grilled meatGood news for people who love barbecue, hot dogs, burgers, and steak cooked on the grill: It pays to eat your veggies.

The key to this story is something called “PhIP.” A few years ago, noted Johns Hopkins scientist Bill Nelson, M.D., Ph.D., director of the Sidney Kimmel
Comprehensive Cancer Center, began investigating its role in cancer. PhIP is a funny little word. (Pronounced “fipp,” it’s a short name for a long chemical
compound.) It sounds so harmless: “Hey, let’s get PhIP and go over to the club for some tennis,” or “I don’t give a PhIP what you do,” or “Let’s do some
PhIP shots!” But it’s not.

PhIP is found in meats cooked at high temperatures. It is a “pro-carcinogen,” a chemical that turns into something that can attack and mutate DNA, and is
known to cause prostate, breast, and colorectal cancer in rats. Unfortunately, we create carcinogens, or cancer-causing agents, with every steak we grill
or piece of chicken we fry, and PhIP is one of them. In 2007, Nelson and pathologist Angelo De Marzo, M.D., Ph.D., reported in Cancer Research
that when rats are exposed to PhIP, DNA mutations occur in the prostate. Since then, they have learned much more about this little sucker’s role as a
dietary contributor to cancer. I recently wrote about Nelson’s work for Discovery, the research magazine for the Brady Urological Institute at Johns
Hopkins.

The scientists have discovered that veggies help counteract the effects of PhIP. “When we fed rats tomato and broccoli along
with PhIP, the animals lived longer and showed reduced incidence and severity of prostate neoplasms (new, abnormal cell growth; particularly of PIN,
prostatic intraepithelial neoplasia – funny-looking cells that are linked to prostate cancer), intestinal cancers and skin cancers as compared to rats fed
PhIP alone,” says Nelson. “This provides even more evidence that eating vegetables may protect against cancer-causing agents like those in overcooked
meats.”

grilled veggiesThere is a twist to the story: Food safety pays off, too.
Nelson, along with De Marzo and scientist Karen Sfanos, Ph.D., has also explored the idea that prostate cancer may involve a combination of “environmental insults” – bad things in the diet, plus something else that weakens the body, like an infection. They wondered whether chronic inflammation, caused by bacterial infection, would make a difference in rats that had consumed PhIP. Using a specific strain of E.coli isolated from a patient with chronic prostatitis/chronic pelvic pain syndrome, they found to their surprise that the charred food plus the nasty bug seemed to have a systemic effect.

Together, E.coli and PhIP caused an increase in the development and progression of cancer in the skin and digestive tract. (Note: many people have E.coli in their gut and it is harmless, but some strains can get into meat when it’s processed and can survive if the meat is undercooked.) The rats that received the double punch of E.coli plus PhIP fared worse than rats that ate the PhIP alone. In one study, the bacteria- and PhIP-consuming rats developed more precancerous lesions within the prostate and might have developed even more problems – except they also died sooner.

In further experiments, they found that “when we inoculated PhIP-fed rats with E.coli in the prostate, the animals developed acute and chronic
prostate inflammation out of proportion to that seen with PhIP ingestion or E.coli inoculation alone, and had more prostate neoplasms, intestinal
cancers, and skin cancers,” says Nelson. “This hints that prostate infections and dietary carcinogens might interact to promote chronic prostate
inflammation and prostate cancers, and that prostate infections might augment carcinogen effects on other tissues, as well.”

What does this mean for you? One, that if these things cause changes in the prostate, it’s a pretty good bet that they are hurting you elsewhere, as well,
so take precautions: eat a veggie in addition to a potato. Potatoes are delicious, but they don’t help fight cancer the way green, leafy vegetables and
tomatoes do. Two, tomatoes and broccoli probably aren’t the only vegetables that can help diffuse the bad effects of charred meat; these are just the ones
that were studied in this particular investigation. Three, don’t eat undercooked meat. You’re not just risking food poisoning, which comes in like a
freight train and goes away quickly; you may be adding to your risk of developing cancer.

Nelson, along with De Marzo, Sfanos, and Hopkins colleagues recently published two papers on these striking new findings in the journals PLoS ONE
and Cancer Prevention Research.

