Reflux (GERD), Eflux, Heartburn, Indigestion & Hiatal Hernia

a man in a red sweater against a blue brick wall

Gastroesophagel reflux disease (GERD) is a common malady, and bothersome problems like heartburn, acid reflux, and indigestion aren’t the simple disorders that they seem. There may be simple reasons for the symptoms. For example, indigestion can result from eating too much or too little at one time. The most common factors include poor food choices, stress or anxiety, taking prescription drugs that induce GERD, and a sphincter valve deformity or problem. In many cases problems associated with GERD can be prevented and treated through a combination of dietary and lifestyle changes along with nutritional and herbal remedies. Conventional medical and surgical treatments are indicated if holistic approaches are unsuccessful. Drugs are too commonly prescribed, although they are helpful in a number of resistant conditions.

In those patients taking prescription medications for GERD, the use of natural remedies, proper diet, and stress management may create an opportunity to lower the dose of these drugs and thus reduce side effects.

CLINICAL PRESENTATIONS

Heartburn is the pain caused by the splashing up of fluids from the stomach into the esophagus. If you suffer from persistent heartburn two or more days a week, the problem may be gastroesophageal reflux disease (GERD). With GERD, the sphincter muscle (or LES) does not relax and close when food is in the stomach. The reflux of stomach acid (chyme) can back-up and erode or wear away the delicate esophagus lining. GERD also can contribute to asthma, pneumonia, hoarseness, and chronic cough.

People with hiatal hernias often have heartburn. This condition occurs when a portion of the stomach slides above the diaphragm, the thin muscle separating the stomach from the chest. The hernia may allow food and acidic stomach fluid to back flow into the esophagus, causing heartburn.

Another condition called hypochlorhydria, caused by low acidity, not hyperacidity, can mimic the symptoms of heartburn or GERD. Hypochlorhydria can possibly be made worse by antacids. The use of antacids and H2-receptor blockers (drugs like Zantac, Tagamet and Pepcid) do decrease heartburn by decreasing HCl production, but impair vitamin B12 and calcium absorption from food. Proton pump inhibitors (drugs like Prilosec, Nexium and Prevacid) inhibit the stomach’s HCl production almost completely. While there may not be any short-term complications, long-term use may cause more maldigestion and poor gastric emptying which may result in poorer intestinal health. These patients frequently need extra hydrochloric acid (betaine and pepsin) to relieve the painful symptoms. Another common symptom of low-pH in the stomach is acne rosacea.

Poor digestion can be a prerequisite for almost all diseases.  Good digestive health is more than just breaking down your food properly- it’s essential for absorption of nutrients, immune function, detoxification, elimination of wastes, and chemical and hormone production.  Some basic tools to markedly improve digestion include eating wholesome foods (ideally organic fruits, vegetables and free-range meats), drinking at least 6-8 glasses of clean water, chew your food well, attempt portion control, and utilize digestive enzymes when appropriate.  Periodic cleansing can rid the body of toxins and pollutants absorbed from the food, water and air we breathe. Try and exercise, and practice stress-management techniques.

A stomach ulcer is a sore or erosion in the stomach lining or intestine. Stomach ulcers are often caused by bacterial infections (caused by Helicobacter pylori) or chronic use of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDS). H. Pylori bacteria is well known to be associated with ulcers and hyperacidity as well as cancer of the stomach. If suspected, a blood test can be done for H. Pylori.  Treatment consists of three specific antibiotics and an antacid for ten days (be sure to take acidophilus when taking antibiotics). No natural treatment is as effective as conventional drug therapy at eliminating this bacterial infection. Some food and supplements, like vitamin C, garlic, and probiotics, have been shown to fight H.pylori. 

DRUG TREATMENT

The following is the common line of treatment for GERD-related disease states: antacids are over-the-counter medicines containing magnesium and aluminum hydroxide that help to buffer hydrochloric acid, thus reducing acid reflux into the esophagus.

