[00:00:11] Speaker A: What's worthwhile?
[00:00:12] Speaker B: It's a question we all need to answer for ourselves. I'm Ramsey Zimmerman. As for me, it's building mind, body and spirit wellness. Let's ponder the big questions together as we seek peace of mind, vitality of body, and joy of spirit.
[00:00:38] Speaker C: Be familiar with what high in fatmap. So when you eat those, eat in moderation, don't you know in the same day, don't have things which are a lot of bread and cheese and beans and then have watermelon and they are orange juice and you know what I mean? So don't just, just know. Just be familiar with what's high in FODMAP and know that these are what's causing the symptoms and avoid them.
[00:01:10] Speaker A: Hey there, it's Ramsay here.
[00:01:12] Speaker D: That was Dr. Mohammad Faravar. Dr. Faravar is the author of Is it IBS or your diet? And is a prominent gastroenterologist with decades of experience in diagnosing and treating not only irritable bowel syndrome, ibs, but also gastroesophageal reflux disease, better known as acid reflux. Those who suffer with either one of these conditions often plan their lives and activities around them to deal with symptoms. But what if there was a better way? Dr. Faravar is very focused on dietary controls for IBS and medicinal solutions for GERD. We talk about IBS first and then picked up on GERD around minute 31. If you'd like to jump ahead to that. Dr. Faravar has helped countless patients over the past decades, and although we're not giving any medical advice on this podcast, I hope you can learn as much as I did. Let's get started.
[00:02:08] Speaker A: Hello, Dr. Farvar. How are you doing today?
[00:02:11] Speaker C: I'm doing fine, Ramsey. How are you?
[00:02:13] Speaker A: I am doing very well. I'm really glad that we have a chance to get together and talk.
You are a board certified gastroenterologist with decades of experience, specifically in the treatment of irritable bowel syndrome, which is IBS and gastroesophageal reflux disease, which is GERD. And I understand that more than 1 in 10 people in the US suffer from IBS and around 1 in 5 people suffer from GERD or acid reflux. So it's a very big issue for many people. Um, they are two, you know, completely different conditions. But we'd like to have the chance to speak with you about both. And, you know, why don't we start with ibs?
So tell me, what, what is ibs and what is it like for those who experience it.
[00:03:17] Speaker C: So by definition is called Rome 4 criteria. By definition, IBS is when you have abdominal discomfort that's associated with change in bowel habits and change in the form of bowel. Bowel change in bowel habits like frequent bowel movements or constipation and bowel movement that are not normal form.
Furthermore, they also associated with bloating, gas, mucus in their stool, urgency, and those kind of symptoms. And those symptoms need to be present one day a week for the last three months of the past six months. Very complicated definition that they have made. But basically to me, this definition means nothing. And that's the Rome four criteria. And it says that if somebody is complaining of something like that, that you don't have to evaluate them and consider that they have IBS and treat them as such. So in other words, if you have one day a week a problem with your stomach in the last three months you had this, you're considered that you have ibs. And this is really not something that's acceptable because there's no disease that you can have it one day a week for the last three months of the last six months.
You know, everything else is daily and so forth. So this is what IBS is. So in my opinion, IBS is when you come and complain that I have gas, I'm bloated, I have abdominal discomfort, I have to go two or three times or four times a day.
This is what IBS is.
[00:05:00] Speaker A: And that, that sounds like something that would certainly impact people's quality of life. Would you say? So? You know, what is that like for people? Does that sort of change how they sort of need to live their lives?
[00:05:14] Speaker C: Okay, so let me illustrate this with a couple of examples that made me write this book about ibs.
As you said, I've been, you know, I've been practice for 50 years now and have had very busy clinical practice and seen thousands of patients both with gels and with ibs. And every time, almost every time really, I've seen an IBS patient, I felt sorry for them. That why they have been mismanaged so much, you know, all their life.