In addition to the book, I have written about this story and much more about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org. The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  As Patrick Walsh and I have said for years in our books, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask. I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease. Many doctors don’t do this, so it’s up to you to ask for it.

 ©Janet Farrar Worthington

 

CigarettesA broken heart.  Shoveling snow.   Being a weekend warrior.   Eating like a pig, no offense to pigs.  What do these things have in common?  They all have the potential to cause a heart attack.  They could kill you. 

“But wait!” you may say.  “I exercise.  I have a good diet.  Gosh darn it, I’m heart-healthy!”  And that, with the use of prescription medicines, if you need them, is the best way to take care of your heart, says cardiologist Curtis Rimmerman, M.D., of the Cleveland Clinic, who also contributes to a blog called Health Essentials for that institution.   

But even so, he adds, there are some things that can trigger a heart attack.  All of them relate to sudden stress on the heart.  He categorizes them as the four “Es” – Exertion, Exposure to cold, Emotion, and (over) Eating.  (Shoveling snow could fit into three of these four categories, by the way; four if you also actively hate it as you lift each heavy shovelful.)

Sudden or overexertion.  The thing about exercise is, you need to ease your way into it.  Aerobic exercise means your heart works harder, causing you to take in more oxygen.  It is important, Rimmerman says, not just to hurl yourself into an activity that will leave you gasping for breath and have your heart working overtime.  Slowly build up your strength and endurance.  Some bad examples:  Playing a vigorous game of basketball or football if you’re not used to it.  Deciding, since you used to bench-press 150 pounds in your twenties, that this is a good weight for you to start with now that you’ve got that new gym membership, and forcing yourself to do it.  Spending your weekend doing heavy lifting of furniture or books or anything, if you haven’t done hard physical labor in years.  Sudden heart stress has even been known to happen after too much exertion in the bedroom.   And again there’s the classic example:  Shoveling snow. 

Ride the HorseCold Weather.  When it’s cold, your arteries constrict.  This raises your blood pressure.  Add intense physical activity, and your heart could feel the strain doubly.   Every year, Rimmerman says, more than 11,000 people go the hospital with problems related to snow-shoveling.  Most are orthopedic issues – oh, my aching back! – but 7 percent are cardiac, and many of those cardiac events are heart attacks.

Extreme emotions.  Maybe it’s a sudden, fierce surge of happiness; maybe it’s acute grief.  Both extremes, happiness, and sadness, can affect the heart’s electrical impulses, and both can set off a heart attack.  Rimmerman explains that this is because of the body’s “involuntary and sudden increase in heart rate and blood pressure brought on by a surprising event.”  Have you ever heard of someone dying, and then very soon afterward, someone close to that person has a heart attack or dies, as well?  The risk of having a heart attack is greatest within the first 24 hours after a loved one dies, but it remains higher than normal for a month, Rimmerman says. 

A subset of this is would be a category called “having a short fuse:” A 2002 Johns Hopkins study of more than 1,000 physicians, published in the Archives of Internal Medicine, found that young men whose knee-jerk response to stress is anger have three times the normal risk of developing premature heart disease.  In the study, such men – whether they vented their anger or bottled it up – were five times more likely than calmer men to have an early heart attack, even if they didn’t have a family history of heart disease.  Their short fuse was the risk factor.   “In this study, hot tempers predicted disease long before other traditional risk factors, like diabetes and hypertension, became apparent,” reported Patricia Chang, M.D., lead author of the study.  “The most important thing angry young men can do is get professional help to manage their tempers, especially since previous studies have shown that those who already have heart disease get better with anger management.

dirty handsEating a huge meal.   A Harvard-led study at the 2000 American Heart Association’s Scientific Sessions found that eating an unusually heavy meal can increase the risk of a heart attack by about four times within two hours after eating. That was the first time that this, by itself, had been proven as a risk factor.  “We hope that the results of our study will help convince people to be more cautious about eating exceptionally heavy meals, especially for people who have coronary artery disease or have suffered a previous heart attack,” said the study’s lead author, Francisco Lopez-Jiminez, M.D.  The investigators asked nearly 2,000 men and women about what they had eaten just before their heart attacks.  Of these, 158 said they had eaten a heavy meal within 26 hours before the heart attack, and 25 had eaten a big meal within two hours before the heart attack.

