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the following program presents principlesdesigned to promote good health and is not intended to take the place ofpersonalized professional care. the opinions and ideas expressed arethose of the speaker. viewers are encouraged to draw their own conclusions aboutthe information presented. hello and welcome to health for a life time.i am your host don mackintosh and today we're gonna talk about digestion.we're gonna talk about some problems that can be encountered with our digestivesystem. talking with us today is dr. neil nedley;he's from ardmore, oklahoma. welcome dr. nedley. thank you.and you deal with all the organ systems

and of course the alimentary canalor the digestive system is something that causes people, well many blessings,but also some problems. yes, absolutely. one of my fields in fact it's probablyone of my primary emphasis in internal medicine,is the field of gastroenterology. and that has to do with the entiregastrointestinal track. okay, so we're gonna talk aboutwhat's called gerd? what does that mean? gastroesophageal reflux diseaseis what it stands for. and of course, the gastro that's where the acid is made,the esophagus is above where the stomach is? and then you have reflux,which means there are stomach contents

refluxing backwards where they're really notsupposed to go into the esophagus. and of course that can produce disease,so that's the, the term gastroesophageal reflux disease.okay, well let's talk about how it's suppose to work first, the digestive system?well, digestion actually begins in the mouth, that's how the digestion begins.and we actually have a graphic in regards to the mouth components.that's actually something that we have voluntary control over, the rest of the digestivetract we really don't have much voluntary control, but we have controlover the type of food or fluid we put into our mouth, we have controlwhen we put the food or fluid into our mouth.

okay. we also havecontrol over the temperature of what we put into a large extent,and then we also have control over how long we chew and savor the food.so, we have quite a bit of control. quite a bit of control on the first partin the digestive system, which is the mouth? so, so what types, well you know,you said digestion begins in the mouth, but doesn't it begin in the mind,i mean sometimes i'll think about something and my mouth will start to salivate.yes, it can, condition response sort of speak. and yes, if we think about something likethat we can or even if we come acrossthe smell for instance,

then the digestive juicescan start going and also on timing. if we're used to being on a regular patterneveryday, which is actually healthier to be that way.if we don't happen to eat at that particular time,my digestive juices go into action and that's inefficiency,if we're not eating at that time. so, the type of food we putor fluid we put in our mouths, what types of things,i mean it's pretty obvious don't put nuts, bolts and all kinds of stuff in your mouth,but you know, i think a lot of people make mistakes concerning that.absolutely, they make mistakes concerning

it.and that's one of the reasons why gastroesophageal reflux diseaseis so prominent. our next slide actually shows some of the symptoms ofgastroesophageal reflux disease. heartburn after a heavy meal orwhen you're bending over or when you're lifting.and when that occurs that's abnormal and that's one of the most common and,prominent symptoms is heartburn. when heartburn occurs when lying down,particularly at night or on the back, that is also gastroesophagealreflux disease. three quarters of people with gerd will experience nighttime

symptoms that might even awaken them fromnight with this burning. and then they can getinto regurgitation as well, where they. throwing up. well, it's not really vomiting,but they'll actually begin to taste the stomach contents there on the backof the throat or in the mouth. and is this an acute,is this something that's chronic or acute or depending on that,you have a big meal you're gonna have this? well, many people in fact,it's estimated that about % of people will suffer from gerd in any given year.and so, gastroesophageal reflux disease is pretty, pretty common and,and then some people about % get into the

severe gerd, where actual complications canoccur? but what i mean is, you know the curse doesnot come causeless, i mean you know that if you ate this big huge mealand then you have some of these problems that you're talking about that night you,you know exactly what that came from? that's right, is that from the big meal.is that different then what you're talking aboutin terms of gerd? no, no matter what the cause of the gerd,gerd is gerd. gerd is gerd. and if it's due to a heavy meal,a voluntary gerd for instance, or you know maybe you weren't informedin regards to that food would do that,