So one day, which I consider the fateful day, because that was the day that I decided I'm going to write this book. I saw two patients, one of them came and was a dental hygienist and she told me that she's quit her job and now is a real estate agent. And she loved her job and so forth because she gets urgency in the middle of treating patients and she has to run to the bathroom. And if not, she may lose control. And she's quit her job and she's been to three of the major hospitals in Boston, major Harvard Hospital, and she's had multiple colonoscopies, a lot of blood tests the last 17, 18 years. And nobody knew what was going on. So she came in to see me for second opinion, and her answer was really, really simple.
And just by talking to her and taking her history and knowing what I'm asking and knowing what I'm supposed to do about this solved her problem. And she went back to work as dental hygienist. Basically, what that lady had was too much bile in her intestine that was creating all these urgencies and incontinence and just putting her on a couple of pills a day to take to absorb extra bile. The problem went away completely. And I've seen a couple of times, once a year after that, and she's fine. So just knowing what to do and what to ask. And the next lady is, which I still see again, is a teacher that had quit using public transportation and was using her bike going back and forth to work because of the same thing. I get urgency and sometimes I have no control and I get pain and discomfort. And so I'm riding my bike so I don't have to be in public transportation. And all I needed to do. And she had the same things four times. They have done blood tests on her by three of very good professors at Harvard to see if csiliac and so forth. And all I had to do is ask her, well, what kind of food do you eat? Because she was very health conscious, educated, thin, and she was a vegetarian. So she was eating food. High fodmap food. High fodmap food are great. They're very good for our health, but they do cause a lot of gas, a lot of bloating, a lot of cramps. And so if you overdo it, you're gonna have problems. So I told her, listen, this is what your problem is. Just go and change your diet and let's have a televisit in couple of weeks and see how you're doing. And after televisit, she says, all these years, nobody ever asked me about my diet. Nobody ever said anything about my diet. And I have no, no more problems. So these are.
So the quality of life is affected in IBS patients. Depends on what kind of IBS and how severe it is. Is affected really badly, is equal to depression or congestive heart failure. Because, you know, another, some Patients, they don't take public transportation, they take Uber because they know that with Uber they can stop any place if they have symptoms or at work, they, you know, they're uncomfortable with bloating and gas and, you know, they change their jobs and so forth to be in a place that they're by themselves. So it has a wide variety of symptoms and people are affected by it to different degrees depending on what is the basic cause of it. So.
[00:09:31] Speaker A: Yeah, well, yeah, it sounds like something. I mean, it's something. It's one of those things that people don't talk about all the time and polite conversation, but it's part of the human experience. And, you know, if you don't have control of what's coming out of you, then that is going to be a very big problem.
And I'm not trying to make light of it. I'm trying to say, in fact, that, you know, quite the opposite. It is a big deal.
You mentioned fodmap and fodmap foods. Let's talk about that. What are some of the causes of.
So the causes of ibs and what, what is fodmap? What does that mean? What. Okay, tell us more about that.
[00:10:16] Speaker C: Okay, so basically the food that we eat, it has to get digested and then absorbed in our gastrointestinal system before it reach reaches our colon and gets exposed to bacteria in colon.
There are some foods that they are high in carbohydrates, short chain carbohydrates, which are more than 2 to 10 carbohydrate those. We have no ability to digest these food. We have no enzyme to digest this food, this kind of carbohydrate in our food. So those that don't get digested, when they reach the sick colon, the bacteria in colon ferments them.
