General Health Quotes

The American Diabetes Association recommends avoiding long periods of sedentary behavior. The Association advises us to break up long periods of sitting with 3-minute breaks every half hour to improve blood glucose control. If you have a sitting job, it may take some creativity to find ways to be less sedentary. In those 3 minutes, you could walk to the bathroom and back, walk in place, do pushups against the wall, do lunges and squats, or any activity that suits you. [2018] - Joy Bauer

Heartburn occurs when gastric acid from the stomach goes the wrong way, or refluxes, up into the delicate tissues of the esophagus, causing a burning sensation at the bottom of the chest and rib cage that can emanate out through the middle of the chest and toward the throat. Regurgitation is the sensation of food coming back up into your chest and throat after you’ve already swallowed it. Over 90% of the people diagnosed with acid reflux disease do not have these typical symptoms. They are more likely to have throat-related complaints such as feeling a lumplike sensation in the throat severe enough to cause dysphagia, or difficulty swallowing. Other common symptoms are chronic cough (cough that persists longer than 8 weeks), hoarseness, frequent throat clearing, and sore throat. [2017] - Jonathan Aviv

The clinical name of throatburn reflux is laryngopharyngeal reflux (LPR). Throatburn Reflux Symptoms: • Hoarseness • Frequent throat clearing • Acidic taste in the mouth: acid regurgitation from the stomach can literally bring an acidic taste all the way into the mouth • Globus sensation: feeling a lump in the throat or that something is stuck in the throat • Trouble swallowing • Chronic cough • Aspiration: food or saliva or any other material going into lungs • Waking up at night due to burning in the throat • Waking up at night with a choking sensation • Excessive mucus in the throat [2017] - Jonathan Aviv

More detailed throat exams used to require sedation because of the difficulty in getting any sort of instrument past the powerful gag reflex. However, an exam called the transnasal flexible laryngoscopy (TFL) is now the preferred method for viewing your larynx and the surrounding structures. The brilliance of any transnasal exam is that it involves passing an instrument through your nose, thereby allowing a physician to bypass the gag reflex and view the tissues and structures below. What will typically be examined are the vocal folds—do they look swollen and red, likely to be the source of hoarseness or throat pain? Is there evidence of postnasal drip or accumulated mucus, the possible cause of chronic cough or a lumplike sensation in the throat?  [2017] - Jonathan Aviv

There are two steps to taking a PPI the correct way: 1. Take a PPI dose thirty to sixty minutes before you eat either breakfast or dinner, or both (allowing it to enter your bloodstream). 2. Eat something to “activate” the PPI within thirty to sixty minutes after taking the medication. In my practice, only 25% of patients with throatburn reflux symptoms improve after 6 weeks of treatment with PPIs, with a larger percentage experiencing relief after 12 weeks of use. Others will require medication for 6 months or longer before they begin to feel better. Numerous studies have suggested that PPIs may give a protective effect against both the precursor to esophageal cancer and esophageal cancer itself. [2017] - Jonathan Aviv

You won’t waste time (or money) trying to test your pH because you know that low-acid eating is about reducing tissue damage and inflammation, not about manipulating your blood or urine pH. You also won’t be eliminating valuable macronutrients that can aid, even accelerate, your healing from long-term acid exposure. [2017] - Jonathan Aviv

When you eat and drink, your stomach naturally expands to make room for what you’ve just ingested, which can increase pressure on the lower esophageal sphincter (LES) and lead to a relaxing of this important muscle. Once this muscle relaxes, the doorway to refluxed acid has been precariously left open. One way to prevent the gastric distention that occurs after you eat from placing too much pressure on the LES is to simply go for a walk after meals. A post-dinner walk has been linked to reduced risk of stomach cancer. To help ensure that this walk prevents rather than provokes refluxed acid, it’s best to stick to a leisurely pace, which should be decidedly slower than the brisk or vigorous one you will aim for during exercise. [2017] - Jonathan Aviv

