Ways your Naturopathic Doctor Approaches GERD
Gastroesophageal Reflux Disease (GERD) is a common chronic disorder that can lead to lower esophageal acid exposure, heartburn, and even cancer. It affects around 10-20% of adults within North America, but knowledge of the disorder is low among the population.
What is GERD and what are the symptoms?
It is important to understand how GERD works first before knowing what it means for a person's health. It starts when the lower esophageal sphincter (LES) does not close properly after swallowing, allowing acid from the stomach to enter back into the esophagus and throat where it causes a burning sensation or pain. Other symptoms include regurgitation, or bringing up food that has been swallowed previously, sore throat, hoarseness, dry cough, vomiting, wheezing, bad breath , and bad taste in mouth. In addition to these characteristics associated with the disease itself, there are related conditions associated with GERD that are not directly related to the disease. These are called secondary conditions.
What are the causes of GERD?
There are numerous causes of GERD. Since the LES is unable to close normally, it can cause gastric contents and stomach acid to come back up into the esophagus and throat. However, there are a few underlying conditions that can also contribute to increased risk: Hiatal hernia (in this condition, valve-like tissue above the diaphragm becomes damaged over time, leading to it becoming displaced), taking NSAIDS for an extended period of time or at high doses will cause one's body does not produce as much protective agents in their stomach lining or enzyme production. Structural abnormalities such as pyloric stenosis (a complication from surgery on the urinary bladder; when surgeons cut through it too low) or anomalous tract (a condition where the small intestine is inappropriately connected to another organ or structure in the body, usually due to birth), obesity, pregnancy, old age, and certain medications.
What cells are involved in GERD?
Parietal cells are the cells that secrete hydrochloric acid to break down food and beverages. Parietal cell-specific gastritis, also called autoimmune gastritis, is found in a large percentage of GERD patients worldwide and is characterized by chronic reflux symptoms. [1,2] Though it's important to note that parietal cells are not the only cells involved in GERD, there are other factors associated with it such as carbonic anhydrase peptide, histamine-secreting enterochromaffin-like (ECL) cells, gastrin-producing G cells, somatostatin-secreting delta cells, and acetylcholine-producing neuroendocrine (NE) cells.
Any other conditions linked to GERD?
When gastric content comes back up from the stomach into the esophagus it can cause a burning sensation, as such GERD is often accompanied by heartburn. The pain typically lasts up to 30 minutes after eating, during which one may take antacids or medications to help bring down stomach acid levels. Heartburn can be very painful especially when it occurs after every meal. The feeling of regurgitation may be difficult to distinguish from heartburn because they have similar symptoms but are different conditions.
More recent research is also exploring the link between Celiac Disease (CD), an intolerance to gluten proteins like gliadin and glutenin, which are actually required to help bread rise properly during baking. Those with CD, both children and adults, seem to experience GERD more often than those in the general, healthy population. [3] Another study saw improvements in both CD and GERD symptoms when patients were placed on a gluten-free diet. [4]
However, if there is a burning sensation that results in blood stained vomit, then that is a sign that there is more serious going on and you should seek medical attention as early as possible.
Pharmaceutical treatment options for GERD
These interventions include proton pump inhibitors (PPI), H2 blockers, and pro-motility agents.
Proton pump inhibitors (PPI) are the most common type of medication prescribed for GERD. They work by blocking the enzyme in the wall of the stomach that produces acid. Examples include the drugs ending in -prazole including omeprazole, esomeprazole, lansoprazole and more.
H2 blockers are also a common type of medication prescribed and work by reducing the amount of acid produced by the stomach. Examples include the drugs ending in -tidine including famotidine, cimetidine and nizatidine.
Antacids are medications used for symptom relief. As a chemical base, they are alkaline and therefore work by neutralizing the stomach acid.
Lastly, prokinetic agents are medications that help to speed up digestion and can be helpful for people with GERD who have problems with vomiting or regurgitation. Examples include drugs like cisapride, bethanechol, domperidone and metoclopramide.