And by fermenting them, they produce some fatty acids and gas, basically CO2, hydrogen, methane, those kind of gas, and they get broken down and that causes also some diarrhea type of things. So by eating those foods, we will develop more gas. So those kind of carbohydrates are all in healthy food that we eat. So things that we eat, that they're healthy, they're high in fodmap, and they're good for us. I mean, the problem is that those foods are good for us, but also they cause problem and not everybody can tolerate it. It all depends on what kind of volume your intestine has. If you have a small amount of volume there and a lot of gas comes in and expands it, you're gonna have pain. If in the other hand you have large volume and you have gas distributed all over it, you're not gonna have a problem. You pass gas and you walk and you're done with it and you don't even notice it. So that's why IBS is more frequent on thin people in female especially educated. Because those people are more concerned about their health and more concerned whether they have gas or no, and pay more attention to it. And as a result, when you have those and you go here and there and to many doctors for several years and have several colonoscopies and nothing is found, then you become anxious, you become depressed, you become socially isolated because you're afraid of things. So the secondary problems related to those are all of those. So let me just give you example of what's ahead, Fatima, okay? Because you want to know. And I'm going to look at this page in front of me so I can go faster. So, like things like apple, pears, watermelon, dry fruits, fruit juices, honey, milk and dairy products, asparagus, broccoli, cabbage, onion, garlic, okra, wheat and rye, legumes, baked bean, chickpeas, kidney beans, lentils, soybean, apricot, avocado, BlackBerry, cherry, plum, plums, prunes, cauliflower and green bell pepper and mushroom. So the reason I picked those, there are a lot of them. But the reason I pick those is because those are the stuff that we eat mostly and is everywhere in our diet. And we enjoy it, and rightly so, and should be in our diet because they help to grow good bacteria in our colon. And good bacteria are what we need, are probiotics that we need. So in other words, FODMAP foods are not bad. They're great, but we need.
[00:13:51] Speaker A: That sounded like a great list.
[00:13:53] Speaker C: Exactly. But we need to realize that, okay, we eat those, there is consequences or that we are going to get gas and bloating. There's nothing wrong with having gas and being bloated and having discomfort as long as you know that this is what's causing it. And as long as you know you can adjust your diet so in one day you don't eat all of those together to give you a lot of problem. And when I went back and at the beginning told you definition of Rome 4, Rome 4 says IBS is when you have symptoms one day a week in the last three months. In other words, one day a week, you probably your diet, you overdo it, you overdoing things and you're going to have symptoms. And the other days you probably are not eating the same. So this definition even should make somebody think of, okay, then why is it like this one day a week? If I had cancer, it would be a lot more every day. If I had inflammatory bowel disease, it would be every day. If I have celiac, it would be all the time. If I have sibo, it will be all the time, one day a week. So that definition even takes you back to this being diet related.
[00:15:06] Speaker A: So it sort of begs the question, a couple of questions in my mind.
What should they eat instead if they're not eating those things in order to replace the nutrition value of the foods that they're avoiding? And then also my follow up question would be, is this the kind of thing that you have to avoid those foods forever or is it the type of thing that if you avoid FODMAP foods for a while that you know the, that your condition gets better and then you can sort of reintroduce those foods?
[00:15:44] Speaker C: Excellent questions. What should they eat? The same thing that they already know, but in moderation. Ah, be familiar with what's high in Fatma. So when you eat those, eat in moderation, don't you know in the same day don't have things which are a lot of bread and cheese and beans and then have watermelon and they have orange juice and you know what I mean? So don't just, just know, just be familiar with what's high in Fodmap and know that these are what's causing the symptoms and avoid them. Now there are some things like for example, now going, so this is as far as, because it's necessary to eat those, because they produce those. Fatma food are food for good bacteria in our colon. Okay, so it's necessary to eat them is good for us. To eat them is only to know that that's what the problem is and to moderate.
So that's really.
So once you have it, can you grow out of it? No, because it's a normal, normal reaction of our body.
So people say, I've seen that on the Internet and so forth. They tell people that, okay, eliminate this, do for six weeks, then eliminate this and that and so forth. This is such a nonsense. Because those short chain carbohydrates are present all the time. The bacteria in our colon doesn't change during our lifetime. Nothing changes. We are the same, Food is the same.
So do we grow out of it? No. Do we need to grow out of it? No, we hope not.
So it's just being knowledgeable, being informed that what the problem is and then trying to live with it now.
