antique spittoon on floorIf you use smokeless tobacco, or know a guy who does and want to help him, this is for you.  Obviously, the best thing you can do is quit.  But if you can’t do that, these three words may save your life:  Move your chaw!

I’ll explain, with help from Jason Campbell, D.D.S., a Prescott, Arizona, dental surgeon who specializes in complex reconstructions.  (Note: Campbell is also a very nice guy, and he says if you have any questions about what we’re talking about in this story, contact him at frontoffice@myprescottdentist.com and he will answer them.)

When you stick a plug of tobacco in your mouth, it begins to break down, or denature, the tissue it touches.  It doesn’t just alter the tissue but the genetic code, as well, and this can lead to cancer.  By habit, says Campbell, “guys typically tend to keep the tobacco in the same spot all the time. “ The repeated chemical attack, of denaturant leaking out of a chaw of tobacco day after day, causes the body’s immune system to launch defensive countermeasures.   “The body’s way of protecting the tissue is, it toughens it up and thickens it, like when you get callouses on your hands from shoveling or lifting weights.  We see that wherever that tobacco goes.”  The official diagnosis of this phenomenon is called “tobacco pouch keratosis.”  (It’s gross.  Google it.)

Tobacco pouch keratosis is a precancerous condition.  “When the body starts laying excessive tissue down in order to protect itself, when those immune system cells get turned on, the body is automatically activating a system for cell formation.”  Cancer, Campbell points out, “is the continuous growth of tissue.  If the chemicals in tobacco alter the normal process, this system can get turned on and never turned off, and that’s when cancer can form.”  Usually, Campbell sees this keratosis on the lip and gum, but it’s kind of a tip-of-the-iceberg situation.  “Some of the fallout is, it creates inflammation in the area.  Periodontal bone loss is a process of inflammation, and that inflammation can cause a receding gum line, because it damages the bone, and then the gum follows the bone.  So periodontal defects are also very common in people who hold their tobacco in the same place over and over. “

If you smoke instead of chew, don’t feel too smug: The heat from a cigarette or cigar damages tissue, as well, and hampers the immune system in that area.  “So the heat is a problem, but the chemicals in smoked tobacco also inhibit the immune system,” says Campbell.  “Consider that the mouth is a pretty dirty environment.  A lot of different bacteria live there, and if the immune system is suppressed, it’s going to increase someone’s risk for bacteria-induced gum disease, as well as bacteria-caused tooth decay.”  (Another downside of smoking tobacco is that it messes up the taste buds; food doesn’t taste as good, and this suppresses the appetite – which is why you might see super-thin models and actresses puffing on cigarettes.  When people quit smoking, food starts to taste better.)

[Tweet “The damage to your lip and gum are reversible when you quit smokeless tobacco”]

Good news: the damage to the lip and gum is “100 percent reversible when tobacco products are discontinued.”  In the mouth, there is “a constant turnover rate of tissue replacement,” Campbell says.  “When the tissue detects that it doesn’t need to protect itself, that over-reactive thickening stops.  Usually that tissue can rebound.”  Periodontal damage, and damage from bone loss, can be corrected with surgery.

If you can’t quit chewing tobacco, there is still good news:  “I encourage our patients, if they are unwilling to quit, to move it.  My job as their dentist is to help them avoid big problems.  I’d much rather have them move it than increase their risk for cancer.”  For example:  If you generally keep your chaw tucked away on the right side of your mouth, put it on the left.

Campbell knows that for a lot of people, this means, “I just reduced my risk for cancer.  It’s okay for me to continue to chew!”  So, just because you can minimize your risk of cancer by moving your chaw, don’t think that’s one more reason why you shouldn’t quit.  “But one upside is, seeing that tissue heal does bring peace of mind for people.” It doesn’t happen right away, but “in six to eight months, we usually see that kind of leathery tissue start to dissipate.  In the tissue where there is receding of the gum, almost instantly we see the inflammation go down.  The gum is usually red and inflamed there, and that will heal very quickly.”

Keep in mind, Campbell notes, that tooth decay and gum disease are bigger oral health worries than the risks of cancer when it comes to smoking or chewing tobacco – and quitting reduces your risk for having to get cavities fixed, having your teeth go bad and needing crowns, or needing to have gum surgery.  “People need to understand that their risk of developing oral cancer is low.  But their chance of survival is very low.”  The mouth has a lot of blood flow – blood that can take cancer elsewhere, allowing it to metastasize.  People who get oral cancer from tobacco may need to have part of their face removed, or may risk having that cancer spread to other parts of the body.   I wouldn’t wish that on anyone.