When you stuff yourself and your body begins the task of digesting what you just put into it, it releases many chemicals, such as norepinephrine, into the bloodstream.  This can cause your heart rate and blood pressure to rise.  Your heart works harder.  Higher blood pressure can act as a power-wash of your arteries, causing chunks, or plaques, of cholesterol to break loose and to form a clot.  This, in turn, can block a blood vessel, cutting off blood flow to the heart – triggering a heart attack or stroke. 

In addition to too much food, too much alcohol, drugs, or even caffeine also can trigger a heart attack in people who already have some heart disease.  Here’s a sad example:  In 2013, “Sopranos” star James Gandolfini died at age 51 after eating a decadent meal, including a lot of foie gras and two big orders of fried prawns with  mayonnaise chili sauce.  He washed it down with four shots of rum, two Pina Coladas, and two beers.   A few hours later, he had a massive heart attack.   

The lesson here?  You can’t help some things, like excessive grief.  But what you can do is try to start off with as clean a slate as possible.   Eat some stuff that’s not fried, not covered in cheese, not fatty, and not bad for you.  Eat some fruits and vegetables.  Try to exercise regularly; you don’t have to climb mountains or run marathons – start by walking.  Walking is good.  Don’t drink a lot of alcohol all at once.  Remember, moderation in all things.  And if you have a problem with anger or stress, get some help dealing with it.  Your heart will thank you.

©Janet Farrar Worthington

sand_sun_beachIn 2002, when I ghostwrote the first edition of The Paleo Diet for Loren Cordain, I thought we were writing sacrilege when he said people need sunlight.  That’s because our view of what’s normal and natural has gotten skewed.  “Oh, no!” I thought.  “Must have sunscreen.  Sunscreen good, sun bad!”  Just a few steps away from Frankenstein being terrified of fire.

I’ve lightened up, so to speak, since then.  Cordain was right:  Yes, excessive sunlight exposure is linked to skin cancers, including squamous cell cancers, which form on the top layers of the skin; basal cell cancers, which form on the bottom layers of the skin; and melanomas, which form within the skin’s pigment-producing cells, the melanocytes.  However, avoiding sunlight is not the way to prevent disease.

“The experience of our hunter-gatherer ancestors proves helpful,” Cordain wrote.  “Many studies have shown that people with high lifetime sunlight exposure, similar to that of hunter-gatherers, have lower rates of melanoma than those with low sunlight exposure.  Also, indoor workers have a greater risk of melanoma than outdoor workers.  Even more puzzling, melanomas often arise in body areas that are infrequently or intermittently exposed to sun.”  Many scientists believe that severe sunburn during childhood — like that time where you went to the beach and came home red as a lobster, and maybe your mom (as mine did) treated it with baking soda and/or aloe, apple cider vinegar, or other home remedies — or intense burns in areas that usually don’t see the sun are bigger risk factors for the development of melanoma.

“When your exposure to sunlight is gradual, moderate and continuous,” Cordain explained, your body responds “in a manner guided by evolutionary wisdom.”  Your skin begins to get tan, because your body is ramping up its production of melanin.  The darkened skin helps protect you from the sunlight’s most damaging ultraviolet rays.  Also important: Vitamin D levels in the blood start to increase, too, as the UV light hits the skin and your body starts to convert cholesterol into Vitamin D.

Vitamin D is a really good thing.  It’s actually a hormone, which is mostly formed in the skin.  As an aside, jumping to other books I’ve co-written: In Dr. Patrick Walsh’s Guide to Preventing Prostate Cancer, Walsh, the noted Johns Hopkins urologist, points out that “over the last 25 years, the death rates from prostate cancer in America have been the highest in the regions of the country that get the least sunshine” (north of 40 degrees latitude).  However, Walsh cautions, taking too much Vitamin D is not a great approach, either.  If you’re going to take a Vitamin D supplement, he advises not taking more than 4000 IU per day.

Cordain cited evidence from population studies confirming that people with the greatest lifetime sun exposures have the lowest rates of prostate, breast, and colon cancers.  But most important to Cordain, from years of study of our Stone Age ancestors, is this: “Exposure to sunlight is natural for humans.  It is part of our evolutionary heritage.  Without sunlight, it is virtually impossible to achieve an adequate intake of vitamin D from the natural foods that were available to our hunter-gatherer ancestors.  Our food supply has been a significant source of vitamin D for a very short time — less than a century, when dairy producers began adding it to the milk and later, to margarine.  Sunlight exposure is healthy as long as it occurs in a slow, gradual, and limited dose over the course of a lifetime.”

