The following
program presents principles
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designed to promote good health
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and is not intended
to take the place of
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personalized professional care.
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The opinions and
ideas expressed are
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those of the speaker.
Viewers are encouraged
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to draw their
own conclusions about
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the information presented.
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Hello and welcome to
Health For A Life Time.
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I am your host Don Mackintosh
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and today we're
gonna talk about digestion.
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We're gonna talk
about some problems
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that can be encountered
with our digestive system.
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Talking with us
today is Dr. Neil Nedley;
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he's from Ardmore, Oklahoma.
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Welcome Dr. Nedley. Thank you.
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And you deal with
all the organ systems
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and of course
the alimentary canal
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or the digestive
system is something
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that causes people,
well many blessings,
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but also some
problems. Yes, absolutely.
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One of my fields
in fact it's probably
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one of my primary emphasis
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in internal medicine,
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is the field of
gastroenterology.
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And that has to
do with the entire
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gastrointestinal track.
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Okay, so we're gonna talk about
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what's called GERD?
What does that mean?
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Gastroesophageal Reflux Disease
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is what it stands
for. And of course,
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the gastro that's
where the acid is made,
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the esophagus is
above where the stomach is?
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And then you have Reflux,
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which means there
are stomach contents
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refluxing backwards
where they're really not
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supposed to go
into the esophagus.
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And of course that
can produce disease,
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so that's the, the term
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Gastroesophageal Reflux Disease.
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Okay, well let's talk
about how it's suppose
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to work first,
the digestive system?
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Well, digestion
actually begins in the mouth,
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that's how the digestion begins.
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And we actually
have a graphic in regards
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to the mouth components.
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That's actually
something that we have
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voluntary control over,
the rest of the digestive
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tract we really don't have much
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voluntary control,
but we have control
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over the type of food or fluid
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we put into our
mouth, we have control
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when we put the food
or fluid into our mouth.
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Okay. We also have
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control over the temperature
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of what we put
into a large extent,
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and then we also
have control over
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how long we chew
and savor the food.
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So, we have
quite a bit of control.
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Quite a bit of
control on the first part
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in the digestive
system, which is the mouth?
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So, so what
types, well you know,
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you said digestion
begins in the mouth,
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but doesn't it
begin in the mind,
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I mean sometimes
I'll think about something
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and my mouth will
start to salivate.
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Yes, it can, condition
response sort of speak.
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And yes, if we think
about something like that
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we can or even if we come across
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the smell for instance,
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then the digestive juices
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can start going
and also on timing.
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If we're used to
being on a regular pattern
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everyday, which is actually
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healthier to be that way.
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If we don't happen to
eat at that particular time,
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my digestive
juices go into action
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and that's inefficiency,
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if we're not
eating at that time.
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So, the type of food we put
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or fluid we put in our mouths,
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what types of things,
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I mean it's pretty
obvious don't put nuts,
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bolts and all kinds
of stuff in your mouth,
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but you know, I
think a lot of people
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make mistakes concerning that.
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Absolutely, they make
mistakes concerning it.
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And that's one
of the reasons why
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Gastroesophageal Reflux Disease
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is so prominent.
Our next slide actually
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shows some of the symptoms of
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Gastroesophageal Reflux Disease.
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Heartburn after a heavy meal or
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when you're bending over or
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when you're lifting.
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And when that
occurs that's abnormal
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and that's one of
the most common and,
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prominent symptoms is heartburn.
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When heartburn
occurs when lying down,
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particularly at
night or on the back,
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that is also Gastroesophageal
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Reflux Disease. Three quarters
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of people with GERD
will experience night time
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symptoms that might
even awaken them from night
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with this burning.
And then they can get
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into regurgitation
as well, where they.
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Throwing up. Well,
it's not really vomiting,
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but they'll
actually begin to taste
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the stomach
contents there on the back
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of the throat or in the mouth.
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And is this an acute,
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is this something that's chronic
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or acute or depending on that,
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you have a big meal
you're gonna have this?
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Well, many people in fact,
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it's estimated
that about 40% of people
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will suffer from
GERD in any given year.
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And so,
Gastroesophageal Reflux Disease
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is pretty, pretty common and,
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and then some people
about 20% get into the
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severe GERD, where
actual complications can occur?
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But what I mean is,
you know the curse does
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not come
causeless, I mean you know
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that if you ate
this big huge meal
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and then you have
some of these problems
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that you're talking
about that night you,
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you know exactly
what that came from?
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That's right, is
that from the big meal.
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Is that different then
what you're talking about
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in terms of GERD? No, no matter
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what the cause of the GERD,
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GERD is GERD. GERD is GERD.
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And if it's due to a heavy meal,
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a voluntary GERD for instance,
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or you know maybe
you weren't informed
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in regards to that
food would do that,
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but basically
anytime we get reflux,
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rather persistent
reflux of stomach contents
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back into the
esophagus that's GERD.