[00:17:39] Speaker A: So what I kind of hear you saying is that it's not a matter of entirely eliminating those foods from your diet, but instead to sort of moderate those foods especially kind of all at once. And that you know, when you have a lot of those foods all together, you'll be that much more likely to experience symptoms. Is that that basically what you're saying?
[00:18:00] Speaker C: Exactly, that's what I said. No, there's a problem. And the problem is that some people have deficiencies in enzyme not part of fatma. Like they have lactose intolerant.
[00:18:12] Speaker A: Yes.
[00:18:12] Speaker C: Or they have fructose intolerance and so forth. Those people. It has nothing to do over lactose intolerance. You drink a glass of milk, you're going to have symptoms. So if you have that kind of things, you cannot have lactose without having symptoms unless you add lactate to your things that to your pizza, for a slice of pizza, or use lactate milk, or use hard cheeses and so forth. Because those are different. Those are not fodmap, those are disaccharidized deficiencies. It's still food related because there's a lot of food that they have those kind of things in them. And 10% of people have disaccharides deficiency other than lactose. And lactose intolerance is really very, very common other than northern European people, the people from Middle east, like where I'm from, Mediterranean area, China, Africa, South America, Central America, probably more than 80% of them are lactose intolerant. And a glass of milk has about 14 gram of lactose. So you drink that, you're going to get bloated. You drink two glass, you're going to get bloated Again, a stomach and you can't even get diarrhea. You drink three glass, you're going to get tenesmos and mucus in the stools and so forth. So those are not.
Is a different story than the fodmap that I mentioned.
[00:19:39] Speaker A: And how do people sort of understand the difference? Are there tests that people should take that you recommend in order to really sort of narrow down causes?
[00:19:53] Speaker C: Okay. This is the second thing that made me write this book. And I said in introduction and in conclusion, both that I was in private practice for 42 years and I had two different instruments that I could measure breath test and hydrogen in the breath of people and diagnose whether they are lactose intolerance, fructose intolerance, they have SIBO and so forth and simple equipment. Not very expensive. Tests are very easy. And I retired, I retired eight years ago. And after that I decided to go, go back to work part time. And that's what I do. And you know, and as a result I've gone to sort of different hospitals and different areas in the country.
You know, in the wintertime I go to warm places. In summertime I go to cool places, do GI consultation for three or four months. And that's what I do.
And right now I'm, you know, at Cambridge Hospital, which is a Harvard teaching hospital and working here.
So you will be amazed that every place that I've gone to, they don't have these, this inexpensive equipment that is necessary to diagnose at least 50% of people with IBS that they come the cause of their IBS, they don't have it, okay? And even some places I've offered that I pay for the equipment. So we buy it so when the patient comes, we can tell them whether they have lactose intolerance, fructose intolerance, sibo, other intolerances like Maltase deficiencies and so forth. And it falls on deaf ear.
My feeling is that the reason for it is that these are, these tests nowadays before insurances will pay good money for them. Not good, but, but not bad. Now Medicare pays for 76 bucks. It takes three hours of time of a technician to do the test. And so nobody wants to get involved with the test that they get paid 76 bucks and take three hours of time of a technician to diagnose it. And that's why I've this taken me a long time to come to this realization. And that's why nobody has it. They say, okay, well you have, you know, you have lactose, you have ibs, and if you are, if you are very good, if you are informed, you say, oh, go on low fodmap diet. What's low fodmap diet? I don't know. Go on the Internet and find it and if not, they give you, oh, it's ibs. Go and see psychiatrist, go and see psychologist, go and do psychotherapy, acupuncture, yoga. This is a problem you had from your childhood. You probably have a PTSD and poor patients, really, they get, and this patient is unhappy, has a problem, then goes to the next big hospital and next man's greatest hospital and so forth and continuously will have, you know, the same issues.
So you need to really get to the base of these kind of problems and find a place that hopefully the doctor that you see is knowledgeable in digestion and absorption, and hopefully they'll have equipment to do these tests.
