Categories Gut Health, Nutrition, Stress

A Nutritional Approach to GERD

The incidence of Gastroesophageal Reflux Disease (GERD) has dramatically increased over the last few decades. I know I see a lot of it in my practice. This blog post will help you to understand the most common causes of reflux, dietary factors that contribute to symptoms, and some helpful tips for management and prevention.

 

GERD is most often caused by the flow of gastric juices (stomach acid) up the esophagus, which can result in a burning sensation, pain, or discomfort often referred to as heartburn. The condition typically intensifies following a meal and when lying down. While some individuals may suffer from occasional cases of heartburn that are easily resolved with over the counter medications such as antacids, GERD is more of a chronic condition. GERD can place individuals at a higher risk for swallowing difficulties, esophageal inflammation, ulcers, and certain cancers.

GERD is frequently associated with abnormalities or a decrease in pressure of the lower esophageal sphincter (LES). Your LES is a valve that controls the flow of food from your esophagus into your stomach. Normally this valve should close tightly, keeping hydrochloric acid and gastric juices in their rightful place – your stomach – so that they can help you digest your food properly. When the LES is compromised, the valve does not close fully, or it opens too often, and stomach acid will creep up into the esophagus as foods are being digested.

GERD can also be associated with muscle contractions known as gut motility. In a healthy gut, foods are normally pushed through the GI tract from the esophagus into the stomach, from the stomach into the small intestine, and from the small intestine into the colon. However, when the gut is impaired, these contractions can become compromised and cause a disruption in the digestive process.

Another factor to consider is hypochlorhydria or low stomach acid. While it may sound counterintuitive, having too little stomach acid can disrupt natural digestion, causing food to remain in the stomach longer then it should. This can cause major discomfort for many individuals including reflux-like symptoms.

Consuming foods that weaken the LES (see list below), along with increased stress, anxiety, and gut dysfunction, can make the symptoms associated with GERD occur more frequently and at a higher intensity.

 Common causes of GERD include:

Overeating / Obesity (puts pressure on the stomach)

Smoking (relaxes the LES)

Ingestion of the following trigger foods (weakens the LES):

  • Alcohol
  • Soda / Carbonated beverages
  • Coffee / Caffeine
  • Chocolate
  • Fatty / Greasy / Fried foods
  • Spicy foods
  • Acidic foods (tomatoes, orange juice, citrus fruit)
  • Peppermint / spearmint
  • Onions / garlic
  • Sugar

Stress (impairs gut motility)

Use of certain medications (NSAIDS, calcium channel blockers, Bisphosphonates)

Additional considerations include:

  • Bacterial overgrowth such as H. pylori, SIBO or yeast
  • Celiac Disease
  • Hiatal Hernia (stomach pushes up through the diaphragm muscle)
  • Food sensitivities / Allergies
  • Chronic constipation
  • Micronutrient deficiencies (from use of GERD medications) such as zinc, B12

When reviewing this list, you may find that few or many of these items pertain to you. The list of trigger foods is a general one, and not all foods listed will trigger symptoms in all individuals with reflux. But it is important to know which ones exacerbate your particular symptoms and to avoid those whenever possible. This will allow your esophagus to heal and will help to avoid the pain and discomfort associated with this condition.

Conventional treatment and management of GERD often involves:

  • Weight loss (when appropriate)
  • Continual avoidance of trigger foods
  • Eating smaller meals
  • Raising the head of the bed
  • Use of certain medications such as antacids and acid-blocker drugs such as Proton Pump Inhibitors (PPIs)
  • Avoidance of eating within 2-3 hours of lying down or going to bed
  • Avoidance of tight clothing that can put pressure on the LES
  • Avoidance of certain exercises that can put pressure on the LES such as sit-ups, inverted yoga poses, and certain forms of heavy lifting

Additional recommendations that can help include:

  • Slowing down at meals
  • Sitting at meals (avoid standing)
  • Taking smaller bites
  • Chewing food thoroughly. This can actually increase saliva production which can help support the integrity of the esophageal mucosal barrier, which is often impaired in reflux patients.
  • Consume meals that are lower in fat
  • Consume meals that are lower in carbohydrates (to help maintain a healthy weight)
  • Consume fermented foods (to support a healthy microbiome)
  • Avoid consuming large amounts of fluids with meals
  • Begin a routine of gargling at night to stimulate the vagus nerve (supports healthy digestion)
  • Stress reduction / Lifestyle change
  • Regular exercise

There are several types of supplements that can support GERD naturally and can help avoid the harmful side effects of PPIs. These include:

  • Deglycyrrhizinated licorice(DGL)
  • Limonene (extracted from citrus fruit peel)
  • Zinc Carnosine
  • Magnesium Citrate or Glycinate
  • Aloe Vera
  • Slippery Elm
  • Marshmallow
  • Glutamine (to heal)
  • Probiotics (to balance the microbiome)
  • Digestive Enzymes
  • Ginger
  • Iberogast (for motility)

It is always important to work with a qualified healthcare practitioner to receive a proper diagnosis for reflux and to identify the root cause.

