Dr. Haase & Mr. Why

Did you know that withdrawal from many drugs CAUSES the same symptoms the drugs were prescribed to TREAT?

• Anti-depressant medication withdrawal often cause acute depression and all kinds of other wacky symptoms.
• Anti-anxiety medication withdrawal often causes severe anxiety – even worse than the initial symptoms.
• AND Anti-ACID drugs used to treat GERD or heartburn – upon withdrawal – will often cause WORSE heartburn than what the person originally experienced when starting the medications.

This has been an observation of mine for years, and the reason I harp that we must look for, and address the underlying CAUSES of dysfunction and disease as opposed to suppressing meaningful symptoms with powerful new-to-nature drugs on a regular basis.     Drugs often blow away the “smoke” of the symptom while letting the “fire” of the underlying abnormality rage on.

A study in Gastroenterology has deeply vindicated my position.     It showed concvincingly that a Proton-Pump Inhibitor (PPI) , or “purple pill” or specifically in this case esomeprazole (Nexium) when given to HEALTHY people without any heartburn whatsoever for an 8 week period caused often severe heartburn, dyspepsia, and GERD symptom in 44% of these people when the medication was stopped!    In most of these individuals the symptoms persisted for greater than the 4 week follow-up period!   There is no reason that other PPI’s such as Prilosec, Protonix, Aciphex, or Prevacid would be expected to act any differently.

This means HEALTHY people now have a new long-term problem due to taking this medication (some forms are now over the counter).    That sounds like a problem to me.  This opinion article reflects my concerns and gives a nice review of the full scope of the problem.  Now, it is certain that these drugs truly benefit some individuals long term (meaning that the benefit they provide over-weighs the detriments they induce) , and I am also certain they are massively overused.  Especially since there are so many effective cause-focused approaches available.

So what has occurred is the rise of a highly profitable class of  medications that help initially, but now we know that many patients are assured of feeling even worse when they stop that medication.    Sounds like a great business plan. 

Another problem is that in real life healthy people don’t take medications – sick people do.   People with heartburn and reflux.       But allow me to ask…  WHY do they have these symptoms?    The presence of these powerful drugs that so quickly and completely removes symptoms have seduced patients into thinking that the problem is that they have a “purple pill” deficiency as a cause of their symptoms, and has equally seduced doctors into believing they are doing the best for their patient because the symptoms go away.

This twin seduction of  doctor and patient closing their eyes to a bigger problem because of a quick fix is the same problem that leads to narcotic addiction, stimulant addiction, sleeping pill addiction, etc.    I currently live in the state that has had the dubious honor of prescribing the most lortab (a potent narcotic) per capita of any state in the union.   Is that because Tennesseans hurt more than people in other states…. obviously not.   The answer is complex … like most truths, but at the center of the problem is the culture we have together developed that cure comes in the form of a drug that will block, inhibit, or short-circuit a normal function of the body.

On the national scale this situation presents a larger problem because 5% of the developed world is taking this EXPENSIVE medication class.  That is a lot of health-care dollars that you and I needlessly pay.

So what are some causes of the severe reflux and heartburn that some people encounter?   My fingers don’t go fast enough to cover all I want to say, but let’s think of some big-bucket causes.   Certain foods can loosen the sphincter that separates the stomach from the esophagus – coffee, chocolate, milk, and sugar are the biggest culprits in the scientific literature, but I can tell you many foods can cause it.   Many foods can cause sensitivities or allergies that will have as a symptom heartburn (remember another class of medications used to treat acid issues are H-2 blockers… the “H” stands for histamine which is a major chemical in the allergy cascade).  Emotional stress both chronic and acute definitely contributes,  Small bowel bacterial overgrowth,  yeast overgrowth or sensitivity, parasite infection, Poor diet leading to inflammation, recent anti-biotic use, recent viral infections, Hiatal hernia (which I have witnessed respond to visceral manipulation in several of my patients), hormone imbalance, Celiac disease, some toxins, some commonly used medications.

WHY is the most important question we can ask when we have a symptom… our body is giving us an early warning that something is not right, and we then get the opportunity to investigate, address the cause and potentially gain side-benefits in other areas of our health from our cause-focused intervention.

