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 Gut Health, Health, Nutrition

Probiotics: What’s In It For Me?

Probiotics have gained a ton of press over the years, and rightly so. Every week new studies surface promoting the benefits of maintaining a healthy gut microbiome, and probiotics are a key part.

probiotics

Probiotics are ‘good’ bacteria and yeasts within the body, and they are everywhere. There are more bacteria in the body then there are cells. Probiotics live within the sinus, mouth, ears, eyes, nose, gums, esophagus, tonsils, stomach, appendix, vagina, joints, and urinary tract, but most live within the large intestine or colon. Probiotics have been researched for decades, and many studies support the theory that they are essential for optimizing your health. Probiotics help to keep pathogens at bay, support proper digestion and nutrient absorption, improve mood, and boost the immune system. So should everyone consider taking a probiotic, or only individuals with health issues? Is supplementation necessary or can probiotics be obtained through food? If taking a probiotic supplement, which one do you choose? Read below to get the answers to these questions and more.

 How can probiotics keep me healthy? Lets start with the immune system. Numerous studies indicate that probiotics can benefit us in this area. Immunity can help with anything from the common cold to chronic infections. Approximately 75-80% of our immune system exists within the gut. One of the many functions of the gut is to act as a protective barrier to antigens. Antigens are the ‘bad’ bacteria. These come from things like the environment or from food. They enter the body and wreak havoc. But we can also lose probiotics from things like stress, chemicals, artificial sweeteners, medications, and poor diet. When your microbiome is out of balance, your health will undoubtedly be compromised. In contrast, when your gut maintains the appropriate balance of healthy bacteria or flora, you are more equipped to fight off colds and illnesses and stay healthy. So, it is of benefit to maintain your good bacteria at all times, not just when taking an antibiotic.

In addition, probiotics can be hugely beneficial to those with digestive disorders such as constipation, diarrhea, IBS, lactose intolerance, Crohn’s and Colitis. Probiotics can help protect the integrity of the gut lining as well as replenish and rebalance the levels of good bacteria in the colon. They can also help to absorb depleted nutrients.

Probiotics can also help treat certain illnesses including, UTI’s, chronic yeast infections, and certain allergies.

Who needs a probiotic? Those who are generally healthy can benefit from having probiotics in their diet in order to stay healthy. Individuals who are taking an antibiotic should consider taking a probiotic as well. Antibiotics are great at getting rid of the ‘bad’ bacteria in our bodies, but in doing so also get rid of the good bacteria. Many people will take a probiotic throughout the duration of their antibiotic. But we don’t just get antibiotics from pharmacy. They also exist within our food supply. They can be found in conventional eggs, poultry, beef, pork, and fish. So even if you have not taken a prescribed antibiotic for quite some time, you could still be ingesting them through your diet.

How can I get Probiotics into my diet?

Probiotics can be found in two sources: fermented foods and supplements.

Fermented foods containing probiotics include yogurt, kefir, sauerkraut, miso, tempeh, kimchi, and kombucha. Having a variety of these foods in your diet can be a simple, healthy, and delicious way to balance your flora.

Probiotic supplements are a bit trickier, as not all probiotics are created equal. One of the most important things to consider is the strain of probiotic. Broadly speaking, probiotics are identified through their scientific nomenclature. This includes three names: Genus, species, and strain. Each name helps to identify the probiotic based on properties that make it distinct from others, beginning at the broadest level, and ending with the most specific classification. It is the strain that can be most important, as this is where you can correlate research studies and data specific to the probiotic. A common analogy is that of dogs. All dogs belong to the genus Canis and the species familiaris, but within the species there is a huge variety among breed. Think shape, size, coat, etc. This same logic applies to a probiotic strain. When choosing a supplement for specific conditions, a healthcare provider or dietitian can help you to identify which strains have been shown to be the most effective. Strains that work well for one condition, might not necessarily work well for another. The strain should be listed on the supplement label. An example would be Lactobacillus (Genus) rhamnosus (Species) GG (Strain).

Other things to consider in a probiotic supplement include whether or not the supplement contains guaranteed live colonies, has an expiration date (don’t buy one without it), whether the manufacturer offers unbiased third party testing, and the total bacterial level. Probiotics are dosed in billions of colonies per pill. This might sound like a lot, but keep in mind that there are between 100-300 trillion probiotics that occur in our body naturally. I generally recommend starting with a low dose of 1-5 billion in order to determine if you tolerate it well, then gradually increasing your dosage to 10-20 billion over time. You can start with .5-1 pill per day depending on the brand and colony level, and go from there. Side effects from probiotic supplements are rare, but ones that I have generally seen in practice include bloating or flatulence when initially started.

Hopefully this gives you a better understanding of probiotics and their benefits. If you are considering adding a probiotic to your health regimen, talk to your health care provider or dietitian to determine which probiotic is best for you.

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Sources:

http://www.health.harvard.edu/vitamins-and-supplements/health-benefits-of-taking-probiotics

https://nccih.nih.gov/health/probiotics/introduction.htm

http://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/probiotics/faq-20058065

http://ajcn.nutrition.org/content/73/2/444s.full

Probiotic Advisor