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April 21, 2014

Andrew Silow-Carroll: Passoverkill? Suggestions to make next year's seders even more culturally sensitive

Sara Israelsen Hartley: Seeking the Divine: An ancient connection in a new context

Christine M. Flowers: Priest's execution in Syria should be call to action

Courtnie Erickson: How to help kids accept the poor decisions of others

Lizette Borreli: A Glass Of Milk A Day Keeps Knee Arthritis At Bay

Lizette Borreli: 5 Health Conditions Your Breath Knows Before You Do

The Kosher Gourmet by Betty Rosbottom Coconut Walnut Bars' golden brown morsels are a beautifully balanced delectable delight

April 18, 2014

Rabbi Yonason Goldson: Clarifying one of the greatest philosophical conundrums in theology

Caroline B. Glick: The disappearance of US will

Megan Wallgren: 10 things I've learned from my teenagers

Lizette Borreli: Green Tea Boosts Brain Power, May Help Treat Dementia

John Ericson: Trying hard to be 'positive' but never succeeding? Blame Your Brain

The Kosher Gourmet by Julie Rothman Almondy, flourless torta del re (Italian king's cake), has royal roots, is simple to make, . . . but devour it because it's simply delicious

April 14, 2014

Rabbi Dr Naftali Brawer: Passover frees us from the tyranny of time

Greg Crosby: Passing Over Religion

Eric Schulzke: First degree: How America really recovered from a murder epidemic

Georgia Lee: When love is not enough: Teaching your kids about the realities of adult relationships

Cameron Huddleston: Freebies for Your Lawn and Garden

Gordon Pape: How you can tell if your financial adviser is setting you up for potential ruin

Dana Dovey: Up to 500,000 people die each year from hepatitis C-related liver disease. New Treatment Has Over 90% Success Rate

Justin Caba: Eating Watermelon Can Help Control High Blood Pressure

The Kosher Gourmet by Joshua E. London and Lou Marmon Don't dare pass over these Pesach picks for Manischewitz!

April 11, 2014

Rabbi Hillel Goldberg: Silence is much more than golden

Caroline B. Glick: Forgetting freedom at Passover

Susan Swann: How to value a child for who he is, not just what he does

Cameron Huddleston: 7 Financial Tasks You Should Tackle Right Now

Sandra Block and Lisa Gerstner: How to Profit From Your Passion

Susan Scutti: A Simple Blood Test Might Soon Diagnose Cancer

Chris Weller: Have A Slow Metabolism? Let Science Speed It Up For You

The Kosher Gourmet by Diane Rossen Worthington Whitefish Terrine: A French take on gefilte fish

April 9, 2014

Jonathan Tobin: Why Did Kerry Lie About Israeli Blame?

Samuel G. Freedman: A resolution 70 years later for a father's unsettling legacy of ashes from Dachau

Jessica Ivins: A resolution 70 years later for a father's unsettling legacy of ashes from Dachau

Kim Giles: Asking for help is not weakness

Kathy Kristof and Barbara Hoch Marcus: 7 Great Growth Israeli Stocks

Matthew Mientka: How Beans, Peas, And Chickpeas Cleanse Bad Cholesterol and Lowers Risk of Heart Disease

Sabrina Bachai: 5 At-Home Treatments For Headaches

The Kosher Gourmet by Daniel Neman Have yourself a matzo ball: The secrets bubby never told you and recipes she could have never imagined

April 8, 2014

Lori Nawyn: At Your Wit's End and Back: Finding Peace

Susan B. Garland and Rachel L. Sheedy: Strategies Married Couples Can Use to Boost Benefits

David Muhlbaum: Smart Tax Deductions Non-Itemizers Can Claim

Jill Weisenberger, M.S., R.D.N., C.D.E : Before You Lose Your Mental Edge

Dana Dovey: Coffee Drinkers Rejoice! Your Cup Of Joe Can Prevent Death From Liver Disease

Chris Weller: Electric 'Thinking Cap' Puts Your Brain Power Into High Gear

The Kosher Gourmet by Marlene Parrish A gift of hazelnuts keeps giving --- for a variety of nutty recipes: Entree, side, soup, dessert

April 4, 2014

Rabbi David Gutterman: The Word for Nothing Means Everything

Charles Krauthammer: Kerry's folly, Chapter 3

Amy Peterson: A life of love: How to build lasting relationships with your children

John Ericson: Older Women: Save Your Heart, Prevent Stroke Don't Drink Diet

John Ericson: Why 50 million Americans will still have spring allergies after taking meds

Cameron Huddleston: Best and Worst Buys of April 2014

Stacy Rapacon: Great Mutual Funds for Young Investors

Sarah Boesveld: Teacher keeps promise to mail thousands of former students letters written by their past selves

The Kosher Gourmet by Sharon Thompson Anyone can make a salad, you say. But can they make a great salad? (SECRETS, TESTED TECHNIQUES + 4 RECIPES, INCLUDING DRESSINGS)

April 2, 2014

Paul Greenberg: Death and joy in the spring

Dan Barry: Should South Carolina Jews be forced to maintain this chimney built by Germans serving the Nazis?