WHY may find the cause is actually a LACK of adequate stomach acid leading to poor digestion, bloating, and all kinds of skin problems.    WHY may lead to the understanding that eating machine-poop instead of real-food does not adequately fuel our lives and help in the attainment of our highest life purposes.   WHY may give the bravery to re-claim your life choices as your own, and give the opportunity for you to start living your life your way.   WHY may lead to you seek a comprehensive evaluation which could identify that weak link in your chain that would shorten your life otherwise.  WHY could get you to the cause of persistent weight gain… and lead to remarkable weight loss.   I have witnessed all these things.   Good stuff that WHY.

Find the Root Cause and give the Right Treatment.

It is my opinion that with the exceptions of acute ulcer healing, erosive esophagitis and Zollinger-Ellis Syndrome we should be very cautions in prescribing these Proton Pump Inhibitors for anything over 1-2 weeks.  Now that rebound acid secretion has been demonstrated to induce symptoms, we are probably obliged to inform patients about rebound acid hyper-secretion and its potential effects.   There is evidence for these meds contributing to dysfunctional long-term gut function, osteoporosis, mal-digestion of  proteins, inhibition of vitamin B12 absorption, and significantly thinning your pocketbook if you take them personally, or if you pay taxes for other individuals to unnecessarily take them life-long.

Fatty Liver is an epidemic at present…  It can lead to liver failure and death and the cause of this current scourge has caused much debate.   Alcohol is a huge contributor to fatty liver disease, but the huge rise in the occurrence of this malady can’t be accounted for just by a higher number of margaritas per capita.     Something else is going on….

People who are overweight or obese (now nearly 60% of the population of the US!) are at higher risk, and so are diabetics,  but not ALL people with diabetes or a bulge get fatty liver disease…   WHY?

How do you know if you have it?   A good place to start would be some blood tests: (liver tests, glucose, hs-CRP, Triglycerides, and Insulin) at the time of your annual inside-and-out physical -  but even those tests are not perfect.

I had noticed something for years – that people with Fatty liver often had hypothyroidism (they also often have inflamatory bowel disease, and/or previous gastric bypass surgery…but more on those later).   And now there is a study that confirms there is a connection.

So what is the connection?   Did you hear him stumble over this with a guess?    He basically said that hypothyroidism caused obesity which caused diabetes all of which contribute to the development of Fatty liver or NASH (which is Fatty liver WITH inflammation).   I’m not beating up on him here, as I am glad for the research, but really the most likely answer is that there is some cause at the root of all of this that is the real culprit.

There are 2 causes he didn’t mention; Mitochondrial Dysfunction and Oxidative Stress.

I know …. MitoWhatchamaCallits?    Mitochondria.   They are the energy factories of the cells that take FAT and SUGAR and make body-energy in the form of a molecule called ATP.   If you have low ATP you have low energy.  If your mitochondria don’t work then it is nearly impossible to make ATP.    Since we do not have a drug that magically kicks them into gear or makes more of these little marvels not a lot of attention is given to them.   But interestingly diet, lifestyle, and certain supplements can have big effects.

How do you find out if your mitochondria are working or not…  the best test is called an Organic Acid analysis (from Metametrix) because it looks at metabolism under the hood from multiple different angles.   Frankly, as a doctor that is somewhat obsessed with the question “WHY?”  I don’t know of a single lab panel that gives me more information for the money than this gem.    This link goes to a document which further describes this test.   To learn more check out this video of two colleagues of mine in the field of Functional Medicine -  Todd LePine, MD and the founder of Metametrix, J. Alexander Bralley, PhD.

Oxidative Stress is the other reason I mentioned…  Whenever fuel is burned (oxidized)  we get fumes & soot.   When metal is oxidized we get rust.   When molecules and tissues in our bodies of all types are injured by this process of burning and rusting called oxidation it is called “oxidative stress”.

This concept has a long and inglorious history of being used to push this vitamin and that as “super-anti-oxidants” which lo-and-behold in high doses and without adequate balancing can actually cause the body harm!

