Getting To The Root Of And Getting Rid Of Heartburn And Reflux with Dr. Todd LePine - Transcript

Dr. Todd LePine: Basically, the stomach is bathed in acid pretty much all the time. And you don't feel any pain when you have acid in your stomach, but you'll feel pain when the acid that's naturally there goes in the wrong place. Dr. Mark Hyman: Welcome to the Doctor's Farmacy, I'm Dr. Mark Hyman. That's Farmacy with an F-A-R-M-A-C-Y, a place for conversations that matter. If you've ever suffered from heartburn or reflux, this podcast should matter to you because it's a special episode of the podcast called House Call, about how we deal with things differently in functional medicine. And today's guest is none other than Dr. Todd LePine, who is my colleague and good friend for over 25 years, both at Canyon Ranch and at the UltraWellness Center. He's a leading educator and doctor in the field of functional medicine, teaches all over the place, but mostly on Zoom now. And he is just one of those guys who's deeply thoughtful, understands things in ways that most people don't and he's the doctor's doctor here. And I'm so excited to have Dr. Todd LePine, again, on the Doctor's Farmacy talking about heartburn. So, welcome, Todd. Dr. Todd LePine: Thank you, Mark. Dr. Mark Hyman: All right. So, let's get right into it. Tell us about how common heartburn is. What is it? What is reflux and how is it different from heartburn? And just sort of give us a little background on this problem, because I think it's a big issue for people and it's the source of a lot of suffering. And it's also the source of billions of dollars in revenue for the drug companies, because I think these drugs are the third category in terms of leading sales of all drugs after statin drugs and antidepressants. Dr. Todd LePine: Yeah. Yeah. So, I mean, I venture to say that most people have experienced heartburn. It's a very common condition. If you overeat, if you eat too late, if you eat certain foods. I've experienced heartburn. I'm actually very fortunate, I have a cast iron stomach. I can literally eat anything, I really can, unlike my father. Dr. Mark Hyman: But you can give yourself heartburn. Dr. Todd LePine: Yeah, absolutely I can give myself and I've experienced heartburn so I know what it's like. And for some people it's a chronic problem, it's really something that they experience all the time. And the big thing about heartburn is, that most of the time it's not about too much acid, that's sort of, I think, the take home message for people. And I always tell people that your body needs and wants to have acid in the stomach. Acid helps you to break down your food. There's a rare condition, which I learned about in medical school, called Zollinger-Ellison syndrome. You remember that, Mark? Dr. Mark Hyman: Oh, I do. Dr. Todd LePine: Have you ever seen it? Dr. Mark Hyman: Only in the textbook. Dr. Todd LePine: I think I've seen it once. So, it's a condition in which your body actually produces too much acid, and what doctors used to do, they used to cut the vagus nerve and they used to do all kinds of surgeries for heartburn and reflux. Dr. Mark Hyman: Oh, yeah. Even ulcers, they used to cut your nerve to your stomach and then they realized it was a bacteria. Dr. Todd LePine: Yeah, exactly. Right. Yeah. So, we'll talk about the bacteria causing some cases of heartburn. So, in heartburn is, is this usually a benign condition and it's oftentimes lifestyle related and you can treat it periodically with, as needed, baking soda or Alka-Seltzer or TUMS if it's mild. But if you're having heartburn all the time, the first thing you need to do is say, "Well, what's driving this?" And again, it's not necessarily stomach acid. In fact, there are a fair number of people who actually have their heartburn because of lack of stomach acid. And you can actually do some testing for a lack of stomach acid. If it's significant, you can actually do testing for gastrin levels. And actually, I'll oftentimes will do this on my patients who are on the proton-pump inhibitors. Dr. Todd LePine: So, gastrin is produced by the body to tell the body to produce more acid. So, if you're taking these heartburn medications for a long period of time and if you're escalating, you start on a low dose and you go to a moderate dose and you go to a high dose, you're really dropping your stomach acids. Your body says, "Hey, guess what? We need to make more stomach acid." So, produces a lot more gastrin. And then what happens is, because you have so much gastrin, you go off of the medication, your body now starts pumping out lots of acid, and then guess what? You're going to get withdrawal symptoms Dr. Mark Hyman: Oh