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What you should know about | Heartburn & GERD

Do you experience burning pain, fullness, acidity, or regurgitation of foods after you eat?


If so, you are the one in every three people in the US who experiences this on a weekly basis. These symptoms are commonly called “heart burn” and “reflux”. Reflux describes the process where partially digested food comes back up the throat rather than staying in the stomach. Both heartburn and reflux can be incredibly uncomfortable and make life miserable until they resolve.

WHAT IS GASTROESOPHAGEAL REFLUX DISEASE (GERD)?

If you have experienced heartburn or reflux at least twice weekly for the past few weeks, you may have gastroesophageal reflux disease (GERD). Nearly one in five Americans currently live with GERD.

GERD occurs when the group of muscles at the base of the throat called the lower esophageal sphincter (LES) fails to close properly. The subsequent reflux of acid that accompanies the partially digested meal from the stomach can lead to damage of the esophageal tissue and increase the risk of esophageal cancer over time. (1,2)

WHAT CAN TRIGGER GERD AND WHY DOES IT HAPPEN?

Often, there are multiple factors contributing to the experience of GERD. Anything that increases the pressure within the abdomen has the potential to affect how the LES closes. In the third trimester of pregnancy, many moms experience worsened heartburn since the baby is putting an upward pressure on her stomach. Along these lines, obesity and smoking are other known risk facts. Cigarette smoking can relax the LES and coughing that results from fume inhalation can increase intra-abdominal pressure making the situation worse. (2)

Certain foods can trigger symptoms in individuals, especially if they have stomach acid levels that are either too high (aka hyperchlorhydria) or too low (aka hypochlorhydria). The most common dietary culprits include greasy & spicy foods, dairy, gluten, coffee, chocolate, carbonation, citrus, allium species, and alcohol. Individual food sensitivities can also contribute, and I’ve found testing to be a useful clinical tool to help guide dietary modifications. (2)

Additionally, certain medications are known to relax the LES such as NSAIDS, certain hypertension medications, statins, tetracycline antibiotics, etc. Be sure to discuss this with your prescribing physician if you are concerned. (2)

HOW IS THIS TYPICALLY MANAGED?

First line treatment of GERD commonly includes the “prazole” family of medications called proton pump inhibitors (PPIs). Their job is to block acid production in the stomach cells and this typically works quite quickly. When I hear that PPIs do not provide relief, that is a sign that stomach acid levels may actually be low rather than high. (3)

Antacids are another way to find relief as they neutralize the overproduced stomach acid. (4)

Histamine blockers such as Pepcid work by blocking the GI based histamine (H2) receptors which act to stimulate stomach acid production. (5)

Ideally, these medicines are used on an as needed basis or as a short-term tool while the underlying triggers for GERD are determined. Once triggers are identified, then lifestyle changes can be made and the medication slowly tapered with the guidance of your prescribing physician. When stopped abruptly, the withdrawal effects of these medications can cause symptoms to rebound intensely and result in significant abdominal pain. Part of the reason we want to be mindful is that long term use can eventually lead to nutrient deficiencies, heart palpitations, muscle cramps, sleepiness, and the potential increased risk of hip fracture and kidney disease. (3-5)



WHAT DOES A NATUROPATHIC APPROACH LOOK LIKE?

FIRST PHASE – Address the Cause

This step takes time, and often there are multiple roots at play. This phase is a cornerstone if your goal is to properly manage GERD long term.


Do you smoke? Do you engage in movement regularly? What is your routine? What makes the symptoms worse? Have you traveled recently? What medications are you taking? Which foods precipitate symptoms for you? When do you eat during the day? How are your bowel movements? How does your body handle stress?


I often pose these questions in my practice and help my patients hone their mindfulness practice in order to answer them. From there, we work together to set realistic goals for how to address their specific roots.

SECOND PHASE – Delve into Digestion

An invaluable tool in phase two is laboratory testing to determine the digestive tracts baseline functional status. Tests I commonly consider in this phase include:

- Comprehensive stool analysis & Parasitology → IBS, IBD, dysbiosis

- Lactulose breath testing → Small Intestinal Bacterial Overgrowth (SIBO)

- H. pylori antibody testing → Ulcers

- Tissue Transglutaminase & Gliadin IgG → Celiac

- IgG Food sensitivity testing

- Nutrient Status

- Referral to GI (ie. endoscopy, biopsy & H. pylori culture, pH testing, etc.) (2)

As a starting point, I like to gauge whether hypo or hyper-chlorhydria may be contributing to the symptoms of GERD. There may also be an enzyme deficiency at play (ie. lactase, cellulase, etc.) or a chemical intolerance, especially if you find a common group of foods problematic (ie. salycilates, oxylates, histamine, methylxanthine, etc.). Treatment is then tailored based on the symptom history and any positive findings.

THIRD PHASE - Rebuild

When acid comes into contact with tissue outside of the gastric tissue or is significantly elevated, a lot of inflammation, irritation and tissue damage can occur. Phase three is where targeted nutritional supplementation (ie. zinc, l-glutamine, etc.) as well as demulcent, bitter and adaptogenic herbs are introduced to support healing of the irritated tissue. Herbs such as slippery elm, DGL, marshmallow and Gotu kola can provide relief. (6)

Additionally, the goal during this phase is to promote healthy GI transit and replete any identified nutrient deficiencies. Bitter herbs and prokinetics such as ginger can be helpful. Common nutrients to be replenished in GERD include iron, B12, vitamin C, magnesium, calcium, etc. all of which can cause fatigue, muscle tension and low mood when inadequate. (7)

FOURTH PHASE - Maintain


The ultimate goal of managing GERD is to resolve the symptoms and prevent future flares. I’ve seen success with the approach as outlined here and it would be a pleasure to partner with you on your journey!

 

Ready to get started? Click here or call (612) 643 - 9837 to schedule your free discovery call with Dr. Aidanne!

 

References:

  1. Reflux & GERD: https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults

  2. GERD: https://www.ncbi.nlm.nih.gov/books/NBK441938/

  3. PPIs: https://www.ncbi.nlm.nih.gov/books/NBK557385/#:~:text=Proton%2Dpump%20inhibitors%20(PPIs),the%20heterocyclic%20organic%20molecule%20benzimidazole.

  4. Antacids: https://www.ncbi.nlm.nih.gov/books/NBK526049/

  5. H2 Receptor Antagonists: https://www.ncbi.nlm.nih.gov/books/NBK525994/

  6. Pickrell C, Saunders P. Advanced Botanical Prescribing. CCNM Press; 2016.

  7. Nutrient Deficiencies: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110863/


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