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Okay, so what are the
risk factors for GERD?
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Well, the risk factors for GERD
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we actually have a graphic
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about that as well. Heavy meal,
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you talked about
that, if you're snaking
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at any time
that's a risk factor,
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but particularly
snacking before bed time
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is gonna
dramatically increase the,
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the incidence of GERD.
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High fat foods will
also increase the incidence;
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it takes a lot longer
for the high fat foods
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to be digested
and for the stomach
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to empty out, if
you're in your third trimester
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of pregnancy,
the pressure that's
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put on the abdomen makes
it much easier to reflux.
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And then there are
additional risk factors,
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if you have asthma or Chronic
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Obstructive Pulmonary Disease or
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Respiratory
Disease, you often are using
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your accessory
muscles and your abdominal
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to breathe that
can produce pressure
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and can cause a
reflux. Tight clothing,
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particularly around the abdomen
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itself will
dramatically increase reflux.
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And many women that
are slightly overweight
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utilize these tight clothing.
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This puts
everything up including,
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including the
food. That's right.
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Tobacco,
nicotine actually relaxes
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the esophagus sphincter
and allows acid to freely
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come into the esophagus.
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Alcohol also
relaxes the lower esophagus
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sphincter and can
cause acid reflux.
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And then the
Non-steroidal anti-inflammatory
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drugs abbreviated NSAIDs,
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these are drugs like Ibuprofen,
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Naprosyn, Aleve,
you know, Celebrex,
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these types of drugs
can significantly increase
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the risk. And then other drugs
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such as the
Nitroglycerin medicines.
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Nitroglycerin
actually relaxes smooth muscle,
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the lower esophagus sphincter
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is a smooth muscle.
Calcium Channel Blockers
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also can cause reflux.
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And then
anatomical problem called
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the Hiatal Hernia
can increase the risk.
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And then many people
are unaware that caffeine,
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peppermint and
chocolate significantly
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increase the risk of
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Gastroesophageal Reflux Disease.
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How does that work?
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Caffeine
increases acid production
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and relaxes the
lower esophagus sphincter,
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so it's working two ways.
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And peppermint does the same?
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Peppermint actually
does relax smooth muscle
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and it will relax the lower
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esophageal sphincter.
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In fact, sometimes
for spasm disorders
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of the intestinal tract
will recommend peppermint
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as a treatment
because peppermint
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will relax the spasm,
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but for the average person
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you don't want a
relaxation of the lower
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esophageal
sphincter. Food is not supposed
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to go back into the esophagus,
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it's supposed to
go the other way.
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And as we relax that
and the stomach contracts,
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it'll come right
back up into the esophagus
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with peppermint on
board. Okay, what about obesity?
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Obesity will
significantly increase
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the risk of reflux and
it's one of the reasons
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why we're seeing
much more GRED today
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because the waistlines
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are increasing. Obesity again
00:09:14.09\00:09:16.34
is increasing the
intra abdominal pressure,
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and that intra
abdominal pressure
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no matter what it's due to,
00:09:21.22\00:09:23.46
third trimester pregnancy
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or obesity can significantly
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increase the
reflux. You know I've seen
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these CAT scans of obese people
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and really the issue is
not what you see outside
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is what is inside,
the fat that's inside?
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That's right. And I think that
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people don't
really realize that.
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They don't really realize
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that's all crammed in there.
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Yeah, the reason
that's pushing out
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is because it's
already crammed in,
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so just a little, a little belly
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could be a big problem.
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And when you do
surgery on these individuals
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you really find that out,
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I mean you open up that abdomen,
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that fat just
you know comes forth
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sort of speak because
it's been so confined.
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Okay, so when is it
that you should do a
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procedure and
figure out what's going on,
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I mean these are
all the risk factors,
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but when do you actually go in
00:10:15.13\00:10:17.49
and do a procedure?
Well we, it is recommended
00:10:17.50\00:10:21.43
now by the
American Cancer Society
00:10:21.44\00:10:23.40
that anybody who's
had reflux intermittently
00:10:23.41\00:10:26.39
for 5 years or
more should undergo
00:10:26.40\00:10:30.22
an endoscopy to have
that esophagus looked at.
00:10:30.23\00:10:33.68
It's also
recommended that anyone
00:10:33.69\00:10:36.19
who has what's called
dysphagia or odynophagia.
00:10:36.20\00:10:40.22
Dysphagia is
difficulty in swallowing,
00:10:40.23\00:10:42.24
that means after you,
00:10:42.25\00:10:43.77
you know take
some bread or maybe eat
00:10:43.78\00:10:46.24
some solid food
that kind of hangs up
00:10:46.25\00:10:47.94
in the esophagus
before it passes through
00:10:47.95\00:10:50.08
that's not normal and that,
00:10:50.09\00:10:54.11
that endoscopy needs
to be done right away.
