Reflux: stop the burning!

Reflux, also known as GERD (gastro-esophageal reflux disease), is a common problem. It's particularly prevalent as we age, with about 20-30% of the adult population in the U.S. experiencing symptoms on a weekly basis. Heartburn, a sense of burning pain in the esophagus and chest, is the most common symptom, but some people also experience nausea, vomiting, trouble swallowing, chronic cough and insomnia. Although GERD is generally not dangerous about 1% of people who have a diagnosis of GERD also have Barrett's esophagus, a condition in which the cells lining the esophagus become damaged enough that they become pre-cancerous and can lead to esophageal cancer. So, careful monitoring and treatment of GERD is warranted, especially for those of us in middle age. Fortunately, there are great natural treatments for GERD and I've helped hundreds of people transition from their medications to natural ways of controlling this condition.

First, a quick review of the drugs used for GERD. Proton pump inhibitors (PPIs) and H2 blockers are commonly used to treat GERD. PPIs (omeprazole/Prilosec, esomeprazole/Nexxium, and lansoprazole/Prevacid) are more effective at reducing acid levels, but H2 blockers (Zantac, Pepcid, Tagamet) have fewer long-term side effects. These drugs are among the most frequently prescribed in the country and people become very dependent on them.

But, there are real problems with long-term use of these drugs, particularly PPIs. People who have more complex cases, especially those with esophageal erosion or Barrett's esophagus may have to use PPIs. Unfortunately, increased risk of some very serious conditions are associated with long term use of PPIS, including:

• stroke

• hip fracture in women (because of problems with calcium absorption and homeostasis)

• dementia

• kidney disease

• heart attacks

The good news is that there are excellent natural and lifestyle treatments for GERD. For some people, diet changes may be helpful, like avoiding foods that trigger reflux, like coffee, chocolate, tomato-based foods, lemon, and mint (I know this is a tough list!). Other people have benefitted from identifying food allergies. I have one patient who did some food allergy testing, hoping to find a solution for her weight gain and hair loss. Much to our mutual surprise, when she eliminated the foods she tested positive for (including wheat, corn, sugar and a few others) her reflux disappeared. It had been so bad that she was considering surgery. Weight loss can also be helpful as carrying extra weight around the middle increases reflux risk.

I often use digestive enzymes for people with reflux. Enzymes can increase the efficiency of your digestion and prevent the gas and bloating that can create pressure in the gut. Enzymes can also be useful for enhancing nutrient absorption in people who have to use PPIs because of Barrett's. Other good possibilities for treatment include:

• DGL (de-glycyrrhizinated licorice)

• Zinc Carnosine

• Probiotics

• L-glutamine

• Aloe vera gel

• mucilaginous herbs, like slippery elm, marshmallow (not the kind you toast over the fire!), and plantain.

• Apple cider vinegar

Ultimately, we need to find and treat the cause of the reflux so you can reduce or eliminate the use of PPIs. Please note that going off PPIs abruptly can lead to terrible rebound heartburn! Slow weaning is critical, and is something I am happy to help you with.

References:

Sehested TSG, Fosbol EL, Hansen PW, Charlot MG, Torp-Pedersen C, Gislason GH. Abstract 765. Proton pump inhibitor use increases the associated risk of first-time ischemic stroke. A nationwide cohort study. Presented at: the 2016 American Heart Association Scientific Sessions. November 12-16, 2016; New Orleans, LA.
PROTON PUMP INHIBITORS: RISKS OF LONG-TERM USE.

Eusebi LH, Rabitti S, Artesiani ML, Gelli D, Montagnani M, Zagari RM, Bazzoli F.

J Gastroenterol Hepatol. 2017 Jan 16. doi: 10.1111/jgh.13737. [Epub ahead of print] Review.

PMID: 28092694