my god, Todd, this is the biggest scam ever, because basically they created a drug that makes you addicted to it. You treat a condition, which is pretty benign, when you try to stop the drug it come back with a vengeance. And so, you get hooked on the drugs. Well, I have to take it because as soon as I stop it, I get worse, and I get worse than I was before I took it. Dr. Todd LePine: Yeah. And a lot of the psychiatric drugs are like that too. A lot of the antidepressant and the [angelytics 00:04:37]. The same thing, is your body gets into a different state, and then if you go off of them too quickly or you're not being supervised, you get these rebound symptoms and that's much, much worse. So, these chronic conditions like heartburn or depression or anxiety, when you use a pharmacologic approach, it's like throwing gasoline on a fire, and you become, like I said, there's no money in dead people and there's no money in healthy people, but there's a lot of money in sick people. Dr. Mark Hyman: Yeah. It was so funny. I think of this condition and we say it's too much stomach acid, but in fact, it's a lifestyle problem and there's many other factors and causes from a functional medicine perspective we look at. And we even come up with new names for conditions that are pretty benign, like gastroesophageal reflux disease. That was a new thing. When I was in medical school, they didn't have that, it was called heartburn. And then they came up with this disease because they found a drug to treat it. Now, I don't know about you, but we were in medical school probably about the same time, and these drugs came on the market, and I remember the drug reps would show up and say, "Look, these are very powerful drugs, no patient should take them for any longer than six weeks. They're used to treat ulcers, they're very effective, but they are dangerous to take long time because they suppress stomach acid, which has all sorts of adverse consequences." And then that just went to the wind and now people are on them for decades. Dr. Todd LePine: Yeah, absolutely. I can remember exactly when they first came out, there was a lot of warning in short-term use. And what we also did is, we used them in the hospital. People who are hospitalized, they can get a thing called stress ulcers. And that can then in turn lead to bleeding and aspiration pneumonia and a whole bunch of different things. And there were some early studies showing that it can decrease the risk of stress ulcers and aspiration pneumonia. So, these were sort of high potential risk medications that should only be used for a defined period of time. And then it sort of went into this chronic long-term use because they figured, oh, we can make a lot of money on this Dr. Mark Hyman: Yeah. I mean, in traditional medicines, okay, you have heartburn, reflux, this is a chronic condition, take this drug. And there's no thinking about why they have it. They might be saying, "Oh, raise the head of your bed." You might say, "Don't eat certain foods like spicy foods or fried foods or citrus or tomato based foods, that can sometimes help." But there's no real thinking about, it's being a solvable problem. Dr. Todd LePine: Right. Dr. Mark Hyman: And sometimes there's things like a hiatal hernia or a structural problem, and you can get a surgical procedure to fix that, but that's a very small group of people out of this. Dr. Todd LePine: Exactly. Dr. Mark Hyman: So, I think from a functional medicine perspective, we look at this very differently. Dr. Todd LePine: Absolutely. Dr. Mark Hyman: We don't just say, "Oh, it's too much stomach acid, take this drug to suppress the acid and you'll be fine." We go, wait a minute, first of all, there are many causes, and if you treat the cause you don't have to worry about taking the drugs. And second, these drugs are not benign. I mean, it'd be one thing to say, "Oh, it's like vitamin C, just take a little vitamin C, it's fine," these drugs have serious side effects that we've now uncovered. So, talk about some of the serious side effects that come as a consequence of these acid blocking drugs. And I'm just going to name them so people know what they are. They're Aciphex, Nexium, Protonix, Prevacid, Prilosec. These are the... Did I forget any? There's a few more probably. I do this all the time. But these are the common ones that people take. You can get them over the counter at your drug store and they're just, it's a free for all now. So, tell us about why we should be concerned about these drugs. Dr. Todd LePine: Right. So, these medications actually have long-term consequences. So, it's well-known now in the literature, and if doctors spend their time learning what's