Rinse Tests for Oral Cancer:  “We’re getting better at detecting oral cancer,” says Campbell.  Most dentists now check your mouth and throat very carefully for tissue changes, and at many practices, you can request a diagnostic test for oral cancer – a fluorescent rinse that bonds with precancerous cells, causing them to glow or stand out when the dentist shines a light on them.  These tests look for abnormal tissue, and aren’t just limited to changes caused by tobacco.  They can also detect other oral cancers, such as those caused by HPV.

©Janet Farrar Worthington

gut ache

Ever had a gut feeling?  Felt butterflies in your stomach?  Maybe gotten a little crampy or needed to make an emergency trip to the bathroom during times of stress?

Now, let’s look at this from the other end, so to speak:  Maybe you’ve been feeling anxious or depressed.   Maybe you feel bad, and you don’t know why.  Maybe something in your diet is making you feel this way.

Maybe what you eat is making you sick.

There is an intimate, intricate link between the brain and the gut that scientists are just beginning to understand.  Questions are being asked and investigated that, frankly, nobody thought of even a few years ago, because the connections weren’t there yet.  That is changing.

[Tweet “There is an intimate, intricate link between the brain and the gut that scientists are just beginning to understand.”]

Here are some fun facts you should know about what scientists call the gut-brain axis:

  • You have as many neurons (nerve cells) in your gut as you do in your spinal cord.
  • These intestinal nerve cells crank out 90 percent of your body’s serotonin and half of its dopamine. Both of these powerful neurotransmitters help the mind stay calm and focused and are natural anti-depressants.
  • If you go to a doctor for irritable bowel symptoms (such as alternating diarrhea and constipation) or dyspepsia (uncomfortable fullness or pain in the upper abdomen, heartburn, or other digestive problems), you are likely to be prescribed one of the same drugs used to treat anxiety or depression. Doctors don’t really understand why these “brain” drugs work on the gut, but they know that they help make symptoms better.
  • As many as 40 percent of people who go to the doctor with gastrointestinal problems suffer from irritable bowel syndrome and gastroparesis (the stomach muscles or the nerves that drive them stop working, and food doesn’t move out of the stomach the way it should) – conditions that involve the enteric nervous system.  This is the massive highway of nerve cells lining the muscular walls of your esophagus, stomach, intestines, and rectum.
  • These nerves control peristalis, the conveyor-belt series of muscle contractions — think of toothpaste being squeezed through a tube — essential for swallowing, for digestion, absorption of food, and for pooping (literally, movement of the bowels).
  • These enteric nerves also affect immune responses and inflammation.
  • Changes in our mood can also affect everything in the gut.

Is there really a food-mood connection?  Here’s a good example:  An estimated 1 in 133 Americans have celiac disease, an autoimmune disease in which the body attacks the small intestine (this can be diagnosed with a blood test).  The culprit is gluten, which is in wheat.  If you have celiac disease and you don’t change your diet, and you get an upper endoscopy, if you are lucky, it will likely show a telltale “cobblestoning” of the small intestine – damage to the villi, tiny, fingerlike oars that help the small intestine absorb the nutrients in your food.  This damage is reversible.  Within a few weeks of going gluten-free, these little dudes come back and your small intestine can do its job again.  If you are not lucky, a biopsy to the small intestine will show that the celiac disease has caused cancer, and this is not good.

Am I saying you have celiac disease if bread gives you a belly ache? No, but bear with me:  One, a lot of people test negative for the disease itself, but notice they feel bad when they eat bread or pasta.  They feel bloated, maybe a little cranky; maybe they also get headaches.  They also feel better when they eliminate gluten from their diet.  They may have gluten intolerance, which is not the same as celiac disease, but responds well to a change in diet.  Two:  People with celiac disease who give up gluten notice a lot of other changes in their lives.  They may put on muscle mass, because their body was starving from the inside; no matter how much they ate, they weren’t absorbing the good nutrients, because their small intestines didn’t function right.  They also tend to realize, with great surprise, that they have felt bad for years; they just didn’t know why.  And here’s the kicker: Their mood improves.

Celiac disease can cause depression, irritability, and anxiety, but can get better with a diet change.

What I want you to think about is this:  If it can happen with one gut disease, it can happen in other problems involving the gut and/or diet.  Food affects mood.  Maybe you have a food allergy or intolerance that you didn’t know about.  The nerve cells in the gut affect your mood.  It’s the opposite of those ads for Las Vegas:  What happens in the gut does not necessarily stay in the gut.

