Acid Reflux

[Guest guest]

Hi Kumar. You need to say away from anything that is Pitta

aggravating. Red Colors, Hot spices, Alcohol, Coffee, Angry situations, to

much sun, and you need to eat your meals in peace... Licorice tea works

pretty well for quick results. But you need to live a Pitta pacify life

style. God bless you my friend.. Noel ..

 

Noel Gilbert

Counselor

Body, Mind & Soul

LifeStyle Counselor

Ayurveda - Herbalism

Nutrition - Medical Astrology

[Guest guest]

Gastroesophageal reflux disease

 

Gastroesophageal reflux disease (GERD) is a relatively new

classification of disease that was at one time known simply by the

generic term of ‘heartburn,’ but has since become a highly pathologized

state, although it is also a normal physiologic phenomenon experienced

occasionally by healthy individuals. The most common symptom of GERD

is a burning sensation or discomfort behind the breastbone or sternum,

and may be accompanied by regurgitation of gastric contents into the

mouth or the lungs. In patients with significant GERD, dysphagia is

common and may indicate stricture of the esophagus. Pulmonary

manifestations such as asthma, coughing, or intermittent wheezing and

vocal cord inflammation with hoarseness may occur in some patients.

Complications of GERD include esophageal erosion, esophageal ulcer, and

esophageal stricture. In a chronic state there may be a replacement of

the normal squamous esophageal epithelium with abnormal columnar

(Barrett's) epithelium. In many cases there is a diminished secretion

of saliva, with increased risk of tooth decay and gum recession.

 

Most episodes of GERD occur during the day, usually after eating,

although some sufferers will also experience reflux during sleep.

Nocturnal reflux is commonly associated with a higher risk and more

severe indications of esophagitis because the acid remains in the

esophagus for prolonged periods due to decreased swallowing and less

saliva produced to neutralize the acid. The symptoms and degree of

esophageal mucosal damage are primarily determined by the pH

concentration of the refluxed material and the duration of esophageal

acid exposure.

 

The typical etiology of GERD is usually attributed to a dysfunction of

the lower esophageal sphincter (LES), with delayed stomach emptying,

ineffective esophageal clearance, and decreased salivation.

Pathologists recognize smoking, caffeine, chocolate, fatty foods,

overeating, tight clothing, a hiatal hernia, and certain medications as

being associated risk factors. In herbal medicine, the issue of GERD

is recognized as an issue of poor gastric tone, with poor motility.

Fundamentally, GERD is recognized as a stomach deficiency. Additional

factors that are recognized and treated by herbalists are the

consumption of flour products, which has a glue-like consistency and

promotes poor motility, as well as poor food combinations, i.e. animal

proteins with carbohydrates, which similarly impairs gastric function.

In some cases gastric impairment is a symptom associated with system

pathologies such as scleroderma in which the dysfunction of the LES is

attributed to autoimmune-induced fibrosis.

 

Medical Treatment

The medical treatment of GERD consists of lifestyle modifications, drug

treatments and surgery. Modern medicine recognizes that diet can play

a role, and encourage patients to become aware of which foods or

activities tend to make the problem worse, such as smoking, and the

consumption of caffeinated foods and beverages, chocolate, fatty foods.

Tight clothing is suggested to be avoided. Body position is also

considered to be an important aspect in managing GERD, and

recommendations might be made to maintain an upright posture, ensuring

that the ingested food does not reflux back into the esophagus. Some

patients may be counseled to insert a wedge under their back at night

to keep the esophagus above the stomach while sleeping. Similarly,

avoid exertion after a meal, such as bending or lifting is considered

important, as this contracts the abdominal muscles and forces food

through the weakened LES. Patients are also recommended to eat in a

relaxed manner, and eat smaller meals. Patients that are obese are

often a greater risk of GERD because of the excess abdominal fat that

puts pressure on the stomach. Similarly, pregnant women often complain

of heartburn, simply because of the pressure placed upon the stomach

from the growing fetus, but also because hormonal fluctuations tend to

make the esophageal and gastric mucosa more sensitive and therefore

more reactive.

 

Some commonly used oral medications have been linked to GERD and

gastric disease, including acetyl salicylic acid (ASA) which is

directly toxic to the gastric mucosa, and well as potassium supplements

or the antibiotic tetracycline that often promote burning sensations in

the esophagus.

 

The classical medical approach to GERD is the usage of antacids such as

calcium carbonate that neutralize stomach acid. Although recommended

for only occasional use many patients are encouraged or end up using

them on a chronic basis, which has a negative effect upon gastric

secretion and weakens stomach function. Another similar regimen is the

use of bismuth subsalicylate (e.g. Peptobismol®) that acts to coat the

lining of the stomach and suppress acid secretion. Like other

salicylates however, it is likely that bismuth subsalicylate is also

toxic to the gastric mucosa.

 

Prescription medications include promotility agents, H2 blockers, and

proton pump inhibitors. Promotility drugs such as the drug cisapride,

metoclopramide and bethanechol are used to promote gastric motility.

