11 09 2016

The Herbal Medicine approach to Acid Reflux

Andrea Hughes Herbal Medicine acid reflux, gerd, h.pylori, hashimotos, herbs for reflux, Lanzoprazole, omeprazole, reflux

What is it?

Acid reflux is where acid and other stomach contents are brought back up (regurgitated) into your throat and mouth.

If you have ever experienced Acid Reflux you will know that it can be extremely painful and at its worst can manifest as actual regurgitation of food via vomiting.

Sometimes Reflux can manifest as a chronic cough with no sign of heartburn or acid.

What is the Medical Understanding?

There are a few medical conditions which can lead to symptoms of acid reflux, these include:

Hiatus hernia: is when part of the stomach squeezes up into the chest through an opening (“hiatus”) in the diaphragm.
GERD: A dysfunction of the LES sphincter: The lower esophageal sphincter (or LES) is a muscle that separates the esophagus from the stomach. It acts like a valve that normally stays tightly closed to prevent contents in the stomach from backing up into the esophagus. When we swallow, the LES opens up (the muscle relaxes) so that the food we swallow can enter the stomach.
H.Pylori: A bacteria which can take up residence in the Stomach, the most common cause of gastric ulcers and often undetected.
If Acid Reflux is left untreated it can cause inflammation or a condition called Oesophagitis and in extreme cases can lead to Barrets oesophagus where the cells are classed as pre-cancerous.

The Functional & Herbal Medicine Approach

Acid Reflux is something that I see and treat a lot in my practice, sometimes it is the reason people come for assistance and other times I discover that they are living with it as a ‘minor symptom’.

There is always going to be an underlying cause for Acid Reflux and it is my job to find it!

Getting to the Root Cause:

Let’s explore some of the underlying issues that I commonly see in my clinical practice..

Diet/Gut Function
Lifestyle
Hormone Balance

Diet and Gut Function.

By Gut Function I mean how is your digestive system working all the way through? It is one long tube really so it makes sense that an imbalance in one area will affect all or other parts of the system.

What are you eating?

There are known dietary triggers for reflux such as:

Fried Foods
Spicy food
Tomato based foods
Processed Foods
Caffeine
Alcohol
Sugar

Often there are other foods which cause a problem for a different reason. For example food intolerances, commonly to Gluten, Dairy or Egg can also be a factor.

I have seen Babies who have food allergies (different to an intolerance) who present with Reflux and are medicated with Proton Pump Inhibitors.

SIBO or Small Intestinal Bacteria Overgrowth can often give symptoms of Reflux.

How are you eating?

Digestion begins in the mouth, the very act of chewing encourages the release of Hydrochloric Acid from the Parietal cells in the stomach, the LES valve then relaxes and food is allowed to pass through to the Small Intestine.

Makes sense that if you eat when you are stressed or if you eat on the run or don’t chew your food then this vital step in digestion will be compromised.

Stress: Affects the nerves in your stomach, making it impossible to process the food properly. This will cause food to go up instead of down. In Chinese Medicine they call this Rebellious Qi!

…and more stress:
When you are under stress the adrenal glands will release emergency energy in the form of adrenaline, the blood and energy will move away from your core (digestion) and to the periphery.

The release of Stomach Acid will be inhibited as the body thinks it needs to fight or run away – so it does not need to digest food!

Stomach Acid- too much or too little?
Most people think that when they experience reflux they are producing too much stomach acid, in fact it is quite rare for anyone to produce too much.

In fact it is more common to have an inadequate production of Stomach Acid or HCL (hydrocholoric acid) It is widely understood that our production decreases with age and I have already spoken about the impact of stress on production of HCL.

Stomach acid has an important role in the body. Not only does it break food down into amino acids, it also kills bacteria, yeast, viruses, and parasites that enter our digestive tract.

The bacteria H.Pylori thrives in a low acid environment, if it is symptomatic then reflux might be present.

It is worth getting checked,this can be done either with myself or your G.P.

Where there is disordered digestion and I suspect low stomach acid I give my patients some HCL tablets in order for them to perform the challenge to check levels of stomach acid

Endocrine issues/Hormone imbalance?
Did you know that there is a link between low stomach acid and the autoimmune Thyroid condition ‘Hashimotos Disease’?

The Gut of course is host to the GALT or the Gut Associated Lymphoid Tissue which holds essentially 70% of the immune system including T Lympocyte Cells which are responsible for mounting attacks against perceived ‘invaders’ and produce antibodies to such potential or perceived threats. This a essentially a protective mechanism but when the integrity of the gut becomes compromised things can go wrong and antibodies to parts of ‘self’ can be created..[1]

In Hashimoto’s the antibodies are formed to the Thyroid tissue which can be described as being ‘under attack’ which eventually leads to a low Thyroid Function.

Studies have shown that the Thyroid Hormones T3 and T4 protect mucosal lining against stress induced ulcer formation[2] as well as showing that examination of gastric ulcers via endoscopy is associated with low T3 and T4 [3].

I have noticed in practice that some of my patients presenting with female hormone issues and imbalances such as Infertility, PMT, PCOS also suffer with acid reflux, we know that the systems of the body work as a whole, not in isolation, that is the true understanding of ‘holistic’ medicine after all…

So here we have an example of how stress can affect both the Digestion and Hormone Balance.

To be brief the adrenal glands produce our stress hormones adrenalin and cortisol. When we are in a state of ‘stress’ and cortisol levels are high, the body is in a state of ‘fight or flight’ rather than ‘rest and digest’ so it makes sense that we will not have a ‘need’ to produce stomach acid to digest our food.

