Gastroesophageal Reflux Disease (GERD)

iStock_000006332600XSmallWhat Gastroesophageal Reflux Disease and Non-Ulcer Dyspepsia?

Gastroesophageal reflux disease (GERD) and non-ulcer dyspepsia (NUD) are medical terms often used to label indigestion and/or heartburn that is not related to an ulcer. The main symptoms of GERD and NUDare heartburn and/or upper abdominal pain as well as difficulty swallowing, feelings of pressure or heaviness after eating, sensations of bloating after eating, stomach or abdominal pains and cramps, as well as all of the symptoms of the irritable bowel syndrome. (IBS). About three out of ten patients with GERD/NUD also meet the criteria for IBS.

What causes GERD/NUD?

Symtoms of NUD and GERD are most often caused by the flow of gastric juices up the esophagus leading to a burning discomfort that radiates upwards and is made worse by lying down. This reflux of gastric juices can be the result of factors that increase intra-abdominal pressure (e.g., overeating, obesity) thereby causing the gastric contents to flow upwards, or factors decrease the tone of the esophageal sphincter (e.g., hiatal hernias, coffee).

What dietary factors are important in GERD/NUD?

Common dietary causes of GERD/NUD include overeating, obesity, coffee, chocolate, fried foods, carbonated beverages (soft drinks), and alcohol. In most cases, simply eliminating or reducing the causative food(s) or beverage is all that is necessary to relieve GERD/NUD. Other tips include decreasing the size of portions at mealtime, chewing food thoroughly and eating in a leisurely manner in a calm, relaxed atmosphere, and not eating within 2 hours of bedtime.

What nutritional supplements should I take for GERD/NUD?

Foundation Supplements. High potency multiple vitamin and mineral formula; Vitamin D3 2,000-5,000 IU/day; Fish oil, EPA+DHA 1,000 to 3,000 mg/day.

Calcium carbonate or calcium citrate can be used as antacids for occasional relief of heartburn. The recommended single dosage is 500 to 1,000 mg.

Betaine HCL. In the person with chronic heartburn or indigestion, rather than focus on blocking the digestive process with antacids, I have found most people respond better if we focus on aiding digestion. One of the most useful digestive aids is hydrochloric acid. Since not everyone can have detailed gastric acid analysis to determine the need for hydrochloric acid supplementation, let me offer a practical method of determination.

  1. Begin by taking one tablet or capsule containing 10 grains (600 mg) of hydrochloric acid at your next large meal. If this does not aggravate your symptoms, at every meal after that of the same size take one more tablet or capsule. (One at the next meal, two at the meal after that, then three at the next meal.)
  2. Continue to increase the dose until you reach 7 tablets or when you feel warmth in your stomach whichever occurs first. A feeling of warmth in the stomach means that you have taken too many tablets for that meal, and you need to take one less tablet for that meal size. It is a good idea to try the larger dose again at another meal to make sure that it was the HCl that caused the warmth and not something else.
  3. After you have found that the largest dose that you can take at your large meals without feeling any warmth, maintain that dose at all of meals of similar size. You will need to take less at smaller meals.
  4. When taking a number of tablets or capsules it is best to take them throughout the meal.
  5. As your stomach begins to regain the ability to produce the amount of HCl needed to properly digest your food, you will notice the warm feeling again and will have to cut down the dose level.

Enteric-Coated Peppermint Oil Capsule provides volatile oils from peppermint in an enteric-coated capsule so that it does not break down in the stomach but is instead delivered to the small and large intestine. Preparations containing peppermint oil in enteric-coated capsules have been shown to be effective in GERD/NUD. In one double-blind study, 120 patients with NUD were given either the peppermint and caraway seed oil or cisapride (Propulsid) for 4 weeks. The mean reduction of pain score was comparable in both groups (4.62 for ECPO; 4.6 cisparide). Other symptoms of NUD also improved in a similar fashion. Positive results were also found in H. pylori positive individuals. The significance of this study is ENORMOUS. While enteric-coated peppermint and caraway oil is extremely safe at recommended levels, Propulsid caused fatal heart rhythm problems. According to the United States Food and Drug Administration, at least 111 people died as a result of Propulsid use and nearly 400 developed heart abnormalities. Propulsid has subsequently been yanked off the market. Take one or two capsules three times daily twenty minutes before meals.

DGL (deglycyrrhizinated licorice) is a special licorice extract effective in promoting healing of ulcers. If there is significant irritation to the esophagus due to gastric acid reflux, chew one or two 380 mg chewable tablets of DGL twenty minutes before meals.

How do I know if the recommendations are working?

Improved digestion and a reduction in symptoms are clear indications of improvement.

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