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Heartburn, also called gastroesophageal reflux disease (GERD), is the most common digestive disorder in the US, and the acid-suppressing drugs used to treat it can have dangerous side effects after long-term use.

The prevailing belief by the public, and even many conventional doctors, is that reflux is caused by having too much stomach acid, hence the standard treatment with antacids and PPIs. But we now know that GERD is not a disease of excess stomach acid, and many GERD patients actually produce lower levels of stomach acid than normal.

In light of this evidence, it seems logical that heartburn must be caused by stomach acid inappropriately entering the esophagus. And indeed, tests for esophageal acid contact time have confirmed that most patients with GERD do have above-normal acid contact time over a 24 hour period. (1)

As I’ve discussed in the past, one cause of increased acid reflux into the esophagus is dysfunction of the lower esophageal sphincter (LES), a valve that separates the esophagus from the stomach. This dysfunction can be caused by increased intra-abdominal pressure, which often results from bacterial overgrowth in the small intestine. This has been one of the prevailing theories about the underlying cause of reflux for several years now, but it has some limitations.

Not all GERD patients have abnormal amounts of acid reaching their esophagus

As I just mentioned, most GERD patients do have above-normal acid contact time. But most is not all. In fact, 24-hour acid contact tests have found that up to 30% of GERD patients actually have normal acid contact time. (2, 3)

Some patients with GERD symptoms even have normal endoscopy results – their esophagus looks the same as a healthy person’s esophagus. These patients are considered to have ‘non-erosive reflux disease,’ or NERD, and up to half of NERD patients have normal acid contact time. (4)

So, what separates a healthy individual from a GERD or NERD patient with normal acid contact time? If there isn’t too much stomach acid reaching the esophagus, what is causing the heartburn?

One theory gaining traction in the scientific community to describe this phenomenon is the idea of impaired epithelial barrier function. In other words – GERD might be a result of “leaky esophagus.”

Is a “leaky esophagus” the cause of your acid reflux? #gerd #heartburn

What is “leaky esophagus”?

You’ve probably heard of “leaky gut” before. Cells in the epithelial lining of the intestine are held together by tight junctions, and if these tight junctions are disrupted, particles that wouldn’t normally be absorbed make their way through the lining of the intestine and into the bloodstream. This can cause a host of problems, from food allergies to autoimmunity and more.

“Leaky esophagus” is a similar concept. It’s actually normal for acid and stomach contents to reflux into the esophagus occasionally. (5) In a healthy esophagus, this acid can’t penetrate the cell membrane of the epithelial cells, and tight junctions prevent it from getting in between the cells.

In fact, normal esophageal tissue is remarkably resistant to acid. In acid perfusion (or “Bernstein”) tests, acid is dripped directly onto the esophagus through a tube that is inserted through the nose (sounds pleasant, right?), and healthy people don’t experience any pain or heartburn, even after half an hour. (6)

However, if those tight junctions are disrupted, acid can make its way between the epithelial cells, decreasing the pH of the intercellular space. Since even small pH changes in this area are threatening to the body, there are pain receptors located close to the epithelial lining, and they send pain signals to the brain in response to the lower pH. These signals are interpreted by the brain as heartburn. Unsurprisingly, patients with NERD or GERD who receive the Bernstein test experience discomfort almost immediately.

As further evidence of the presence of leaky esophagus, biopsies of GERD and NERD patients almost always reveal dilated intercellular spaces, which is a marker for impaired barrier function. (7) These dilated spaces are increasingly being accepted as a hallmark symptom of both NERD and GERD.

Is leaky esophagus a cause or a symptom of reflux?

It appears that leaky esophagus is present in most cases of GERD. But it’s not clear whether leaky esophagus is a cause of reflux, or just another side effect.

Even though a healthy esophagus is resistant to acid, high levels of acid exposure over time will eventually lead to inflammation and impaired barrier function. In this case, increased acid exposure comes first – most likely due to a dysfunctional LES – and leaky esophagus is not the root cause; it’s just another symptom.

