ARE MILLIONS OF US BORN with a genetic defect that makes us produce too much stomach acid? Do we just have a major evolutionary design flaw that requires us to take powerful acid-blocking drugs to prevent heartburn and reflux?
I believe that the answer to all of these questions is a resounding “no.”
In this week’s blog, I’ll explain why, but more importantly, I will outline a simple 3-step approach that will help you prevent acid reflux and heartburn by treating its underlying causes.
數(shù)以萬計的美國人生來就有胃酸過多的遺傳缺陷嗎？而又是因為人類進化的需求，所以必須使用強抑酸藥物來防止胃灼熱和反酸癥狀嗎？
我相信針對以上問題的答案都是 “NO” ！?在這篇文章中，我會解釋原因并列出三個基本步驟，從根源上來進行預防。
The Truth about Acid-Blocking Medications
At least 10 percent of Americans have episodes of heartburn every day, and 44 percent have symptoms at least once a month. Overall, reflux or GERD (gastroesophageal reflux disease, also known as heartburn) affects a whopping 25 to 35 percent of the US population! As a result, acid-blocking medications are the third top-selling type of drug in America today.
關于抑酸藥物的真相。
美國人口中，約10%每天都會有胃灼熱的癥狀發(fā)作，約44%一個月至少會發(fā)作一次，總體來說，目前高達20%-35%的美國人口正遭受著反酸或GERD（胃食管反流病，也稱作胃灼熱、燒心）的困擾！因此，抑酸類藥物居然進入了美國藥物銷售排行榜的前三名！
Studies show that people who take acid-blocking medications for the long term can become deficient in vitamin B12.
研究表明，長期服用抑酸藥物會造成體內維生素B12缺乏。
Things have certainly changed since I was in medical school. In those days, GERD wasn’t even considered a serious disease. Instead, people had heartburn or ulcers, but that was pretty much it. When acid-blocking drugs first came on the market, even the pharmaceutical representatives warned us how powerful these drugs were. They told us not to prescribe them any longer than 6 weeks and only for patients with documented ulcers.
從我在醫(yī)學院學習到現(xiàn)在的這段時間里，變化已經悄然發(fā)生了。那時候GERD沒有被認為是一種嚴重的疾病，只是有燒心癥狀或潰瘍而已。當抑酸藥物進入市場后，甚至醫(yī)藥代表也警告我們藥力有多么強大，建議開藥不要超過6周，而且只能給有明確潰瘍診斷的患者。
Now, these drugs are given like candy to anyone who ate too many hot dogs at a ball game — and one drug, Prilosec, is available without a prescription. Their manufacturers have created the illusion that we can eat whatever we want with no consequences, just by popping a pill. They even have commercials showing a family rushing to stop their father from eating a big sausage with fried onions and peppers — and he tells them not to worry because he took his acid-blocking pill!
然而到了今天，這些藥物就像糖果一樣隨意發(fā)放，比如熱狗吃多了就可以服用奧美拉唑，甚至不用醫(yī)生開處方就可以買得到。藥品制造商給我們形成這樣的一種幻覺——任何時候你都可以用一片藥來解決問題！甚至有的商業(yè)廣告是這樣的：一家人企圖制止父親不要吃一個帶有洋蔥和辣椒的大三明治，但他說“不用擔心，因為我吃了抑酸劑”。
I know someone who used to work for the makers of Pepcid, another acid blocker. He told me that when it first became available over the counter, teams of drug company representatives would stand at the gates of county fairs and southern barbeques and hand out free samples.
一個曾經在制造法莫替丁的公司的員工告訴我，當這個藥物首次作為非處方藥物出現(xiàn)時，藥廠團隊甚至在游樂場外面發(fā)放免費的試用裝。
In reality, acid-blocking drugs are a double-edged sword. Let’s look at some of the recent research on the dangers of these drugs.
事實上，抑酸劑是一把雙刃劍，讓我們來回顧一下近期有關藥品危害的報道。
What the Research Tells Us about Acid-Blocking Medications
Acid blocking drugs obviously block acid that can cause symptoms of heartburn and reflux. But your body actually needs stomach acid to stay healthy. Stomach acid is necessary to digest protein and food, activate digestive enzymes in your small intestine, keep the bacteria from growing in your small intestine, and help you absorb important nutrients like calcium, magnesium, and vitamin B12.
抑酸藥確實可以抑制會導致燒心和反酸癥狀的胃酸，但事實上，我們的身體是需要胃酸的！它可以幫助身體有效的分解蛋白和食物，刺激小腸中消化酶的活性，并抑制小腸壞菌的產生，幫助吸收營養(yǎng)物質，如鈣、鎂、維生素B12。
There’s evidence that taking these medications can prevent you from properly digesting food, cause vitamin and mineral deficiencies, and lead to problems like irritable bowel syndrome, depression, hip fractures, and more.