but basically anytime we get reflux,rather persistent reflux of stomach contents back into the esophagus that's gerd.okay, so what are the risk factors for gerd? well, the risk factors for gerdwe actually have a graphic about that as well. heavy meal,you talked about that, if you're snaking at any time that's a risk factor,but particularly snacking before bed time is gonna dramatically increase the,the incidence of gerd. high fat foods will also increase the incidence;it takes a lot longer for the high fat foods to be digested and for the stomachto empty out, if you're in your third trimester of pregnancy, the pressure that'sput on the abdomen makes it much easier to

reflux.and then there are additional risk factors, if you have asthma or chronicobstructive pulmonary disease or respiratory disease, you often are usingyour accessory muscles and your abdominal to breathe that can produce pressureand can cause a reflux. tight clothing, particularly around the abdomenitself will dramatically increase reflux. and many women that are slightly overweightutilize these tight clothing. this puts everything up including,including the food. that's right. tobacco, nicotine actually relaxesthe esophagus sphincter and allows acid to freelycome into the esophagus.

alcohol also relaxes the lower esophagussphincter and can cause acid reflux. and then the non-steroidal anti-inflammatorydrugs abbreviated nsaids, these are drugs like ibuprofen,naprosyn, aleve, you know, celebrex, these types of drugs can significantly increasethe risk. and then other drugs such as the nitroglycerin medicines.nitroglycerin actually relaxes smooth muscle, the lower esophagus sphincteris a smooth muscle. calcium channel blockers also can cause reflux.and then anatomical problem called the hiatal hernia can increase the risk.and then many people are unaware that caffeine, peppermint and chocolate significantlyincrease the risk of

gastroesophageal reflux disease.how does that work? caffeine increases acid productionand relaxes the lower esophagus sphincter, so it's working two ways.and peppermint does the same? peppermint actually does relax smooth muscleand it will relax the lower esophageal sphincter.in fact, sometimes for spasm disorders of the intestinal tract will recommend peppermintas a treatment because peppermint will relax the spasm,but for the average person you don't want a relaxation of the loweresophageal sphincter. food is not supposed to go back into the esophagus,it's supposed to go the other way.

and as we relax that and the stomach contracts,it'll come right back up into the esophagus with peppermint on board. okay, what aboutobesity? obesity will significantly increasethe risk of reflux and it's one of the reasons why we're seeing much more gred todaybecause the waistlines are increasing. obesity againis increasing the intra abdominal pressure, and that intra abdominal pressureno matter what it's due to, third trimester pregnancyor obesity can significantly increase the reflux. you know i've seenthese cat scans of obese people and really the issue is not what you see outsideis what is inside, the fat that's inside?

that's right. and i think thatpeople don't really realize that. they don't really realizethat's all crammed in there. yeah, the reason that's pushing outis because it's already crammed in, so just a little, a little bellycould be a big problem. and when you do surgery on these individualsyou really find that out, i mean you open up that abdomen,that fat just you know comes forth sort of speak because it's been so confined.okay, so when is it that you should do a procedure and figure out what's going on,i mean these are all the risk factors, but when do you actually go inand do a procedure? well we, it is recommended

now by the american cancer societythat anybody who's had reflux intermittently for years or more should undergoan endoscopy to have that esophagus looked at.it's also recommended that anyone who has what's called dysphagia or odynophagia.dysphagia is difficulty in swallowing, that means after you,you know take some bread or maybe eat some solid food that kind of hangs upin the esophagus before it passes through that's not normal and that,that endoscopy needs to be done right away. odynophagia is a painful swallowingand if anyone has pain at all when they swallowed that's an indicationto get that esophagus looked at.