Cisapride in particular has since been recognized to have some

dangerous effects including ventricular tachycardia and ventricular

fibrillation, as well as diarrhea, gastric pain, headaches, and

somewhat quizzically, constipation. Due to the concern over the

effects of cisapride it is no longer available to the vast majority of

patients, although doctors can still prescribe it in certain

circumstances. More commonly, H2 blockers (e.g. cimetidine,

famotidine, nizatidine, ranitidine) and proton pump inhibitors (PPIs,

e.g. omeprazole, lansoprazole, rabeprazole and pantoprazole) are

commonly prescribed to reduce the amount of acid produced in the

stomach, which refluxes into the esophagus. The theory behind their

usage appears to be that it is an excess secretion of stomach acid that

underlies GERD, even though most patients with this condition can be

seen to have lower than normal gastric acid levels. The problem of

course is that acid is refluxed into the esophagus, which does have the

same kind of mucosal protection as the stomach. Although the usage of

acid-suppressing drugs can give the esophageal epithelium time to heal,

they may indeed promote the underlying problem because they weaken

gastric function, and have a questionable success rate. Further, if

these drugs are resorted to on a long term basis it can be reasonably

assumed that the chronic diminishment of acid production can result in

a decreased production of intrinsic factor, and therefore anemia.

Unfortunately there is little research on this issue, and while the

drug manufacturers recommend that H2 inhibitors and PPIs be used short

term, many patients, especially elderly patients that suffer from

impaired digestive activity, take them on a chronic basis.

 

Surgery is an alternative to prescription drugs when treatment is

unsuccessful, or when certain complications of GERD are present.

Negative effects to surgery can occur in up to 20% of patients, such as

difficulty swallowing or an impairment of the ability to belch or

vomit. Another problem is that the surgery can breakdown over time,

experienced in up to 30% of patients, requiring the continued use of

the medications to control symptoms.

 

Holistic Treatment

From a herbalist’s perspective GERD is viewed as a kind of digestive

deficiency, manifesting poor motility and a commensurate weakening of

the LES as the ingested food is caused to reflux back into the

esophagus. Thus the most important element of treatment is to restore

gastric motility, through dietary reeducation and herbal therapies.

Bitter-tasting botanicals are particularly helpful in this regard, and

are thought to promote the secretion of gastrin by stimulating

chemoreceptors on the tongue, and as a result stimulate the secretion

of gastric juices, closing of the LES and the opening of the ileocecal

valve, thereby promoting proper motility. Bitter herbs also appear to

modulate the secretion of CCK, which allows for proper gastric churning

and the secretion of bile and pancreatic juices in anticipation of the

chyme moving into the duodenum. Dietary therapies are important, and

specifically, the patient should be counseled to eat less, and observe

the rules of food combining, in which protein foods are never mixed

with starchy foods, and fruits are always eaten on an empty stomach.

In acute cases a bland diet of steamed vegetables and basmati rice,

with minimal oil and spicing can used, followed eventually completed by

meals consisting of steamed, baked or broiled animal proteins and

steamed above-ground vegetables.

 

The management of acute symptoms however is extremely important, and as

a result herbal remedies are used to soothe the irritated esophageal

mucosa and provides nutrients to promote tissue healing. This is often

implemented at the outset of treatment, and then discontinued as the

primary technique of bitters and dietary reeducation begin to resolve

the underlying condition. The following is a list of the basic

approaches and examples of each:

 

1. Reduce esophageal inflammation

•Demulcents: cold infusions of Slippery Elm bark, Marshmallow root or

Comfrey leaf, 50 g per 1 liter, taken as needed, up to 1-2 liters

daily; OR powders of Licorice, Marshmallow root or Slippery Elm bark,

5-10 g mixed with cool water, taken as needed; OR De-glycyrrhized

Licorice (DGL), suitable in patients where obesity or hypertension is

an issue, in doses of 2-3 tablets as needed; OR Aloe juice, up to one

liter daily, may promote diarrhea

•Astringing vulneraries, to promote muscular tone of the LES, check

hemorrhaging and heal ulcerations, e.g. Calendula, Oak bark,

Goldenseal, etc.

 

2. Promote healing of epithelium

•Vitamin A, 25,000-50,000 IU daily

•Vitamin C, 1-2 g bid-tid, to bowel tolerance

•Vitamin E, 800-1200 IU daily

•Zinc, 50 mg daily

•Methylsulfonylmethionine (MSM), 2-3 g, bid-tid; OR 500-1000 mL of

freshly juiced cabbage daily; OR the Chinese patent formula Vitamin U

(Fare for U), 3 tabs tid, all of which are alternatives to MSM

 

3. Promote proper gastric digestion and motility

•Bitters, taken in small doses before meals, e.g. Katuka, Barberry,

Gentian, Centaury, Goldenseal, etc. NOTE: the usage of bitters are

often avoided at the outset of treatment because the initial

stimulation of acid production may worsen any esophageal ulceration

•Robert’s Formula, as a more balanced strategy, 20 gtt tid before

meals, to stimulate proper GI motility and decrease inflammation

•Shatavari ghrita, 6-12 g, bid before meals

•Digestive enzymes, full spectrum (i.e. HCl, pancreatic enzymes, ox

bile), 2-3 caps with meals

•Food combining: avoid mixing animal proteins with starchy food, fruit

should only be consumed on an empty stomach

•Avoid dairy and flour products, which due to their sticky and heavy

properties impair gastric motility

•Avoid overeating, do not eat within three hours of bedtime

•Avoid alcohol

•Avoid tobacco

•Avoid deep-fried foods, e.g. French fries, potato chips, etc.

•Weight loss, to reduce intra-abdominal pressure

 

Contraindications

•Pungent botanicals such as Ginger and Cayenne, and especially

aromatics such as Mint, Caraway, Lavender should be avoided as they can

worsen the condition.

Caldecott

todd

www.toddcaldecott.com