Russell Setright Naturopath

 REFLUX & HEARTBURN (GERD)

Russell Setright

This small article is in part taken from one of my small Get Well (Get Well Indigestion) books written over 20years ago and some of the products mentioned may now not be available under the names given and the references are older however the message is the same, reduce the incidence of reflux and protect the gastric mucous that protects the stomach.

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Information about the side effects of Proton pump inhibitors used to treat GERD can be found on my website (above link). This contains information about the side effects of PPI's that you may need to discuss with your doctor.

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Heartburn

Gastroesophageal reflux disease (GERD)

Is a burning pain felt in the upper middle of the abdomen that can radiate through to the back and often occurs after eating or at night, and worsens when a person lies down or bends over. The pain can range from mild to intense, however, whatever the pain level, heartburn is an uncomfortable complaint. Triggers include consuming food in large quantities, or specific foods containing certain spices, high fat content, high acid content or/and alcohol and smoking., pregnancy, overweight, excessive stomach wind and tight clothes  can all place pressure on the stomach and, in some cases , a small amount of the gastric juices  rise into the oesophagus  causing a burning sensation. Heartburn is also often associated with hiatus hernia. 

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Heartburn or chest pain after eating or drinking and combined with difficulty swallowing may also indicate esophageal spasms and needs to be diagnosed medically.

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People with chest pain related to GERD are difficult to distinguish from those with chest pain due to cardiac conditions. Each condition can mimic the signs and symptomatic findings of the other. Further medical investigation, such as imaging, is often necessary.

 

Some natural treatments that may help

The herb slippery elm taken just after meals will be of benefit.  Slippery elm bark has soothing effects on the digestive tract and can also ease the discomfort of ulcers in adults. The herb peppermint is also beneficial as this herb will help relieve gastric wind. Peppermint is an integral part of the many gripe water formulations. It is mentioned in the British Herbal Pharmacopoeia specifically for flatulent digestive pains.  The specific indigestion formula ACID-EZE, contains micro-pulverised slippery elm and peppermint in combination. This formula  can quickly give temporary  relief from the pain of indigestion, heartburn and wind.  ACID-EZE is an instantly dissolving formula that gives quick relief to many of the symptoms of an upset digestive system. Acid-Eze does not contain aluminium hydroxide, one of the main ingredients of most antacid formula. ( see the dangers of aluminium based antacids).

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It is better to improve the protective process than to just lower stomach acid. Lowering digestive acid can result in poor digestion and a decrease in calcium metabolism resulting in an increased risk of osteoporosis.

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lifestyle changes can make a difference.

1. don't eat large meals at night, the old saying eat like a King in the morning and a pauper at night is best.

2. Don't eat just before bed.

3. Lift the head of the bed up about 5cm not just extra pillows.

4. Reduce weight to a comfortable and recommended weight.

5. reduce alcohol intake particularly spirits at night alcohol relaxes the cardiac sphincter, the cardiac sphincter is between the esophagus and the stomach, opening at the approach of food that can then be swept into the stomach by rhythmic peristaltic waves. If relaxed or under extra pressure from large meals then stomach acid can raise up into the esophagus and case burning (heart Burn)

6. Don't smoke as this also relaxes the Cardiac Sphincter and increases the risk of gastric cancer.

7. Taking Probiotics each morning as directed and slippery elm before bed can help reduce symptoms

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Probiotics

Recent research has shown that people who consumed a specific probiotics every day changed their bacterial balance and reduce some of their problems with indigestion (BMJ Open Gastroenterology, online Sep. 16, 2016).

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The field of probiotic therapy is still developing and which probiotic strains will be most helpful to overcome heartburn or manage another digestive problem. However, some strains of Lactobacillus have been found to counteracts disease-producing bacteria such as Salmonella, E. coli  and Clostridium difficile (Microbiologyopen, June 2015) and also suppresses acid secretion and could help overcome heartburn.

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PEPPERMINT

Peppermint contains  between 1-3% of  volatile oils. Around 85 constituents have been identified in peppermint oil with a further 40 still under investigation.

