
So if you're having a hard time, if you feel like you just got more of an acidic environment, you then yeah, maybe an acid.
Right. And we have to remember, too, that Pepto bismol is promoted for use in multiple issues, for multiple issues, including diarrhea,
you know, nausea and stuff, which which are different and could be potentially involve different mechanisms of the medication that are beyond the scope of heartburn and indigestion.
Yes. And maybe there maybe if you if you are able to solve the diarrhea problem, they might have some downstream effects on the heartburn and indigestion for some reason.
And it's like, oh, look, we did that, too. Yes. Yeah.
It's yeah, that's a good point. It's beyond my scope here.
So, OK, OK. Then the other the other medications that you're going to see.
So the next thing that if you want to take something that maybe you don't have to take as frequently, that also works to help to control acid production in your stomach
is going to be what we call a histamine to receptor blocker.
That's going to be your thing like a cimetidine or for modinine or pepsin.
You know, so tagamet and pepsin are the brand names.
It used to be that Xantac was also available, but Xantac has been removed from the market a couple of years ago because it was identified and researchers
that identify that it contained a chemical in it that could be a potential human carcinogen or could potentially cause cancer in patients.
So they took all the Xantac off the market. But that problem is not seen with pepsin or tagamet.
And so these drugs, they're like I said, they're histamine to receptor blockers or we call them H2Rase.
They reduce acid secretion by inhibiting histamine on the histamine receptor of the parietal cell.
Parietal cells line your stomach, and that's the cell that produces the acid in your stomach.
So if you are able to block the receptor, the histamine receptor on this parietal cell,
you can help to prevent acid from being released into the stomach.
OK, gotcha. So when you're taking in an acid, you're just neutralizing the acid that's in your stomach.
But this already been produced. But this blocks it at the source.
Right. It's like it's almost like you have a spigot of acid coming out.
You're blocking the spigot with these. OK, that makes sense.
And so these histamine blockers, histamine receptor blockers have a longer duration of effect than antacids.
And they have but it takes them a little bit longer to start working.
So in acids are going to start working a little bit quicker, but you have to take them more frequently.
Whereas if you take something like pepsin or tagamet, it may take a little bit longer for it to work.
But it's going to you don't have to take it four times a day.
Is it safe to take these medications, these histamine blockers and but then do antacids while you're waiting for it to kick in?
You can. You can. That's safe to do. Yes.
You know, all drugs are going to have issues.
I think the thing with antacids, if you are taking other medications,
antacids can bind other medications, so sometimes there's guidelines and rules as far as when you're supposed to take your antacid and when you take your other medication.
Usually there's about a two hour gap that you have to allow, you know, between taking the antacid and the other medication,
because the antacid could bind your other medication and then it wouldn't work right.
So you don't want that to happen as well.
OK, histamine two receptor blockers, they've got some drug interactions, but not that same kind.
So the other thing that's kind of interesting, too, with a histamine two receptor blocker is that you want to usually just take them as needed
because you could develop tolerance to it as you if you took it all the time.
So you're just looking for an as needed type of a medication for this.
So when you're having those heartburn symptoms, indigestion symptoms, then that's when you take your histamine blocker.
All right. OK.
And then the last class of drugs that are that are available are called proton pump inhibitors.
And these are your drugs like Prilosec, Omeprazole, Prilosec, Asifax.
They are going to. So while you've got your histamine receptor blocker that's blocking histamine release,
I mean, blocking acid release from that histamine receptor, your proton pump inhibitors,
there is actually a what we call a proton pump inside the.
One. It's inside the parietal cell.
And so by blocking this pump, then you are blocking the production of acid even further down than just at the release point.
And so you have less being produced.
Yeah, because remember from our earlier talk about what acids are,
acids are essentially the ability to donate these positive proton ions.
So if you are taking away one of the ingredients to make these acids, then, yeah, you're going to diminish the amount of acids.
Right. I just want to make sure I'm speaking.
You know what? I think I misspoke. May I may I rewind?
You may rewind. So you've got, you know, your histamine receptors that allow acid to be released.
But this proton, this this pump is the last step in gastric acid secretion.
And so blocking it then allow blocks acid for being released from the cell.
So it's a more it's a more potent binding. It's a more sounds more prolonged finding.
And so basically, proton pump inhibitors are not prescribed unless you have more frequent heartburn.
So it's going to be the people that have it a couple of times a week.
And so not for the occasional heartburn.
Yeah, it's not going to be for that occasional heartburn so much as it's going to be for more things like gastroesophageal reflux.
Yes. This isn't something you can get over the counter.
You can get it over the counter. You can.
You can. But and I think that some people may maybe mistakenly pick this up for occasional heartburn.
But I would I would make a choice to pick something like an H2 receptor blocker, like a Pepsid for that, those occasional cases.
Whereas I would choose your Prilosec, you know, more for those those people that either have GERD or are plagued with, you know,
indigestion or heartburn a couple of times a week and stuff.
Again, if you have heartburn more than two times a week, there could be something else going on.
So that's when you want to see your physician or your or your health care provider.
Again, if you end up getting diagnosed with GERD, then a proton pump inhibitor is one of the treatments for GERD.
And so you could then purchase it over the counter.
Sometimes it depends. This is just a little aside, but it depends on your prescription drug program that you have with your insurance.