Histamine H2-receptor antagonists inhibit gastric secretions. In high doses, H2-receptor antagonists provide partial or complete resolution for 50-70% of symptoms (albeit temporarily). Examples include cimetidine (Tagamet), famotidine (Pepcid), ranitidine (Zantac), and nizatidine (Axid).

Proton pump inhibitors, through the inhibition of H+/K+ ATPase, provide a greater antisecretory action and give longer and stronger relief of symptoms. These drugs suppress acid output almost entirely. Examples include omeprazole (Prilosec), Nexium and Prevacid.

DYSBIOSIS

Physiologically healthy intestinal flora is very important for a sound organism. Dysbiosis can be defined as a condition in which an unhealthy digestive system exists. Dysbiosis, one of the most common health problems in America today, involves a poorly functioning digestive system causing diarrhea, constipation, bloating, belching, and rebound acidity or flatulence. Dysbiosis of the small intestines may be caused by surgical trauma, environmental and emotional stress, and altered intestinal transit which can facilitate the overgrowth of bacteria and contribute to malnutrition. The germs form toxins which may affect the liver, interstitial connective tissue and the immune system, causing an overgrowth of candida/yeast. The first thing to attempt to do is correct the pH and digestive problems.

DIET

Dietary influences are significant on bowel flora. People who eat a western diet consisting of too much meat and protein have many more gram-negative, non-spore forming anaerobes in their feces. High animal protein may mutate the bowel bacteria, resulting in an increase of procarcinogenic activity and an increase in colon cancer. People who eat a more eastern vegetarian diet have been found to have a higher proportion of aerobe (oxygen breathing) bacteria in the colon. Supplementing with probiotics including Lactobacillus and Bifidobacterium is crucial in maintaining a balance bowel flora.

There are a number of foods that may decrease lower esophageal sphincter pressure, thus aggravating reflux disease. These food and beverages include: chocolate, citrus fruits, cola and caffeine, fatty meats, garlic, onions, peppermint and spearmint, spices, and tomato juice. 

CAUSES

  1. Anxiety, stress, depression and other “stressors” are a frequent contributor to gastrointestinal distress, including a change in the bowel’s microflora. Anxiety is associated with bowel frequency, while depressed patients tend to be more constipated. Emotional reactions trigger changes in the intestinal motility (movement of feces through the bowel) and enzyme, bile, and/or mucin secretion. Mucin is an important substrate for many intestinal microorganisms. 
  2. Eating too many acidic (low pH) foods, including colas; sugar, white bread and flour products, alcohol, caffeine, spicy foods, tomatoes, dairy products, citrus fruits, vinegar, chocolate and fats. 
  3. Food allergies are a huge contributing factor. Try utilizing the elimination diet. 
  4. The use and overuse of antibiotics.
  5. Esophageal peristalsis (faulty sphincter valve between stomach and esophagus). 
  6. Eating large meals and late meals, especially red meat, causes higher levels of acid (which can inhibit the production of hydrochloric acid [HCl] needed to digest the protein load). Eating large and late meals also causes a wasting of bicarbonate, the alkali buffer of the body. To correct this problem, eat less proteins and fats, which are more difficult to digest, and more fruits and vegetables. 
  7. An inadequate amount of hydrochloric acid (HCL) in the gastric juice secreted by the stomach walls. HCL initiates protein digestion and also neutralizes the putrefactive byproducts that result from poor food combining, such as eating high starchy foods at the same time as high protein foods. [Starches pass through the stomach in less than one hour, whereas proteins take three or four hours.] Examples of poor food combining include meat and potatoes, cheese and bread, or fish and rice. Protein foods staying in the stomach too long, without enough acid to break them down, causes a back-flow of bile from the duodenum into the stomach. Bile is an irritant for the stomach lining. It is highly alkaline, so an acidic stomach tries to neutralize it by increasing the production of HCL. This causes an excess of HCL, resulting in acid reflux and discomfort. Natural digestive enzymes help treat this problem. After food leaves the stomach and moves to the duodenum, it’s mixed with bile and pancreatic juice which supply enzymes such as PROTEASE to further break down protein, LIPASE to break down fat, and AMYLASE to break down starch. If the pancreas does not have an adequate supply of these enzymes, complete absorption cannot take place, and the uptake of minerals, vitamins, fats and amino acids is compromised. 
  8. Smoking and alcohol use. 
  9. Weight loss. 
  10. Genetic, hormonal and neurologic factors. 

