Dr. Roach: Anxiety symptoms still need physical exam

Keith Roach
To Your Health

Dear Dr. Roach: A year ago I lost two family members in a very violent way. Since the event, I’ve been vomiting most mornings. It is never food, just stomach bile and the water I drink when I first wake up. If I don’t drink water, I dry heave until I do drink something, then the bile comes up.

I’ve spoken with my doctor, and we’ve tried a few medications and done an ultrasound, but the vomiting continues. He now wants me to get an upper GI, but just the thought makes me nauseated.

I’m fairly confident that it isn’t as much stomach-related as it is a mental state. Granted, I’m not a doctor, so I don’t know how much value this holds.

How do I tell this to my doctor? And how do I get him to take me seriously about my thoughts of this being a sign of depression?

E.M.

Dear E.M.: I think I (mostly) agree with you and your doctor. I agree with you that your GI symptoms are likely to be related to the horrible trauma you had. Nausea and vomiting are more likely a symptom of anxiety than they are of depression, but certainly it could be either or both.

On the other hand, I understand why your doctor wants to be sure that there isn’t something terribly wrong inside your GI tract rather than assume it’s just a mood disorder. A wise cardiologist teacher of mine once told me, “It’s better to work up someone with anxiety than it is to psychoanalyze a corpse.” It may be that an experienced clinician, after completing a careful history and physical exam, could rule out something being seriously wrong, but I don’t want to second-guess your doctor’s judgment and would urge you to consider getting the upper-GI study, which isn’t so horrible.

If the upper-GI exam is normal (and even if it isn’t), I would ask your doctor for a referral to a mental health professional (psychiatrist, psychologist and mental health social worker are most common) with experience in treating someone with a loss such as yours. Working in New York City since 2001, I have seen many people with anxiety, depression and post-traumatic stress disorder with different physical symptoms related to their psychological trauma. There are many effective treatments, but you need to have a diagnosis first.

Dear Dr. Roach: I read that drinking warm lemon water with honey has many health benefits, partially because lemons are an alkaline food. Is this correct?

B.W.

Dear B.W.: I think I saw the same article. Lemon water may have some health benefits, but it is not an alkaline food, and drinking it has almost no impact on the acidity of your blood or urine, because the body’s buffer systems (the chemical processes used to keep the pH carefully regulated) are so effective. Lemons have a pH of about 2, so they are highly acidic. Ascorbic acid (vitamin C) makes the urine more acidic.

There is no consistent evidence that the foods we eat have a health benefit due solely to their effect on body pH. Many of the foods recommended for their supposed alkaline effects are indeed healthy, but for other, complex reasons apart from pH.

Email questions to ToYourGoodHealth@med.cornell.edu.