the latest literature, is that they associated long-term use with increase in food allergies, problems with vitamin and mineral absorption, specifically B12, problems with calcium. So, you can develop increased risk for osteoporosis. Absolutely. So, they have long-term... Leaky gut is another thing that they tie in with. Absolutely. Dr. Mark Hyman: Pneumonia. Dr. Todd LePine: Yeah. Yep. Dr. Mark Hyman: And one of the things that's so striking to me is one of the most common side effects is you develop irritable bowel and bacterial overgrowth. So, literally you swap one GI problem for another GI problem. Dr. Todd LePine: Exactly. It's like adding gasoline to the fire. It truly, truly is. And they're not cheap. And the other thing, I don't actually have a television set, so I don't necessarily see ads unless I'm over at somebody's house or in an airport watching TV, waiting for a flight, but they have ads where somebody is overweight and they've just eaten a lot of food, and then they're having heartburn- Dr. Mark Hyman: The sausage and the pepper. No, don't worry, take this drug. Dr. Todd LePine: Exactly. So, you can... And that's the mindset that people have, is that you just keep doing what you're doing that's giving you the problem and take this to suppress the symptoms. Dr. Mark Hyman: If you have a little pill dispenser at McDonald's. Dr. Todd LePine: Yeah. And literally, there are some really good integrative and functional medicine gastrointestinal doctors, like Jerry Mullen, who we talked about, he's written a textbook on integrative gastroenterology. But most of the GI doctors, in my opinion, are handing out these acid blocking medications pretty much like pesky. Dr. Mark Hyman: Oh my god. Dr. Todd LePine: And you go to them and you're going to get it. Dr. Mark Hyman: Well, you can get it now on your own. You go to the grocery store or the pharmacy. Dr. Todd LePine: Yeah, actually you're right. Because now they're actually at lower doses over the counter, which is, in my opinion, it really shouldn't even be there. Dr. Mark Hyman: It's a serious [inaudible 00:09:57]. Dr. Todd LePine: Absolutely. Dr. Mark Hyman: There's all these consequences. So, from a functional medicine perspective, one, it's not safe to take these medications long-term. Dr. Todd LePine: No. Dr. Mark Hyman: Two, the problem isn't really dealt with. And three, there are better approaches to this. So, what is the functional medicine view of reflux? What are the causes? Dr. Todd LePine: Well, obviously, first look at the foods that you're eating, because certain people will start reacting to certain foods. So, for some people it may be chocolate, it may be alcohol, may be foods that are citrus or tomato based foods or spicy foods. So, you want to sort of eliminate some of the peppermint- Dr. Mark Hyman: Coffee, I hate to say. Dr. Todd LePine: Yeah, coffee. Well, coffee, I think in my opinion, I've seen more people with gastritis, especially higher levels of coffee. And a lot of these foods can actually affect the lower esophageal sphincter tone, which is the muscle that keeps the stomach contents closed. So, you want to have that muscle between the food pipe and the stomach be tight. And if you're overweight or if you have these certain foods which relax that muscle, then the stomach contents can go upward. And the lining of the esophagus is more sensitive to pain, because basically the stomach is bathed in an acid all at pretty much all the time and you don't feel any pain when you have acid in your stomach, but you'll feel pain when the acid that's naturally there, goes in the wrong place. Dr. Mark Hyman: Yes. Dr. Todd LePine: Yeah. So, that's really, I think, the key thing. And understanding that it's not an acid problem, it's really related to the balance of where the acid should be at the proper time. Dr. Mark Hyman: Yeah. And sometimes if you're overweight and you got a big gut, that keeps pushing things up. Dr. Todd LePine: You're pregnant. I mean, it's almost, I would say, it's almost normal to have some heartburn when you're pregnant, because you've got this baby, this food baby, if you will, pushing up on the diaphragm. Dr. Mark Hyman: Yeah. So, there's a lot of things. I see magnesium deficiency, I see problems with food sensitivities, like gluten causing reflux. I see problems with- Dr. Todd LePine: Zinc deficiency. Dr. Mark Hyman: Zinc deficiency. I see problems with, also with a bacteria that's common in ulcers, but I think also plays a role in some cases of heartburn and reflux, called H. Pylori. Talk about what is this bug and why connected to these problems. Dr. Todd LePine: Well, it's really interesting. So, H. pylori, for a long time, we didn't