00:10:54.12\00:10:56.50
Odynophagia is a
painful swallowing
00:10:56.51\00:10:59.85
and if anyone has pain at all
00:10:59.86\00:11:01.94
when they swallowed
that's an indication
00:11:01.95\00:11:03.64
to get that esophagus looked at.
00:11:03.65\00:11:06.30
And I think you
have a graphic on
00:11:06.31\00:11:07.87
something you called EGD.
00:11:07.88\00:11:10.57
Yes, an EGD is the
procedure where we take a
00:11:10.58\00:11:15.38
camera on a, the end of a scope,
00:11:15.39\00:11:19.52
it's a thin scope
its about as big around
00:11:19.53\00:11:21.28
as my little finger here,
00:11:21.29\00:11:22.84
it's flexible and has
a light on the end of it
00:11:22.85\00:11:25.18
and with that light
we can get some very
00:11:25.19\00:11:28.38
sophisticated pictures
of the esophagus to stomach
00:11:28.39\00:11:31.85
and the duodenum.
00:11:31.86\00:11:32.90
And that scope is called an EGD,
00:11:32.91\00:11:35.88
it stands for
Esophagogastroduodenoscopy,
00:11:35.89\00:11:40.80
and we do have
a graphic on that.
00:11:40.81\00:11:43.55
Alright, well let's look at,
00:11:43.56\00:11:44.73
it's recommended
when you have heartburn
00:11:44.74\00:11:46.34
for 5 years or more?
00:11:46.35\00:11:47.49
Yes, or if you've had
th persistent symptoms
00:11:47.50\00:11:50.86
despite being on anti-acids
or something like that
00:11:50.87\00:11:53.54
that would be
another indication.
00:11:53.55\00:11:54.90
And that picture
that you see there
00:11:54.91\00:11:56.92
on the screen
is actually reflux,
00:11:56.93\00:11:59.02
that scope is in
the esophagus there
00:11:59.03\00:12:01.36
and what you are
seeing is actually acid
00:12:01.37\00:12:04.61
and other stomach
contents coming backup
00:12:04.62\00:12:07.31
that lower esophagus sphincter
00:12:07.32\00:12:09.07
into the esophagus itself.
00:12:09.08\00:12:11.30
So, sometimes on
endoscopy we will see that
00:12:11.31\00:12:13.69
in a real time.
The actual esophageal
00:12:13.70\00:12:16.97
sphincter being weak
and that reflux occurring
00:12:16.98\00:12:21.80
right into our
lens sort of speak.
00:12:21.81\00:12:24.39
Alright, so any
other indications,
00:12:24.40\00:12:28.78
I think your
graphic continues as well
00:12:28.79\00:12:31.89
Yes, yeah the other indications.
00:12:31.90\00:12:34.59
Well, these are
actually complications.
00:12:34.60\00:12:37.06
This particular
graphic is the complications
00:12:37.07\00:12:39.86
of reflux. And
notice the erosions there,
00:12:39.87\00:12:43.42
Erosive Esophagitis
those are actual ulcerations,
00:12:43.43\00:12:48.56
that white area on
top of the red area
00:12:48.57\00:12:51.62
about the 6 O'clock
position that's actually
00:12:51.63\00:12:53.94
purulent material
or puss type material
00:12:53.95\00:12:57.01
that's right
there in the erosions.
00:12:57.02\00:12:59.61
And you're seeing
erosions in several areas
00:12:59.62\00:13:02.52
there in the
esophagus and then sometimes
00:13:02.53\00:13:04.60
a discreet ulcer can form,
00:13:04.61\00:13:06.05
that's the picture
on the right-hand-side
00:13:06.06\00:13:08.05
is the ulcer. Then
we can get Stricture.
00:13:08.06\00:13:11.98
Stricture is due
to scar tissue forming
00:13:11.99\00:13:14.18
with all that reflux
and actually narrowing
00:13:14.19\00:13:17.39
that down to the
point where the individual's
00:13:17.40\00:13:19.81
food starts hanging
up before it passes down
00:13:19.82\00:13:22.26
through. And a very significant
00:13:22.27\00:13:25.05
severe condition
called Barrett Esophagus.
00:13:25.06\00:13:27.79
This is where
the esophagus changes
00:13:27.80\00:13:30.60
its mucus
permanently into a Barrett's
00:13:30.61\00:13:34.49
type esophagus which increases
00:13:34.50\00:13:36.47
the risk of malignancy.
00:13:36.48\00:13:37.50
So, these complications and the,
00:13:37.51\00:13:41.53
what causes them it's
very significant really?
00:13:41.54\00:13:44.54
And can get, go from
bad to worse it looks like?
00:13:44.55\00:13:47.80
Yeah, absolutely
and of course those
00:13:47.81\00:13:50.14
complications can
produce further complications.