However, there maybe some reverse causality, particularly in GERD patients who have normal acid contact time. In this case, something other than acid exposure disrupts the epithelial tight junctions, which causes heartburn even at normal acid levels. Over time, this “leaky esophagus” can lead to the visible epithelial tissue damage observed in GERD patients.

This happens because the “back” side of an epithelial cell is not as resistant to acid as the “front” is, so once the acid seeps through the tight junctions, it can enter cells from the back and cause cell death and tissue damage. (8)

Unfortunately, this process can actually lead to LES malfunction and increased acid exposure, creating a vicious cycle. Now, increased acid exposure in the esophagus is a symptom of GERD, rather than the root cause.

What causes leaky esophagus?

So if leaky esophagus happens first in some cases of GERD, what causes leaky esophagus in the first place?

One possibility lies in the esophageal microbiome. The esophagus houses a community of microbiota similar in complexity to the intestinal microbiome, and the makeup of this bacterial community is different in healthy people compared to people with GERD. The microbes found in the esophagus of GERD patients are primarily gram-negative, while the microbes in the esophagus of healthy people are primarily gram-positive. (9)

Increased numbers of gram-negative bacteria can trigger inflammation by exposing epithelial cells to lipopolysaccharides (LPS), a component of gram-negative bacteria that causes immune responses in the body. (10) The inflammatory cytokines released in response to LPS can then lead to loss of tight-junction integrity, resulting in esophageal permeability. (11, 12)

Exposure to LPS can also cause the LES to relax, promoting reflux and increasing acid exposure time – again, creating a vicious cycle. (13)

Unfortunately, there isn’t a lot of research yet that clarifies the causes of increased esophageal permeability. But if the mechanisms at work in the esophagus are similar to those in the intestines, other probable causes could be stress, excessive alcohol consumption, and excessive use of non-steroidal anti-inflammatory drugs (NSAIDS). (14, 15, 16, 17)

All of these factors can contribute to leaky gut, so it wouldn’t be surprising if they contributed to leaky esophagus as well.

What does this mean for heartburn sufferers?

As you can see, GERD is a complex and multifaceted disorder with no single cause or presentation. Luckily, all of the strategies for healing heartburn and GERD that I’ve been recommending for years would also be expected to heal leaky esophagus.

A low-carb Paleo diet, gut-healing foods like bone broth and fermented foods, regular stress-management, and a focus on balancing the intestinal (and esophageal) microbiome with probiotics and prebiotic foods are always good approaches to treating the root cause of GERD.

Now I’d like to hear from you. Have you cured your heartburn using a Paleo diet? What other strategies have worked for you? Share your story below!

https://www.girlsgonestrong.com/

As a new mom, adjusting to life with your new responsibilities and new schedules, you may be itching to start (or get back into) a fitness routine to carve out some me-time and reap the benefits of exercise. After having a C-section, there are definitely some very effective exercises and workouts you can do. However, it’s important to also know which exercises and workouts that are not recommended after a C-section.

Rehab is important after a C-section. Although it’s often treated like a minor procedure (likely because it’s so common) it is actually a major surgery. Keep in mind that I’m not saying this to scare you, but rather, to help you understand the importance of taking the time and care to rehab your body after your C-section, just like you would any other major surgery. For more on rehabbing and returning to exercise, read Returning To Exercise After A C-Section.

This scar is not just on the surface, remember, it’s many layers deep into the belly.

The core and pelvic floor have undergone pressure and changes throughout pregnancy, as it is. Compound this with incisions, pulling, and stress from a C-section, and you have a body that deserves adequate care and recovery protocols.

The exercises below are ones I recommend you avoid after a C-section—att least until you have healed your core and pelvic floor with exercises that restore function to those muscles (e.g. healed diastasis recti, no incontinence, no pelvic or back pain, etc).

I also advise you see a pelvic floor or women’s health physiotherapist after a C-section (from 6-8 weeks onwards) to have an assessment of your abdominal wall and your scar function.

The following exercises are not recommended because:

• They could cause more harm than good.
• You risk damaging the pelvic floor or pelvic organs.
• They could increase the severity of your abdominal separation.
• They could cause undue stress to the incision, and prevent the scar from healing properly.