A study published in the American Journal of Gastroenterology revealed that abdominal breathing had a positive effect on reflux symptoms and reduced the need for reflux medication in people with GERD. To practice diaphragmatic breathing, first get into a comfortable starting position. This could be lying down on your back with your knees bent and feet on the floor, sitting on a chair that allows your feet to be flat on the ground, or standing with your feet hip-width apart. In either position, focus on keeping your spine erect as you place one hand on your chest and one hand just at your beltline. Inhale deeply and slowly through your nose, taking air into your belly. Exhale through your nose, feeling your belly as it sinks back in. Repeat five to ten times, alternating the position of your hands if you’d like.  [2017] - Jonathan Aviv

A study published in the Journal of the American Medical Association on May 17, 2016, and the corresponding editorial, provided proof that refluxed acid initiates a deep-tissue inflammatory response, which sets off the release of a multiplying body of pro-inflammatory proteins. The link between acid damage and worsening systemic inflammatory symptoms, which I had witnessed in practice for so many years, had essentially been scientifically validated. [2017] - Jonathan Aviv

When a Danish study came out in May 2014 concluding that regular, long-term use of certain PPIs was linked to greater risk of developing esophageal cancer, the use of this popular acid-blocking medication was put into question. It was an alarming argument, but it’s not one you should give too much credence. The authors of the study were unable to control for significant risk factors for the development of esophageal cancer such as alcohol consumption. Nor were other lifestyle considerations, such as smoking or dietary habits, taken into consideration. [2017] - Jonathan Aviv

I recently examined data from my reflux patients using the Reflux Symptom Index. Here were the symptoms, in decreasing order of frequency: 1. Too much throat mucus 2. Chronic throat clearing 3. Hoarseness 4. Lump-in-the-throat sensation 5. Chronic cough 6. Heartburn 7. Difficulty swallowing 8. Choking episodes [2015] - Jamie Koufman

The optimal LDL cholesterol level is probably 50 or 70 mg/dL, and apparently, the lower, the better. An LDL around 70 mg/dL corresponds to a total cholesterol reading of about 150. The population target should be a total cholesterol level under 150 mg/dL. To become virtually heart-attack proof, you need to get your LDL cholesterol at least under 70 mg/dL. Researchers have found that kale--dubbed the "queen of greens"--might help lower LDL cholesterol and boost HDL cholesterol. [2015] - Michael Greger

Waist-to-Height Ratio, or WHtR, is a better tool than BMI that we can use to gauge the health risks of body fat. Stand up straight and take a deep breath, exhale, and let it all hang out. The circumference of your belly (halfway between the top of your hip bones and the bottom of your rib cage) should be half your height--ideally, less. If that measurement is more than half your height, it's time to start eating healthier and exercising more regardless of your weight. [2015] - Michael Greger

The American Heart Association defines "normal" blood pressure as a systolic pressure under 120 and a diastolic pressure under 80--or 120/80. Anything above 140/90 is considered hypertensive. Values in between are considered prehypertensive. The 140/90 threshold for hypertension is considered an arbitrary cutoff. There are benefits to having a blood pressure that is even lower than the "normal" range. So even people who start out with a so-called normal blood pressure of 120/80 appear to benefit from going down to 110/70. [2015] - Michael Greger

Silent reflux is the single most common cause of difficult-to-diagnose chronic cough, and neurogenic cough is the second most common cause. [2014] - Jamie Koufman

The first step in the diagnosis of chronic cough is to rule out a pulmonary cause. [2014] - Jamie Koufman

Reflux treatment with acid-suppressive medications alone (e.g. PPIs, "purple pills") is not useful as a diagnostic test. If a chronic cougher does not respond to antireflux medication, it does not prove anything. Reflux may still be the cause of the cough. [2014] - Jamie Koufman

GI reflux-testing techniques lack pharyngeal (throat) reflux data and that is why esophageal pH monitoring is virtually useless. [2014] - Jamie Koufman

Two medications are used to treat neurogenic cough and vagal neuropathies: amitriptyline 10 mg. before bed, and gabapentin 100 mg. four times a day. [2014] - Jamie Koufman

Besides cough, there are several other common vagal neurogenic symptoms, such as burning tongue, chronic sore (burning) throat, and painful speaking (odynophonia). [2014] - Jamie Koufman