Can Acid Reflux Medications Cause Dementia?

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An interesting article caught my attention regarding the association between long-term proton pump inhibitor use and rates of dementia. Researchers from the University of Rostock in Germany analyzed over 73,000 medical records from an insurance database from 2004 to 2011. What they found was that patients receiving proton pump inhibitors (PPIs) for acid reflux were found to have significantly higher rates of dementia (44%). 

My interest in this study comes from the fact that acid reflux and obstructive sleep apnea tend to go hand in hand. Obstructive episodes can create tremendous vacuum forces in the chest and throat cavities, literally suctioning up normal stomach juices into the esophagus and even the throat. Besides conservative recommendations, acid-reducing medications such as PPIs (various brands include Prilosec, Nexium, and Prevacid) are usually prescribed. All these medications work by blocking the proton pump in the acid-secreting cells in the stomach. Another class of medications includes the H2 blockers, with two common brand names seen is Tagamet or Zantac. These medications are sold over the counter, as well as by prescription. It’s estimated that the market value for acid reflux medications in 2016 was $5.66 billion. 

Here are some of my comments and observations about this study:

  1. Mouse models have shown increased rates of beta-amyloid buildup in mice given PPIs.
  2. PPI use was shown to block the neurotransmitter acetylcholine, potentially leading to dementia. 
  3. Untreated obstructive sleep apnea (OSA) is also associated with higher rates of dementia. In this Taiwanese insurance database study, there was an overall 1.7x increased risk of having dementia if you also had OSA. For older males (ages 50 to 59), the risk was 6x higher, and for older females (> 70), about 3x higher.
  4. In this prospective study, older women (average age 82) without dementia were found to develop higher rates of mild cognitive impairment (1.85x) if they had obstructive sleep apnea (AHI > 15).
  5. Intermittent hypoxia (low oxygen levels), which is commonly seen in patients with untreated obstructive sleep apnea has been shown to increase levels of beta-amyloid plaques in mice.
  6. Acid reflux medications do nothing to prevent acid reflux. Instead, they lower acid production in the stomach, rather than keeping stomach contents in the stomach. What comes up, however, still includes bile, bacteria, and digestive enzymes. Pepsin, a well-known stomach enzyme, has been found in the lung, ear and nasal/sinus areas.

It’s important to realize that all of the above-mentioned studies don’t prove cause and effect, but only associations. It’s hard to tease out if dementia and OSA have the same causes (leading to an association), or if needing to take …

To Breathe, or Not to Breathe, That is the Question: The Face Mask Controversy

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I couldn’t understand why my head was throbbing. I wasn’t feeling well at all. There was no fever or any other signs or symptoms of an infection. I had eaten a healthy dinner before starting my 12-hour overnight shift in the ICU. 

It was 3 AM, and my four patients were relatively stable. I decided to go to the break room to eat a snack. A few minutes after taking off my N95 mask, my headache went away completely. I felt my scalp with my fingers and noticed two deep crevices where the tight elastic bands had left their marks. The mask had clearly cut off blood flow to my scalp.

After returning to the nursing station in front of my patients, I noticed that I was more clear-headed and less anxious. The few minutes of escape from my mask with unrestricted blood flow to my scalp and normal breathing without a mask was liberating.

The Face Mask Controversy

During the past few months of the coronavirus pandemic, there have been a number of recommendations by The World Health Organization (WHO) and the US Centers for Disease Control (CDC) that have been reversed, or even contradictory. The recommendation for using a face-mask is one of such guidelines, with conflicting studies, changing recommendations, and even a study publication retraction. 

Several studies from past pandemics as well as recent ones suggest that using a face mask (non-N95) may lower the rate of virus transmission. Other studies have refuted such findings. However, I am not going to address whether or not face masks can potentially reduce infections. There are so many variables that affect rates of transmission, I don’t think there ever will be a definitive answer. What I wish to focus on in this blog article are the documented side-effects of using a face mask.

Comparing Apples to Oranges

In contrast to rigorously controlled research studies, regular people who wear face masks us a variety of different masks. There are countless other variables, such as the fit, facial shapes and sizes, mask materials, and even your ability to breathe normally without a mask. To ask whether or not a face mask works is not the right question. What we should be asking is, to what degree does a specific type of mask, if worn and used properly, offer protection from transmitting or being infected with the coronavirus, compared to the potential side effects. Just like any prescription medication, there are side effects. Some people will have more side effects than others.