Exercises to Avoid After C-Section

1. Traditional/advanced abdominal exercises

In this category, I would include exercises that put a lot of stress on the abdominal wall. Exercises that feel like you’re working the abs really hard/you feel a lot of pulling or straining on the abdominals, or that you cannot breathe through, or you can see your belly and lower pelvic region bulging up/out when you’re doing the exercise.

This doesn’t mean that you shouldn’t do exercises that work the abs. You should, in fact. That being said, there are abdominal exercises that are more beneficial than others.

I place these ‘not-so-beneficial’ abdominal exercises into two categories:

Exercises where the belly/lower pelvic region is bulging up or out: crunches and sit-ups, leg raises, bicycles, knee tucks, jackknives.

You don’t want to train the belly to bulge outwards. This can create too much pressure on your C-section incision and on the connective tissues of the abdominal wall increasing the severity of diastasis recti.

These exercises could also be placing a lot of stress downward on the pelvic floor and pelvic organs. You might feel pressure on your bladder, like you can’t hold your bladder.

If we train the belly to bulge, it will keep bulging!

Exercises where the belly is hanging or drooping down towards the floor: front planks and variations, pushups, renegade rows, conventional deadlifts, etc.

In these exercises the belly may be hanging towards the floor. This can be an issue if you can’t feel “tension” in the abdominals; if you feel like you’re going to ‘fall out the front’ of your belly.

For example, if you’re doing a front plank directly on the floor and you never feel it in the abs, but feel a TON of work in the shoulders and upper back, or some discomfort in the lower back, this is a good sign that variation of front plank needs some tweaking.

2. Plyometric exercises

In this category, I would include exercises or workouts that use:

• Running, sprinting, jogging
• Jumping, box jump, jumping rope
• Burpees, squat thrusts, and other similar conditioning exercises

The issue here is that you’re working on an unstable pelvis and core post C-section. These plyometric exercises require so much core stability!

If your body doesn’t quite have it yet, you’re just waiting for an injury to happen. These injuries can show up in the form of lower back, hip, knee, and neck pain.

3. Intense exercise/exercise classes

You need to re-train the body. Just as there would be with any other surgery, a C-section requires taking just a couple of steps back to teach the core and pelvic floor muscles that are so intimately affected by the procedure of a C-section, how to function at their best again.

If you jump right back into heavy weight training (or the abdominal and plyometric exercises mentioned above), intense cardiovascular workouts, or something like a typical ‘mom and baby bootcamp’ class (with lots of running, jumping, crunches, etc) you’re again risking injury.

Keep your sights set on the long-term gains. This is where the physical results come from – consistency.

Whenever you start working out again after having your baby, it is simply more effective to stick to exercises and an exercise schedule that rebuild your strength slowly and steadily, rather than starting where you think you “should be” or where you left off before pregnancy.

We want to keep you exercising for the long term, not for three weeks until you throw your back out from exercise that’s too intense for your core to handle.

If you’re looking for an example of a safe C-section recovery strength training workout, read this article.

4. Exercises that cause pain

This applies to your whole body, but pay special attention to how your incision/scar site feels during and after exercise.

You may feel some gentle tenderness if you’re just beginning to work out again. Knowing that you worked out the day or two before is great. Having some muscle soreness is good!

But, if you’re feeling aching or pain in your scar that bothers you in your workouts or daily activities, you need to reevaluate and make some changes.

I strongly recommend seeing a pelvic floor physiotherapist, women’s health physio, massage therapist, or other therapist who works with scar tissue, and have them work on your scar or teach you a few techniques to do “scar mobilization” on yourself.

This is an important piece of the puzzle to helping your scar heal well (it’s never too late for this), and for getting good sensation and movement back in the tissues around your scar.

5. Anything that your gut tells you isn’t quite right

Listen to your body. Trust your body.

If something doesn’t feel quite right during an exercise, it’s probably not. If you just “know” that what you’re feeling in your body isn’t comfortable, stop.