Mayra Bitsko: Save me! An alien took over my child's personality

Frank Clayton: Get happy: 20 scientifically proven happiness activities

Susan Scutti: It's Genetic! Obesity and the 'Carb Breakdown' Gene

Lecia Bushak: Why Hand Sanitizer May Actually Harm Your Health

Stacy Rapacon: Great Funds You Can Own for $500 or Less

Cameron Huddleston: 7 Ways to Save on Home Decor

The Kosher Gourmet by Steve Petusevsky Exploring ingredients as edible-stuffed containers (TWO RECIPES + TIPS & TECHINQUES)

Jewish World Review

Acid reflux: You can calm the fires of heartburn

By Steven A. Porter, M.D.




One of the nation's leading gastroenterologists offers analysis and practical advice that can improve the lives of sufferers of an ailment impacting 40 percent of Americans monthly and 18 percent weekly


JewishWorldReview.com | Pharmacy shelves are full of medications for reflux "heartburn." Most of us know the symptoms: a burning sensation in the chest with belching, sour stomach fluid coming up into the mouth--or worse yet, awakening suddenly choking on burning acid in the airway. These symptoms are very common, affecting 40 percent of Americans monthly and 18 percent of Americans weekly.

In addition to annoying symptoms, untreated reflux could eventually cause death due to esophageal cancer. One of the most deadly cancers, it currently strikes about 14,000 Americans every year. But the numbers are growing rapidly. Research shows that the increase in reflux and cancer is directly related to the nation's increase in obesity.

There is a correlation between increased weight and heartburn, and another correlation between weight loss and improvement of heartburn symptoms. In 1991, 15 percent of Americans were considered obese and 30 percent were considered overweight. Today 30 percent are obese with 60 percent overweight.

WHAT IS HEARTBURN OR REFLUX?

The stomach normally produces acid to aid in the digestive process. The problem is not the acid itself but when the acid comes up, or refluxes, into the esophagus. To understand the nature of acid reflux it's helpful to understand a little bit of human anatomy.

We are able to breathe because the rib cage and diaphragm function like a bellows. The diaphragm is a sheet of muscle separating the chest cavity from the abdominal cavity. In the middle of this muscle is a hole, or hiatus, that allows the esophagus to join with the stomach. When you inhale, your diaphragm contracts and expands the chest cavity, allowing air to flow into your lungs. As your rib cage expands, it decreases chest pressure and increases abdominal pressure.

Reflux can happen because gases and fluids tend to flow from high-pressure areas, like the abdomen, to low-pressure areas, or the chest. When you inhale, the pressure can force acid up from the stomach into the esophagus and even up into the mouth or airway.



Of course, our bodies are naturally designed to keep this from happening. Acid reflux occurs only when something goes wrong. Factors that allow reflux include:

1. TLESR, or transient lower esophageal sphincter relaxation. The lower esophageal sphincter is a weak ring of muscle that closes off the bottom of the esophagus from the top of the stomach, preventing acid from rising. But sometimes the sphincter relaxes when it shouldn't.

2. Delayed acid clearance. When sleeping, we stop producing saliva, which helps clear acid from the esophagus. Saliva also contains growth factors that heal the esophagus from the damaging effects of acid.

3. Reduced resistance to injury. Once your esophagus or stomach are injured -- for instance, if you have an existing ulcer--the injured tissue loses its protective defenses and is much more susceptible to further injury.

4. Delayed stomach emptying. Food and acid can sometimes sit in the stomach longer than usual.

5. Sleep apnea. The partial blockage of your airway can cause your chest to expand harder than normal. This pulls more acid into your esophagus.

6. Hiatal hernia. This condition occurs when a portion of your stomach protrudes into your chest cavity through the hiatus. It forces the lower esophageal sphincter open and basically brings the food and acid up into your chest.