If your ‘engine’ is burning too much fuel, or is burning it in a way to cause lots of fumes, soot, and rust, don’t you think the body would have a mechanism to slow down the damage?   Indeed it has many – one of them is called insulin resistance and it slows the penetration of your body tissues by glucose.   This shuts off the “fuel line”.   But what happens when the glucose can’t get in the cells to do it’s work?  It builds up in the bloodstream and then goes to the liver, and it turned into fat.    Fatty Liver.   What happens when the liver is full?  Fat starts spilling out into the bloodstream (High Triglycerides) and finally ends up being stored in a fat cell somewhere.

The thyroid too, can be damaged by oxidative stress.   It is injured very easily and is somewhat of a ‘canary’ in a coal mine when it comes to toxicity.    Thyroid dysfunction then makes mitochondria work less efficiently…. leading to less energy, the storage of more energy (fat), and potentially worsening ‘combustion’ efficiency in the mitochondria which may cause more oxidative stress.

Body fat (especially arround the tummy) goes up with oxidative stress.   And this belly fat leads to more inflamation and oxidative stress as well…   a viscious cycle.

Diabetes basically sets in when you no longer can produce enough insulin to tell your cells to suck up glucose from the bloodstream.   This decrease in production of insulin may have at it’s heart inflammation and you guessed it… oxidative stress.

So, if you have stuck with me through all this gobbledegook of concepts, tissues and hormones then you will see that a common theme of MULTIPLE ORGAN DYSFUNCTION occuring in a self-reinforcing cycle is what may be at the heart of not just Thyroid disease and Fatty Liver, but Obesity, Diabetes, and Fatigue as well.    Now let me throw in that these processes of inflammation an oxidative stress also participate in heart disease, dementia, allergies, eczema, inflammatory bowel disease, post-gastric-bypass illness, depression, anxiety, headaches, periodontal disease, osteoporosis, and yes, even autism.

So what causes these evil sisters to rev-up and do their evil work?   That will be the tale for another rainy day…

Until then, keep asking “But WHY, Doctor?”    It could save your life.

“But … Why?”

“Because I told you so.”

“No, really. Why do you and other doctors do that?”

“I don’t really have a good reason … it’s just what I’ve always done. It’s what I’ve been trained to do.”

“Do you really think that is a good enough reason to continue to do that?”

“I have done this for years and it seems to be working, and my patients wouldn’t understand if I did anything differently. They are used to ________. And it’s what most other doctors do – even though there have been several studies that have thrown question on whether or not it does any good. You know ‘standard-of-care’ is how they judge me in the legal realm…doing anything other than ‘standard’ might be frowned upon by my colleagues even though it would be better for my patients.”

“Is that really how you want to live your life…. Is that really why you went to Medical School, took the Oath and did all that training? Is that a professional life you will be proud of having lived?”

“You are really annoying, you know. I would just like for you to shut up and let me Diagnose illnesses and treat people. That way I can make a living for my family, pay off these medical school debts, and not have to admit I don’t have an answer to the deep ‘WHY’ questions.  I can be a therapeutic nihilist and not really expect people to get better… because it is not really  my job to help them get better… it’s my job to do illness management.   It might be ‘cookbook medicine’ but it is what I am expected to do.”

“Oh, yea. But the problem is you don’t believe that is the way it works anymore. The old “Name the disease, Blame the disease, and Tame the disease with some highly marketed drug Game” is hogwash and you know it. You know that each individual is unique, and that the only thing that really juices you is finding and treating the underlying causes of illness. Face it, you have seen lives changed by treating the cause and you are forever ruined for the “Script ‘em and Street ‘em” routine again.”

“Arrrrggggghhhhh! Can’t you just let me be a doctor?”

“That’s exactly what I’m trying to get you to do.”

“So this is not the end of this conversation?”

“Nope, only the beginning. Buckle-up. It’s going to be a bumpy ride. Deepening in your understanding of what in your practice comes as a result of Medical Training (how to “do” doctoring) and what comes as a result of  Medical Education (how to “be” the ever-learning inquisitive, discerning physician) won’t come easy, but it will be worth it for both you and your patients.  There are whole fields of thought, traditional approaches, epi-genetic influences, alternative modalities, metabolic healing, health-response-able living, proactive medicine, nutritional therapies, complexity theory…. you will likely become obsessed with the process of health creation.  Isn’t that what you went to medical school for?    Isn’t that why doctors all across our nation are changing how they practice?”

“Are you sure you won’t just go away?”

“But, Why ?”