really know what caused stomach ulcers. And stomach ulcers are different than heartburn, but you can get similar symptoms to it. Stomach ulcers can cause bleeding, and actually over time in some susceptible individuals, H. pylori can actually cause gastric cancer. So, not everybody who has H. pylori has symptoms, but there are some individuals where it can. And it's probably related to a genetic component to it. And you can test for H. pylori through stool testing, you can do it through antibody testing- Dr. Mark Hyman: Breath testing. Dr. Todd LePine: And also breath testing. Exactly. And if you have it, you treat it, it's the best thing to do. And it's an interesting thing because there are some literature saying that, in some individuals, having H. pylori can actually be protective against allergies and asthma. And for some people it's not. So, it's not one- Dr. Mark Hyman: It's tricky. Dr. Todd LePine: Yeah, exactly. Dr. Mark Hyman: It's tricky but it's super common. I remember many patients I've had who had reflux, not ulcers, but who we find H. pylori and we treat it and they get better. Dr. Todd LePine: Absolutely. Dr. Mark Hyman: So, I think you have to treat everybody as an individual and see. But this is a bacteria that people saw in the gut. It was lining these ulcers and doctors thought it was just incidental, not relevant. But it turned out that this guy, Barry Marshall, who was a doctor in Australia said, "Maybe these are not just a coincidence or hanging around, maybe they're the cause." And they thought he was a kook. Dr. Todd LePine: Exactly. Dr. Mark Hyman: And so, he decided he decided to drink a whole beaker of this bacteria, give himself an ulcer and then have his partners scope them and then take antibiotics, kill the bacteria, cure the ulcer, and ended up winning the Nobel prize. Dr. Todd LePine: Right. So, he changed the paradigm. Dr. Mark Hyman: He changed the paradigm. Because it used to be stress and emotional issues and all these things that cause all sorts, and now it's a bacteria. So, I think we have to sort of understand that reflux is not just caused by food, but can be caused by other factors, stress, being overweight, being pregnant, bacteria, food sensitivities. And I think it's a very specific method we use in functional medicine to help restore gut function. And I can't tell you how many people just completely get rid of heartburn and reflux almost overnight by just understanding how to fix the problem. Dr. Mark Hyman: Hey everybody, it's Dr. Hyman, thanks for tuning into the Doctor's Farmacy. I hope you're loving this podcast, it's one of my favorite things to do and introducing you to all the experts that I know and I love, and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks, it's my weekly newsletter. Dr. Mark Hyman: And in it, I share my favorite stuff, from foods to supplements, to gadgets, to tools, to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays, nothing else I promise. And all you have to do is go to to sign up. That's, P-I-C-K-S, and sign up for the newsletter. And I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger, longer. Now, back to this week's episode. Dr. Mark Hyman: What do we do in these patients? Give me a case of a patient who had reflux. Dr. Todd LePine: I have a great case, a patient came in to see me and the patient's main symptoms was neuropathy. So, neuropathy is painful nerves sensations, usually in the extremities, in the legs or the arms. So, the patient came in with neuropathy and was, I think if I remember correctly, was being treated with Gabapentin. And when I actually started diving into the history, which, that's one of the things we do, is we sort of play detective and ask a lot of questions and get the timeline of what started when and how, and what were you doing and what were you taking, what were you eating and all that, all those kinds of things. And that's, to me, the fun part of this because it's like solving a murder mystery. It's like, okay, who done it? Who did it? Dr. Mark Hyman: Being a functional medicine doctor is being a medical detective. Dr. Todd LePine: Exactly. A medical detective. So, in this particular case, the gentleman had high blood pressure and was on a medication called a calcium channel blocker. So, that was the first thing in my mind. So, for people that don't know about calcium channel blockers, they block calcium channels to lower blood pressure in the body. Well, another side effect is, guess what? They lower esophageal sphincter tone. So, there's a variety of different calcium channel blockers, there's Norvasc, Diltiazem and Verapamil and such. Dr. Mark Hyman: They relax that muscle that's keeping the food