A Taste of Naturopathic Medicine (Acid Reflux/GERD)

Dr. Dowling gave a presentation for his LEADS networking group at the Fort Collins Chamber of Commerce yesterday, 11/6/2024. 

He's on a mission to help more people in the NOCO area, and giving presentations like these to the community helps the broader public understand just how all-encompassing, insightful, and empowering a Naturopathic Medical approach can be. 

Today he discussed how 10 different people with the same diagnosis would be given the same treatment in a conventional setting. This is how standards of care create cookie-cutter treatments to suppress symptoms rather than identify and treat the cause of the symptoms.

The diagnosis and conventional treatment he used as an example in his presentation was Omeprazole(a proton pump inhibitor - PPi) for Acid Reflux/GERD. Even though there are multiple potential causes/etiologies of Acid Reflux/GERD, standards of care have everyone suppress acid production for 8 weeks before performing imaging.

You have to come off the PPi before doing the imaging, which may lead to rebound acid reflux and more damage. The causes of Acid Reflux can range from: hiatal hernia, hypochlorhydria, food sensitivities/allergies, Excessive physical/emotional Stress, eating GERD trigger foods, IBS/SIBO, Excessive alcohol/smoking, or Histamine intolerance/MCAS. Identifying what the etiology is will drastically alter and guide the specific treatments that I would use as a Naturopathic Medical Approach.

The mechanism of action for PPi's

They suppress acid production in the stomach by inhibiting proton pumps on Parietal cells. (The cells responsible for making hydrochloric acid(HCl) and the stomach more acidic so you can break down, absorb, and assimilate nutrients from your food. Acidity is also important for helping keep the Lower esophageal sphincter closed tight enough to prevent heartburn). The Acid also helps convert pepsinogen to its active form, pepsin, which is a protease that breaks down proteins.

Benefits of PPi's:

Prevent further damage to the esophagus and stomach that helps prevent progression to Barrett's Esophagus, Esophageal Strictures, Esophageal Hemorrhaging, and Cancer.

Consequences of Longterm-Use without a plan for weaning off

(just a few mentioned here)

• Increased risk of infection or food poisoning - (especially C. Difficile)

• Vitamin B12 Deficiency and downstream consequences from that. (Decreased Glutathione production and increased Homocysteine levels that increase the risk of developing Dementia and having a Cardiovascular event - MI, Stroke, Aneurysm)

• Magnesium Deficiency

• Increased Risk of Bone Fractures and Osteoporosis because of prolonged poor digestion/absorption

• Common Side Effects

  • headache

  • abdominal pain

  • nausea

  • diarrhea

  • vomiting

  • flatulence

  • fever (peds pts)

  • URI sx (peds pts)

  • vitamin B12 deficiency (long-term use)

  • fundic gland polyps (long-term use)

Often patients come to me who are taking a PPi and have never been told what common trigger foods they could avoid or pay attention to or what lifestyle factors might be making the situation worse. 

Trigger Foods

• Tomato, Alliums(onion, garlic, shallots), Citrus, Peppers, Fried/Greasy foods, Chocolate, Coffee, Carbonated drinks, Alcohol, Peppermint.

Lifestyle Habits to Avoid

• Eating too fast or too much food in 1 sitting.

• Eating too close to bedtime (Eat at least 3 hours before bed)

• Lying horizontal <1hr after eating

• Stressed eating or eating on the run.

• Tight Clothing around the waist.

• Popping Tums when you have symptoms - Use DGL or Slippery Elm lozenges instead (they coat the esophagus/stomach instead of disrupting the pH of the stomach even more)

Lifestyle Habits to Do

• Eat slowly in a seated position and smaller portions.

• Wear loose-fitting clothing.

• Minimize alcohol/smoking.

• Post-prandial(after eating) walks - also improve blood sugar and Insulin levels.

• Improve Intestinal barrier(lessen Intestinal permeability):

  • Eat less processed food

  • Increase glutamine-rich foods or supplements

  • Eat more whole foods

  • Increase Protein, Healthy Fat, Fiber

  • Implement stress reduction tools/habits: Exercise(Yoga), Reading, Music, Therapy, Massage/CST/VM, Acupuncture, Socializing with friends/family, Meditation.)

Naturopathic Herbal Therapies that help while lowering your PPi dose

• Add herbs like DGL (Licorice Root), Marshmallow root, Slippery Elm, Larch Bark, and Aloe vera.

Work on all of these things mentioned before jumping to a PPi prescription and Tums unless you already have imaging(EGD-scope) and proof of damage/irritation to the esophagus/stomach, or if you're having symptoms daily or multiple times a day. (Symptom management is more crucial in these more severe states.)

https://posts.gle/SVZGFS

Disclaimer:

The information provided in this article is for educational purposes only and is not intended as medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional before making changes to your healthcare routine or beginning any new treatment.