Known Complications of Face Mask Use

Any type of mask or covering over your nose and …

The Surprising Link Between Vitamin D and the Sleep Neurotransmitter Acetylcholine [Podcast #91]

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Interview With Doctor Stasha Gominak

Please join me on this fascinating interview with Dr. Stasha Gominak, where she will give us an update on Vitamin D and the gut biome. Dr. Gominak’s two past interviews were two of the most popular downloaded podcast episodes.

In this 84 minute interview, she will discuss:

  • How vitamin D is linked to acetylcholine, an important brain neurotransmitter
  • Acetylcholine’s role in sleep
  • New findings about vitamin B5 (pantothenic acid).

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Show Notes

Dr. Stasha Gominak’s website


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My Interview on Healthy Home Habits Summit: How to Promote Health, Reduce Toxins, and Create a Home That Keeps You Healthy!

Originally at: Domonique Silva

As a husband, parent, and physician, I know how hard it is to get trustworthy information that helps you get down to the root causes of your health challenges.

I remember when I first had my revelation about the importance of proper breathing during sleep, which lead to me write my book, Sleep Interrupted. Over the years, however, I realized that health and wellness are more than just good breathing and optimal sleep. It’s about addressing various other important factors, many of which come from your environment: what you eat and what you are exposed to.

That’s why I was so thrilled when my friend Domonique told me she was hosting an interview series all around this topic, which actually came out of her own research project to learn how to promote health and reduce toxins around the home and inside the body. Domonique is an Environmental Health and Safety Specialist and she has struggled through her own health challenges over her lifetime.

Her summit is called: Healthy Home Habits: How to Promote Health, Reduce Toxins, and Create a Home That Keeps You Healthy!

21 experts are unifying to help each other satisfy this calling. We have to take more control of our health and healing and learn more about the risks that threaten us. Together, we want to help you with the how and the what behind the toxins in your environment while giving practical tips that you can apply right away. Domonique will interview me about the importance of good sleep as a prerequisite for your body to heal properly and to better detoxify any toxins you may be exposed to.

You can register here. It starts Monday, June 1.

Just so you know, you will be able to watch from your home, office, or on the go. This is a great opportunity for anyone in my community who is out there seeking answers to your health problems, (and of course, you can also attend if you are just curious).

This is something I wish I had when Kathy and I started our personal health journey. This is why I am so glad Domonique is hosting this and that I get to share it with you.

Click here to register for the Healthy Home Habits Summit.

Hope to see you on Domonique’s summit.

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7 Ways You Can Prevent Putting on Pounds During This Pandemic

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One casual observation I’ve seen during countless Zoom and FaceTime sessions with old friends and acquaintances is that many seem to have gained significant weight. I admit that just by seeing their faces onscreen is not an objective way of documenting weight gain. But from what I’m seeing and hearing from patients during our video sessions, many are telling me that they have gained significant weight in the past 4 to 6 weeks. Some of the reasons why people are putting on pounds are pretty obvious, but some are not.

Here are 7 reasons why you may be gaining weight during the pandemic and what you can do about it.

1. Less Physical Activity

This is the most obvious change for everyone. Since I’ve been doing more video teleconferencing for meetings and patient encounters, I’ve been sitting dramatically for longer periods of time. When I’m seeing patients, I’m often getting up, walking around, greeting patients, walking over to my secretary or another staff member to ask a question. Now, everything is done in front of a computer. 

Sitting for long periods without regular breaks has been found to lead to less productivity and creativity. Regular 5 to 10 minute breaks every 45 to 60 minutes is important not only to increase productivity but also to create a sense of time-limited urgency, like catching up on all your work and loose ends before going on vacation. Everyone has different needs regarding how long to work in-between breaks. The important point is that you need to take the time for regular breaks. 

One new routine (and now ritual) that our family started is a short walk outside along with our dog, Louie. We’ve been doing it after every dinner, as well as after lunch if I can join them. This was a custom I remember doing while growing up in South Korea. It brings back fond memories of my childhood. If you Google health benefits of walking after dinner, you’ll see countless articles and studies supporting this activity, especially with glucose control. 

2. Less Sun Exposure

Many people have jobs that already requires working indoors, but now it’s even a greater proportion, especially with the pandemic lockdowns. Sunlight is a crucial component of your internal circadian clock. It resets the daily 24 hour rhythms of the body, optimizing all body functions, as well as to prepare you for optimal sleep at night. In fact, it’s been recently discovered that every cell in your body has genes for a 24-hour clock.