So the reason I say they don't have equipment, you know, I have practiced at Harvard Hospital in Boston University, in Tufts Medical School, Hospital and other medical schools throughout the country. So this is not only here, this is everywhere. And I think that it's the duty of people in media to let people know what goes on, really. And especially IBS patient, to let them know that their problem, it could be found out very easily. What it is, could be taken care of and treated very easily. They don't have to live with this problem for the rest of their life and they don't have to suffer from it.
So, but that's. It takes, I think, as far as I'm concerned, it really takes the media to publicize this issue, you know, to four people, because seven in 10 person, seven in 10 will suffer from IBS symptoms here and there. And some of them, about 5% of those people are so severe, as I mentioned, that they quit their job and they changed their job and they go into social isolation and they have had many endoscopies and colonoscopies and so forth.
[00:24:35] Speaker A: Wow.
So tell us what, tell us what is the book? Tell us the, the name of the.
[00:24:42] Speaker D: Book and, and where we can find the book.
[00:24:44] Speaker A: Let's start there.
[00:24:46] Speaker C: Okay, so my book is. I show you the picture of it. I don't know whether you see it or not. It says, is it IBS or your diet?
[00:24:55] Speaker A: Okay.
[00:24:56] Speaker D: And is that available through.
[00:24:57] Speaker C: That's available on Amazon.
[00:25:00] Speaker A: Okay.
[00:25:00] Speaker C: Okay. It is available on Amazon also. There is audiobook of it too, and is on Kindle as well.
This book not only has a lot of good information, I wrote the book originally. I started right. To write the book for patients and educate them that. Listen, the doctor that you're going to see is not going to know much, is going to tell you this. Don't believe it. Ask for this kind of thing specifically to find out for you. Then I realized that, okay, this is not enough. The information should be there for doctors too. So they know what to do, what to ask, what kind of tests to do, what causes IBS. There's more than 40 different problems and diseases that can cause IBS symptoms. Okay, so it's not that 40% is diet, 80% diet has a role in it, but a lot of people with ibs, they have more than one reason for it. They have three or four different reasons for their IBS symptoms. So some people go on low fodmap diet and they Continue to have problems, they get better, but still problem because they have other issues. And you need to know and you need to find out those other issues and find out. So a lot of people, IBS has more than one reason, definitely in some people up to four or five. And in this book I have illustrated the cases that. And these are about the last. Like when I wrote that about a year ago, it was about the last two years before I wrote the book. Cases, real cases that I have seen. And it's illustrated what kind of problems and what kind of issues they could have.
So I think I forgot what your second question was. But.
But basically when they. Oh, this is what I was saying. So this book I recommend is really because you need to know, have the knowledge to be able to ask the right question and find out the right problem and then treat it. And the knowledge the doctors should have it, which a lot of them don't. I mean, okay, I'm not shy in saying that my colleagues that are professors, Harvard professors about ibs, they really don't care. They care a lot more to know about Crohn's disease and ulcerative colitis and cancer and things like that then to know about ibs, which is, oh, well, just what kind of problem is that? Have a nurse practitioner see those patients. Whereas is the most complicated problem and most complicated issues that the person can have. And as I said, there are more than 40 problems, 40 diseases that can cause IBS symptoms. So the book is recommended for both patients to be knowledgeable when they go to see their doctor and ask questions. What about this? What about that? And the doctors to know that what other problems can present like this and how to diagnose it. So that's what the book is for.
[00:27:56] Speaker A: Well, it sounds like a tremendous resource and based on how complex the issue is and how life sort of changing and dominating it is and based on, you know, how many different things could potentially be causing it and you know, strategies to help it. It sounds like a great resource.
[00:28:18] Speaker C: Let me mention one other thing because it's important for people to know and that is that around IBS a lot of market has developed when you go on the Internet for supplements, there are so many more than 100 supplements for. From enzymes to probiotics to symbiotic to. To prebiotics to whatever. A lot of the different supplements and all of them are waste of money.