In addition, many people find it valuable to work with a dietitian to help control their diet, which will make it easier to manage reflux and its related symptoms.

Common dietary approaches that I recommend in practice:

  • Identify and avoid trigger foods
  • Avoid processed foods and those high in refined sugar that can impair gut integrity and motility
  • Identify and support any nutrient deficiencies
  • Practice the key principles of eating properly (slow down, chew your foods, do not overeat)
  • Dietary support of Hypochlorhydria if present
  • Dietary support of bacterial infections if present
  • Incorporation of fermented foods and probiotics to heal the gut and support your microbiome
  • Stress reduction each day

 

Sources:

Gaby, Alan R., MD. Nutritional Medicine. Alan R. Gaby, M.D., 01/2011. VitalBook file.

Murray, M. T., & Pizzorno, J. (2012). The Encyclopedia of Natural Medicine, 3rd Edition. New York, New York: Atria paperback.

University of Wisconsin School of Medicine and Public Health. An Integrative Approach to GERD (Gastroesophageal Reflux Disease). (2018)

Mullin, G. E., & Swift, K. M. (2011). The Inside Tract: Your good gut guide to great digestive health. New York, New York: Rodale.

https://www.iffgd.org/motility-disorders.html

Rishikof, D. Health Takes Guts Ebook, 2018.

Hyman, M. 7 Steps to Reduce Acid Reflux. 2018.

https://www.mayoclinic.org/diseases-conditions/gerd/expert-answers/heartburn-gerd/faq-20058535

Categories Gut Health, Health, Weight Loss

Gut Health and Obesity – Is Your Microbiome Making You Fat?

If you are like many of my clients, you may be seeking guidance and recommendations for weight loss. I often teach people about the benefits of eating healthy unprocessed foods, getting the proper amount of exercise, reducing stress, and prioritizing sleep as a means of achieving a healthy weight. But what if you are doing all of those things and still not seeing results? What else should be considered? The answer is: your gut.

“All Disease Begins In the Gut”

These were famous words spoken by Hippocrates thousands of years ago, and they still hold true today.

Our gut contains 100 trillion microorganisms known as our microbiome. This vast and awesome environment consisting mostly of bacteria, houses 70-80% of our immune system. It is also where serotonin is produced. Serotonin is a neurotransmitter that is responsible for regulating mood, behavior, appetite, digestion, sleep, memory, and sexual desire. While we want to strive to have as healthy and diverse of a microbiome as we can, we can easily find ourselves in situations where our microbes will become altered or imbalanced.

An imbalance in our microbiome is known as dysbiosis. Dysbiosis occurs when we have low microbial diversity, an overabundance of bad bacteria vs. good bacteria, or pathogens. Dysbiosis typically results from things like poor diet, stress, certain medications like NSAIDS, chronic infections, and toxins in the environment. Dysbiosis has been linked to many chronic diseases such IBS, depression, anxiety, thyroid disease, and autoimmune conditions and obesity.

But how exactly, does bacteria in our gut contribute to our ability to gain and lose weight? Several obesity studies have shown that specific microbes in the gut alter how we store calories and fats. Studies that compared the microbiome of lean individuals to obese individuals have found that the leaner study participants had a wider variety of microbes that break down plant starches and fiber into shorter molecules that the body can use as energy. Studies have also shown that a diet high in processed foods can lower diversity within the gut. Gut bacteria can also alter how we regulate glucose levels and how we respond to hormones that make us feel hungry or full, both of which can contribute to changes in body weight and metabolism.

Simply put, an imbalance in our microbiome may increase our risk of weight gain and obesity.

How do you know if you are at risk?

Digestive issues such as gas, bloating, constipation, diarrhea, reflux, or IBS are all signs that your microbiome is impaired and out of balance. If you are struggling to lose weight, these issues may be a contributing factor. Other signs of gut impair include fatigue, brain fog, depression and anxiety, frequent colds and infections, and autoimmune disease.

What to do about it

Repair your gut – for many this can start with a quality probiotic. Probiotics help to diversify your flora  and keep your gut functioning at its best. I recommend professional grade probiotic supplements along with glutamine or collagen to help maintain a healthy gut mucosal lining . But if you are experiencing any of the issues mentioned earlier, it could require a more extensive gut protocol that includes additional supplements such as digestive enzymes, HCL, Magnesium, herbal microbials, or reflux supportive supplements such as DGL. This may seem extensive, but keep in mind that many of these might be temporary supplements that are needed to reduce inflammation and put you on the road to better health.