In addition, sunlight is a major factor in your body’s ability to make vitamin D, which is a hormone …

Can Coronavirus Cause You to Gain Weight?

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I have to admit that the title is a head fake. There are no studies that I’m aware of that suggests that catching the coronavirus may lead to weight gain. However, I will make a strong argument that for many people, it can promote weight gain indirectly through these 5 possible scenarios:

  1. Altered Eating Patterns

Sheltering in place definitely changed everyone’s eating habits, timing, as well as food quality. There’s no doubt that many more people have to order their meals, which in general tends to be less healthy. Even if you wanted to cook more often at home, everything has changed. Grocery shopping can be an ordeal, with long lines, empty store inventories, and stressful environments. This change in your cooking/eating/purchasing patterns is sure to alter what you eat, when you eat, as well as how much you eat. Watching more online movies at night can also promote snacking later into the evening times. This goes against my most important health recommendation to improve sleep—don’t eat or snack within 3-4 hours of bedtime. 

  1. Altered Exercise Patterns

For those of you who rely on regular gym facilities, your exercise patterns are severely disrupted. Many of you are resorting to online courses or live-streams, but it’s not the same as physically working out at the gym with others or even on your own. It’s likely that the duration or intensity of your exercise routine is now much lower. This can contribute to challenges in losing weight.

  1. Altered Sleep Patterns

Although you may think that you have more time to sleep due to the shelter in place regulations, it’s not necessarily true. Many people are watching more movies or television programs. Oftentimes, it can go later into the night, leading to sleep deprivation. Furthermore, whether you watch on your widescreen TV or computer, extra blue lights from the LED screen will lower an important sleep hormone, melatonin. This will delay the time you want to fall asleep. As mentioned before, watching TV late at night is associated with snacking. It’s proven that lack of sleep significantly promotes weight gain.

  1. Less Sunlight/Lower Vitamin D

Even with the onset of spring and warmer temperatures, sheltering in place lessens time spent outdoors. This means less time for sun exposure, leading to lower levels of vitamin D. In general, most Americans have low levels of vitamin D, and what we ingest in our food supply is not nearly enough. A healthy gut biome (with optimal sleep and healthy diet) is needed for proper vitamin D absorption, as well as conversion to the active form of vitamin D that the body uses as a …

How Mouth Breathing May Put You At Risk for Viral Infections

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In his classic book, Shut Your Mouth and Save Your Life (1870), American painter George Catlin described a correlation between pre-civil war Native Americans who were mouth breathers and various chronic illnesses. In a 30 year span (1830 to 1860), he visited over 150 Native tribes in North, Central, and South America. 

Catlin observed that tribes with no Western influences had zero infant mortality, and no childhood deformities or diseases. He noted that Native American nose breathers tended to be much healthier compared to white “civilized” people who were more prone to mouth breathing and tended to be much more sickly in general. He also commented on how beautiful the natives’ smiles were with beautiful teeth.

An interesting story illustrates Catlin’s observation: Two Native Americans were in an argument and knives were drawn. Catlin and others were successful in calming the two men down and eventually, they were reconciled. Catlin later took aside one of the two men and asked if he was afraid of his opponent, who was much bigger and stronger. The man reportedly responded, “No, not in the least; I never fear harm from a man who can’t shut his mouth, no matter how large or how strong he maybe.”

Beautiful smiles and no cavities, but 100 years ago?

Almost 60 years later, Catlin’s observations were mirrored and expanded on in his classic book, Nutrition and Physical Degeneration (1939) by Dr. Weston Price. An active researcher in the Canadian and American Dental community, Price traveled to numerous remote areas of the world finding that cultures that ate completely off the land had broad faces, beautiful, full smiles, and minimal to no cavities. Only after the adoption of Western diets did their children’s teeth come in crooked with many more cavities and more chronic medical illnesses. 

Why mouth breathing may make you sick

So what does mouth breathing have to do with viral infections? I’ve written before that our nose and sinuses make a gas called nitric oxide. This gas has two important features: proven antimicrobial properties and the ability to increase oxygen uptake in your lungs. There have been many studies showing nitric oxide’s ability to kill viruses, bacteria, fungi and even parasites. In particular, nitric oxide was also found to lower SARS Coronavirus replication by 82% in this study from 2005. The study authors showed that nitric oxide inhibits viral protein and RNA synthesis. 

