Expert: Dr. Kristina Conner - 1/21/2008

Question
QUESTION: Hello Kristina,
I wish you can bring a little bit of hope and light for my health problem.
I suffer from heartburn almost all the time. Day and night. But sometimes it
is less intense than other. Fortunately.
My diet is good with natural Whole Foods. Exercising is fine too. I love to go
cross-country skiing or bicycling according to each season. I also do basic
yoga and light weight lifting regularly.
I am a 56 years old male. I don't smoke (gave it up 23 years ago), I do enjoy
red wine sometimes but can easily let go of it. I do not drink coffee or tea.
Besides GERD I am otherwise in rather good health. My life is good - a
wonderful wife, very nice children and fantastic grand-children, nice simple
house, no real financial problem, good friends etc. In other words, at this
point in time my life is not very stressful except for the GERD symptoms that
are stressors all by themselves.
My biggest problem right now is that I cannot eat very much because of the
pain and I have lost 15 pounds in the last 6 weeks. For some people this
would be good news but not for me  I am already very thin. I do not need to
lose any weight at all.
Any suggestions to help with GERD and its painful symptoms will be
appreciated. I had an episode like this about one year ago. It lasted for few
monbths and almost disappeared for a good 6 months. I do not understand
how and why it came back. Nothing specific seems to explain it.
I have had a camera down my throat and according to the specialist there is
no hernia, no Barretts, no nothing. This is a functional problem it seems. The
biopsy was normal too. But it hurts just the same and I do not sleep well and
have developed an unpleasant level of anxiety too that I try to balance with 2
sessions of meditation every day.
Prevacid was prescribed. I tried it and quite frankly hated it. I have been using
natural means to help myself for the past 20 years and I do not take any kinds
of medical or recreational drugs. I really want to keep it that way. Herbs,
supplements and any non-toxic tools are welcome.
Thanks for your time and your help.



ANSWER: Hi Bourouba, First I would say that it's a good idea to get these symptoms check out by your primary physician.  Just because the symptoms are similar and you had a full work-up last time does not negate the necessity to check your current symptoms.  I am all for self-treatment when appropriate, but it may be time to find out more information about what's going on.  And then if you need more specific natural treatment, I'd suggest consulting a naturopathic physician (www.naturopathic.org) in addition to your conventional doctor.  The information I can provide without a full evaluation is general.  It is the basic 3 step approach for GERD.  
First, remove any food intolerances, which can cause or worsen GERD.  Some of the common sensitivities are dairy, wheat, gluten, corn, sugar, egg, food additives/ preservatives, peanuts, shellfish, and soy.  Common triggers for GERD are coffee, tea, cigarettes, mint, chocolate, alcohol, spicy foods, and high fat foods.  Either testing these foods, or eliminating them for a few weeks then adding them back in one by one might give you some indication of which ones might be sensitive for you.  
Second, improving digestion is very important, by eating slowly, chewing well, and supplementing with bitters before meals, digestive enzymes with meals, or hydrochloric acid with meals, or a combination of these.  
Finally, helping the GI tract to soothe and heal with aloe juice, deglycrrhizinated licorice, slippery elm, or marshmallow will provide a lasting effect.
Again, I stress that if these remedies do not help within a few weeks, make sure you seek out further guidance.  
Thanks for writing and good luck
Dr Conner



---------- FOLLOW-UP ----------

QUESTION: Thank you so much for a clear and detailed answer. I will look more closely
at the allergy possibility, especially since I know I am allergic to some pollen
and other products. I am already avoiding the trigger foods you mentioned.
Soothing the GI track will help I am sure but improving digestion will
probably be the most helpful for me. I wonder if you could expand on that
part.

The amount of time that food remains in my stomach is longer than normal,
sometimes MUCH longer, more than 6 hours or even 8 hours for some foods.
Then it tends to ferment and create a volcano - so to speak - that erupts in
my esophagus.

I have found that gentian helps to speed up that process a little bit. Along
with gentian would you know of other products that increases the rapidity at
which the food leaves the stomach for the small intestines. Once foods has
passed the stomach the rest of my digestive process seems to be normal. But
the problem is that food just sits in my stomach for long period of time. I
never experienced this problem before last year after I had the flu for 1 week.
BTW I was tested negatively for H Pylori.

Thank you again for your already very good and complete response. If you
have other ideas for delayed stomach emptying I will be even more grateful
as this is a very difficult experience.  

Answer
I agree with you that improving digestion will be a significant area to address for this condition.  Your further description confirms this.  Without proper triggers of sufficient stomach acid and enzymes, emptying will be delayed.  Gentian, one of the best known bitters, helps stimulate secretions, which is why it helps speed up the process.  Also, with a deficiency of stomach acid, there is no trigger to close the area leading back to the esophagus--this stays open and allow reflux to occur.  
So it appears that it would be a very good idea to supplement with the bitters and/or hydrochloric acid.  Digestive enzymes typically work more in the small intestines, so would be a second choice since you seem to have fewer symptoms there.  
Other things you may want to consider, besides eliminating food sensitivities, is food combining.  these are fairly simple rules they may help with the timing of digestion.  Such as eating fruit away from meals, eating vegetables & grains together, or vegetables and meats together, but not meat & grains, etc.  To find out more about this, look at the book Fit For Life.  
Dr Conner