in your stomach. Dr. Todd LePine: Relaxes the muscle. That's like a low-hanging [inaudible 00:16:54]. If I have anybody who's on a calcium channel blocker and they have heartburn, I get them off the calcium channel blocker. Okay. So, that was the first thing. And then he was also on a medication for high cholesterol, and that's another bugaboo of mine, because the statin medications are actually associated with neuropathy. And you've got to treat about 500 patients with an elevated cholesterol to prevent one heart attack. So, 499 patients don't benefit by the statins and there's significant side effects in some people with- Dr. Mark Hyman: And the reason it causes this nerve damage is the nerve sheets are covered by cholesterol. And so, if you shut down cholesterol production, you can't actually make- Dr. Todd LePine: I love cholesterol. Cholesterol is a great molecule. Heart disease is not about cholesterol, it's about inflammation. I tell patients, "You want cholesterol," it's the building block of all your hormones and your myelin sheaths. Dr. Mark Hyman: But people need the right kind of cholesterol. Dr. Todd LePine: Yeah. Dr. Mark Hyman: They can get screwed up. Dr. Todd LePine: Yeah, you're right. There's nuances to it too. But cholesterol is a good molecule in the body. It's a building block of lots of things. So, he was on these two medications. And he was the kind of guy who was a hardworking guy. He would oftentimes skip lunch, he would then have late dinners, overeat because he was so hungry. And then he developed heartburn. So, guess what the doctors did? They put them on a PPI. So then he came in to see me, and he was having a lot of GI symptoms. He was having neuropathy symptoms. So, I did a workup on him and I checked his vitamin B12, and in addition to his vitamin B12, I also checked methylmalonic acid, which is a precursor molecule that when you have B12 deficiency, you'll get elevations of methylmalonic acid, even before you get B12 deficiency. And he had been on it so long that he actually had B12 deficiency. And guess what? No one ever checked his B12. Dr. Mark Hyman: Yeah. [inaudible 00:18:43] super important, one of the main side effects of these drugs is they shut down B12 absorption because you need acid. Dr. Todd LePine: Exactly. You need acid. Dr. Mark Hyman: Yeah. So, it shuts down B12 absorption. And what you're saying is, this patient got B12 deficient because of the drug, caused the nerve damage, because B12 is necessary for proper nerve function. Dr. Todd LePine: Correct. Exactly, exactly. And this was a, I called this case Iatrogenica imperfecta. So, it was doctor induced illness. I mean, literally the doctors, by giving him the medications inappropriately without thinking, actually caused the disease. Dr. Mark Hyman: Yeah. I mean, they're doing what they were trained to do, but we're not trained to think about getting to the root cause, which is what functional medicine is, what we do here at the UltraWellness Center in Lenox, Massachusetts. And we do virtual consults. We can see people from anywhere and we're just so grateful to be able to see people with these chronic problems to provide a pathway for getting better, which they've been struggling to find for often decades. Dr. Todd LePine: Absolutely. Dr. Mark Hyman: It breaks my heart because after doing this for 30 years, and you've seen the same thing, you see so many patients get better from things that traditional medicine just doesn't work with. Dr. Todd LePine: Absolutely. Dr. Mark Hyman: And it's not that hard, once you know what to do, it's like that joke of the guy who had an appendectomy and the doctor sent him a bill for a thousand dollars and the guy goes, "Wow, that's such an expensive operation for such a simple thing, to take my appendix out. It's a lot of money for just taking out my appendix." He's like, "You're right." And he sent him a new bill. He says, "Taking out your appendix, $1, knowing that's what needs to be taken out, $999." Functional medicine is like that. It's like, you look like a genius, but it's just the right roadmap. And the truth is, the body is not organized like we thought it was according to all these organs and diseases, it's organized according to systems. And the body has one integrated dynamic system and everything's connected. And so, functional medicine really helps us to navigate using that map we call the matrix. And it's so satisfying for us as doctors because we can start to treat people with problems that are often intractable and frustrating and yet have simple solutions. Dr. Todd LePine: Exactly. And then going back to this particular patient, so in addition, the patient also had pre-diabetes. So, he