00:13:50.15\00:13:53.02
Well, we wanna comeback,
00:13:53.03\00:13:54.73
we're talking
with Dr. Neil Neldley,
00:13:54.74\00:13:56.27
we're gonna look a little more
00:13:56.28\00:13:57.45
at those complications,
but also some solutions,
00:13:57.46\00:13:59.63
join us when we comeback.
00:13:59.64\00:14:01.21
Are you confused
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00:14:04.08\00:14:06.59
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00:14:59.77\00:15:01.32
Welcome back we
have been talking with
00:15:03.67\00:15:04.83
Dr. Neil Nedley,
we've been talking about
00:15:04.84\00:15:06.48
digestion, and
it's a wonderful thing
00:15:06.49\00:15:08.87
if it's working
well, but what we have
00:15:08.88\00:15:11.64
discovered is that many times
00:15:11.65\00:15:12.97
it doesn't work well. Dr. Nedley
00:15:12.98\00:15:15.37
this is because of
choices that we make,
00:15:15.38\00:15:17.28
the food that we
eat, when we eat it,
00:15:17.29\00:15:18.92
the temperature of it
00:15:18.93\00:15:20.01
and all these different things.
00:15:20.02\00:15:21.37
That's right;
actually the stomach
00:15:21.38\00:15:23.50
has to have four
things that are constant
00:15:23.51\00:15:27.18
for the end of the
stomach the pylorus
00:15:27.19\00:15:30.31
to begin to
empty the food into the
00:15:30.32\00:15:32.45
intestinal tract.
And those four things
00:15:32.46\00:15:35.37
that has to have
the constant pH. Oh!
00:15:35.38\00:15:37.64
So, that's the acid based.
00:15:37.65\00:15:39.44
And there are
sensors in the duodenum
00:15:39.45\00:15:41.60
that will sample
the food as it's emptied
00:15:41.61\00:15:45.05
from the stomach and
if it's not a constant pH,
00:15:45.06\00:15:47.96
a constant temperature
and a constant osmolarity,
00:15:47.97\00:15:51.53
or if the size is too big,
00:15:51.54\00:15:53.87
if it's greater
than a millimeter square
00:15:53.88\00:15:55.95
it will actually
clamp that pylorus down,
00:15:55.96\00:15:59.22
to keep, so the
stomach can mix it all up
00:15:59.23\00:16:02.10
to get that constant
and then it will begin
00:16:02.11\00:16:03.84
to sample it again. And
that's one of the reasons
00:16:03.85\00:16:06.70
why eating between meals
is one of the worst things
00:16:06.71\00:16:09.47
that can happen
for an individual
00:16:09.48\00:16:11.63
as far as
initiating reflux is concerned
00:16:11.64\00:16:15.26
because the stomach
may have things already
00:16:15.27\00:16:17.97
and then some
new food is put down
00:16:17.98\00:16:19.38
in there before it
has a chance to completely
00:16:19.39\00:16:21.36
empty. The
pylorus has to clamp down
00:16:21.37\00:16:23.96
and begin to emulsify
and to mix that food up
00:16:23.97\00:16:28.54
to try to get
those constant readings.
00:16:28.55\00:16:30.53
Probably why it's important
00:16:30.54\00:16:32.47
to chew as well? That's right,
00:16:32.48\00:16:34.18
chewing thoroughly
will help our stomach
00:16:34.19\00:16:36.00
out significantly to
get those sizes again less
00:16:36.01\00:16:39.36
than a millimeter
square is what the
00:16:39.37\00:16:41.06
duodenum is looking for.
00:16:41.07\00:16:42.20
Now, we were looking
at some complications
00:16:42.21\00:16:44.01
and I wanna go
through those again
00:16:44.02\00:16:46.16
for those who
maybe are just joining us
00:16:46.17\00:16:48.92
and show us what these are?
00:16:48.93\00:16:50.96
Yes, Erosive
Esophagitis that's graphed
00:16:50.97\00:16:54.78
there one of the things
that Erosive Esophagitis
00:16:54.79\00:16:56.88
and ulcerations
both of those can cause
00:16:56.92\00:16:59.08
is bleeding. We
will often see a person
00:16:59.09\00:17:02.05
with anemia due to reflux.
00:17:02.06\00:17:04.60
And the reflux
causes microscopic bleeding
00:17:04.61\00:17:08.36
or maybe massive bleeding,
00:17:08.37\00:17:09.67
some of the
ulcers in the esophagus
00:17:09.68\00:17:11.24
can bleed rather readily,
00:17:11.25\00:17:12.79
can erode into a blood
vessel and you can start
00:17:12.80\00:17:14.94
vomiting up blood
and get massive bleeding
00:17:14.95\00:17:17.21
as a complication of reflux.