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Peppermint's  action is well documented as a carminative, spasmolytic and choleretic.

 

As peppermint  is  also a smooth muscle relaxant it has been used in the treatment and relief of   painful intestinal colic, gastric and intestinal flatulence, intestinal griping  and dyspepsia. It should be noted that a large amount of peppermint oil should not be taken by itself as this could lead to over-relaxation of the cardiac sphincter and may increase gastric reflux is some patients. Always take peppermint with slippery elm.

 

A double-blind crossover study found that 0.2ml of peppermint was more effective than a placebo in relieving  the symptoms of irritable bowel syndrome.

 

SLIPPERY ELM

Slippery elm bark is from the dried inner bark of  Ulmus fulva. This tree is native to North America and its bark has been used in foods, and included in folklore as a demulcent (soothes irritated tissues and mucous membranes). Slippery elm was once an official drug in the United States Pharmacopoeia.

 

Slippery elm bark powder has a long history of soothing irritated gastrointestinal tract mucosa. It is indicated for the treatment of inflammation and ulceration of the gastrointestinal tract including colitis, gastritis, diarrhoea, gastric and duodenal ulcers, Crohn's disease and oesophagitis.  Slippery elm  has also been used as a soothing, nutritious food for patients with sensitive digestive systems during their convalescence.

 

D.G.L. LIQUORICE

Liquorice is well known to both prevent and treat gastric and peptic ulcers. It is also a mild laxative and a demulcent. The latter property has made it a reliable addition to cough remedies. One main active in liquorice is glycyrrhizin. Glycyrrhizin, is a mineralocorticoid which affects the sodium/potassium balance and has a slight mediating effect on the inflammatory process.

 

This pseudo-aldosterone activity of liquorice can result in hypertension as a result of sodium retention and therefore should only be used by naturopaths, herbalists, or medical practitioners with post-graduate training.

 

Studies have found that DGL can prevent the occurrence of gastric ulcer in animal models, without ill effects. Human studies have also found that DGL is as effective as cimetidine in the treatment of gastric ulcers. The mechanism of DGL is unlike other anti-ulcer agents which usually act by reducing gastric acid secretion. DGL's action appears to work by increasing the secretion of mucus from the stomach lining cells, improving mucus quality,  coating the intestinal lining and improving the intestinal microcirculation.

 

There have been several clinical studies, including my own, that have shown that DGL is more effective than a placebo or Carbenoxolene  in reducing ulcer size over a period of four weeks. These studies have found that DGL is considerably superior to antacids.

 

THE DANGERS OF ALUMINIUM BASED ANTACIDS

 

Aluminium is a toxic mineral with no known beneficial effect on the human body. Aluminium hydroxide, an aluminium salt, is used in many antacid preparations that are freely available. Studies have shown that blood levels of aluminium can rise after administration of aluminium based antacids ( Puntis J. et al. "Raised plasma aluminium in an infant on antacid", Lancet. vol 11. 1989 ). These antacids may also interfere with the absorption of calcium and phosphorus. This, in turn, may increase the rate of calcium loss from bones and accelerate osteoporosis ( Spencer H, Kramer l. "Effect of small doses of aluminium-containing antacids on calcium and phosphorous metabolism" Amm. J. Clin. Nutr. 36:32-40, 1982 ).

 

Even cooking in aluminium cookware could cause problems to our health. Foods that are cooked in aluminium cookware can produce a poisonous chloride that can neutralise some digestive juices and possibly contribute to acidosis. Acid foods including fruit and tomato cooked in aluminium cookware can increase the levels of aluminium in the food, and this can result in aluminium toxicity and may cause gastro-intestinal irritation and colic. It is also associated with neurological disorders including memory loss, Alzheimer's disease and other dementia  ( Martyn C, et al. "Geographical relationship between Alzheimer's disease and aluminium in drinking water. Lancet 1:59-62, 1989 ). 

