What is heartburn?

It's tough to watch TV these days without seeing commercials for Zantac, Prilosec, Tums, or some other heartburn medication. And many of you have likely needed these medications or experienced heartburn, but what causes heartburn?

First, heartburn = acid reflux = gastroesophageal reflux (GERD). You'll hear these words used interchangeably, and they all mean the same thing.

Heartburn actually has nothing to do with the heart. Our stomachs are normally acidic. Specific cells in the stomach called parietal cells secrete acid. The acid helps fight bacteria and activates certain enzymes such as pepsin, which helps digest proteins. This is a good thing, if the acid stays in the stomach. But that can be a big if...

After we chew up food, we swallow it via the esophagus. The esophagus connects to the stomach at the gastroesophageal junction (a.k.a. the GE junction). A muscle at this junction called the lower esophageal sphincter ideally is able to open to let food and liquid in but will close afterwards to keep things from going the wrong way. This junction, though, often does not close sufficiently. Some of the acidic contents can, therefore, come back up.

The stomach lining generally can handle acid, but the esophagus cannot. Heartburn describes the irritation of the esophagus caused by exposure to acidic contents from the stomach. Aside from being uncomfortable, long standing acid reflux can actually have very serious side effects. It increases the risk of esophageal cancer and esophageal dysfunction (via stricture/closure of the esophagus). In addition, if the acid makes its way up to the throat, it can cause cough, runny nose, and even lung problems like pneumonia.

A number of treatments can help reduce heartburn. The next post will be about how heartburn medication works, but other interventions can also help. 

Avoid laying down right after eating. The stomach contents have to work against gravity to enter the esophagus when sitting or standing. But when you lie down, it makes it easier for things to come up. Ideally, avoid laying down for 3 hours after a meal.

Raise the head of your bed. Kind of the same concept: gravity can be your friend. Just using extra pillows will not do the trick, though, as this can put additional pressure on the stomach. Use one of the two techniques below, with the block generally being the preferred method if possible:

Lose weight. Additional weight puts pressure on the stomach, which can push more of the acid into the esophagus.

For more tips on decreasing acid reflux: http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000197.htm

Jamie Oliver: Teach every child about food

A few years old, but a great talk nonetheless by Jamie Oliver.

Be vitamins?

We all hear people talk about vitamins. The B vitamins, in particular, seem to be coming up more often. So what is a vitamin, and specifically what are B vitamins?

A simple definition of a vitamin is a small molecule that the body needs to carry out certain reaction(s). In our bodies, there are an unbelievable number of chemical reactions happening every second, and, though only effecting a small portion of those reactions, vitamins are crucial to our health and survival.

So where did the letters and numbers for vitamins come from? Essentially the vitamin names came from the order in which they were discovered and whether or not they were water soluble (i.e. can be dissolved in water). But more on that in a future post...

Here is a brief overview of the B vitamins as well as links for more information.

Vitamin B1
B1, or thiamine, is most notable for its role as a cofactor in the production of energy, in the form of adenosine triphosphate (ATP), in our bodies.

Vitamin B2
B2, or riboflavin, is important in reduction and oxidation reactions, or redox (pronounced like "re-docks") reactions. Essentially, these reactions allow for transfer of electrons.

Vitamin B3
B3, or niacin, like vitamin B2, is also important in redox reactions. Niacin can also decrease lipid (fat) levels in the blood.

Vitamin B5
B5, or pentothenate, is needed for energy production and for the production of fatty acids.

Vitamin B6
B6, or pyridoxine, is a cofactor in a number of very important reactions. Vitamin B6 helps in the production of vitamin B3, in the production of properly functioning red blood cells (via its role in heme synthesis), and in the production of important neurotransmitters such as dopamine, just to name a few.

Vitamin B7
B7, or biotin, is involved in the production of fatty acids and glucose in our bodies, among other roles.

Vitamin B9
B9, or folate, is important in DNA and RNA production.

Vitamin B12
B12, or cobalamin, is important in DNA and RNA production, metabolism, and maintenance of the central nervous system (including the brain and spinal cord).

Are people naturally overweight?

I hear that some people are naturally overweight. Is there any truth to that?

In short, yes. There is some evidence that there are a number of genetic (and possibly even viral) associations with obesity.

 

However, environment plays a big role. Unfortunately, this is not something one can always control. If an individual is raised by overweight individual(s), he or she will likely share the same diet. So if someone is raised on fatty, unhealthy food and/or too much food, they may be overweight as a child. And that weight can be tough to lose later in life. In addition, TV, video games, and a sedentary lifestyle are making this worse, as kids used to exercise much more frequently.

Some individuals are more likely to be overweight, just as some individuals are more likely to have a heart attack, have cancer, or have other health issues. However, as with many predispositions for health issues, a good diet, exercise, and a healthy lifestyle can greatly reduce the risk. Many individuals who have, based on their genes, an increased likelihood for being obese maintain a normal weight through a healthy diet and exercise. 

To read more: http://www.cdc.gov/features/obesity/

The folate story

Folate (aka folic acid or vitamin B9) is a vitamin crucial for a number of processes related to DNA production/repair and cell division/growth. Folate is naturally found in fruits, vegetables, and beans.

A number of years ago, researchers recognized that a lack of folate in pregnant mothers could contribute to defects of the spine and/or brain of their newborns (called neural tube defects). As a result, beginning in 1998 folic acid fortification of grain and cereal products became mandatory in the U.S. In addition, women who are pregnant or planning to become pregnant often should receive folate supplementation to ensure adequate levels.

 
Most individuals receive enough folate in their diet. However, for women of childbearing age, individuals who consume large amounts of alcohol, and for individuals with celiac disease or other malabsorptive gastrointestinal disorders, it is important to ensure adequate levels of folate.

To read more: http://www.health.harvard.edu/newsweek/the-ups-and-downs-of-folic-acid-fortification.htm

Calories and metabolism

Ever wondered what a calorie is? How the values on nutrition labels are calculated? Why two people who eat the same amount of food may gain weight differently? This video addresses a few of these questions:

How does weight loss surgery work?

There are a number of different weight loss procedures with different goals. Here are a few:

• Gastric banding
• In this procedure, a band is placed around the top of the stomach. The tightness of this band can be adjusted via adding or removing saline to the access port. Essentially, the goal is to stimulate a feeling of fullness. A very notable advantage of this procedure is that it is reversible.

• Gastric bypass
• In this procedure, a surgeon reroutes the way that food passes into the digestive tract. Gastric refers to the stomach, so as described by the name, this surgery causes food to bypass the stomach (and the initial part of the small intestine). As digestion normally occurs in these bypassed areas, enzyme supplementation is sometimes necessary to make sure nutrients can be properly absorbed.

 

• Sleeve gastrectomy
• In this procedure, a surgeon removes part of the stomach. The rest of the digestive system is left otherwise intact.

All of the procedures are associated with side effects, sometimes severe, and in some cases the procedures do not work or lose their effectiveness over time. To read more: http://win.niddk.nih.gov/publications/gastric.htm