00:17:17.22\00:17:19.30
The next slide also
shows some additional
00:17:19.31\00:17:24.12
complications
of Gastroesophageal
00:17:24.13\00:17:26.19
Reflux Disease. And
that is a stricture,
00:17:26.20\00:17:30.26
that's where food
starts to hang up.
00:17:30.27\00:17:32.09
What we will do
with that stricture
00:17:32.10\00:17:33.89
when we see it as we will take a
00:17:33.90\00:17:35.11
balloon dilator with
the scope and open that up,
00:17:35.12\00:17:38.40
so the individual can
swallow like they used to.
00:17:38.41\00:17:41.30
Does that hurt?
00:17:41.31\00:17:42.28
Well, we have
monitored anesthesia,
00:17:42.29\00:17:44.69
so it's doesn't
hurt at that time,
00:17:44.70\00:17:46.88
but it will only
last for maybe up
00:17:46.89\00:17:50.30
to three years the
stricture will come again,
00:17:50.31\00:17:52.67
the scar tissue will form again.
00:17:52.68\00:17:53.97
Some people have-to-have that
00:17:53.98\00:17:55.21
dilated every 6 months.
00:17:55.22\00:17:56.58
And what started
the whole process off
00:17:56.59\00:17:59.12
was reflux? And
the Barrett's Esophagus
00:17:59.13\00:18:02.37
that you saw on
the screen there,
00:18:02.38\00:18:03.67
Barrett's is actually
a change in the mucosa
00:18:03.68\00:18:07.31
to an abnormal
mucosa that can actually
00:18:07.32\00:18:11.73
initiate cancer.
And this is why once
00:18:11.74\00:18:15.16
we find Barrett's
Esophagus that individual
00:18:15.17\00:18:17.31
has to be scoped every year
00:18:17.32\00:18:18.66
or maybe every two
years to make sure that
00:18:18.67\00:18:21.67
the beginnings of malignancy
00:18:21.68\00:18:22.97
are not starting to form.
00:18:22.98\00:18:24.39
And that's because
the cells are multiplying
00:18:24.40\00:18:29.11
and they are kind of
abnormal cells already.
00:18:29.12\00:18:32.18
Yes, the columnar
epithelium of Barrett's
00:18:32.19\00:18:35.71
Esophagus is abnormal
and it does help bring
00:18:35.72\00:18:40.42
about cancer in some instances.
00:18:40.43\00:18:44.07
Now, most people with Barrett's,
00:18:44.08\00:18:45.58
if we know about it
ahead of time we can put
00:18:45.59\00:18:48.16
them on a program,
so that it reduces the
00:18:48.17\00:18:51.44
likelihood of
them developing cancer,
00:18:51.45\00:18:53.75
but still we need to find out.
00:18:53.76\00:18:55.12
In our last graphic in regards
00:18:55.13\00:18:58.73
to the complications
is actually cancer itself.
00:18:58.74\00:19:01.36
This starts out
with Barrett's Esophagus
00:19:01.37\00:19:04.27
and then it goes
into Adenocarcinoma,
00:19:04.28\00:19:07.18
a glandular cancer.
And there's two different
00:19:07.19\00:19:10.35
patients there on the screen
00:19:10.36\00:19:12.69
that we had and
both of them did not get
00:19:12.70\00:19:17.44
scope like they
were supposed to do
00:19:17.45\00:19:18.94
and following up there Barretts,
00:19:18.95\00:19:20.12
and so they ended up
with the Adenocarcinoma.
00:19:20.13\00:19:22.48
And
Adenocarcinoma is the fastest
00:19:22.49\00:19:24.79
rising cancer in
the United States.
00:19:24.80\00:19:27.05
It's dramatically
increasing and it's increasing
00:19:27.06\00:19:30.88
because reflux is
increasing and that's why
00:19:30.89\00:19:32.85
we're having a
program on this because,
00:19:32.86\00:19:34.85
if we can prevent
the reflux or treat
00:19:34.86\00:19:37.71
the reflux we
can prevent cancer.
00:19:37.72\00:19:39.75
And the
unfortunate thing about the
00:19:39.76\00:19:41.42
Adenocarcinoma
Esophagus is death
00:19:41.43\00:19:43.93
within a year in
virtually all cases,
00:19:43.94\00:19:45.95
very few people are spared.
00:19:45.96\00:19:48.29
We'll do surgery,
we will do radiation,
00:19:48.30\00:19:50.91
we will do chemo,
those things can prolong
00:19:50.92\00:19:52.71
the life to some
extend, but normally
00:19:52.72\00:19:55.32
it still death within a year.
00:19:55.33\00:19:56.79
Once you get it,
that's it usually.
