I hope all is well with you and yours. As I write this Newsletter, Covid-19 cases are increasing on top of a challenging political landscape. And as I have written about in past Newsletters, it takes resilience and stress hardiness to thrive during these times. To deal best with this stress, I always recommend that you follow the Don’t Mess with Stress ™ core four lifestyle behaviors—Diet, Meditate, Walk (Move, Exercise, Dance), and Sleep and also have social connection when possible.
Recently, I have seen in my patients an increase in stress-related gastrointestinal tract conditions. People are having more heartburn, and others are having more lower gastrointestinal symptoms like constipation and/or diarrhea, what Western Medicine often calls Irritable Bowel Syndrome.
For this edition of the Newsletter I am going to focus on a condition called Gastroesophageal Reflux or GERD. In the December Newsletter I will focus on the lower GI tract.
During this time, I must confess that I have had some symptoms of GERD.
GERD happens when the food and acid from the stomach come up through a valve called the Lower Esophageal Sphincter (LES). Normally this sphincter or valve is closed after we eat, so food won’t come back up. One of the causes of GERD is an anatomical issue such as a hiatal hernia, where part of the stomach is pushed up through the diaphragm, the thin piece of muscle that separates the chest cavity from the abdomen. People are either born with a hiatal hernia or they can develop it.
Another major cause of GERD is when the LES loosens and the food and acid come up the esophagus. Things that can causes the LES to relax are: being overweight or obese, nicotine, caffeine, chocolate, mint, alcohol, citrus, spicey food, fatty foods, aspirin, Non-Steroidal Anti-Inflammatory Agents (NSAIDS) like Ibuprofen, Motrin, Advil, Aleve. There are also other medications and supplements that have been associated with GERD.
I don’t know if you remember, but restaurants have often given people a mint covered chocolate after dinner. And for people with GERD, this could be problematic. 😉
Not everyone feels the symptoms of GERD. There is what is called “Silent Reflux”—where you are having reflux but you’re not aware of it. Silent reflux can show up as hoarseness, chest pain, a cough, waking up choking at night, and even having breathing symptoms, such as asthma. It is important to make sure that the chest pain is not from a cardiac or heart cause.
How does Stress cause GERD? It’s not completely clear, but we know that GERD tends to worsen with stress. ⁽¹⁾ ⁽²⁾. I believe that stress is a significant cause of GERD.
Before I give you some remedies to help with GERD, here are urgent situations where you must see your doctor or health provider.
- If you have symptoms such as chest pain, you should immediately seek medical attention to rule out a heart issue.
- If your symptoms have been persisting for at least two weeks despite treatment you should also see your physician.
- If food gets stuck in your esophagus while eating or you have pain when the food is moving down your esophagus, you must seek medical help as soon as possible to make sure there is no constriction or anything blocking the esophagus.
Here are some recommendations and remedies that can help GERD.
As always before taking any of these remedies, it is best to discuss them with your physician or health provider:
“Anti-Reflux” Measures:
- Avoid going to bed on a full stomach. This will increase the risk of GERD. Leave at least 3 hours between your last meal and bedtime. As one of my colleagues, Dr. Jamie Koufman, has said, “Kitchen closed at 6:30pm.” I know that is early for many of us, but it is probably wise to eat early, not only for your stomach, but for your brain.
- Not everyone has the same triggers for GERD, but in general it is best to avoid: caffeine, chocolate (which also has caffeine), alcohol, spicey foods, citrus fruits/juices, NSAIDs, mint, and fatty foods.
- Stop smoking if you smoke.
- Raise the head of the bed at least 6 to 8 inches with wooden blocks under the head of the bed; a foam wedge, or other devices.
- Avoid tight fitting clothes around the waist.
Conventional treatment for GERD—should not be used indefinitely unless indicated
- Antacids—usually give temporary relief
- H2 blockers (an antihistamine different than the antihistamines over the counter for allergies) such as Pepcid (Famotidine). Zantac has been removed from the market. Side effects are rare but can include Vitamin B12 deficiency and confusion. ⁴
- PPIs or Proton Pump Inhibitors such as Prilosec (Omeprazole) or Protonix (Pantoprazole) for more severe symptoms. With prolonged use, PPIs can have side effects such as magnesium and b12 deficiency, as well as osteoporosis and fractures. ⁴
Holistic Remedies for GERD—“Demulcent”—soothing and coating
- Aloe Vera juice
- Marshmallow root
- Deglycyrrhizinated licorice (DGL)—this is often used as a chewable tablet in between meals
If you are interested in learning more about GERD and other GI issues, I recommend a self-paced, online course called “The Art of Digestive Wellness” that my friend and colleague, Dr. Liz Lipski, a PhD-Nutritionist and gut expert, is offering. This course is for lay people and professionals, and has been approved by several nutrition organizations, which offer Continuing Education credits.
To learn more about Dr. Lipski’s course, please go to www.innovativehealingacademy.com. She is also offering a free Digestive Health Appraisal Questionnaire at www.dhaq.info. I do not receive any compensation if you register.
Finally!! The Excitement! My Book is done and will be launching on Amazon tomorrow!
I will be sending you an email early tomorrow morning with the details!
I can’t wait for you to read it!
Until tomorrow!
Dr. Jill
References:
- Song EM, Jung HK, Jung JM. The association between reflux esophagitis and psychosocial stress. Dig Dis Sci. 2013;58(2):471-477. doi:10.1007/s10620-012-2377-z
- https://www.healthline.com/health/gerd/stress (https://za454.infusion-links.com/api/v1/click/6477996899303424/6675696780967936)
- Khan BA, Sodhi JS, Zargar SA, Javid G, Yattoo GN, Shah A, Gulzar GM, Khan MA. Effect of bed head elevation during sleep in symptomatic patients of nocturnal gastroesophageal reflux. J Gastroenterol Hepatol. 2012 Jun;27(6):1078-82. doi: 10.1111/j.1440-1746.2011.06968.x. PMID: 22098332.
- Uptodate.com