Sometimes exercises will feel a bit awkward when you’re first learning them, and that’s ok. My clients often tell me that a lot of the exercises in their training plans feel really awkward at first when they’re learning them!

But, if an exercise is causing you pain, if there’s a ton of pulling through your scar, if you feel pressure in your bladder or rectum, if you’re leaking urine during or after a workout, and/or if you can’t breathe well, stop the exercise.

Remember: FUNCTION first, before any intense exercise.

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Originally posted at: http://www.nerdfitness.com/

“[Luke,] I am your father.”

I bet you can remember where you were when you heard that famous line uttered by Darth Vader to Luke in The Empire Strikes Back. I remember watching this as a small child and my jaw dropping at this revelation: holy crap! The bad guy is the dad of the hero! Han is frozen in carbonite! How the heck do they get out of this?

With today being Star Wars Day (“May the Fourth be with you!”) and a recent trailer dropping that took the internet by storm, I felt like this would be a good chance to explore our fate and what we really get out of our time on this planet.

Ultimately, do we have to follow in our parents’ footsteps? Am I predestined to be like them? 

Star Wars explores this very question, and I want to talk about our own fate today. It’s probably best you listen to Duel of the Fates in the background while reading.

Destined for the dark side?

“The Force is strong in my family. My father has it. I have it. My sister has it.”

When Luke discovers Vader is his father, you have to feel for him. The guy he’s been chasing, the guy who killed his mentor, the guy who is trying to kill him…is his freaking DAD. Luke is wondering “if he is capable of this great evil, am I capable of it as well? The same blood that flows in his veins flows in mine.”

I’m sure we’ve all been there, parents especially – when growing up we saw our parents do something and said, “when I’m a parent I’m not gonna be like them!” And then you have kids, and realize things are more complicated. Or maybe your parent was a smoker, or struggled with addiction/obesity, and you vowed to be different. But can we?

We have to face facts first: genetics and the habits we were brought up with do matter. Whether they are healthy habits or unhealthy habits, learned from great parents or parents who didn’t pass along a solid foundation – they matter. Maybe you have anger management issues like your dad, a sugar addiction like your mom, or you had parents who struggled to hold a job (or, parents who are doctors or scientists)!

We can’t pick our parents, just as Luke didn’t pick for his father to be Darth Vader. We also can’t pick how we were brought up (good or bad), or go back in time and change how we were treated or raised:

• If you have overweight parents who thought trying to get healthy was a waste of time (“my dad was overweight, so was his, and you will be, too”), or they ate unhealthy foods and never gave it a second thought, it’s challenging to break free of that destiny.
• If you had parents who placed values on the wrong things, or shamed others for being different, there will be a STRONG pull to go in that direction.
• If we had parents who struggled with addiction or abuse, it can feel like ‘history will repeat itself.’

Ultimately, it can feel as though the deck is fixed and it’s going to play out in a certain way regardless of what decisions we make, which can make us feel helpless.

But there is (a new) hope!

In my years of running Nerd Fitness, I have seen thousands upon thousands of people buck the trend, break free of their fate, and change the ‘predetermined path’ they were on. The pull towards the dark side is strong, but with the right strategy you CAN turn out differently.

And only you can alter your path.

It’s something we need to learn before it’s too late.

You are not your father

In the book The Top Five Regrets of the Dying, do you know what the #1 regret was of people who were on their deathbed?

“I wish I’d had the courage to live a life true to myself, not the life others expected of me.” 

Maybe you grew up in a family where obesity is par for the course: fast food, diabetes, and heart attacks at an early age are part of the plan. Maybe now you feel like you dying young of heart disease is a foregone conclusion, as it happened to your dad and your grandpa. Heck, it even applies to your career, education, and other life choices!

I was fortunate to be raised by loving parents, and I subconsciously led myself to follow a particular career path because I thought it would make them (and thus make me) happy; I figured that they were both in sales and thus I should get into sales too. It turns out, they just wanted me to be happy, but I put unnecessary pressure on myself because I thought this was what was expected of me.

But let me tell you something that Luke learned long ago:

You are not your father.