Food, Body & Mind

“The gut has its own brain,” says Pankaj “Jay” Pasricha, M.D., gastroenterologist and neuroscientist, director of the Center for Digestive Diseases at Johns Hopkins Bayview Medical Center, and co-director of the new Johns Hopkins Food, Body & Mind Center.  At this center, the science is a fusion: it’s Gastroenterology, Neuroscience, Microbiology, Immunology, and Psychiatry.  They’ve got a bunch of doctors and scientists working together to figure out just how important a role the gut plays in diseases that seem like they wouldn’t trouble the intestines – diabetes, heart disease, depression, anxiety, even cancer.

I have interviewed Jay Pasricha several times for the Johns Hopkins Center for Innovative Medicine’s magazine, Breakthrough.  At the Center, he says, many of their patients come to them by way of a rather long road.  Basically, they’ve been through a lot — medicines that may not have worked, for example, or doctors who may have addressed one of their problems without realizing the whole body was involved.  Pasricha told me that his research involves multiple aspects of the gut-brain axis.  He is very interested in the pancreas, in exploring “how the gut can be a signal that drives metabolic disease,” he says, and “finding the mechanism by which gastric bypass surgery relieves insulin resistance and diabetes.” Pasricha has also shown in mouse models of diabetes that there is remodeling of the enteric nerves that help control insulin production; he believes that a new approach to treating diabetes — by changing the way the nerves signal to each other — may be on the horizon.

Enteric nerves

Exactly how the brain in the gut relates to the “big brain” is what Pasricha and his colleagues are working hard to find out, testing the potential of never-before-recognized molecular targets for treatment of nausea, abdominal pain, and other symptoms that may arise when mind-gut pathways go awry.   “The treatment of motility disorders (like irritable bowel disease and gastroparesis) really requires the art as well as the science of medicine, because every patient responds differently,” notes Pasricha.  “In fact, there are very few effective treatments, and what works for one person might not be very helpful for another,” which is why he believes that entirely new avenues of treatment might make a huge difference in care.

But better treatment for motility disorders is most likely just the tip of the gut-brain iceberg, Pasricha believes. The enteric nerves almost certainly play a role in obesity, diabetes, in pancreatitis; they may even be involved in Alzheimer’s disease, some forms of cancer, and other diseases that aren’t usually thought of as relating to the gut.

These nerves are involved in immune responses, he explains, “and this process, called neurogenic inflammation, is a problem in many disabling diseases.” Signals from the enteric nervous system affect metabolism in the brain, liver, and elsewhere.  “The bigger picture here is enormous.”

Next: Bacteria in your gut, good and bad.

©Janet Farrar Worthington

soft drinks and chilisYou asked for it, and you got it!  A nice lady at church told me, “My husband has heartburn and keeps hoping it will go away. He won’t go to the doctor, and he doesn’t know anything about what he should do.  He needs very basic information.” 

So, this is part of an occasional series of very basic stuff that you should know about your body.  We’ll start with heartburn.  A lot of men have frequent heartburn, and either take something for the symptoms or tough it out, and neither approach is ideal.  If you are having a lot of heartburn, you should talk to a doctor, ideally a gastroenterologist, a doctor who specializes in the digestive tract.  You may be treating it the wrong way.  If you’re ignoring it, you should know that untreated heartburn can lead to a very bad situation called Barrett’s esophagus — which is treatable, but which can lead to cancer if it’s not addressed.

Heartburn 101

I hate heartburn.  It’s a burning in your esophagus, a fire in the chest, pain that, if it’s really bad, can make you think you’re having a heart attack.  It can affect the throat, too.  This is called throatburn (the medical name is “laryngopharyngeal reflux”), and it can make you cough and need to clear your throat a lot, can make your voice hoarse, even make it harder to swallow. 

Just about everybody gets heartburn sometimes.  But if you have it more than twice a week, then what you call this miserable condition should probably change to GERD — gastroesophageal reflux disease. 

What is it?

Basically, the problem is a leaky valve.  When you eat, food goes down your esophagus and into the stomach.  There is a stopper — a muscle that’s supposed to clench like a fist after food gets into the stomach — called the Lower Esophageal Sphincter (LES).  In a lot of us, it doesn’t always work right.  This is bad because stomach acid, also called gastric acid, is very powerful.  It’s made up of hydrochloric acid, potassium chloride, and sodium chloride, and its job is to activate digestive enzymes, so they can start breaking down the proteins in what you just ate.  Think of Coke taking the tarnish off a penny:  stomach acid just works away, breaking down hamburgers and pizza and biscuits and gravy and apples and beer and cereal and salad.  That’s usually not a problem in the stomach, because the stomach is equipped to handle all that acid.  But the esophagus and throat are not protected from that spillover — so it’s like holding a hot pan without an oven mitt.  Not pleasant.