00:19:56.80\00:19:58.81
Yeah, and so that's
why we want to catch it
00:19:58.82\00:20:00.49
in the Disc Plastic form
before gets to the cancer
00:20:00.50\00:20:04.16
form because then we
can prevent the deaths
00:20:04.17\00:20:07.78
now completely. So, someone
00:20:07.79\00:20:10.07
that's having
some of those symptoms
00:20:10.08\00:20:11.37
we talked about early on,
00:20:11.38\00:20:12.39
don't just dismiss
those make sure that
00:20:12.40\00:20:15.03
you either amend your lifestyle,
00:20:15.04\00:20:17.18
so they don't come
about or if they continue to,
00:20:17.19\00:20:20.37
make sure and see
someone like yourself?
00:20:20.38\00:20:21.97
That's right, be sure.
00:20:21.98\00:20:24.16
You know,
interesting in the Bible
00:20:24.17\00:20:25.87
it says that at
end of time people
00:20:25.88\00:20:30.19
will be
struggling because their God
00:20:30.20\00:20:33.15
is their belly. You think this
00:20:33.16\00:20:35.15
is kind of related to that?
00:20:35.16\00:20:36.30
Absolutely, yes,
people have choices
00:20:36.31\00:20:40.63
what they are
putting into their food
00:20:40.64\00:20:42.81
and
particularly the over eating,
00:20:42.82\00:20:44.38
the high fat meals,
those type of things are
00:20:44.39\00:20:46.48
lending to
Gastroesophageal Reflux Disease,
00:20:46.49\00:20:49.74
the alcohol as well,
I mean there's a marked
00:20:49.75\00:20:52.09
increase risk of Adenocarcinoma
00:20:52.10\00:20:53.95
and those who
drink and smoke as well.
00:20:53.96\00:20:55.69
So, let's talk about treatment.
00:20:55.70\00:20:57.12
Well, the
treatment actually first
00:20:57.13\00:20:59.91
should be diet,
actually and lifestyle measures.
00:20:59.92\00:21:03.90
And we have a graphic in regards
00:21:03.91\00:21:06.54
to the actual treatment,
00:21:06.55\00:21:08.32
but lifestyle
and dietary change,
00:21:08.33\00:21:11.36
44% of patients will experience
00:21:11.37\00:21:13.60
relief of symptoms
with modest changes
00:21:13.61\00:21:16.65
in their diet. Now,
these aren't significant
00:21:16.66\00:21:18.78
changes, but modest changes.
00:21:18.79\00:21:20.49
And those if we do
significant changes
00:21:20.50\00:21:24.05
80% of patients
experience relief
00:21:24.06\00:21:26.76
with bold dietary
and lifestyle changes.
00:21:26.77\00:21:29.23
So, what we are talking about in
00:21:29.24\00:21:30.38
these changes,
are we talking about
00:21:30.39\00:21:31.44
chewing your food? That's right,
00:21:31.45\00:21:33.32
chewing the food adequately
00:21:33.33\00:21:35.01
and thoroughly,
savoring the food,
00:21:35.02\00:21:37.02
taking time for
that and actually
00:21:37.03\00:21:38.65
for not eating in a
stressful environment
00:21:38.66\00:21:40.67
it's one of the
reasons why we want to be
00:21:40.68\00:21:42.33
stress free with
good conversation
00:21:42.34\00:21:45.07
and those types of
things and savoring the food,
00:21:45.08\00:21:48.27
chewing the thoroughly
will help significantly
00:21:48.28\00:21:50.38
in preventing reflux.
00:21:50.39\00:21:51.65
Secondly, the type of
food that we are eating,
00:21:51.66\00:21:54.64
the modest
changes that we recommend
00:21:54.65\00:21:56.51
in virtually
everyone is no caffeine,
00:21:56.52\00:21:59.23
decaf even, decaf
has tannins in it,
00:21:59.24\00:22:03.28
and the tannins will
actually also cause reflux.
00:22:03.29\00:22:08.65
Chocolate,
chocolate weakens the lower
00:22:08.66\00:22:11.63
esophageal sphincter,
and so we have everyone
00:22:11.64\00:22:14.42
avoid chocolate, peppermints,
spearmint and alcohol.
00:22:14.43\00:22:17.71
Also eliminating
carbonated drinks,
00:22:17.72\00:22:20.21
the carbonated
drinks because of the air,
00:22:20.22\00:22:22.61
the carbon dioxide in
them will tend to come
00:22:22.62\00:22:25.08
right back up,
and that's why people
00:22:25.09\00:22:27.00
tend to belch
afterwards, decreasing the size
00:22:27.01\00:22:29.88
of the meal. And so this,
00:22:29.89\00:22:32.61
this is what we recommended
virtually every individual
00:22:32.62\00:22:35.75
if they're overweight
they need to lose weight
00:22:35.76\00:22:38.04
down to their ideal
weight to get that intra
00:22:38.05\00:22:40.01
abdominal
pressure under control,
00:22:40.02\00:22:42.20
thoroughly chewing the
food and then increasing
00:22:42.21\00:22:44.79
whole grains rich in selenium
00:22:44.80\00:22:46.27
has also been
shown to be healthful
00:22:46.28\00:22:48.18
in preventing
reflux. What is selenium?