If hyperacidity occurs, elevate your upper body while sleeping. Eat small meals, frequent snacks, and nothing after 8 PM. Do not consume alcohol, spices, or caffeine. Do not smoke. Avoid NSAID-type drugs and decrease your consumption of acidic foods.

SUPPLEMENT PROTOCOL

  1. DEGLYCYRRHIZINATES LICORICE (DGL)
    DGL helps in healing ulcers and promotes healthy stomach and intestinal tract at doses up to 760mg 3 times a day. Take 20 min before eating. Licorice contributes to the secretion of anti-inflammatory mucus in the lower esophagus, protecting and hydrating the epithelial cells underneath. Long-term use of DGL is generally not considered safe. Adding additional carminatives like MARSHMALLOW, CHAMOMILE, HOPS, and FENNEL can be helpful. CHAMOMILE is indicated most for patients with GERD whose symptoms are triggered by stress and who may experience concomitant esophageal colic.
  2. DIGESTIVE PANCREATIC ENZYMES
    Enzymes are the life force that is found in foods and then transferred to our bodies to keep every system functioning properly. They are catalysts that make possible the chemical reactions that help to promote digestion of our food, improve gastric emptying, may absorption of nutrients possible, and decrease inflammation. The most common enzymes include bromelain, lipase, amylase, and papaya. Additional digestive enzymes decrease gastric stress in a hypochlorhydric (low stomach acid) environment. Use BETAINE for hypochlorhydria.
  3. PROBIOTIC SUPPORT
    Lacto-acidophilus, L. Bifudis and BiodophilusFOS replicate the friendly bacteria in the gut. Probiotics make contact with the gut mucosa where they aid in digestion and stimulate systemic, cell-mediated immunity.
  4. FIBER supplements such as PSYLLIUM promote regularity. Indigestion is often due to a lack of bulking fiber. Keep in mind that fiber ONLY exists in plant foods, none in animal products.
  5. PEPPERMINT
    Peppermint is one of the most popular herbs used in teas, flavorings and candy. Peppermint’s primary use is in relieving indigestion and bloating caused by excessive gas production. Peppermint is helpful in spastic complaints of the gastrointestinal tract, gallbladder and bile ducts. The essential oil is used in irritable bowel disease and non-ulcer dyspepia. Peppermint’s antispasmodic action on the smooth muscles of the digestive tract and its carminative activity are proven. Dosage: Take 1-4 g daily after meals for flatulence and digestive pains. Do not take internally for more than 2 weeks.
  6. FLAX SEED OIL
    Take 2 tablespoonfuls twice a day, or one cup of cooked flax seed once a day on an empty stomach. Other essential fatty acids are also helpful.
  7. ALOE VERA
    Aloe Vera is a very effective herbal agent used to promote esophageal mucosal healing and the reduction of GERD symptoms. It has demonstrated wound-healing properties and may help to heal and soothe the mucous membranes of the intestinal lining and tract. Use distilled aloe vera juice.
  8. ORANGE PEEL EXTRACT
    Orange peel extract works to reduce the surface tension of the liquid contents of the stomach, decreasing the potential for acid to splash up in to the esophagus. Dosage: 1,000mg every other day for up to 20 days.
  9. L-GLUTAMINE
    L-Glutamine is an essential amino acid used to help strength the mucosal lining of the GI tract.
  10. VITAMIN E (Tocopherols and Tocotrienes)
    The antioxidant properties of vitamin E in the epithelial tissue of the esophagus are significant. Dosage: 400 IU daily. Other antioxidants that can be utilized include BUFFERED VITAMIN C (500-2000mg/day), ZINC (25-50 mg/day), VITAMIN A (10,000 IU/day), and a VITAMIN B12 shot every 2-4 weeks.
  11. MAGNESIUM
    Magnesium relaxes muscle spasms. Dosage: 200-500 mg/day.
  12. ZINC-CARNOSINE
    There now exists a potent complex of zinc and carsonine which was recently patented in the United States after research done in Japan. Zinlori relieves occasional heartburn and digestion, upset stomach, and mild nausea and bloating. It is the most extensively researched natural supplement that interacts with Helicobacter pylori. The product also supports a healthy gastric environment. Dosage: twice daily between meals.
  13. MASTIC GUM
    Mastic is a gum resin derived from the mastic tree (Pistacia lentiscus), which grows on islands in Greece. A safe alternative to proton-pump inhibiting drugs (like Prilosec, Nexium), mastic gum can be effectively used in supporting gastrointestional function and health by inhibiting H. pylori and for ulcers, heartburn and reflux. Dosage: as directed.
  14. CHAMOMILE
    Chamomile is a common herbal tea effective for inflammatory diseases of the gastrointestinal tract including digestion, flatulence, and/or bloating.
  15. ARTICHOKE
    Artichoke has bile increasing, diuretic, hepatoprotective, and cholesterol-reducing effects. It may be recommended for digestive disorders marked by poor assimilation of fat. It is very safe.
  16. pH BUFFERS
    pH buffers decrease intestinal acidity and promote alkalinity.
  17. BETAINE HCl
    Betaine hydrochloride is a plant-based acid that reduces food sensitivities through proper digestion. Take one hour after each meal to aid in protein digestion. In cases where H2-antagonist drugs (i.e. Zantac, Pepcid, Axid) and proton-pump inhibitors (i.e. Nexium, Prilosec, Prevacid) are used continually for more than 2-3 months, low stomach acid may develop. This state of hypo (low) acidity that develops in the stomach may lend to poor digestion, gas, and acne rosacea. Betaine supplementation can achieve positive results in only 3-4 weeks. Dosage: 1-2 tablets 3 times a day with meals.
  18. NONI JUICE
    Noni juice elicits a “cleansing” effect  and is useful in the cases of sluggish digestion and slow moving bowels.  Noni can exert a stimulating effect by increasing peristalsis. Dosage: As directed on paackage.
  19. CHITOSAN
    Chitosan is a highly digestible form of fiber that binds to fat and prevents its absorption. Lowers cholesterol.