was overweight. And, he worked with me, worked with a nutritionist, we changed his blood pressure medication, so his lower esophageal sphincter started to work. I'm trying to remember. I think I actually decreased his statin medication, put him on Coenzyme Q10, which also is a vitamin that gets depleted by taking the statin medications, and then put him on some vitamin B12. And within probably three months, his neuropathy symptoms was about 50% better. He had lost weight. And then by six months, his neuropathy was gone. His heartburn, reflux was gone and he had lost 25 to 30 pounds. And his pre-diabetes was no longer there. Dr. Mark Hyman: So, it's so simple sometimes. And I've seen case after case, sometimes it's just getting off of gluten and dairy. Sometimes it's just cleaning up their diet a little bit. Sometimes it's getting a little extra magnesium ,or sometimes just treating the H. pylori or treating the bacterial or yeast overgrowth in their gut. These things really can have a huge impact. I wrote a textbook chapter years ago for functional medicine, integrative medicine textbook on reflux. And I was just amazed to see the literature, what you could do and all the treatments that are available from a functional medicine perspective that really work. Dr. Todd LePine: Yep, absolutely. There's a really good nutritionist I know, Katie Maura who wrote a nice ebook about heartburn and reflux, which patients can get. And it's a sort of a simple guide that you can give to your patients to help them do it on their own because a lot of these things are really sort of, once you know what to do, you can really make interventions. So, so, so, so simple. And I think, one of the key things is really having a good relationship with a really good functional medicine nutritionist, not a dietician or not a regularly trained nutritionist, because oftentimes their thinking is really skewed. They're trained in hospital medicine and they're about calorie counting and taking Ensure. And it's really, a functional medicine nutritionist is really- Dr. Mark Hyman: Ensure, which essentially high fructose corn syrup casein from [8281 00:23:02] cows, it's just inflammatory and refined Omega six vegetable oils, which are super inflammatory. So, it's not exactly healthy. Dr. Todd LePine: Yeah, Some of these... what do you call it? Meal replacement things, such as Ensure are really not necessarily the best way to be getting your calories. Dr. Mark Hyman: It's the last thing I'd be giving a sick person. Dr. Todd LePine: Yeah. Yeah, exactly. And, as you say, your food is information, your food talks to your genes, as Jeff Bland has always said. Getting real food into your body and taking out the bad stuff that the fake food, the toxic food, the frozen food is so important, so, so important. Dr. Mark Hyman: So, what kind of workup would you do for a patient with reflux to see what was going on, from a functional medicine perspective? Dr. Todd LePine: Well, to some degree, a heartburn patient does not need a big extensive workup. There are some times when you may refer them and get an EGD and make sure they don't have a hiatal hernia or make sure they don't have- Dr. Mark Hyman: That upper endoscopy. Dr. Todd LePine: Upper endoscopy, yeah. Dr. Mark Hyman: A scope down there to look around. Dr. Todd LePine: Yeah, I'll do that. You can do testing for stomach acid by gastrin levels. Oftentimes, I also combine that with antiparietal cell antibodies. And parietal cells are the cells in the body that make stomach acid. And there are some people that will actually have auto-immunity so that their body is attacking the stomach acid producing cells. So that they're not actually having enough stomach acid. So, sometimes stomach acid support can be really helpful, things such as apple cider vinegar, which is a simple sort of home remedy, I've had patients do very well with that. Also Betaine HCL is another thing that you can use to support stomach acid. Eventually the system Dr. Mark Hyman: It's almost counterintuitive, you're giving stomach acid support to people who are traditionally thought to have too much stomach. Dr. Todd LePine: Yes, absolutely. Yes. Yeah, it is counterintuitive, exactly. Dr. Mark Hyman: But in the right patient it can be very effective. Dr. Todd LePine: Yeah, exactly. And the other thing, Mark, which is, this is really interesting, and this ties in back in with H. pylori is that, there are some genetic snips with the interleukin-1-beta and TNF alpha. If you have those snips and you also have H. pylori, your body down-regulates stomach acid production. Dr. Mark Hyman: Yeah. Dr. Todd LePine: So, chronic inflammation actually can, with H pylori, can