If you are struggling with digestive issues and weight gain, it is worth exploring the topic of gut health and working with a qualified health practitioner such as myself, to develop a gut protocol to get you well. Once your gut is repaired you may find it easier to lose weight and maintain a healthy weight longer.

For more information on gut health and nutrition counseling, contact me here

Categories Weight Loss, Exercise, Health, Hormones, Sleep, Stress

Menopause and Weight Gain

Menopause. That notorious phase of life where one is prone to mood changes, fluctuating stress levels, anxiety, hot flashes, insomnia, food cravings and weight gain.

I counsel women about this topic all of the time. What I typically see is someone who is restricting calories, engaging in high intensity cardio multiple times per week, and not losing one pound. One of the most important things I want women to know is that there is A LOT going on behind the scenes during this time that is causing that stubborn weight gain, and much of that may not be your fault. And while a healthy diet and exercise are important, it may take more then that to handle the major fluctuation in hormone levels that can occur.

As your ovaries begin to decline in estrogen production, your body will try to compensate by producing estrogen in other ways. One way is through your fat cells. This is why it is so common for women to gain weight (especially in their abdomen) during menopause. Those fat cells are trying to produce and hold on to estrogen. Your body will make it much harder to lose fat then it will to gain it.

In addition, your adrenal glands (which regulate the stress hormone cortisol) will also try to support your declining sex hormones, essentially working overtime to help your body regulate itself. This is a problem because cortisol can then become out of balance, and run high or low at the wrong times. Normally, cortisol should be highest in the morning upon waking, giving us energy to start our day. Throughout the course of the day, cortisol should gradually decline and be at its lowest as we prepare for sleep. When cortisol becomes imbalanced, it can end up running high at night (causing insomnia) or low in the morning (causing fatigue). Or sometimes, cortisol will run high all day long. When this happens, it can cause your blood sugar to chronically run high, which can lead to increased appetite, food cravings, weight gain, and insulin resistance. Cortisol also plays a role in causing symptoms like hot flashes and night sweats.

So what’s a woman to do?

The following strategies can help…

Balance your plate

The first thing I typically recommend is to balance your blood sugar with plenty of high fiber non-starchy vegetables, complex carbs, lean protein, and healthy fats. Complex carbs include fruit, starchy vegetables, beans, legumes, and high fiber grains such as quinoa. For protein, I like to recommend wild caught fish, free range chicken or turkey, and grass fed beef. Healthy fats would include olive oil, grass fed butter, ghee, coconut oil, nuts and nut butters, seeds, and avocado.

Do not deprive yourself of calories

It’s important to note that while we are normally inclined to limit calories in order to lose weight, in times of stress we actually want to be cautious about going too low. When this happens, it can actually cause additional stress on your body. That’s why it’s important to fuel your body with the right amount of calories to support its needs. Calorie needs differ for each individual. Know your minimal calorie range (I can help you with that) and stick to it. Do not over restrict yourself.

Stick to a meal schedule

Eat small meals throughout the day, and avoid going long stretches of time without eating. I usually recommend fueling your body every 3-4 hours. This will help to stabilize blood sugar and optimize your energy levels.

Limit or avoid caffeine and alcohol

Caffeine and alcohol can raise cortisol, increase hot flashes and night sweats, and impair sleep. Many women report a reduction in symptoms when they reduce or eliminate these from their diet.

Exercise

Exercise on the regular, and include strength training. Strength training will help burn fat and build muscle, which is known to decline as we age. It will also help to slow down the onset of osteoporosis, which women are at risk of during menopause because of the direct relationship between estrogen and bone health. Avoid frequent amounts of intense exercise. This can actually raise cortisol levels which will make it harder to lose weight. Have variety in your workouts, such as strength training 2-3x per week, cardio 2-3x per week, and low impact exercise such as walking or yoga 1-2x per week to really balance things out.

Focus on Stress Reduction

Manage your stress! Deep breathing, yoga, laughing, being outdoors, and simply taking time for yourself are all things that can help support your adrenals and lower cortisol levels. You can also incorporate supplements such as Vitamin C or B vitamins to help reduce stress. Adaptogenic herbs such as Ashwaganda, Holy Basil, Rhodiola, Lemon Balm, or Valerian can be especially helpful, but I recommend starting with these in the form of a tea versus a supplement, unless you’ve taken a cortisol hormone test and know what your specific levels are throughout the day. Work with a qualified health practitioner to learn more.

Prioritize your sleep

Adapt a healthy sleep routine and stick to it. Turn off electronic devices after 10pm, keep your bedroom cool and dark, and practice healthy sleep habits such as reading or meditating to help clear your mind and prepare you for restful sleep. The ultimate goal is 7-9 hours of uninterrupted sleep per night.