You are not your mother.

Luke was aware of his father’s path, and had the choice to join him. In a what is surely a 20 seconds of courage moment, instead of seeking his dad’s approval, he chooses to stand on his own:

As Henry Rollins points out in The Iron and the Soul:

“I believe that the definition of definition is reinvention. To not be like your parents. To not be like your friends. To be yourself. Completely.”

You get to pick if you want to go to the light side or the dark side: Become the Jedi you want to be, not the person you think you’re supposed to be. There might be a very strong pull in one direction, but ultimately it is never too late to start your training, or change course. Villains can become heroes, second-tier characters can become major players, and futures can change. But it requires honesty, a bit of bravery, and taking bold action.

Just know you’re not alone – We have about 33,000 Rebels on our free message boards who are here to support you, help you, and offer up words of advice as I’m sure many of them have felt the same.

Remember, true courage is living a life true to yourself, not the life others expected of you.

Motivation goes both ways

Although we spend three full movies absolutely loving to hate Darth Vader, he redeems himself in the Return of the Jedi when he chooses to sacrifice himself and destroy the Emperor in order to save his son:

There are few tougher conversations to have than one as a child telling his or her parents, “I’m worried about you, and I want you to be healthier.” Parents are often set in their ways (see Vader), but deep down it doesn’t mean they’re not listening (see Vader).

We grow up seeing our parents as invincible….until the day they’re not. My parents weren’t the healthiest people – raising three kids and both working jobs resulted in them putting on a few unhealthy pounds over the years. After starting Nerd Fitness, I started to worry more about them, but struggled with finding a way to bring it up the right way.

So I did the next best thing: I got myself in the best shape I could. I asked for healthier foods when I came home to visit, laughing at the “wait, but I thought you only ate pizza and spaghetti?” jokes. Unbeknownst to me, it had an effect on my parents – they actually started to apply some of the principles I chose to live by as well! It was really cool to see and I’m glad to see my choices have influenced their choices.

Having a conversation with parents about making changes, when it comes to being healthy or happy, is never easy. This is especially true if your name is Luke Skywalker, and your dad is trying to chop your head off with a lightsaber. If your name isn’t Skywalker, then you’re still up against the people who changed your diaper – tough.

Use the Force: If you still have parents and talk to them regularly, then your best bet is to become a model Jedi. Be ready, willing, and able to have a conversation with them about being healthier and happier when they bring it up, and offer support when they ask. The pull can be strong on you – but know that the pull can work BOTH ways, so use that to your advantage!

What are you giving to the next generation?

This Winter, Star Wars Episode VII will be released, and a whole new generation of Jedi, X-wing pilots, storm troopers, and Sith lords will do battle. Oh and the freaking Millenium Falcon is back. And a whole new generation of Star Wars fans will be born.

You have an opportunity to change the fate of the Galaxy as well. A study in the Journal of Pediatrics said the factor that puts children at greatest rick of being overweight is having obese parents.

If you want to give your kids the best possible chance to live the life of a healthy Jedi, taking care of yourself (and ‘selfishly’ making your health a priority) is the first place to start. Your kids are watching not what you say, but what you do, and you can drastically impact how they treat others, how they feel about themselves, and how they take care of themselves through YOUR actions.

The choice is yours. I hope you pass along the great qualities you’re building in yourself. And please, don’t blow up any planets.

I want to hear from you: have you bucked the trend of unhealthiness or unhappiness in your family? Have you broken out on your own against the path set for you? Or did you end up following a “pre-determined path” and now realize it wasn’t the path you wanted for yourself?

How about inspiring your parents to live better lives through example? Or have you gotten in shape and helped your kids make the connection with healthier choices too?

May the fourth Force be with you.

-Steve

PS: With a bunch of new campers signing up over the weekend, we have something like 25 spots left for Camp Nerd Fitness this fall! Hope to see you there

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photo source: JD Hancock: Luke vs Darth, JD Hancock: Han vs Luke, Kenny Louie: Luke Lego, JD Hancock: Snake Eyes vs Luke