actually down-regulate stomach acid. Dr. Mark Hyman: So, basically we tell people the basic stuff. We might look at stool testing, food allergy testing, we might look at H. pylori, we'll look at their vitamin levels, zinc, which gets mal-absorbed, magnesium. We'll look at their B12 levels or [inaudible 00:25:45] acids. We'll get a really good sense of what's going on with this patient, like you did with yours. And then we'll give them some basic lifestyle recommendations, which are not uncommon, even in traditional medicine. Avoid fried foods, spicy foods, tomato based foods, citrus foods, too much coffee, chocolate, certain spicy foods. So, all that can be helpful for some patients. We'll tell them to stop smoking, we'll tell them to stop eating late, we'll tell them to raise the head of their bed. All that's great advice. But to get to the root cause we have to deal with these other factors, and often you can't just stop the acid blocking medication because you'll get this rebound effect that we talked about. So, you really have to taper it down, right? Dr. Todd LePine: Yeah, exactly. That is definitely something that you do when you do that sort of slowly. If they're on a 80 milligram dose, you may actually then go to 80 one day, 40 the next day, and then gradually decrease it. And then as you do that, you can then go to a lower, maybe an H2 blocker, and then transition to an H2 blocker, add in some things like DGL. Dr. Mark Hyman: Yeah. Dr. Todd LePine: And thanks to aloe for the aloe and glutamine, Glutagenics. I oftentimes will use in patients to help with the stomach lining, and patients, if they do it slowly, they oftentimes can get off of the proton-pump inhibitors. Again, if they have... And one of the things I actually will do is, is I'll measure gastrin levels. And if they have very high levels of gastrin, then I know it's going to be a slow process because it takes a while for the body to requilibriate. Yeah. Dr. Mark Hyman: So, it's really powerful. So, you can come out with your medications off and cut the dose by half, once a week, over a period of weeks. And you're right, in addition to just stopping the drugs and the dietary things and lifestyle factors, there's a number of products we use that can be very, very helpful. And you mentioned a few of them, DGL, which is deglycerized licorice, and they're like chewable tablets that are natural Tums that you can take before you eat, very, very effective. And what you mentioned also as a combination of glutamine, aloe and licorice, which also can be extremely helpful. You can drink the powder before you eat every day. And I find when I do that, and maybe a few other supplements that sometimes are effective are magnesium, a little of this, that, people do really, really well. It's one of those conditions that people just don't have to suffer from, but they do have to make the dietary and lifestyle changes. It's not just about eating your sausage and peppers and deep fried food and take your pills so you avoid the symptoms. And that's just a dumb idea. Dr. Todd LePine: Yeah, symptoms suppression. I mean, that's what Sidney Baker talked about for years, he's the sort of the grandfather of functional medicine, is most medicine nowadays is symptom suppression. It's a blocker, some type of blocker, an antihypertensive, an anti-calcium channel blocker. It's blocking. When you really think about a system's biology, it's like having this big complicated machine, you just sort of throw this wrench in it and you just stop it. And then what happens is, all of a sudden it builds up, and all of a sudden the conveyor belt, all the stuff starts backing up. And that's what happens when you have these very powerful interventions in very complex systems in the body. We saw that with Vioxx. Vioxx is a classic case where Vioxx as a medication was taken off the market and it was used- Dr. Mark Hyman: Like a super, duper Advil. Dr. Todd LePine: Yeah, super, duper Advil. And it worked really well. But in the process of blocking a prostate gland is we actually cause people to have strokes, or some people strokes and heart attacks. Dr. Mark Hyman: They took it off the market. Dr. Todd LePine: They took it off the market. And unfortunately, a lot of times when medications go on the market, they're studied for a relatively short period of time. And what happens when you take the PPIs for a long period of time? If you study the PPIs for six to eight weeks, you're not going to have problems. If you take PPIs for six to eight years, you're going to have problems. And I think that's really one of the areas where Big Pharma is really lax, because we are not following up these patients long-term on these very