Last week I read about a new “BLACK BOX” warning the FDA placed on the reflux drug Reglan and it got me thinking about Alice in Wonderland.
Remember when Alice followed the white rabbit down the hole? She comes upon a tiny door, but she’s too big to squeeze through it to get to the beautiful garden on the other side. So she drinks a bottle labeled “DRINK ME.” She shrinks down small enough to fit through the door. But the door’s locked and she’s left the key on the table now above her. So then she eats a piece of the cake thinking it will make her small enough to squeeze under the door. But instead it makes her grow much too big.
Sometimes I think we’ve all fallen down the rabbit hole. Especially when I hear about someone taking a pill that could cause more trouble than it solves.
Case in point: Reglan.
Trading one problem for another, bigger one
Reglan (or metoclopramide) is a prescription drug used to treat common, everyday reflux. It alleviates reflux by increasing the muscle contractions in your upper digestive tract. It basically speeds up how fast your stomach empties into the intestines.
According to the FDA, about 2 million Americans take drugs containing metoclopramide. But does it cause more trouble than it solves?
In fact, if you take it for more than 3 months (and research suggests that as many as 20 percent of patients do), you may be putting yourself at risk.
That’s because long-term use of Reglan has been linked to an increased risk of tardive dyskinesia (TD). What is tardive dyskinesia, you ask? Well, it’s a lot worse than reflux. In fact, tardive dyskinesia is described as "involuntary, repetitive movements of the extremities." According to the FDA this includes "lip smacking, grimacing, tongue protrusion, rapid eye movements or blinking, puckering, pursing of the lips, or impaired movement of the fingers."
To make matters worse, tardive dyskinesia appears to be irreversible. So even if you stop taking Reglan, the symptoms might not go away.
Three cheers for the FDA!
But don’t worry folks; the FDA is on the case. Our stalwart bastion of public safety has issued its strongest warning (the famed “BLACK BOX” warning) against long term use of metoclopramide, including Reglan.
According to an FDA statement, “The development of this condition (TD) is directly related to the length of time a patient is taking metoclopramide and the number of doses taken. Those at greatest risk include the elderly, especially older women, and people who have been on the drug for a long time.”
But here’s the kicker. Most folks are prescribed Reglan to treat reflux…a chronic problem. But if it’s going to get you into trouble after just 90 days, why is it used to treat a chronic condition?
That conundrum has still got me scratching my head.
Janet Woodcock, M.D. and Director of the FDA’s Center for Drug Evaluation and Research, has just added to my confusion. In a new release, she stated “The chronic use of metoclopramide therapy should be avoided in all but rare cases where the benefit is believed to outweigh the risk.” I guess Janet has fallen down the rabbit hole too. (Remind me, how do you treat a chronic problem without a chronic solution?)
A safe, chronic solution to reflux
Even if they’ve never resorted to Reglan, lots of people get stuck taking Prevacid, Nexium, or Prilosec to treat this common problem. But, in my opinion, there are much safer and easier ways to deal with acid reflux.
The most common misconception about reflux is that you’ve got too much acid. But I’ve found the opposite to be true. By adding more acid and enzymes to your system, the symptoms of this “chronic” problem disappear. Basically, the goal is to create a digestive environment that doesn’t allow reflux to occur.
Right off the bat, I would encourage anyone with reflux to add acidophilus to their regular regimen. The acidophilus will help restore the natural balance of bacteria in your gut. This will aid in the overall digestion of your food. Go for a capsule that contains billions of units of acidophilus. The trick is to open the capsule and pour it down your throat. Let your saliva wash down the powder. This will help to coat and protect your esophagus with good bacteria.
I would also add digestive enzymes to your regimen. I’d go for “full spectrum” enzymes to start. These help the body break down all food types (proteins, fats, and carbs). Take them immediately after meals, so as to augment, not replace, the body’s manufacture of its own enzymes.
For the tougher cases of acid reflux
Occasionally the combination of acidophilus and digestive enzymes isn’t enough to stop the burning of acid reflux. Though it’s very rare, the stomach’s defenses can weaken over time. You may develop an ulcer.
If that’s the case, I’d recommend adding DGL, a form of licorice that has one component removed (DGL means De-Glycerrhizinated Licorice). Chewing or sucking on one 20 minutes before eating can be very helpful in difficult cases.
Potter’s Acidosis solution—an all-natural herbal blend from England—can be very effective in improving your symptoms. Just bear in mind that it only “masks” your symptoms and doesn’t alter your gastric environment. Therefore I don’t consider it a “cure” to reflux.
I would also suggest eating multiple, small meals, instead of three all-you-can-eat feasts. Common sense applies here, folks. Avoid foods containing tomatoes or chocolate. Refined flour products, sugar, and alcohol are definitely all triggers as well and should be avoided.
If you begin to experience any of the symptoms of tardive dyskinesia, contact your doctor and please make sure to report your adverse reaction to the FDA‘s MedWatch program at 800-FDA-1088, by mail at MedWatch, HF-2, FDA, 5600 Fishers Lane, Rockville, Md. 20852-9787, or online at: www.fda.gov/medwatch/report.htm.