有數(shù)據表明服用抑酸藥物可以導致消化不良，營養(yǎng)素和微量元素缺乏，并有可能引起IBS（腸易激綜合征）、抑郁、髖骨骨折，甚至更嚴重的疾病。
For example, studies show that people who take acid-blocking medications for the long term can become deficient in vitamin B12,(iii) which can lead to depression, anemia, fatigue, nerve damage, and even dementia, especially in the elderly.
還有研究證明長期服用抑酸劑的人群可能缺乏維生素B12，甚至抑郁、貧血、疲乏、神經損傷，癡呆（尤其是老年人）。
The research also tells us that taking these drugs can cause dangerous overgrowth of bacteria in the intestine called Clostridia, leading to life-threatening infections.(iv) For many more people, low-grade overgrowth of bacteria in the small intestine leads to bloating, gas, abdominal pain, and diarrhea (many of the common “side effects” noted in the warnings for these drugs). This can cause irritable bowel syndrome.
研究同樣證明長期服用這些藥物可造成腸道孫內梭狀芽胞桿菌的過度生長，嚴重感染者可威脅生命。對于大多數(shù)人來說，低級別的腸道壞菌過度繁殖可導致腹痛、脹氣、腹瀉（常見的藥物副作用），進一步引發(fā)IBS。
In addition, a recent study in the Journal of the American Medical Association found that chronic use of acid-blocking drugs leads to an increase in the development of osteoporosis and increase in hip fracture because blocking acid prevents the absorption of calcium and other minerals necessary for bone health.
另外，近期發(fā)表在《美國醫(yī)學協(xié)會雜志》上的一個研究表明長期應用抑酸劑影響維持骨質健康的鈣和礦物質的吸收，這會導致骨質疏松和髖骨骨折風險的增加。
All this is only part of the problem. There have even been some reports that these drugs may increase the risk of certain cancers.
這只是其中的一些小問題而已，更有研究表明這些藥物可能會增加某些癌癥的發(fā)生。
These are serious health concerns, and it’s pretty clear that in this case, the “cure” of acid-blocking drugs is worse than the “disease” of GERD. But that’s of little comfort when you’re suffering from heartburn.
這些都是值得重視的健康問題，我們要很清楚的一點是，抑酸藥物的“療效”不及胃食管反流病帶來的“危害”更大，但當人們經受胃灼熱的痛苦時還是會有一些改善的。
So if drugs are not the answer, what is? We need to find the real causes of reflux and heartburn, get rid of them, and use the right foods, nutrients, and lifestyle therapies to heal the problem.
如果藥物不能解決問題，那應該怎么辦呢？我想，我們應該找出燒心和反酸癥狀的真正原因并避免它，從食物、營養(yǎng)和生活方式的干預上來從根本上解決問題。
What Causes GERD?
Fried food, alcohol, caffeine, and soda can all trigger reflux. Spicy, tomato-based or citrus foods may also cause problems for some people. Smoking also increases the risk of reflux. Being overweight and having your belly fat push up on your stomach can prevent it from emptying, triggering reflux. Having a hiatal hernia (where your stomach pushes up through your diaphragm) can also cause trouble and can be diagnosed by x-ray. Eating large meals and eating before bed are two other main reasons for reflux. These are the most obvious causes, and the ones you have probably heard about. However, there are a few more that bear mentioning.
到底是什么引發(fā)了GERD?
油炸食物、酒精、咖啡因、軟飲料都會引起反酸，而辛辣、以番茄為原料或柑橘類的食物也都有可能造成人們的不適感。吸煙會增加反酸的風險，肥胖或腹部脂肪過多會妨礙胃的排空，引起反酸。食管裂孔疝（可以通過X線檢測來確診）也同樣造成影響。另外兩個重要誘發(fā)因素就是暴飲暴食和睡前2小時內進食。這些都是最常見的、你可能聽過的誘因。然而，還有一些可能是鮮為人知的。
Stress contributes to reflux. Clearly, food is supposed to go down, not up, when you eat. That’s why there are two main valves, or sphincters, that control food going in and out of your stomach — the one at the top (or the lower esophageal sphincter) and one at the bottom (the pyloric valve). When you’re stressed, the valve on the top relaxes and the valve on the bottom tightens up. This may result in food traveling back up your esophagus. Practice active relaxation and you mitigate this problem.
壓力可以導致反酸。很顯然，吃進去食物的時候是向下的，而不是向上，這就是為什么我們的身體有兩個閥門（括約肌），控制著食物在胃里的進出，一個在胃的頂部（食管下端括約肌），一個在胃的底部（幽門瓣）， 當壓力來襲時，胃頂部的閥門放松，但底部的閥門收緊，這就會導致胃內容物涌入食道。嘗試練習放松，可以緩解這個問題。
Magnesium deficiency is another cause of reflux because magnesium helps the sphincter at the bottom of the stomach relax, allowing the food to go down.
另一個導致反酸的重要原因是鎂離子缺乏，鎂可以使胃底部括約肌松弛使食物向下。
While controversial, I believe that a common infection can cause not just ulcers but reflux as well. This bug is called Helicobacter pylori and can be identified by a simple test blood or breath test. In my experience with patients, this treating the bacteria can eliminate reflux even if you don’t have an ulcer.