00:22:48.19\00:22:51.21
Selenium is a trace mineral,
00:22:51.22\00:22:53.28
that's present
particularly in grains
00:22:53.29\00:22:55.46
from the
Dakotas. And then the more
00:22:55.47\00:22:57.83
aggressive measures
that we would recommend
00:22:57.84\00:22:59.60
in some people and
this is where we can get,
00:22:59.61\00:23:01.47
increase the
yield from 44 to 80%,
00:23:01.48\00:23:04.07
more aggressive
measures are avoiding
00:23:04.08\00:23:05.95
ascetic food such as oranges,
00:23:05.96\00:23:07.57
lemons, grapefruit,
pineapple, tomatoes.
00:23:07.58\00:23:09.82
Lot of people don't realize meat
00:23:09.83\00:23:11.65
is an ascetic food
and it very much is.
00:23:11.66\00:23:14.20
And then not eating
fruits and vegetables
00:23:14.21\00:23:17.73
at the same
meal, it's good to eat
00:23:17.74\00:23:20.14
your fruits at meal,
vegetables at another.
00:23:20.15\00:23:22.41
For people they
don't have reflux problems
00:23:22.42\00:23:24.94
there is no
problems eating fruits
00:23:24.95\00:23:26.41
and vegetables at the same meal,
00:23:26.42\00:23:27.64
but if you are
having problems of reflux
00:23:27.65\00:23:30.78
and you've tried the,
00:23:30.79\00:23:32.03
the common measures
and you are not in that 44%
00:23:32.04\00:23:35.83
category to experiencing
relief from the common
00:23:35.84\00:23:38.99
measures then we
would recommend more
00:23:39.00\00:23:40.65
aggressive measures and
that would be not eating
00:23:40.66\00:23:43.22
fruits and
vegetables at the same meal
00:23:43.23\00:23:44.83
and even avoiding,
completely avoiding
00:23:44.84\00:23:46.82
certain types of fruits
00:23:46.83\00:23:48.51
that are high in acid content.
00:23:48.52\00:23:49.75
Well, this is talking
about significant changes and,
00:23:49.76\00:23:53.30
and things that
people usually don't like
00:23:53.31\00:23:55.50
to be talked with about,
I mean people want to eat
00:23:55.51\00:23:59.41
what they want to
eat, when they want to eat,
00:23:59.42\00:24:00.99
how they want to eat
it? And so, have you had
00:24:01.00\00:24:04.85
success in talking with
your patients about this?
00:24:04.86\00:24:07.28
Well, absolutely and
people tend not to want
00:24:07.29\00:24:11.36
to be depended on
medicines for life,
00:24:11.37\00:24:13.35
and although if you
have any erosion or an ulcer
00:24:13.36\00:24:15.80
we are gonna put you on a
medicine to actually block
00:24:15.81\00:24:18.77
your stomach
from producing acids,
00:24:18.78\00:24:20.36
so even if you are
refluxing the acids not at least
00:24:20.37\00:24:23.08
going up into the esophagus,
00:24:23.09\00:24:25.40
and you will have
another for eight weeks,
00:24:25.41\00:24:27.78
but eight weeks will cure it.
00:24:27.79\00:24:29.15
In most cases, and then
if you're on a good lifestyle
00:24:29.16\00:24:33.21
program you won't need medicine
00:24:33.22\00:24:34.87
the rest of your
life, but otherwise
00:24:34.88\00:24:36.51
you are gonna need
to take these expensive
00:24:36.52\00:24:38.23
medicines and lot of
these drugs are expensive,
00:24:38.24\00:24:40.46
$130 a month that
you're having to pay off,
00:24:40.47\00:24:43.81
and they also can
have side effects.
00:24:43.82\00:24:45.46
The medicines that
help reflux can cause
00:24:45.47\00:24:47.96
the abdominal
pain, it can decrease the
00:24:47.97\00:24:50.22
absorption of vitamin B12,
00:24:50.23\00:24:51.86
for instance because
you are not producing
00:24:51.87\00:24:54.26
that acid which can help
00:24:54.27\00:24:55.59
with the absorption of B12.
00:24:55.60\00:24:56.92
Well, what about
the person that says,
00:24:56.93\00:24:59.27
well you know my
family's always just had
00:24:59.28\00:25:01.44
bad stomach it's just because
00:25:01.45\00:25:03.76
of my family history?
00:25:03.77\00:25:04.89
Well, people may have
a genetic predisposition
00:25:04.90\00:25:08.55
to a weak lower
esophageal sphincter
00:25:08.56\00:25:10.42
and they have
predisposition to obesity
00:25:10.43\00:25:13.36
genetically, but
despite those genetic
00:25:13.37\00:25:17.48
predispositions, if
we are on a good diet 80%
00:25:17.49\00:25:21.70
of those
individuals will not need
00:25:21.71\00:25:24.88
to take
medicine. And so they can
00:25:24.89\00:25:27.70
control it with
their diet and lifestyle.