In the long term, acid reflux can lead to ulceration or stricturing (narrowing) of the esophagus, which makes it difficult to swallow. It can also lead to Barrett's esophagus, a mutation in the lower esophageal tissue that can eventually develop into esophageal cancer.

Cigarette smoke and alcohol, especially in combination, can worsen esophageal injuries. The theory is that the esophagus is protected from toxins in cigarette smoke by a mucus lining, as well as the swallowing of saliva, which washes acid out of the esophagus. Alcohol dissolves the mucus layer and also dissolves the smoke toxins so they are absorbed directly through the esophageal surface. If you have acid reflux, smoking and drinking can greatly increase your risk of complications, including the development of esophageal cancer.


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If you have acid reflux, avoid the following:

1. Eating large volumes of food

2. Eating less than three hours before bedtime

3. Caffeine, including coffee and soft drinks

4. Liquor, including wine and beer

5. Citrus, tomato, and cranberry fruits and juices

6. Ice cream or milkshakes

7. Chocolate (one of the worst offenders)

8. Sour cream

9. High-fat desserts

10. Peppermint (one of the most potent esophageal sphincter relaxers of all! Avoid those after-dinner mints)

11. Wearing overly tight clothing.

HOW IS REFLUX DIAGNOSED?

Your doctor may suspect reflux based on your symptoms, and will typically confirm the diagnosis with an upper endoscopy, especially if any red-flag symptoms are present. These flags may include:

1. Difficult or uncomfortable swallowing

2. Unexpected weight loss

3. Vomiting blood or material that looks like coffee grounds

4. Black, tarry stools

An onset of symptoms after age 50

A sudden disappearance of reflux symptoms without any change in lifestyle, body weight or medication may suggest the development of Barrett's esophagus--a mutation that will protect you against reflux but can lead to cancer of the esophagus.

MEDICATION OPTIONS

The antacid aisle at the drug store can be confusing. There are dozens of options, which offer different results, and it's important to have a basic understanding of how they work and what can be expected of each type.


  • Acid neutralizers, such as Tums, Rolaids, Alka-Seltzer, Maalox and milk of magnesia. These medications work by neutralizing the acid already produced in the stomach and are largely available over the counter. They can be effective for occasional symptomatic reflux. If you have other medical conditions--especially kidney disease--use caution with over-the-counter preparations containing calcium magnesium or phosphate. It's also important to know that Alka-Seltzer contains aspirin. For acid reflux, use the Alka-Seltzer Heartburn preparation, which does not contain aspirin.

  • H2 blockers, or histamine blockers, such as Pepcid, Zantac, Tagamet and Axid. These medications work by blocking much of the acid produced in the stomach. They are available in both over-the-counter and prescription strength. H2 blockers are more effective for frequent heartburn treatment and for healing injury to the esophagus than the acid-neutralizing medications.

  • Proton pump inhibitors (PPIs), such as prescription-strength Prilosec, Nexium, Aciphex, Protonix, Zegerid, Prevacid and Kapidex. They block the final common pathway of acid production in the stomach and are the most effective for the healing and maintenance of symptoms. Prilosec has an over-the-counter option but it's not time-released and therefore not as effective as the prescription strength. Most of these medications should NOT be taken with Plavix, an antiplatelet agent for the prevention of heart attack or stroke. PPIs may interfere with the effect of Plavix. If you take Plavix and are on a reflux medicine, check with your doctor or pharmacist to be sure it's safe.

NON-MEDICATION TREATMENTS

If you want to avoid taking prescription medication for acid reflux--or if you've tried it and your reflux is still a problem--you might consider the following treatments:

1. Surgery can tighten the junction of the stomach and the esophagus.

2. Lifestyle modification, primarily weight loss, can have dramatic results. But even if you don't have a lot of weight to lose, eating smaller meals and going to sleep with an empty stomach can help.

3. Elevating the head of the bed a few inches with wooden blocks can make a difference. Let gravity help you.

I hope you now have a good idea of what acid reflux is, how it develops and the possible treatment and lifestyle options that can help alleviate its uncomfortable symptoms. This information may help prevent potential complications that can result from untreated, long-term exposure of the esophagus to acid. If you have frequent symptoms--especially a red-flag symptom--it might be worthwhile to see a castroenterologist near you.

(Dr. Steven A. Porter is recognized as one of the nation's leading gastroenterologists, specializing in colonoscopy, upper endoscopy, pancreatic and biliary issues. He and his physician assistant, Phil Merrill, provide many other GI services, including treatment for reflux, irritable bowel, Crohn's, colitis and liver and bile duct disorders. Dr. Porter practices in Ogden, Utah.)

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