How Naturopathic Medicine Approaches GERD
Your ND has a few naturopathic treatment options up their sleeve for GERD. These include dietary changes, acupuncture, herbs, and probiotics. Dietary changes involve avoiding foods that increase stomach acid production such as caffeine, chocolate, peppermint, fatty foods, tomato-based foods, and spicy dishes. Due to alterations to stomach acidity to prevent tissue damage, your ND will also send you for lab testing to determine your risk of nutrient deficiencies. A 2021 publication showed those suffering from chronic autoimmune gastritis are at risk of a variety of deficiencies. More specifically, a vitamin B12 deficiency develops in 37-69%, iron deficiency develops in 52%, and vitamin D in 12.1%. [5]
Elevating your pillow by a few centimetres also raises the esophagus above the stomach, helping to prevent the acid and contents from making their way up the esophagus. [6]
Acupuncture is a therapy that involves the use of needles to stimulate specific points on the body. Herbs can be helpful in treating GERD by decreasing stomach acid production and soothing the esophagus. Lastly, probiotics are beneficial bacteria that help to restore balance in the gut and may be helpful for people with GERD.
Your ND may include some of the following points in their treatment protocol for GERD:
BL18 (Ganshu - 肝俞)
BL19 (Danshu - 膽俞)
CV12 (Zhongwan - 中脘)
LV3 (Taichong - 太沖)
PC6 (Neiguan - 內關)
ST36 (Zusanli - 足三里)
In a clinical trial where patients received these particular points, the group receiving acupuncture scored better than a group taking a common proton pump inhibitor (omeprazole) and another group taking traditional Chinese medicine herbs. This was evidenced by pre- and post-treatment scores on the Reflux Disease Questionnaire and by the data collected from a esophagogastroduodenoscopy that assess' tissue damage along the esophagus, in the stomach and the small intestine. 6 months later, the relapse rate in the acupuncture + herbs group was 21.7%, in the herbs group alone, 35.0% and in the medication group, 45.5%. [7]
Did you mention probiotics?
Would it surprise you to learn that walking in to a health food store and buying the first probiotic you see might not be the best option? As the research on the microbiome and gut health continues to expand, we are learning that certain strains may be more beneficial in specific conditions. For example, Lactobacillus rhamnosus seems to be the most beneficial in patients battling cystic fibrosis.
Lactobacillus gasseri for 12 weeks has led to notable improvements in those experiencing reflux and dyspepsia. Other studies have shown the stomach emptying faster and reductions in the over-secretion of stomach acid. Bifidobacterium bifidum is another strain of keen interest to scientists. [8]
What are your next steps?
GERD is a common digestive disorder that can cause pain and discomfort after eating. There are a few pharmaceutical treatment options for GERD, but adding naturopathic treatments to your overall care plan may be more beneficial in the long run. Some of the interventions your ND may use to treat GERD include acupuncture, herbs, and probiotics. A healthy diet is also important when you battle reflux on a daily basis. Living with GERD can be difficult, but there are many resources available to help you manage the condition. Book your consult now to learn about the benefits of adding an ND to your care team.
Share the ways you treat GERD in the comments below!
References
Lenti, Marco Vincenzo, et al. "Autoimmune gastritis." Nature Reviews Disease Primers 6.1 (2020): 1-19.
Kulnigg-Dabsch, Stefanie. "Autoimmune gastritis." Wiener Medizinische Wochenschrift 166.13 (2016): 424-430.
Lucendo, A. J. "Esophageal manifestations of celiac disease." Diseases of the Esophagus 24.7 (2011): 470-475.
Nachman, Fabio, et al. "Gastroesophageal reflux symptoms in patients with celiac disease and the effects of a gluten-free diet." Clinical Gastroenterology and Hepatology 9.3 (2011): 214-219.
Livzan, Maria A., et al. "Chronic Autoimmune Gastritis: Modern Diagnostic Principles." Diagnostics 11.11 (2021): 2113.
Albarqouni, Loai, et al. "Head of bed elevation to relieve gastroesophageal reflux symptoms: a systematic review." BMC family practice 22.1 (2021): 1-9.
Zhang, Wan, et al. "Therapeutic effects of the integrated acupuncture and Chinese herbal medicine on reflux esophagitis." Zhongguo Zhen jiu= Chinese Acupuncture & Moxibustion 37.7 (2017): 729-733.
Cheng, Jing, and Arthur C. Ouwehand. "Gastroesophageal reflux disease and probiotics: a systematic review." Nutrients 12.1 (2020): 132.
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