Acupuncture

Consider complementary therapies such as acupuncture to help with stress and hormone balance.

Hormone Replacement

Talk to your doctor about hormone replacement therapies such as compounded bio-identical hormones. Your doctor will be able to discuss options and help you determine if this is something right for you.

Finally, recognize that this is a journey and that it may take time to see your body respond to some of these changes. Set goals, stay consistent, and be patient.

For more ideas on how you can manage menopause and weight gain, contact me here

Photo by Jennifer Burk on Unsplash

Categories Food, Nutrition

Healthy Snacks for Traveling

For many people, summer is a time for fun in the sun, relaxation, and vacation. As great as it is to travel, it can also be a challenge in terms of sticking to your nutrition goals. Long trips in the car can lead frequent stops at rest areas where the choice of food and snacks can be limiting and often times, really unhealthy. The key is to plan ahead. Before hitting the road, visit your local supermarket and stock up on healthy snacks. Pack them in a portable cooler to help you save time and money when traveling, and to keep you on track with healthy eating. You’ll be glad you did!

Here is a list of items I recommend. They pack well, taste great, and will keep you fuller longer. Strive for lots of fruits and veggies, lean proteins, healthy fats, and high fiber complex carbs. Eat your proteins and carbs at the same time to maintain proper blood sugar balance. This will help you stay energized and focused and avoid needing large amounts of caffeine.

Make sure to pack your cooler with plenty of ice or ice packs to keep your items cold and to avoid spoilage. Also be sure to include plenty of bottled water to help you stay hydrated and avoid high calorie juices, sports drinks, and sodas that are loaded with sugar, colors, and other artificial ingredients.

Fruits and Veggies:

  • Baby carrots
  • Bell pepper slices
  • Broccoli florets
  • Cucumber slices
  • Apples
  • Oranges
  • Grapes
  • Pears
  • Peaches

Protein:

  • Hard boiled eggs
  • Vermont Beef/Turkey/Pork sticks
  • Protein Bars (RX, Lara, Zing, Kind)
  • Siggi’s yogurt
  • Lifeway Kefir
  • Babybel Cheese

Healthy Fats:

  • Hummus cups
  • Guacamole cups
  • Justin’s peanut butter packets
  • Almonds
  • Walnuts
  • Cashews
  • Sunflower seeds

Complex Carbs:

  • Brown rice cakes
  • Pecan Thins
  • Almond Thins

Hydration:

  • Bottled Water
  • LaCroix sparkling water
  • Hint Flavored Water
Categories Food, Health, Nutrition

The Power of Phytonutrients

Phytonutrients are natural compounds in plants that are a powerful tool for building better health. Phytonutrients provide numerous functions, such as providing the body with a rich source of antioxidants, which protect us from oxidative stress. Phytonutrients also stimulate enzymes that help the body get rid of toxins, boost the immune system, improve cardiovascular health, promote healthy estrogen metabolism, and stimulate the death of cancer cells.

The best source of phytonutrients in the diet are fruits and vegetables, along with whole grains, legumes, herbs, spices, nuts, seeds, and teas. Phytonutrients in food come in a variety of colors including red, orange, yellow, green, blue, purple, tan, and white. For optimal health, it is important to eat a variety of colorful foods often.

Remember to strive for at least two servings of vegetables (about half of your plate) at meals, and one serving at snacks. Challenge yourself by aiming for one to two colors per day and choose a variety of fruits and vegetables within those color groups each week. In addition, vary your preparation methods. Enjoy veggies raw or cooked. Try adding colorful fruits to salads, smoothies, or hot cereal. Experiment with different varieties of beans and grains. Add colorful spices to your foods.

Below is a sample list of phytonutrient rich foods by color. Which ones do you enjoy often? Which new ones will you try?

Green – Apple, artichoke, asparagus, avocado, bell peppers, bean sprouts, Bok choy, broccoli, cucumbers, green beans, peas, zucchini

Yellow – Apple, pears, banana, bell pepper, corn, summer squash, pineapple

Orange – Apricots, bell pepper, cantaloupe, carrots, mango, nectarine, oranges, papaya, persimmons, butternut squash, sweet potato, tangerines, turmeric, yams

Red – Apple, kidney beans, beets, bell pepper, cranberries, cherries, pink grapefruit, goji berries, grapes, plums, pomegranate, radishes, raspberries, strawberries, rhubarb, tomato, watermelon

Blue/Purple/Black – Blueberries, blackberries, boysenberries, cabbage, carrots, cauliflower, eggplant, figs, grapes, kale, plums, potatoes, prunes, raisons

White/Tan – Apples, cauliflower, coconut, dates, garlic, ginger, jicama, white beans, lentils, mushrooms, onions, pears, shallots, seeds, grains, black or white tea

Source: Institute Functional Medicine