盡管有爭議，我依然認為這種常見的感染不僅可以引發(fā)潰瘍，也可以導致反流——就是幽門螺旋桿菌（可以通過血液或呼吸測定）陽性。在我醫(yī)治患者的經驗中，即使沒有潰瘍的存在，治療幽門螺旋桿菌的感染也是可以有效抑制反流的。
Food sensitivities or allergies can also cause reflux. Common culprits include dairy and gluten-containing foods like wheat, barley, rye, and oats. Plus, overgrowth of bacteria in the small bowel or yeast overgrowth in the gut can cause reflux.
食物敏感或不耐受也是導致反流的一個原因，常見的“元兇”包括奶制品、含麥麩蛋白的食物如小麥、大麥、黑麥、燕麥。另外，小腸中過度的細菌或霉菌生長也是可以導致反流。
These are all treatable conditions that you don’t need powerful acid blocking drugs to fix.
以上就是不需要強力抑酸制劑的一些狀況。
To properly diagnose the causes of your reflux, you may need to do the following.
要準確找到引起反流的原因，可參考以下幾點：
1. Ask your doctor for an H. pylori blood antibody test or breath test.
2. Consider a test for IgG food allergies and celiac disease.
3. Get a breath or urine organic acid test to check for small bowel bacterial overgrowth.
4. If you don’t get better with the suggestions below, consider getting an upper endoscopy or upper GI series x-ray to see if there is anything else wrong.
1. 血液檢測或呼吸實驗診斷是否有幽門螺旋桿菌感染。
2. 檢測食物過敏，排除乳糜瀉。
3. 呼吸實驗或尿液有機酸檢測腸道菌群過度生長狀況。
4. 如果下面的建議對你并沒有起到什么幫助，可嘗試上消化道內窺鏡或放射線檢查是否存在器質性病變。
3 Steps to Permanently Overcoming Heartburn and Acid Reflux
Step 1: Treat the Bugs if You Have Them
If you have H. pylori, treat it with triple antibiotic therapy from your doctor.
Treat yeast overgrowth with antifungal drugs such as nystatin or Diflucan or herbs such as oregano or caprylic acid.
Treat bacterial overgrowth in the small bowel with Xifaxin (see my blog on irritable bowel syndrome).
三步驟幫助你克服燒心和反酸?
第一步：修復
如果存在幽門螺旋桿菌感染，使用三聯(lián)療法殺菌。
治療霉菌過度生長，抗霉菌藥如制霉菌素、氟康唑，或草藥如牛至葉、亞羊脂酸。
腸道壞菌過多，使用Xifaxin。
Step 2: Change Your Diet
Try to eliminate dairy and gluten (see www.celiac.com for sources of gluten in the diet).
Eliminate alcohol, caffeine, citrus, tomato-based, and spicy foods.
Don’t eat within 3 hours before bed.
Don’t eat junk food.
Avoid processed foods.
Eat cooked foods, like fish, chicken, cooked veggies, and rice; avoid raw food for now.
Eat smaller, more frequent meals, at least 4 to 5 times a day.
第二步：改變飲食習慣
限制奶制品、麥麩蛋白攝入。
避開酒精、咖啡因、柑橘類、番茄類、辛辣食物。
睡前3小時不再進食。
不吃垃圾食品。
限制精加工食品攝入。
可以吃熟食如雞肉、魚肉，煮熟的蔬菜，大米，不吃生食。
少食多餐，4-5次每天。
Step 3: Try Some Natural Remedies to Help Soothe the Gut
Take 2 to 3 capsules of digestive enzymes with each meal.
Re-inoculate the gut with healthy bacteria by using probiotics.
Try 75 to 150 mg of zinc carnosine twice a day between meals — this has been extensively studied and is used frequently in Japan.
Take 3 to 5 grams of glutamine powder in water twice a day to help heal the gut lining.
Chew 2 to 3 chewable tablets of DGL (a form of licorice) 15 minutes before meals.
Try 200 to 400 mg of magnesium citrate or glycinate twice a day.
第三步：嘗試一些舒緩腸道的自然療法。
每日每餐的同時服用2-3顆消化酶。
使用益生菌重建腸道健康菌群環(huán)境。
每日兩餐間服用鋅75-150mg ，一日2次（在日本有深入的研究，應用較廣）。
谷氨酰胺粉劑3-5g溫水沖泡，每日2次，可幫助修復腸道內皮。
餐前15分鐘咀嚼2-3片DGL（甘草片）。
甘氨酸鎂或檸檬酸鎂200-400mg,一日兩次。
As you can see, there’s no need to suffer from heartburn and reflux — or to take expensive and dangerous acid-blocking drugs. I hope the changes I’ve suggested here will soothe your stomach and have you feeling healthy in no time!
所以，你并不一定要忍受燒心或反酸的痛苦，亦或使用昂貴、危險的抑酸類藥物，我希望今天給出的建議可以幫你舒緩胃部不適，保持健康的狀態(tài)！
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