and i think you have a graphic onsomething you called egd. yes, an egd is the procedure where we takea camera on a, the end of a scope,it's a thin scope its about as big around as my little finger here,it's flexible and has a light on the end of itand with that light we can get some very sophisticated pictures of the esophagus tostomach and the duodenum.and that scope is called an egd, it stands for esophagogastroduodenoscopy,and we do have a graphic on that. alright, well let's look at,it's recommended when you have heartburn

for years or more?yes, or if you've had th persistent symptoms despite being on anti-acids or something likethat that would be another indication.and that picture that you see there on the screen is actually reflux,that scope is in the esophagus there and what you are seeing is actually acidand other stomach contents coming backup that lower esophagus sphincterinto the esophagus itself. so, sometimes on endoscopy we will see thatin a real time. the actual esophageal sphincter being weak and that reflux occurringright into our lens sort of speak. alright, so any other indications,i think your graphic continues as well

yes, yeah the other indications.well, these are actually complications. this particular graphic is the complicationsof reflux. and notice the erosions there, erosive esophagitis those are actual ulcerations,that white area on top of the red area about the o'clock position that's actuallypurulent material or puss type material that's right there in the erosions.and you're seeing erosions in several areas there in the esophagus and then sometimesa discreet ulcer can form, that's the picture on the right-hand-sideis the ulcer. then we can get stricture. stricture is due to scar tissue formingwith all that reflux and actually narrowing that down to the point where the individual'sfood starts hanging up before it passes down

through. and a very significantsevere condition called barrett esophagus. this is where the esophagus changesits mucus permanently into a barrett's type esophagus which increasesthe risk of malignancy. so, these complications and the,what causes them it's very significant really? and can get, go from bad to worse it lookslike? yeah, absolutely and of course thosecomplications can produce further complications. well, we wanna comeback,we're talking with dr. neil neldley, we're gonna look a little moreat those complications, but also some solutions, join us when we comeback.are you confused about the endless stream

of new and often contradictory healthinformation, with companies trying to sell new drugs and special interestgroups paying for studies that spin the facts, where can you find a common sense approachto health? one way is to ask for your free copy of dr. arnott's realistic waysto improve your health. dr. timothy arnott and the lifestyle center of america producedthis helpful booklet of short practical health tips based onscientific research and the bible that will help you live longer, happier and healthier.for example, did you know that women who drink more water lower the risk of heartattack? or that to hours of sleep at night can minimize your risk of ever developingdiabetes.

find out how to lower your blood pressureand much more if you're looking for help not hike,then this booklet is for you. just log on to abn.org and click on free offersor call us during regular business hours, you'll be glad you did.welcome back we have been talking with dr. neil nedley, we've been talking aboutdigestion, and it's a wonderful thing if it's working well, but what we havediscovered is that many times it doesn't work well. dr. nedleythis is because of choices that we make, the food that we eat, when we eat it,the temperature of it and all these different things.that's right; actually the stomach

has to have four things that are constantfor the end of the stomach the pylorus to begin to empty the food into theintestinal tract. and those four things that has to have the constant ph. oh!so, that's the acid based. and there are sensors in the duodenumthat will sample the food as it's emptied from the stomach and if it's not a constantph, a constant temperature and a constant osmolarity,or if the size is too big, if it's greater than a millimeter squareit will actually clamp that pylorus down, to keep, so the stomach can mix it all upto get that constant and then it will begin to sample it again. and that's one of thereasons

why eating between meals is one of the worstthings that can happen for an individualas far as initiating reflux is concerned because the stomach may have things alreadyand then some new food is put down in there before it has a chance to completelyempty. the pylorus has to clamp down and begin to emulsify and to mix that foodup to try to get those constant readings.probably why it's important to chew as well? that's right,chewing thoroughly will help our stomach out significantly to get those sizes againless than a millimeter square is what theduodenum is looking for.