00:25:27.71\00:25:30.68
Well you know, you
are a Christian physician,
00:25:30.69\00:25:33.96
what kind of
spiritual lessons do you draw
00:25:33.97\00:25:36.37
from the digestive
system and when you talk
00:25:36.38\00:25:39.07
with people, how do you
00:25:39.08\00:25:41.04
point them to the master?
00:25:41.05\00:25:42.22
Well, we point
them to the master
00:25:42.23\00:25:44.84
by being able to
change our lifestyle.
00:25:44.85\00:25:47.06
All of us are creatures of habit
00:25:47.07\00:25:48.47
and we as human
beings don't like to change
00:25:48.48\00:25:53.07
that readily.
But if we know that
00:25:53.08\00:25:56.59
is best for us to change,
00:25:56.60\00:25:58.02
we still can't
change unless we have the
00:25:58.03\00:26:01.33
Holy Spirit working in our life.
00:26:01.34\00:26:02.88
And if we just
simply ask God to help us
00:26:02.89\00:26:06.54
with the change, he knows that
00:26:06.55\00:26:08.67
we need to change and
00:26:08.68\00:26:10.18
we are willing to do our part,
00:26:10.19\00:26:11.87
at first it seems
like a tremendous sacrifice
00:26:11.88\00:26:14.82
for people to leave
out some of these items
00:26:14.83\00:26:17.83
in their diet
particularly the more addictive
00:26:17.84\00:26:19.71
substances, I mean chocolate
00:26:19.72\00:26:21.01
can be addictive,
alcohol can be addictive,
00:26:21.02\00:26:23.45
but study show
repeatedly that if
00:26:23.46\00:26:26.89
we do our part and we
are willing to make that
00:26:26.90\00:26:29.76
decision to
change, if we rely upon God
00:26:29.77\00:26:33.63
even the 12 Step
program that works with food
00:26:33.64\00:26:36.16
as well, let go and let God,
00:26:36.17\00:26:38.70
God can indeed
help us to completely
00:26:38.71\00:26:42.89
change our life.
And that's why when
00:26:42.90\00:26:44.51
we leave the spiritual
component out of giving
00:26:44.52\00:26:47.44
information we're
really leaving out the power
00:26:47.45\00:26:50.96
for people to change
and change permanently.
00:26:50.97\00:26:53.90
You know, sometimes
people have their stomachs
00:26:53.91\00:26:56.98
clamped or this
gastric resection,
00:26:56.99\00:26:59.33
does this cause
problems with the,
00:26:59.34\00:27:01.76
this kind of esophageal problems
00:27:01.77\00:27:04.68
that you've mentioned?
00:27:04.69\00:27:05.69
Yes, it can the,
the stomach surgeries
00:27:05.70\00:27:07.76
that are done can
lead to more reflux
00:27:07.77\00:27:09.80
that's true, of
course there is a surgery
00:27:09.81\00:27:12.47
to tries to get rid of reflux,
00:27:12.48\00:27:14.16
it's called the fundoplication
00:27:14.17\00:27:16.44
where the stomach is wrapped
00:27:16.45\00:27:17.49
around the esophagus,
00:27:17.50\00:27:18.60
and that might
help with the reflux,
00:27:18.61\00:27:20.26
but the individual never be able
00:27:20.27\00:27:21.65
to belch or vomit again. Okay.
00:27:21.66\00:27:24.22
And that can produce bloating
00:27:24.23\00:27:25.38
and other types of symptoms,
00:27:25.39\00:27:26.55
so we just trade
one disease for another
00:27:26.56\00:27:28.34
sometimes with the surgery.
00:27:28.35\00:27:29.39
We've been talking
with Dr. Neil Nedley,
00:27:29.40\00:27:31.43
we have been
talking about the wonderful
00:27:31.44\00:27:33.68
divinely
inspired digestive system
00:27:33.69\00:27:35.81
and we have talked about how
00:27:35.82\00:27:37.28
we can really complicated,
00:27:37.29\00:27:39.23
but we have also seeing that
00:27:39.24\00:27:40.28
there is a good
news, a large percentage
00:27:40.29\00:27:42.63
of you that are
struggling with these things
00:27:42.64\00:27:45.67
can actually stop
them and reverse them
00:27:45.68\00:27:47.46
with just simple changes.
00:27:47.47\00:27:48.88
We encourage you to do that,
00:27:48.89\00:27:50.51
we're thankful
that you watched today,
00:27:50.52\00:27:52.47
and we hope you have health
00:27:52.48\00:27:53.50
that lasts for a lifetime.
00:27:53.51\00:27:55.06