Why doesn’t my dang valve work? 

“There are three major reasons why people reflux,” says Prescott gastroenterologist Mark Worthington, M.D.  (Disclaimer: I happen to be married to Mark, an excellent, caring physician who was on the faculty at the University of Virginia for 10 years and then on the faculty at Johns Hopkins for five.  He’s in private practice now.) 

One reason:  Transient (temporary) lower esophageal relaxations, “where the lower esophageal sphincter winks open,” just like it does when you burp, “and it bathes the lower esophagus in acid.”  The acid may never go all the way up to the throat; in fact, “some people don’t think they have reflux because they don’t taste acid,” Worthington says.  People with this problem have a normal valve; it just doesn’t function properly. 

Two: Hiatal hernia.  That’s where the junction between the stomach and esophagus is stretched, so that it no longer functions properly.  The valve itself is abnormal.  Have you ever heard of a dunlop?  As in, “my gut dunlopped over my belt?”  Well, in this case, there’s a tiny “dunlop” in which a little piece of your stomach pokes upward into the chest.  By itself, a hiatal hernia is not a worrisome thing; a lot of us have it.  But it can contribute to GERD.

The last big reason: Extra poundage:  Speaking of dunlops, if you want your heartburn to get better and you don’t want to take medicine forever, lose a few pounds.  It’s that darn belly fat again.  Using a few thousand patients from the Nurses’ Health Study, a massive long-term study of more than 238,000 nurses, Harvard physicians studied the link between Body Mass Index and symptoms of GERD; their work was published in the New England Journal of Medicine in 2006.  They found that women who gained just a few pounds had more frequent and severe symptoms of GERD.  The problem with excess weight around the gut — as opposed to extra weight elsewhere, as in thunder thighs or junk in the trunk — is that it pushes on the stomach, causing more pressure in there.  Very simply, this is a mechanical problem.  More pressure on the LES forces some of that stomach acid out and upward.  Now, there’s a flip side to every statistic, and the good news here is that even losing a little bit of weight is going to take some of that pressure off and make your symptoms better.  “You can make reflux better by losing weight, often as little as 10 pounds,” Worthington says.

Here are some other factors:

The luck of the genetic draw:  GERD has a genetic component.  It is known to run in families.  Now, you may say that in a lot of families, everybody eats the same food, so no wonder they all have it, and that’s a good point.  But there still seems to be an inherited tendency to GERD, so if a parent or sibling has it, you might have it, too.  A hiatal hernia can also be hereditary.

Tobacco: In addition to everything else bad that smoking does, it makes GERD worse.  When you smoke, your mouth produces less spit — and saliva helps buffer that awful acid from your stomach. Nicotine also seems to relax the Lower Esophageal Sphincter — it causes that fist to unclench.  And, if you cough a lot from smoking, that can cause acid to shoot upward, as well.  Chewing tobacco, because it has nicotine, is going to have that same effect of relaxing the LES.

 Stress:  Stress makes heartburn worse.  It’s not clear why; it may be that it makes you more sensitive to stomach acid, so even a little goes a long way to making you feel bad.  Also, when you’re stressed, you make fewer prostaglandins, chemicals that help protect against stomach acid.

Eating like a pig:  Yes, I could have put it more delicately.  But I don’t judge; we’ve all done it.  Two things here:  One, when you pig out, it causes more pressure on the stomach, which puts more pressure on that valve, which can open and send acid into the esophagus and throat.  Two, you know it, I know it: Chances are, when you’re scarfing down food, it’s not broccoli and kale. The kind of foods that people tend to overeat — comfort foods, high in fat or oils — are known to relax the valve.  Chili, cheesesteaks, pizza, burgers, lasagna, fried chicken, cheese puffs, onion rings, etc.  Also, garlic, chocolate, alcohol, coffee, citrus fruit, and tomatoes can trigger GERD.

 Tight clothing:  Loosen your belt, and you may feel better.  It takes the pressure off the belly — which, in turn, takes pressure off that pesky valve.

Don’t miss the next article on what you can do to make heartburn better!  Sign up below to get it in your mailbox. 

©Janet Farrar Worthington

300_200_hard_workI may not know you personally, but I know that, because you’re a man, chances are good that you do two things. One, you most likely respond to health issues with denial. I can relate to this – I do it, too.

