Special Q&A With Dr. Param Dedhia

If you've followed Health & Wealth Bulletin lately, you've likely heard of Dr. Param Dedhia.

Param is one of the most interesting people I've met. He's a physician trained at Johns Hopkins who practices both modern and traditional medicine. He serves as the Weight Loss Program Leader and the Director of Sleep Medicine at Canyon Ranch, a wellness retreat in Tucson, Arizona.

He's board-certified in sleep medicine, internal medicine, and obesity medicine, and he also did a fellowship in geriatrics.

Over the past few months, he has told readers...

The response from readers like you has been incredible. We've gotten so many questions so I asked Param if he wouldn't mind taking over one of my Friday Q&A's.

So today, Param is answering some of your health questions...

Q: Thank you for your series on digestion. This is a huge issue for members of my family. We all seem to have the same GI tract issues. My father had what he called "irritable bowel" (IB) and at the age of about 45-50 he had ulcers. My father's mother had intestinal cancer in about 1960 and my oldest brother had it in 1990. I read on the Mayo clinic web site that people with IB should not eat lettuce and that has helped a lot. But I've also heard that red wine aids digestion. What can you tell us on the relationship between alcoholic beverages (by type) and digestion?

Thank you for sharing your knowledge and discoveries with us all. – B.W.

Param comment: Hi B.W., thank you for your sharing. Moreover, we appreciate your question.

As said by the roman poet, Lucretius – One man's meat is another man's poison. Alcohol can have varying effects on different people. For example, for some it can lead to food passing quickly through the digestive tract. And for others, it slows digestion and can promote constipation. Some people may become significantly dehydrated with alcohol whereas other people will be minimally affected. They likely were better hydrated before they drank or while they were drinking.

Nutrition research is difficult due to the nature of collecting the data – people need to recall everything they eat and drink and report it honestly. But we do know there are two things that show associations with our gut: Tannins and gluten.

The tannins in red wine and in dark beers have been noted to have potential benefits like the creation of a tannin-protein layer. Some believe this creates a protective layer in the stomach. Beyond this, tannins have been shown to have antioxidant activity, promote tissue repair, fight Helicobacter pylori infections, and act in gastrointestinal tract as an anti-inflammatory.

Gluten has become a widely discussed food allergy or food sensitivity, and can be found in wheat, oat, barley, and beer too. Gluten is not an enemy for all people... Some people have no issues with gluten and it is unlikely that they ever will. Yet others like me are not so lucky. Even a sensitivity can cause problems like bloating, cramping, and poor absorption.

Potential harms for alcohol come from the amount consumed. Typically, most people can clear two servings of alcohol per day without issue. Please know that a serving can be much less than what we typically pour. Moreover, everyday consumption may fatigue our natural detoxification process. I commonly see nutrient depletion in those who drink alcohol every day, most commonly in their B vitamins.

As alcohol can be a special ritual in our lives, here are some reminders to make it easier for us to be healthier with our alcohol intake.

  • Seek an opportunity to be well hydrated before your night out.
  • During your evening out, please drink water and be aware of hydration.
  • Eat something before you drink. 

Q: Thank you Dr. Eifrig for having Dr. Param Dedhia on board to present the continuing series on digestion. I am more than a little concerned regarding the effects of the digestive acid and its effects, both positive and negative.

Specifically, I had an endoscopic exam recently. It was a follow up to the two I had done in 2017, before and after a similar series of complaints I experienced regarding digestive issues. The gastro specialist insists that I take a daily dose of the proton pump inhibitor, pantoprazole, 40 mg. for the control of the acid that is "eroding my esophagus". He states that it has reached a very serious level. There was also a diagnosis of H. pylori, for which I benefitted by a 14-day high antibiotic regimen, and feel much better.

I am seeking a/an alternative(s) to the PPIs, specifically natural options. There are so many items listed on the internet, including H2 inhibitors. Can you offer some viable options and new habits that can be a real benefit? Elevating the bed by 10 cm. proved to be a real and easy benefit! I am 71 years old. I travel frequently overseas as a missionary, which makes some recommendations to be a challenge. Thank you in advance. – L.S.