Okay. There is no. And they may create temporary relief. For example, you take enzymes and the food that hasn't been digested before it gets to your intestine, it digests it, so it gives you temporary relief, but it's not, is not going to be something that's going to cure it. Probiotic we don't need. There's only two indications for using probiotic in medicine, and IBS is not one of them. We already have a lot of good bacteria. Those bacteria that is causing gas and cramps and bloating. They're all good probiotics in our system.
So you don't need to go and waste your money and this. And then there are labs also that have grown on the Internet that those labs are claiming that they do a stool test and hair test and blood test and so forth and tell you what's causing your IBS symptoms. They charge, I've seen, they've charged up to $2,500 patients to check their stools or their hair or their blood. And then they give them bunch of nonsense, useless information because they measure IgG antibody to different foods and they say, oh, you're allergic to these things. Don't eat and don't eat these. And, and patient come to me and said, Dr. Fariber, we have spent that money because everywhere else we went to and we, you know, did not get any relief. And they gave me this information and this information, the things that they say don't eat, I eat and I don't have a problem. And the things that they say that eat, I eat and I, and I have problem with those. So in other words, those labs that are on the Internet and they're none of them are FDA approved and they look like legitimate lab and they charge a lot of money and their report is about 100 page. When you get those and those probiotics and so forth that you get and supplements, they are really useless and they're a waste of money. And patients and people should not waste their money on buying these kind of things. They're at best temporary relief.
[00:30:47] Speaker A: Higher beware.
[00:30:49] Speaker C: Yes, exactly.
[00:30:52] Speaker A: All right, let's talk a bit about gerd acid reflux.
And this is another issue that lots and lots of people have. And you know, we hear about it a lot.
But can you explain to me what is gerd?
[00:31:11] Speaker C: Okay, so that's, that's what I always tell the patients when they come to my office because they've taken omeprazole for six weeks and they still have symptoms. And they come and say, oh, I still have symptoms, I'm not cured. What am I going to do? So GERD is when contents of a stomach regurgitate or comes back and reflexes back into the esophagus. And since content of a stomach is acid, when it comes back into the esophagus, esophagus is not an environment that likes acid. So it burns like if you pour acid in your skin, it burns the same thing. So in order to have ger, you have to be born.
And that's important with an asphyx that's between the esophagus and the stomach, that's incompetent, that's weak, that's not present, okay, you need to be born or something must happen in your stomach that overwhelms the pressure, the normal pressure of a normal sphincter. And so things backs up. So, but most of the time, GERD is the result of having a weak lower esophageal sphincter. Now you have a weak lower esophageal sphincter. If there's too much acid in the stomach, it returns into your esophagus, it's going to burn, it's going to have problem. But even some people, when you eliminate all of their acid, they still get heartburn. And the reason for it that things are going to come back anyway. So now bile is coming back and it's causing heartburn. Food is coming back and it's causing heartburn. So GERD basically is the result of. And this is the simplified. But that's the most important thing for people to know. And that's why in some families, everybody has gerd, because genetically, they're born with the weakest sphincter. So everybody, you know, else too, has a weakest sphincter, lower subdulin sphincter. So that's what GERD is. GERD is reflux of stomach content into the esophagus that can also come up further into the throat and cause sore throat into. In kids even, it can cause otitis media, goes into their nose and cause inflammation there, gets into the lungs of older people and aspirate and get pneumonia and bronchiectasis, cause cancer in larynx. If there's chronic gear that comes all the way here can cause chest pain that mimics exactly like heart angina, so is a disease that. And unfortunately, about 40% of people suffer from GERD. Okay. And things that happens, like if you eat fat, fatty food, fried food sits in the stomach for too long. And so things are sitting in the stomach, stomach fills up. So once it fills up, it's easier for the content to come back. Right?
So fatty food, large amount of food, you know, drinking A lot. Eating late at night and lying flat, because if you have your sphincter is incompetent, Lying flat things comes back at night and is going to create problem.