How nose breathing can increase oxygen in your lungs

This study found that blood oxygen levels were 10% higher in healthy volunteers who were nose breathing compared to mouth breathers. In ICU patients who were intubated, …

The Consequences of Sleep deprivation in the ICU

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Imagine if you went to sleep at your normal bedtime, but 5 minutes later, the lights went on. You hear multiple peoples’ conversations right next to your bed. The TV turns on and stays on. A car alarm goes off just opposite your window,  and a siren-screeching ambulance drives by your house every few minutes. 

This may sound a bit far fetched, but this is essentially what most patients who are in the intensive care unit (ICU) experience. It’s not just at night, but 24/7. 

This is what I saw during my recent time spent in a COVID-19 ICU. Fluorescent lights are on constantly. Doctors, nurses, technicians, and various other staff members are repeatedly going in and out of the room. You’re being poked for blood samples on a regular basis. Invasive and noninvasive procedures are performed on a regular basis. You may even  have to be on a ventilator with a tube in your windpipe. 

This experience brought back memories of articles I read many years ago on the consequences of sleep deprivation in the ICU. In particular, there are many papers on delirium during or after time spent in the ICU. A good overview of this subject can be found in this review article in 2014. It’s highly technical in nature, but you can get an idea of the basic concepts just by looking at the figures and tables. 

In general, sleep studies on patients in the ICU generally have much higher  durations of light sleep and arousals, and much lower time spent in deep and REM sleep.

What all these review articles show is that you’re not really getting any quality or good quality of sleep in the ICU. Here are 6 main areas of concern:


This is the most obvious factor that prevents good sleep quality. The World Health Organization (WHO) recommends average background noise in hospitals not be higher than 30 decibels, with nighttime peaks not higher than 40 decibels. As you can see from this paper, average noise levels range from 55 to 70 decibels and can peak as high as 120 decibels. (A chainsaw or motorcycle reaches 100 decibels.) These levels stay the same at night as well as during the daytime. Staff conversations can reach 85 decibels and were found to be the most disruptive for ICU patients. Sleep studies in ICU patients have found that about 11% of all brain wave arousals and 17% of all awakenings are due to noise.


Most ICU rooms are separated and closed off with a door, but with glass doors and walls. Even if the lights are off inside …

My Coronavirus ICU Experience: Good & Bad [Podcast 90]

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In this episode, I will reveal my positive and negative insights during the time I spent in our hospital’s intensive care unit (ICU). 

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Alicia Keys Empire State of Mind Youtube video


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No Excuses: Get Your Sleep Study Done Now

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During this COVID-19 pandemic, most “elective” medical care has come to a standstill. Sleep testing and various surgical options are also included.

Jennifer is a 53-year-old woman who made an appointment to see me this July. This was the earliest appointment she could get with me since my schedule is booked completely for many months. She recently called me to say that her snoring and apneas are getting worse and that her husband is complaining. 

The first good news is that due to the pandemic, our state (NY) changed the requirements to allow doctors to diagnose and treat new patients over the phone or by video. Insurers are now required to pay for this service. Now that our elective operative cases are canceled, I’m doing a lot of video telehealth sessions for new and follow-up patients. For the first time in years, patients are able to “see” me within 1-2 weeks.

The second good news is that the vast majority of testing for obstructive sleep apnea can be done at home using validated home sleep units. In most cases, this still involves going into a sleep lab to see a sleep physician and to physically take home the testing unit. You also have to bring back the unit to the sleep lab. If there’s a concern for other sleep conditions besides obstructive sleep apnea, then you may have to wait for an in-lab study.

The third good news is that there are a number of home sleep testing companies that will mail patients the home sleep testing equipment. The patient sleep with it as directed and mails it back the next day. This is definitely much more convenient, but a doctor still has to order the test. 

In the US, many of the common insurance carriers are requiring home sleep testing as the first-line test to see if you have obstructive sleep apnea. Numerous studies have validated home testing to be relatively reliable compared to in-lab testing. In general, home testing is equivalent to in-lab testing for people with moderate to severe obstructive sleep apnea, but may underestimate sleep apnea severity in patients with mild sleep apnea. So if your home sleep test is positive, it’s reliable. If it’s negative, it’s not as reliable, especially if you still can’t sleep. 

Once you’ve been officially diagnosed with obstructive sleep apnea through an in-lab study, then the next step in the traditional model is to go back to the sleep lab for a CPAP (continuous positive airway pressure) titration study. This is another sleep study using a mask with different levels of air pressure to calibrate the exact pressure …