now, we were looking at some complicationsand i wanna go through those again for those who maybe are just joining usand show us what these are? yes, erosive esophagitis that's graphedthere one of the things that erosive esophagitis and ulcerations both of those can causeis bleeding. we will often see a person with anemia due to reflux.and the reflux causes microscopic bleeding or maybe massive bleeding,some of the ulcers in the esophagus can bleed rather readily,can erode into a blood vessel and you can startvomiting up blood and get massive bleeding as a complication of reflux.the next slide also shows some additional

complications of gastroesophagealreflux disease. and that is a stricture, that's where food starts to hang up.what we will do with that stricture when we see it as we will take aballoon dilator with the scope and open that up,so the individual can swallow like they used to.does that hurt? well, we have monitored anesthesia,so it's doesn't hurt at that time, but it will only last for maybe upto three years the stricture will come again, the scar tissue will form again.some people have-to-have that dilated every months.and what started the whole process off

was reflux? and the barrett's esophagusthat you saw on the screen there, barrett's is actually a change in the mucosato an abnormal mucosa that can actually initiate cancer. and this is why oncewe find barrett's esophagus that individual has to be scoped every yearor maybe every two years to make sure that the beginnings of malignancyare not starting to form. and that's because the cells are multiplyingand they are kind of abnormal cells already. yes, the columnar epithelium of barrett'sesophagus is abnormal and it does help bring about cancer in some instances.now, most people with barrett's, if we know about it ahead of time we can putthem on a program, so that it reduces the

likelihood of them developing cancer,but still we need to find out. in our last graphic in regardsto the complications is actually cancer itself. this starts out with barrett's esophagusand then it goes into adenocarcinoma, a glandular cancer. and there's two differentpatients there on the screen that we had and both of them did not getscope like they were supposed to do and following up there barretts,and so they ended up with the adenocarcinoma. and adenocarcinoma is the fastestrising cancer in the united states. it's dramatically increasing and it's increasingbecause reflux is increasing and that's why we're having a program on this because,if we can prevent the reflux or treat

the reflux we can prevent cancer.and the unfortunate thing about the adenocarcinoma esophagus is deathwithin a year in virtually all cases, very few people are spared.we'll do surgery, we will do radiation, we will do chemo, those things can prolongthe life to some extend, but normally it still death within a year.once you get it, that's it usually. yeah, and so that's why we want to catch itin the disc plastic form before gets to the cancerform because then we can prevent the deaths now completely. so, someonethat's having some of those symptoms we talked about early on,don't just dismiss those make sure that

you either amend your lifestyle,so they don't come about or if they continue to,make sure and see someone like yourself? that's right, be sure.you know, interesting in the bible it says that at end of time peoplewill be struggling because their god is their belly. you think thisis kind of related to that? absolutely, yes, people have choiceswhat they are putting into their food and particularly the over eating,the high fat meals, those type of things are lending to gastroesophageal reflux disease,the alcohol as well, i mean there's a marked increase risk of adenocarcinomaand those who drink and smoke as well.

so, let's talk about treatment.well, the treatment actually first should be diet, actually and lifestyle measures.and we have a graphic in regards to the actual treatment,but lifestyle and dietary change, % of patients will experiencerelief of symptoms with modest changes in their diet. now, these aren't significantchanges, but modest changes. and those if we do significant changes% of patients experience relief with bold dietary and lifestyle changes.so, what we are talking about in these changes, are we talking aboutchewing your food? that's right, chewing the food adequatelyand thoroughly, savoring the food,

taking time for that and actuallyfor not eating in a stressful environment it's one of the reasons why we want to bestress free with good conversation and those types of things and savoring thefood, chewing the thoroughly will help significantlyin preventing reflux. secondly, the type of food that we are eating,the modest changes that we recommend in virtually everyone is no caffeine,decaf even, decaf has tannins in it, and the tannins will actually also cause reflux.chocolate, chocolate weakens the lower esophageal sphincter, and so we have everyoneavoid chocolate, peppermints, spearmint and alcohol.also eliminating carbonated drinks,