powerful medications. Dr. Mark Hyman: Yeah. And then the pH has to be right in your gut for the right bacteria. So, if you shut off the acid and then you have no acid in your small intestine, you're going to get bad bugs growing in there, you're going to get yeast growing in there. So, often I find myself having to deal with the consequences of the drugs in repairing the gut. So, not only do they have reflux, but they end up having irritable bowl and SIBO and SIFO, which are these bacterial and yeast overgrowth's in the gut. And so, you have to fix all that too. So, you have to do a cleanup after they get on these drugs for a long time. Dr. Todd LePine: Exactly. We're fixing the Iatrogenic induced illness. I mean, when you really think about it, a lot of the stuff that we see nowadays, a good part of it is related to some of the side effects of the medications. And what oftentimes happens in mainstream medicine now is that you have a side effect of medications, your doctor gives you another drug to counteract that side effect. So, then you get this poly-pharmacy and that's a big, dangerous thing, especially in the elderly. These patients come in and they're on tons of medications. One of the things that some of the geriatricians are doing now, they're realizing this, is they have these patients, they saw like five doctors, each doctor gave them two medications, they're on 10 medications, they're in the nursing home and they're semi-comatose and almost on death's door. And guess what? They get them off of the medications, and they wake up. Dr. Mark Hyman: I once saw this patient, I did a house call on this woman, and she was on 22 different medications. It was just unbelievable. Unbelievable. Dr. Todd LePine: Right. Dr. Mark Hyman: So, I think this is really a great case of a disease which is easily treatable with functional medicine, that avoids you having to take potentially very harmful drugs, that requires a little bit of a different thinking and approach, but that is available pretty easily. And I've written a lot about this and not only the textbook chapter, but I've written a lot of blogs. You can go to and search for reflux or heartburn in the search box and you'll find a bunch of articles sort of detailing some of these ideas on functional medicine. But I just want to emphasize for people who are suffering from this, a lot of this you can fix on your own. You don't need to see the doctor, just follow these guidelines. Dr. Mark Hyman: But if you do, we're at the UltraWellness Center here in Lenox, Massachusetts. We've been dealing with this stuff for decades, and collectively we probably have over 60 or 70 years of experience in functional medicine between all of us practicing here. And we can really help people remotely through Zoom consultations, wherever you are in the world. And we really would love you to not suffer. And I think that's really what... What's your life's mission? Really, to end needless suffering through the power of functional medicine, to get to the root cause of disease. Dr. Todd LePine: Yeah. Yeah. Mental and physical suffering, emotional suffering, they all are tied in. There's the suffering that people have with pain, there's suffering with their day-to-day existence. And when you see enough people, it really is, you're absolutely right, it's all about helping people to be alive and well. And when we're healthy, we don't really know we have a body. That's a beautiful thing. You'll breathe, you're not wheezing. You can move your body, it doesn't hurt. You go to bed and you actually sleep. And you move your bowels and you don't think about it. It's just like, when everything's working, you literally don't know you have a body. It's just like, it's just there, it just works. Dr. Mark Hyman: It's true. What is functional medicine? It's the path to figuring out how to get to know you don't have a body. I love that. Dr. Todd LePine: Yeah, exactly. Dr. Mark Hyman: Well, Todd, thank you so much for joining us on this special episode of House Call for the Doctor's Farmacy. Again, if you've been suffering from challenges with digestion and reflux and heartburn, or you know anybody, please direct them our way, the UltraWellness Center here in Lenox, we take our people from all over the world and do it all virtually. Now, if you want to come in, we're happy to see you, but you don't have to. Please share this podcast with your friends and family and social media. Leave a comment, tell us how you've struggled or not, and how you solved your issues with heartburn or anything else. And subscribe, wherever you get your podcasts. And we'll see you next time on the Doctor's Farmacy. Dr. Todd LePine: Great. Thank you, Mark.