Pregnalone is produced in the adrenal glands and is the building block for the female hormone Progesterone, as well as the stress hormone Cortisol. If there is a high demand for the stress hormone Cortisol then something called ‘Pregnalone Steal’ occurs, where the Pregnalone is used to make more Cortisol at the expense of Progesterone. This can be part of the cause of a progesterone deficiency or a relative oestrogen dominance. This combination of hormonal symptoms and digestive symptoms could well be contributory towards Reflux, remember the production of stomach acid is affected by stress…

I noticed also that some of my Menopausal Patients also suffered with Reflux and I wanted to find if there were any Medical Studies to back up my thoughts of a connection between the two conditions, this is what I found:

Postmenopausal use of estrogens, selective estrogen receptor modulators, or over-the-counter hormone preparations is associated with an increased risk of symptoms of gastroesophageal reflux. This suggests a hormonal component to the pathophysiology of gastroesophageal reflux in women.[4]

and…

The purpose of this study was to determine the prevalence and describe the pattern of gastroesophageal reflux disease (GERD) symptoms in premenopausal-, perimenopausal-, and menopausal-age women.

The implications for Practice say: These findings are strongly suggestive of a hormonal link between perimenopausal and menopausal states and increasing GERD symptoms. Women of all ages should be screened for symptoms of GERD, especially in the perimenopausal and menopausal population of women because diagnosis of GERD is often not made or misdiagnosed. The impact on the quality of life of women experiencing GERD symptoms cannot be underestimated.[5]

Treatment?

The Herbal Medicine Approach is to treat the underlying cause whilst soothing and calming the symptoms.
I look for the underlying cause as well as the effects of the acid and treat accordingly, no two people will receive the same treatment but there are core herbs which I use as part of my protocol when withdrawing from PPI’s or helping to ease symptoms while we treat the underlying cause, I will write about these in my next post!

Orthodox Treatment?

Commonly people suffering with Reflux are prescribed a medication known as a proton pump inhibitor such as Omeprazole or Lanzoprazole.

Proton pump inhibitors or PPI’s are pharmaceutical medications which suppress the production of HCL (stomach acid) the SPC on Omeprazole states that administration for reflux is expected to bring results within 4-8 weeks.[6]

I have seen many patients who have been left on this type of medication for more than 8 weeks, in some cases for years, without further investigation.

This is not a good idea for the following reasons:

Is the cause of the problem an overproduction of HCL? Does it need to be suppressed?
PPIs have been associated with an increased risk of vitamin and mineral deficiencies impacting vitamin B₁₂, vitamin C, calcium, iron and magnesium metabolism.[7]
All PPIs have been documented to cause AIN. Several adverse drug event registries now note PPIs as the most common cause of drug-induced acute interstitial nephritis ( kidney disease) [8]
Continuous Proton Pump Inhibitor Therapy and the Associated Risk of Recurrent Clostridium difficile Infection.[9]

Coming back to our hormone link, this is also an interesting study:

There is a statistically significant independent association between oestrogen-only hormone and GORD and PPI use. Oestrogen-only hormone has a stronger independent association with GORD than progesterone, refuting earlier in-vitro studies suggesting progesterone was the most important hormone in GORD aetiology.[10]

A couple of case Studies ( for confidentiality there are no names and personal details are omitted)

Female in early 60’s had a positive diagnosis of Inflammatory Bowel Disease, she came to see me in order to avoid the Steroid medication her consultant wanted to prescribe.I noticed she was taking a Proton Pump inhibitor – Lansoprazole which had been prescribed a couple of years ago and when I questioned her further she told me it was for ‘acid caused by a hiatus hernia’
We performed a Digestive Stool Analysis and subsequently treated a gut dysbiosis of bacteria and yeast. As part of the treatment we identified Gluten and Dairy as problem foods for her and removed them.We also used anti-inflammatory herbal medicines for the gut, liver support herbs for detoxification pathways alongside probiotics and omega 3 EFA’s. I gave her a herbal medicine mixture of: Marshmallow Syrup, Calendula and Meadowsweet and some Swedish Bitters to take 3 drops before each meal. She went through a process of withdrawing from the Lansoprazole which took around a month, using the Marshmallow mixture as needed whenever she experienced reflux. After approx 3-4 months she only experienced slight reflux when bending down and a couple of drops of Swedish Bitters took away the symptoms quickly. Now she no longer suffers from reflux at all, the Hernia is still there of course but is quiet as the rest of her digestion is improved. Her inflammatory bowel disease is in remission with no symptoms and inflammatory marker Calprotectin has been repeatedly below detectable levels!
Female mid 30’s came to see me as she was experiencing irregular periods and anxiety. She had also been prescribed a proton pump inhibitor Omeprazole at a high dose of 30mg, she had not been investigated for a Hiatus hernia or checked for H.Pylori.We checked for H.Pylori which was negative and set about finding the cause of her hormonal symptoms by checking her adrenal function. She had incredibly high cortisol which I felt was likely impacting her levels of progesterone and her digestion.I gave her lifestyle advice ( relaxation, mindfulness techniques) and herbs to help normalise the high stress response – Holy Basil, Oatstraw, Motherwort and herbs to help normalise production of Progesterone – Paeonia root and Vitex.She took a while to completely withdraw from the Omeprazole and seemed to be stuck on one every other day for a while.I gave her some Slippery Elm capsules to take as needed.She is now having regular periods and is completely off the Omeprazole with no symptoms of acid reflux.

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