Reflux & Heartburn
Esophageal Reflux - Heartburn, Indigestion Heartburn afflicts 44% of
Canadians & American non-ulcer dyspepsia afflicts 20-40%. Swallowed food descends
through the chest in the esophagus into the stomach. Pain in the central chest
may come from an inflamed esophagus. This pain is often burning in quality but
may also be a severe ache, suggesting a heart attack.
The term Gastroesophageal Reflux Disease (GERD) is a popular description
of all the adverse events that cause esophageal reflux and inflammation with
heartburn. A hiatus hernia may show up on the x-ray, but treatment with diet revision
will often help or resolve the problem. Many patients who benefited from proper
diet revision have reported that their heartburn and indigestion only returns
when they eat the wrong foods - this food intolerance may last for many years.
Here are the basic principles:
- Digestive disorders are common and originate in the food supply.
- Diet revision should be primary therapy.
- Digestion of food is achieved by the Gastrointestinal Tract.
- The likely source of digestive disorders is the food passing through it!
- The solution is to adjust the incoming food supply until the problem is
The gastrointestinal tract is a sensing, reactive device which monitors the
material flowing through it. Symptoms arising from this system provide
information about its dysfunction. Seven basic symptoms alert the patient to
gastrointestinal tract displeasure with food choices - nausea, heartburn,
vomiting, bloating, pain, constipation and diarrhea.
Further down in the stomach, a surface reaction results in upper-middle
abdominal pain and nausea; sometimes vomiting is triggered-a defensive reflex
which gets rid of the offending food and usually relieves the pain. Some
patients induce vomiting to avoid discomforts after eating.
Recurrent irritation in the upper GIT is food-caused until proven
Obviously smoking, drinking alcoholic beverages, coffee and teas are the
first problems to eliminate, but surface "allergy" to common, "normal" foods may
also be responsible. Symptoms from the upper digestive tract are often
associated with lower abdominal pain, bloating, constipation and diarrhea. A
trial of diet revision can provide prompt relief. If the clearing diet is
unsuccessful, further investigation is always required.
Self Treatment of Symptoms
Self-therapy of milder symptoms - dyspepsia and early ulcer-like symptoms
consists of retreating to Alpha Nutrition Phase 1 foods, using brown rice
instead of white rice with the option of taking tagamet or zantac as
recommended by the manufacturer. Remember that the bedtime dose is very
important because your stomach will spend 8 hours or more in a near-empty
condition vulnerable to the action of accumulating acid.
Proton pump inhibitors (PPI) are popular drugs for treating heartburn but
have negative effects if taken long term. Several drugs are marketed, some are
over the counter and all are available on prescription. Common brand name PPIs are Nexium
(esomeprazole) , Prevacid (lansoprazole), Prilosec (omeprazole),Protonix (pantoprazole).
Both PPIs and H2 blockers suppress stomach acid secretion.
PPIs shut down the proton pumps in the stomach that
create an acidic environment. H2 Blockers block histamine receptors on acid
producing cells in the stomach. PPIs have delayed onset and prolonged
action while H2 blockers reduce acid secretion within an hour and with a
duration of about 12 hours. There are some adverse effects. Long-term PPI
use causes reduces calcium absorption which increases the risk of bone
fracture. The absorption of vitamin B12, iron and magnesium is also reduced.
An editorial in the Lancet Gastroenterology & Hepatology journal that
reviewed the growing awareness of serious adverse effects of long-term use
of PPIs: “For more than a decade, researchers have reported various
PPI-associated adverse effects, including nutritional deficiencies,
bacterial gut infections, bone fractures, and even heart attacks. So far
this year, PPIs have been in the news with reports of increased risk of food
poisoning and bacterial gut infections. Last year their long-term use was
linked to dementia risk, chronic kidney disease, and end-stage renal
disease—findings accompanied by massive media coverage. The evidence for
kidney damage was based on two studies, both observational. In a cohort
study of more than 10 000 individuals with no kidney disease at baseline,
those who took a PPI were reported to have a significantly increased risk of
developing chronic kidney disease compared with those who hadn't taken such
drugs. Another study showed that long-term PPI users were more likely to
develop chronic kidney disease and end-stage renal disease compared with
those taking H2RAs.”
PPIs can increase risk of Salmonella, Campylobacter, Clostridia Difficile
and other infections. Other negative effects, some serious, limit their use
Reed et al stated: “Eosinophilic esophagitis (EoE) is a chronic
immune/antigen-mediated disorder defined by eosinophilic-predominant
esophageal inflammation and by esophageal dysfunction. It is diagnosed when
there are at least 15 eosinophils per high-power field in esophageal
biopsies. EoE represents a major cause of oesophageal morbidity. The
pathogenesis of EoE is multi-factorial, but improvement with dietary
elimination strategies supports the role of food antigen sensitization in
the etiology of the disorder. The most commonly identified food trigger was
dairy (53%) followed by wheat (37%) and eggs (26%). There were seven
patients with a single food trigger, which was dairy in five cases. For 10
patients, there were two food triggers with wheat being a trigger in seven
There were two patients with three or more food triggers.”
[i] C. C. Reed; C. Fan;
N. T. Koutlas; N. J. Shaheen; E. S. Dellon,Food Elimination Diets Are
Effective for Long-term Treatment of Adults With Eosinophilic Oesophagitis.
|Aliment Pharmacol Ther. 2017;46(9):836-844.
Diet Revision Plan
Phase 1 of the Alpha Nutrition should be sustained for 2 weeks or until all
symptoms are gone and then food is reintroduced using the medium track - foods
from Phases 2 and 3 are reintroduced next. If adequate diet revision does
not resolve symptoms promptly and/or prevent recurrent gastritis or ulcers, you
need medical assessment and treatment.