 

Aluminium is a neuro-toxin ( damaging to the central nervous system).  It inhibits tetrahydrobiopterin, the rate-limiting co-factor in  the synthesis of many neurotransmitters (brain chemicals). Tetrahydrobioterin is significantly reduced in Alzheimer's disease patients ( Leeming R, Pheasant A. "The role of tetrahydrobioterin in neurological disease": A review. J.Ment. Defic. Res. 25:231-41, 1981 )

 

An article in the Canadian Medical Journal  1991 also reported that there are four different lines of evidence which confirm that aluminium is one of the pathogenic factors in the development of Alzheimer's disease.

Further evidence supporting the link between prolonged exposure to aluminium in the diet was reported by  Harrington, C R, et al, Lancet 1994. In this placebo controlled study, neurological changes consistent with the development of Alzheimer's disease pathology was found in patients subjected to prolonged aluminium exposure.

 

In light of the evidence linking aluminium and aluminium based antacids with serious conditions including Alzheimer's disease and osteoporosis, it would be prudent to avoid their use, until there is positive evidence that gives them the all clear.

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SOME OLDER SELECTED REFERENCES

 1.    British Herbal Compendium Volume 1,  British Herbal Medicine Association  1992.

 2.    Mills,S. The A-Z of Modern Herbalism  1989.           

 3.    British Herbal Pharmacopoeia, British Herbal Medicine Association, 1983

 4.    Martindale The Extra Pharmacopoeia 28th. The Pharmaceutical Press, 1982

 5.   Rees, W.D.W. et al., Br. Med. J. 2,835, 1979.

 6.   Turpie, A.G.G. et al.,'Clinical trial of deglycyrrhizinated liquorice in gastric ulcer' Gut    1969, 10, pp 299-303.

 7.   Wilson, J.A.C.  Br. J. Clin. Pract., 1972, 26,563.

 8.   Tewari, S.N.,  Wilson, A.K.  Practitioner, 1973, 210, 820.

 9.   Hikino, H. 'Recent Research on Oriental Medicinal Plants', In: Wagner H. and    Farnsworth N.R., eds. Economic and Medicinal Plant Research, Vol.1 London:   Academic Press. 1985,53-85.

10.  Morgan, A.G., McAdam, et al,'Comparison between cimetidine and Caved-S in the treatment of gastric ulceration, and subsequent maintenance therapy', Gut, 1982, 23pp. 545-51.

11.  Kassir,  Z.A., 'Endoscopic controlled trial of four drug regimens in the treatment of chronic duodenal ulceration', Irish Med. J., 1985, 78 pp153-6.

12.  Kruck, T.P.A., McLachlan DR., 'Mechanisms of aluminium neuotoxicity: relevance to human disease'. In: Sigel H, ed. Metal ions in biological systems:                Vol xxiv, aluminium and its role in biology. New York: Marcel Dekker, 1988:   285-315.

13.  Martin, CN., Barker LJP, et al., 'Geographical relationship between Alzheimer's disease and aluminium in the drinking water'. Lancet  1989; 59-62.

14.   Puntis, J.W.L. et al., 'Raised plasma Aluminium in an Infant on Antacid',  Lancet 1989; 2: 923.

15.   Setright, R.T., 'Crohn's disease', Get Well  An A-Z of Natural Medicine for  Everyday Illness. pp64-65, Atrand Pub. 1990.

16.   McLachlan, D. et al., "Would Decreased Aluminium Ingestion Reduce the incidence of Alzheimer's Disease", Canadian Medical Journal 145(7):793- 802, 1991

17.  Harrington, CR, Wischik, CM, et al., "Alzheimer's- disease-Like changes in tau protein processing: associated with aluminium accumulation in brains of renal  dialysis patients", Lancet1994;343:993-97

18.  Jenkins, S.A. " Vitamin C and Gallstone formation, a preliminary report"  Experientia, 33:pp1616-7, 1977

19.  Breneman, J.C. " Allergy elimination diet as the most effective gallbladder diet"   Ann. Allergy, 26:p83, 1968.

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NOTICE; This article is for educational purposes only and is not medical  or treatment advice. Always talk to your healthcare practitioner/doctor about  any treatment and prevention and follow their advice