©Janet Farrar Worthington

coffee beansImagine:  John Wayne in True Grit, charging bad guys on horseback, with the reins in his teeth, a Colt revolver in one hand and a Winchester rifle in the other, and suddenly, he veers off and heads for the woods.   He’s acutely regretting that cup of coffee he had back at the campfire.

Well, that didn’t happen, because he’s John Wayne.  But it certainly might happen to us lesser mortals.  In fact, this laxative effect is a known consequence — or, hey! It’s a benefit, depending on how you look at it – of drinking coffee.  The effect can happen in as little as four minutes, according to an English study published in the journal, Gut.

Why does coffee make some people need to poop?  Several reasons.  It’s not the caffeine (decaf can produce the same effect), and it’s not the heat of the beverage; the English scientists tested drinking hot water in the same group of study participants, and nothing happened.  Out of 14 people studied (12 men, two women), eight of those who drank black, unsweetened coffee needed to move their bowels.  The coffee sped up the gut’s motility – movement of food through the digestive tract, using a series of muscle contractions called peristalsis – in the eight responders, but not in the others.  “The increase in rectosigmoid motility induced by coffee lasted at least 30 minutes,” the scientists reported.  “These results suggest that drinking coffee can stimulate a motor response of the distal colon in some normal people.”

The fact that this happened so darned fast, the researchers speculated, doesn’t mean that coffee actually rockets through the system.  Instead, “we suspect that coffee may induce a ‘gastrocolonic response’ by acting on epithelial receptors in the stomach or small bowel.”  This might be activated by nerves or hormones in the GI tract; also, they added, “coffee has been shown to promote release of gastrin, which can increase colonic … motor activity.”  So for some people, coffee shifts the gut into temporary fast-forward mode. 

Why Does Coffee Make You Poop?Coffee is a great way to wake you up, and it’s also a great way to keep you regular. What’s so special about coffee that it makes you poop?—–For a collection of all our videos, check out TestTube Video!

Posted by Discovery News on Wednesday, July 29, 2015

What else does it do?  I am fortunate to be married to an excellent gastroenterologist, Mark Worthington, M.D., formerly on the medical faculty at the University of Virginia and Johns Hopkins and now in private practice in Arizona.  “Basically, coffee causes a net secretion of fluid into the small intestine,” he says.  “For most people, the colon takes up the slack – it sucks up the extra water – but it gets activated in the process.  For some people, coffee actually leads to diarrhea because the colon can’t handle it all.”  People who particularly have trouble with coffee, he adds, are those with colitis (inflammation of the colon).  Also: “coffee sweeteners, such as Stevia, can cause diarrhea in some people.”  If you add a lot of dairy to your coffee, and dairy products are difficult for you, this might make coffee a bit of a digestive challenge, as well.

Is that it?  Well, no, there’s the acid.  Coffee is loaded with a phenol called “chlorogenic acid,” and – again, not in everyone – for those of us who lack cast-iron stomachs and are already prone to acid reflux, or for people who drink coffee on an empty stomach, the acid can irritate the stomach lining.  This is called gastritis, and it can result in heartburn, hiccups, pain in the belly, nausea, and can even make you throw up if you don’t get some food in there to help combat the acid.  Caffeine itself – let’s face it, the major reason we drink coffee – also can cause the stomach to pump out more acid.   

Note:  Don’t think I’m anti-coffee.  I’m not at all.  Coffee also does a lot of good things, including help lower your risk for Alzheimer’s disease, which I will talk about in some future post.  This is not that post.

Good news for your tummy:  If coffee starts your day off with an upset stomach or gives you the rumblies, don’t despair:  You are not alone.  In fact, there are so many people with this problem that gut-friendly coffees – with more available all the time – have been developed just for you.

Which is good news.  However, if you’re one of those susceptible to coffee’s Number Two side effect – no matter how gentle or organic or gourmet your coffee may be — you’ll still probably have to poop after you drink it.

©Janet Farrar Worthington

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.)

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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.

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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.

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©Janet Farrar Worthington