Discomfort at the Table: When Heartburn Strikes!

Gastroesophageal Reflux Disease (GERD)

Many people in the Western world suffer from heartburn on a daily basis. Of those individuals, approximately 20-40% of them have GERD (Gastrointestinal Reflux Disease). The symptoms result from exposure to gastric contents causing esophageal irritation. For most people, the lower esophageal sphincter (LES) is often weakened or other interfering factors can prevent it from closing properly.

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Common Causes

-       Functional (frequent transient LES relaxation) or mechanical problems of the LES
-       Foods (eg. coffee, alcohol, citrus fruits) or medications (eg. Calcium channel blockers and nitrates) that decrease the pressure of LES
-       Hiatus hernia
-       Obesity leading to increased intra-abdominal pressure
-       Deficiency of hydrochloric acid (HCl) in the stomach, also known as hypochlorhydria

Symptoms

-       Heartburn, which can be felt after eating, bending over, or lying down
-       Regurgitation, which can sometimes get into the tracheobronchial tree and cause respiratory complications
-       Difficulty swallowing, which produces a feeling that food is stuck
-       Coughing, or wheezing, hoarseness, and non-cardiac chest pain

Conventional Treatment

Typical treatment of heartburn symptoms is the use of antacids (eg. Tums) or stronger medications that can block or suppress the production of hydrochloric acid (HCl).

Naturopathic Treatment

Usually a combination of nutritional, dietary and lifestyle treatment is used to address GERD. If the patient is compliant, usually treatment is very effective.  Almost every GERD patient will need to identify and avoid foods and medications that trigger symptoms.  Most people also find eating smaller meals with more frequency (6 small meals as opposed to 3 larger meals) and not lying down immediately following a meal is also beneficial.

Dietary and Drug Triggers of GERD

Foods that weaken the LES
-       Alcohol
-       Chocolate
-       Coffee
-       Fats
-       Food allergies
-       Mints
-       Onions
-       Sugar

Drugs that weaken the LES
-       Beta-blockers
-       Bronchodilators
-       Calcium channel blockers
-       Cigarettes
-       Diazepam
-       Demerol
-  Nitrates

Nutrients and Herbs

Melatonin: Found to be capable of protecting the esophagus and mitigating the effects of many inflammatory mediators. One study where individuals were treated with melatonin and a few other nutrients (l-tryptophan, Vitamin B6, folic acid, Vitamin B12, methionine, and betaine) or omeprazole, and those treated with melatonin experienced 100% resolution of symptoms compared to 65.7% in those treated with omeprazole.

Phosphatidylcholine (PC): Cell membranes are typically rich sources of endogenous PC, which usually acts as a reservoir for free choline. Free choline is important for acetylcholine synthesis, and acetylcholine has been linked to increased closure of the LES.

Licorice Root (Glycyrrhiza glabra): Considered a demulcent, meaning it coats, soothes and protects tissue. Commonly used for a number of gastric concerns including GERD.

Marshmallow (Althaea officinalis): Another good demulcent and anti-inflammatory herb that is particularly known for soothing inflamed or irritated mucous membranes.


There is no one set formula for preventing GERD, but through proper treatment and working with your health care provider you can learn to manage this condition well. Talk to your Naturopathic Doctor today about getting assessed and treated if needed, and as always talk to your health care provider before
beginning any new medication or supplement.


Note: There are many possible causes of chest pain, including more severe conditions such as a heart attack. If you are uncertain of the cause of your chest pain make sure you see your doctor to get it evaluated as soon as possible.




References:

Godfrey A. & Saunders P.R. (2010) Principles & Practices of Naturopathic Botanical Medicine: Volume I: Botanical Monographs. Central Nervous System, pg. 161-163. CCNM Press.
Prousky J. (2008) Principles & Practices of Naturopathic Clinical Nutrition. Gastroesophageal Reflux Disease (GERD), pg. 126-129. CCNM Press.