[00:34:18] Speaker A: Well, let me ask you a question. Yes.
Are there things that cause that esophageal sphincter to fail over time?
[00:34:28] Speaker D: Yeah.
[00:34:29] Speaker C: Okay. Does it get stronger over time? No, I don't think so. I haven't. I haven't seen that.
But does the gear gets better over time? It could, because if you make less acid, see, it depends on the volume of the stomach and how much acid is sitting in the stomach. If you, at some point you make less acid. Yeah, you could get better if you're not eating as much and losing weight, it could get better if you don't do things which weakens the sphincter, like smoking, eating chocolate, eating fatty food, those kind of things weakens it. So the sphincter, if it's weak already, for example, so if you make it even weaker so it's easier for you to get reflux. If you overeat, it overwhelms this even normal sphincter and you get reflux. So it could get better. But does this finger changes? No, it wouldn't.
[00:35:21] Speaker A: Okay. And there are, it seems like there's a. There's quite a few different medications and different types of medications, traditional antacids, and then there are a host of medications that were prescription only, but seems like they've been rolling out over the counter. Uh, what are some of the limitations or sort of dangers of relying upon those medicines versus doing other kind of lifestyle or diet changes?
[00:35:54] Speaker C: Very good. Very good question again.
So if you can lose weight and stop smoking and change your diet and don't eat three hours before you go, go into bed and take occasional Tums and get relief from your gut, so be it.
Okay. Nothing wrong with that. But then there's some people that they get frequent heartburn. Quality of life again is gone. Basically, you can go out, you can have a glass of wine, you can eat the food that you like at night with your friends. You always have to be careful. You, you know, burping this, that, things like that. Then something needs to be done about it. Something needs to be done about it. It was H2 blockers for a long time. It was since 78, I think. And then afterward the PPI proton pump inhibitor came. And I think they have been the best thing that happened to humanity as far as I'm concerned. Because there are a lot of people with geared, a lot of people who had A lot of problems and you don't see that anymore. I mean, I used to have patients that I used to dilate them because of their esophagus was pictured and narrowed because of acid reflux once a week. And we haven't seen that for years and years now since the PPI came out. So there are two things in the market right now, which I mentioned it, and there's a new one that's come to one is the PPIs. Like Pepcid is the one. Pepcid AC, Pepcid Famotidin that reduces the acid in the stomach and reduces the heartburn. And you use it once or twice a day. Or in GERT people, you can use it up to four times a day. I don't use those that often because I like PPIs and I use PPIs. And the one that I dislike the most is pantoprazole because I think it's the weakest of them all.
And the one that I like more is omeprazole because it's the cheapest of them all and is most effective.
Comparing milligram per milligram. Now I'm talking about.
So I use omeprazole usually tell people, take one half an hour for breakfast if need to be two, two times a day. And if can get away with every other day, fine. And if once every Thursday, they need it, fine. So anyway, so they can use it according to the symptoms. Now, there's been a lot of publicity or bad publicity about the PPIs, about, okay, they cause cancer, they cause dementia and Alzheimer's, they cause osteoporosis and hip fracture, they cause B12 deficiency, iron deficiency, calcium deficiency, magnesium deficiency, and all of them pseudomembrance colitis and so forth. And all of them, they could. But first of all, when the patient calls me and say, Dr. Farber, I'm taking two lansoprazole a day, and things in the newspaper last night, I saw it and the TV said that it causes such and such. What am I going to do? I said, stop it. They say, stop it. But I can't. I said, okay, I rest my case.
If you need, if you need to take the medication that has been so good for your quality of life, that prevents you from getting a stricter esophagus cancer of esophagus, throat cancer, aspiration, all of those you worried that it may cause, like osteoporosis 20 years down the road.
And what is the cause of osteoporosis? Poor calcium. So you take calcium supplements.