Param comment: Dear L.S., thank you so much for sharing – this is an opportunity for me to share the heart of integrative medicine teaching: looking at both Western medicine and traditional herbal approaches.

Let me start by saying that it is easy for me or any medical reviewer to speak and write about the downside to medicines that can lower stomach acid. But I will share that they have helped many, many people. Bleeding ulcers used to fill a number of hospital beds in the past. PPIs (proton-pump inhibitors) are the most aggressive way to reduce stomach acid and have saved many lives. Yet it is not one size that fits all. Not all people need something so strong.

Plus, as we have written about before, drastically reducing stomach acid can make it more difficult to breakdown foods and to maintain the balance of healthy bacteria in our digestive tracts. For gastroesophageal reflux and gastritis, we have herbals that can be very helpful such as slippery elm, marshmallow root, and licorice bark. I have seen them be helpful for people with symptoms who do not have significant esophageal or stomach injury. Yet I am not able to trust them to be effective if an active ulcer or non-healed ulcer is found. This would be the same for significant esophageal structural changes from stomach acid.

Given that there are erosions on your esophagus, it is important to heal these first. Your doctor can see that progress with an endoscopy (a camera that goes down your throat). Therefore, start with PPIs. Once you're thoroughly healed, then it would be a better time to review treatment options and consider whether herbal approaches can be beneficial to you. It would be helpful to review the possibilities and research other ways to reduce the risk of future injury.

Q: Very interesting article on promoting digestion. Much of what you said includes the encouragement of stomach acid production. Those of us with GERD spend our time trying to slow or stop stomach acid. Could you reconcile these? Thank you! – R.J.S.

Param comment: Hi R.J.S. Thank you so much for the question. This has been a huge area of interest in allowing for acid during times of digestion but not in the times between meals. With GERD, there is the challenge of acid— and PPIs are again very effective. Yet the full treatment with PPIs leads to a dramatic reduction in stomach acid. This can then lead to difficulties with breaking down food and balancing probiotics in the digestive tract.

Let me share that a 2013 article by Yago and colleagues published in Molecular Pharmaceutics looked at this (you can read it here). They took normal volunteers and put them on a PPI. They took betaine hydrochloric acid (betaine HCl) before a meal. It made the stomach sufficiently acidic within two to 10 minutes. The acid effect lasted for 50 to 100 minutes – enough time to enjoy a meal. Therefore, the acid effect and benefit was there for meals but the acid was not allowed to surge intermittently throughout the day. I have used this with people with mild to moderate GERD who have been able to become symptom free on their PPI. I have also asked them to meet with a GI specialist to make sure that there is no known damage. Overall, they were able to better digest their food with the addition of betaine HCL.

Q: Does Moroccan mint tea work similarly to peppermint tea [to promote better digestion]? – C.V.

Param comment: Hi C.V., I'm smiling reading this question regarding the mint teas. All of my medical colleagues would be confused that I am speaking about mint for digestion and for gastroesophageal reflux.

We are taught in medical school that mint is a common trigger for reflux. This is true... well sort of. The key detail to add is the amount of mint. The higher amount leads to higher risk for reflux. Please know that I love all mint teas. I love Moroccan mint yet it does not soothe my occasional reflux. I've found peppermint tea to be helpful when the reflux is acting up. Many herbalists have written about peppermint as a digestive aid in the mint family of teas. I have not seen them tout other mint teas for this.

Also please note that most mint tea is combined with green tea. Green tea is caffeinated. I did not realize that the last box of Moroccan mint tea that I bought had green tea. Not surprisingly, I did not sleep well after I drank my post-dinner tea .

C.V., please let us know how your mint teas affect you. I raise my cup (of tea) to you and with you.

Please keep sending your comments, questions, and ideas to [email protected].

Here's to our health, wealth, and a great retirement,

Dr. David Eifrig and Dr. Param Dedhia

December 20, 2019

P.S. In February, we'll be with Dr. Steve Sjuggerud at Canyon Ranch for the first Canyon Ranch Immersion Week, hosted by Stansberry Research. You'll hear from us and Canyon Ranch Wellness Architects™ to help you start living a healthier, wealthier life. Learn more at http://stansberryimmersion.com/.