I have previously stated in this series that chronic pharmacologic treatment of GERD can result in a myriad of complications including Vitamin B 12 deficiency, dementia, dysbiosis, food allergies and sensitivities, H. pylori infection, vitamin and mineral depletion and so on. Chronic use of pharmacologic agents including antacids, H2 Blockers and PPIs is not a very wise decision, yet physicians continue to prescribe these modalities despite the potential effects of chronic use. Today, I will begin a discussion of the treatment of the potential causes of GERD without chronic use of pharmacologic agents.
The first step is to eliminate any dietary triggers for heartburn and/or GERD. These may include caffeine, alcohol, chocolate, garlic, onions, mint, spicy foods, fried or fatty foods, citrus or tomato based foods and highly processed or “junk” foods. You must find what trigger(s) is unique to you. Elimination of all of these classes is never necessary. But a whole food, low glycemic load, phytonutrient rich, plant based high fiber diet often resolves reflux symptoms.
Nutrient interventions can reduce the dose or eliminate the need for several medications known to worsen GERD. Anticholinergics, sedative/hypnotics, tricyclic antidepressants, theophylline, prostaglandins, calcium channel blockers, alpha and beta adrenergic blockers, nitrates and progesterone all have the potential to cause or to aggravate GERD. Medications such as steroids, aspirin, NSAIDs such as ibuprofen, potassium and biphosphonates can also cause or aggravate GERD.
Many patients with GERD are found to consume food that triggers symptoms, as discussed above, Dietary changes, starting with foods that have a potential for causing GERD symptoms are a good place to start. For some this may not produce success whereas a broad based elimination diet under the supervision of a physician will solve the problem. Such a diet, along with a food diary can often pinpoint the culprits that aggravate the patient’s symptoms. In my patients with GERD, a daily or twice daily GOOD probiotic along with digestive enzymes and hydrochloric acid tablets often helps with 80% of the symptoms.
Remember, it takes time and effort to address symptoms at a fundamental level rather than just popping a pill. It is necessary to remember the long term negative consequences of chronic suppression with pharmacologic agents. Medication begets medication and many patients begin to slide down the proverbial slippery pharmaceutical slope as they start that first long term prescription. So with this in mind, I offer the following therapeutic suggestions:
(1) Digestive enzymes including Amylase, protease, lipase and lactase before or at the beginning of a meal. These can be found in readily available formulas. Digestive bitters may also aid digestion.
(2) Prebiotics, non-digestible components of fibrous plants serve as growth factors for healthy intestinal bacteria, which metabolize the fiber to aid digestion. Traditional dietary sources include jicama, Jerusalem artichoke, garlic, dandelion greens and leek.
(3) Probiotics, in a dosing form of 5-10+ billion organisms per day on an empty stomach will greatly help. Look for reputable brands of mixed flora with organisms balanced for guaranteed potency.
In the next blog I will continue with this list of therapeutic options. Thanks for reading and as usual, comments are welcomed…..