So I'm Going to go over that. So there's been studies in five different countries of 53,000 patients. And they looked at all the side effects that they said and they saw. There is really no difference between people who take omeprazole or PPIs and those who don't take it. In term of all of those complications that I mentioned, except you are prone to get more infectious gastroenteritis, in other words, if you eat bad food that has salmonella in it or campylobacter in it, like food poisoning that we're talking about, because the acid is reduced, acid kills those bacteria. So because more of those get into intestine, then you get more gastroenteritis, you're more prone to get food poisoning if you get exposed to those. Everything else is not statistically significant.
Now, I have seen patients that's been on high dose of PPIs for a long time with B12 deficiency, calcium deficiency, magnesium deficiency, iron deficiency, because you need acid for most of those to get absorbed, okay? And so when you eliminate acid completely, which is very, very difficult to do, but sometimes it happens for a long time, those things may not get absorbed, but the treatment is simple. Replace them, give them supplement.
So it's not a big deal. So it's a big deal to know and to treat the problems that you have for a lot of different reasons is not a good idea to get scared about everything that comes. And the other things that like nursing home, a lot of them are association things. Like everybody in the nursing home is on omeprazole, right? But nursing home has a lot of demented people.
So you cannot take by association that these people, that they were demented, 80% of them, they were taking omeprazole. Therefore, omeprazole may be doing that. You know what I mean?
[00:41:44] Speaker A: Well, what I, what I hear you, what I hear you saying is that it's a matter of degree and it's a matter of priority and it's a matter of sort of addressing what's right in front of you. I do, I do wonder. We, we spent a lot of time talking about diet to help with ibs are that I'd like to hear about sort of dietary ways to help GERD as well.
[00:42:13] Speaker C: Okay? So I tell GERT patient those people that I put them on omeprazole, for example, on ppi, I keep saying omeprazole because this is what I'm used to using.
Put them on ppi. I tell them, okay, the purpose of you taking PPI is so you can eat whatever you want.
Therefore Eat whatever you want and if it doesn't agree with you, then don't eat it.
So basically, fried food and spicy foods are the thing that cause more of an indigestion and heartburn and so forth.
So diet, I don't put limitations, but if I want to put limitation. If you go on my website, gerd-Ibs.com and look at the GERD and patients and self help and self help says about diet, things that don't eat that may cause problems, like in the morning, what we eat, the typical American breakfast, which is orange juice, bacon and eggs and toast and butter, they all cause reflux.
So, okay, so don't eat them. Okay. And so the purpose of medications really is to make you comfortable and to give you quality of life and to be able to do what you want to do.
And so you can control GERD by diet a lot of time by avoiding spicy food and acid food and fried food food and not eating late and not wearing tight belt and not eating chocolates and not drinking wines and so on and so forth.
But if you take a medication and your symptoms are controlled by all means, you're not causing any harm to yourself by not following that diet.
[00:44:04] Speaker A: Very good. Well, Dr. Faravar, you've been very generous with your time. I know that you have an appointment coming right up here.
Thank you. I learned a tremendous amount and I find it fascinating that being able to use our diet to manage things like IBS symptoms is really valuable and sometimes medications are able to manage those as well. So it's a great opportunity, I think, for people to learn and understand the differences. And I appreciate your, your book and the education that the, the book will have for and, and is having for many, many people who are struggling with IBS in that condition. So thank you so much. I appreciate you taking the time today.
[00:44:59] Speaker C: Thank you, Ramsey. It was very nice talking with you. Thank you for all these very good questions that you ask and I hope that it's going to be useful for some people that will listen to it. So yes, indeed.
[00:45:13] Speaker A: Fantastic. Thank you.
[00:45:15] Speaker B: Thank you for asking what's worthwhile. Visit whatsworthwhile.net to learn more about me, Ramsay Zimmerman. And please provide your name and email to become a supporter. I'm asking for prayer, advice, feedback and connections with what's Worthwhile. Podcast is on Spotify, Apple, Iheart and Amazon. You can also
[email protected] thanks.