the carbonated drinks because of the air,the carbon dioxide in them will tend to come right back up, and that's why peopletend to belch afterwards, decreasing the size of the meal. and so this,this is what we recommended virtually every individualif they're overweight they need to lose weight down to their ideal weight to get that intraabdominal pressure under control, thoroughly chewing the food and then increasingwhole grains rich in selenium has also been shown to be healthfulin preventing reflux. what is selenium? selenium is a trace mineral,that's present particularly in grains from the dakotas. and then the moreaggressive measures that we would recommend

in some people and this is where we can get,increase the yield from to %, more aggressive measures are avoidingascetic food such as oranges, lemons, grapefruit, pineapple, tomatoes.lot of people don't realize meat is an ascetic food and it very much is.and then not eating fruits and vegetables at the same meal, it's good to eatyour fruits at meal, vegetables at another. for people they don't have reflux problemsthere is no problems eating fruits and vegetables at the same meal,but if you are having problems of reflux and you've tried the,the common measures and you are not in that %category to experiencing relief from the common

measures then we would recommend moreaggressive measures and that would be not eatingfruits and vegetables at the same meal and even avoiding, completely avoidingcertain types of fruits that are high in acid content.well, this is talking about significant changes and,and things that people usually don't like to be talked with about, i mean people wantto eat what they want to eat, when they want to eat,how they want to eat it? and so, have you hadsuccess in talking with your patients about this?well, absolutely and people tend not to want

to be depended on medicines for life,and although if you have any erosion or an ulcerwe are gonna put you on a medicine to actually blockyour stomach from producing acids, so even if you are refluxing the acids notat least going up into the esophagus,and you will have another for eight weeks, but eight weeks will cure it.in most cases, and then if you're on a good lifestyleprogram you won't need medicine the rest of your life, but otherwiseyou are gonna need to take these expensive medicines and lot of these drugs are expensive,$ a month that you're having to pay off,

and they also can have side effects.the medicines that help reflux can cause the abdominal pain, it can decrease theabsorption of vitamin b, for instance because you are not producingthat acid which can help with the absorption of b.well, what about the person that says, well you know my family's always just hadbad stomach it's just because of my family history?well, people may have a genetic predisposition to a weak lower esophageal sphincterand they have predisposition to obesity genetically, but despite those geneticpredispositions, if we are on a good diet %of those individuals will not need

to take medicine. and so they cancontrol it with their diet and lifestyle. well you know, you are a christian physician,what kind of spiritual lessons do you draw from the digestive system and when you talkwith people, how do you point them to the master?well, we point them to the master by being able to change our lifestyle.all of us are creatures of habit and we as human beings don't like to changethat readily. but if we know that is best for us to change,we still can't change unless we have the holy spirit working in our life.and if we just simply ask god to help us with the change, he knows thatwe need to change and

we are willing to do our part,at first it seems like a tremendous sacrifice for people to leave out some of these itemsin their diet particularly the more addictive substances, i mean chocolatecan be addictive, alcohol can be addictive, but study show repeatedly that ifwe do our part and we are willing to make thatdecision to change, if we rely upon god even the step program that works with foodas well, let go and let god, god can indeed help us to completelychange our life. and that's why when we leave the spiritual component out of givinginformation we're really leaving out the power for people to change and change permanently.you know, sometimes people have their stomachs

clamped or this gastric resection,does this cause problems with the, this kind of esophageal problemsthat you've mentioned? yes, it can the, the stomach surgeriesthat are done can lead to more reflux that's true, of course there is a surgeryto tries to get rid of reflux, it's called the fundoplicationwhere the stomach is wrapped around the esophagus,and that might help with the reflux, but the individual never be ableto belch or vomit again. okay. and that can produce bloatingand other types of symptoms, so we just trade one disease for anothersometimes with the surgery.

we've been talking with dr. neil nedley,we have been talking about the wonderful divinely inspired digestive systemand we have talked about how we can really complicated,but we have also seeing that there is a good news, a large percentageof you that are struggling with these things can actually stop them and reverse themwith just simple changes. we encourage you to do that,we're thankful that you watched today, and we hope you have healththat lasts for a lifetime.