And two, when things get tough, you just put your head down and keep going. You work harder, trying to take care of your family and not let anyone down at your job. Trust me on this, because I know and love the men in my family who do these same things:

[Tweet “You need a vacation. Time off. Relaxation. Your body needs it.”]

A famous neurosurgeon in Baltimore, when he used to interview residents, would ask them to show him something they had made with their hands. He did this because he knew how demanding the job was, how much pressure there was, and that being able to relax and take the time to tinker, or play a musical instrument, or whittle, or work on a car, not only calms you down and boosts your mental health, it can help you live longer and keep you healthier. A study from the Mind-Body Center at the University of Pittsburgh, of nearly 1,400 people who were taking part in other health studies, found that people who had more leisure activities had more satisfaction in life, found more meaning, were more spiritual, and basically just more positive in general. And that’s just down time, which we all need. But we also need to kick it up a notch and take actual vacations.

The Framingham Heart Study is a long-term study, started in 1948 in Framingham, Massachusetts, by what’s now the National Heart, Lung and Blood Institute. Over the years, they have followed thousands of participants, three generations of families who come back every two years for laboratory tests, a history and physical. Among their many important findings over the years was this one, from a study that looked at the effects of vacations in more than 12,000 men over a nine-year period. Men who didn t take vacations for several years had a 21-percent higher likelihood of dying, and were 32 percent more likely to have a heart attack than men who got away from work for at least one week a year. There was a definitive link between taking vacations and living longer, and staying healthier. The more vacations a man took, the longer he lived. Not taking a vacation doesn’t mean that you are going to have a heart attack, but it does mean that your risk of having one is most likely going up a little bit.

Does this mean you need to spend a lot of money to go on a cruise, or stay in a fancy hotel? Heck, no! But it does mean that you need to shut off the working guy for a few days, ideally a week, and be the relaxing guy. Resist the urge to check your work e-mail and phone messages! Resist it as if your life depends on it. Go fishing. Read a book. Wander around a museum, if that floats your boat. Or float in a real-life boat! Go to the movies, take a hike, play golf, go see a baseball game. Lie on a blanket and watch the clouds roll by. Whatever you do, do something you enjoy, and do it for several days straight. You have to break the cycle of lifestyle stress – commuting to work, being stressed at work, being stressed when you come home at family issues and all the things you need to do around the house, not
sleeping well – at least once a year.

We’ll talk more about stress in future posts, but when you get stressed, among other bad things that happen, your body makes a hormone called cortisol. Cortisol sucks. It ages you faster, and also makes your waistline thicker. When our ancestors were running away from mammoths or something equally horrible, their bodies produced cortisol and adrenaline. We still do, too. The adrenaline fades, but the cortisol makes our bodies think, as our Stone Age ancestors might have, “Maybe there’ll be no more food! I’d better eat while I can!” And when we eat in this situation, that weight tends to stay right in the worst possible place for heart attack risk – the belly.

When you come back from your vacation, chances are good that you will be more productive and that you’ll have a mental cushion that will protect you from burnout. Even if you get all stressed out the minute you walk back in the office and see 500 e-mails and a big pile of work. Dont worry, that s okay! You will have that cushion, and it will protect you, even if the glow of vacation is fading faster than the poster of Farrah Fawcett that used to hang up in your bedroom when you were a kid. Look at it this way: Say you have a great night’s sleep. You’re going to get tired again the next day, but that doesn’t mean that your body didn’t benefit from the good, healing sleep you had. It’s like recharging a battery. It’s money in the bank.

We Americans are mostly bad at taking vacations. In Europe, many employers give at least three weeks, and in France, many people take off for an entire month. In America, if we’re lucky, we get maybe two weeks, and one study done by the Families and Work Institute found that fewer than half of us use all of our allotted vacation days. Working parents, for instance, hoard them, so they can be there for their kids if they are sick. I’ve done it, and I can tell you that, although it’s a blessing to be there for your child, that’s not a vacation!

I would add that, when you plan your trip, don’t try to do too much. Ambition here is not what you need. Also, if you have a job that just wont give you a whole week off at once, you can still help your body and mind by taking more breaks, a weekend here and there.

Finally, I would like to leave you with the very sad case of Li Yuan, a Chinese advertising executive who died of a heart attack at age 24. For the entire month before he died, he had been staying late at the office, working until nearly midnight. A report from China said that more than 600,000 workers in that country die of exhaustion every year. That is just so wrong. Don’t be that guy. Take care of yourself.

©Janet Farrar Worthington