SPECIFIC GASTRO PROBLEMS

Digestion – If it appears that digestive improvement may reduce reflux, consider beginning with digestive enzyme therapy.  Also eat clean (organic) food, lots of fresh water, chew your food well, cleanse the bowel periodically, exercise and relief stress.

Hypochlorhydria – Contrary to popular physician beliefs, a majority of GERD sufferers produce deficient amounts of hydrochloric acid, probably due to prolonged poor diets. Consider repairing the stomach lining with DGL and amino acids. Look for low levels of adrenal, thyroid, and sex hormones. Add betaine after assessment is made.

Food allergies – Food allergies are one of the most common causes of a GI problem. Use IgG and IgE antibodies profile to assess allergies that may impair digestion.  In most cases the offending food(s) include dairy products, wheat gluten, nuts and soy.

Infections – Most commonly, H. pylori infection in the stomach irritates the stomach lining. A stool culture may reveal candida. Sinusitis may be caused by a low-level simmering infection. Treat with appropriate antibiotics.

Gastritis –  When present, treat with DMG to soothe the stomach and the esophagus. Also, esophageal tissue requires relatively more zinc.

Lower Esophagael Sphinctor Signal – This problem is activated by acetylcholine. Supplementation of phosphatidylcholine has provided relief to many with GERD, presumably by toning the sphincter. If that doesn’t work try adding huperzine (50 mcg twice day) or mastic gum.

 

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