If you have health insurance and prescription insurance, sometimes it could be cheaper to get it filled through your prescription plan than buying, you know,
omeprazole over the counter, you know, so you just have to figure that out price wise and stuff.
But you do have the ability to buy it over the counter if you need it.
But I would hold off on getting this for those occasional heartburn symptoms, you know.
So it interestingly, this drag, it's it only it only works on active proton pumps.
So it's better to take it in the morning, whereas histamine two receptor blockers.
I mean, yes, you can take it for your occasional heartburn, but it tends to work better with your your acids creating histamine cells overnight.
So it's better to take it at bedtime or closer to bedtime if you've got to take one.
Now, if you get heartburn in the middle of the day, then you can definitely take a pepsi, you know, and stuff.
But it might be after your dinner, like you might be experiencing after that, which would be a good time to take the pepsi.
You don't want to take a proton pump inhibitor on your own without guidance for more than 14 days straight for two weeks or for more than once every four months,
unless you're being guided by your health care provider, because, yes, it can be taken daily to treat GERD.
But you want to have that diagnosis and you want some guidance by your by your health care provider as to how long to take it and what things to watch out for.
OK, great. I think those are great treatment options and a really good summary of,
you know, almost like the most basic to the most severe.
Yeah, yeah. Good, right.
So so let me just kind of review a little bit about when heartburn when heartburn can be more serious than heartburn.
So if you have frequent or constant heartburn, heartburn every day,
then it could indicate that you may have gastroesophageal reflux disease, which can lead to esophageal cancer if you don't treat it.
So you're going to want to get some help with that.
If you have abdominal pain, it could mean that you got a stomach bug, you know, or it could be that you've got an infection, excess alcohol use, a lot of alcohol.
Overuse can cause some other issues that can cause abdominal pain.
And so you'd want to have that checked out.
Medication induced stomach ulcers can also cause abdominal pain.
So, again, you want some help with that as well, too.
If you have the hiccups or coughs related with things like heartburn, it could indicate a high aileronia.
So you want to get that checked out.
If you have difficulty swallowing, it could mean that you have an irritation in your esophagus or gastroesophageal reflux disease.
Want to get that checked out.
If you have nausea and vomiting associated with it, then you could have GERD, you could have a hiatal hernia, or you could have esophagitis.
So something else to check out.
And again, as we mentioned before, if you have severe chest pain or pressure, if you take an E and acid and in a few minutes you don't see any relief,
you could potentially be having a heart attack.
So you want to get some help right away.
So let me just kind of summarize what we've talked about.
Josh, do you have any other things to say before I kind of summarize what we've talked about today?
No, I'm ready to wrap it up.
Okay.
So self-treatment of heartburn and indigestion or dyspepsia should be limited to mild or moderate symptoms.
Like we talked about, if you have that burning in your upper abdomen or chest after you eat, or you have some centralized abdominal discomfort.
So pretty much limited symptoms to things like that, no other symptoms associated with that, then you can treat it yourself.
If you have any atypical or alarm symptoms, please go get help from either an emergency center,
if it seems like it's a heart attack or your health care provider, if it's any of those other types of symptoms.
If you're a parent with a kiddo, treatment of mild, transient or infrequent heartburn, sour stomach or indigestion should be limited.
And really, if you got some frequent, a kiddo that's complaining of that frequently, then I would see your health care provider for that.
Pregnant women can treat mild and infrequent heartburn, which you're going to possibly see with later pregnancy,
with calcium and magnesium containing acids. They have been shown to be safe in pregnancy.
Patients with heartburn should be, remember the lifestyle measures that we talked about that maybe you could implement to help reduce your cases of heartburn and indigestion.
You should try to go through those as well, too, so that you can minimize experiencing heartburn and indigestion.
Things like overeating or losing some weight, not lying down after you eat, that type of thing.
And also, too, we talked about the different types of over-the-counter medications that are available to you.
You can try the different ones, specifically in acids and histamine blockers for those occasional cases of heartburn to see what works best for you.
Remember, they both kind of help to block the effects of acid on your stomach.
Again, in acids, they're going to work a little quicker, but you have to take them more frequently.
Histamine receptor blockers may take a little bit longer to work, but they are going to work longer.
And then proton pump inhibitors should be used for those people who have frequent heartburn, occurring more than twice a week.
Make sure that you don't use them chronically without some guidance from a health care provider.
If you have any symptoms that worsen or change, make sure you contact your health care provider as well, too.
So that's all I've got.
Well, that's fantastic. And I feel full.
Maybe we need to go get some sort of antacid.
Yeah, maybe we should prevent that heartburn.
Yeah. And again, for those of you out there, also just remember, eat a little slower, savor that meal, be thankful that you have a meal.
And that might cause you to slow down just a little bit.
But we hope that this helps during the holiday season.
Please be around people that you love and give them an extra hug for us because there's no greater time than just sitting around with your loved ones, eating really, really good food.
And if you do it responsibly, then you'll wake up the next day wanting to do it again.
So thanks again for just coming with us on this journey for this year.
We are so happy that you came along with us and we will see you in 2024.
So with that being said, my name is Josh Klaus.
And I'm Jennifer Seltzer.
And this has been another episode of Your Mom on Drugs.
See you next time.