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ALERT for patients on Hormone Replacement Therapy:

Please be aware that as of August 1, 2010, all female patients that elect to have their Hormone Replacement Therapy prescribed through our office will be required to maintain their annual exams (pelvic/pap, breast exam, etc.) and mammograms directly through our office.

Managing and Healing GERD
Managing and Healing GERD

GERD (Gastrointestinal Esophageal Reflux Disease) is a serious condition. Symptoms may be mild or severe and can include heartburn, reflux, pressure, stomach cramping, abdominal pain, nausea, hoarseness and chronic cough. Depending on frequency and intensity of symptoms, it can lead to chronic pain, damage to the stomach and lower esophagus, the development of Barrett?s Esophagus (a pre-cancerous condition) and even damage to gums and teeth. The symptoms can be deceptively mild, such as a slight sore throat in the mornings. It can start with any one or more of the following and often progresses to include several of these conditions:

1. The development of a hiatal hernia caused by frequent excessive upward pressure in the stomach. A hiatal hernia can be the original cause of the development of GERD, or it can be a result.
2. Imbalances in stomach chemistry, including both hyperchlorhydria (excess hydrochloric acid) and hypochlorhydria (inadequate stomach acid).
3. Ulcers, or patches of the stomach lining where the protective lining is ?worn away? and the tissue is inflamed. Even low stomach acid can cause pain if you have an ulcer.
4. Pathogens in the stomach or intestines (such as Helicobacter pylori bacteria and Candida albicans yeast).
5. Malfunctioning of the Lower Esophageal Sphincter (LES). This is the valve between the top of the stomach and the bottom of the esophagus which keeps stomach contents from moving back up into the esophagus.
6. The loss of normal bowel flora (beneficial bacteria), which produce food for the cells of the bowel.
7. Severe or chronic constipation, which can lead to slowing down and toxicity of the entire digestive tract.
8. Poor digestion (usually rooted in a lack of digestive enzymes, inadequate stomach acid, or a high carbohydrate diet). Poor digestion also often leads to constipation.
9. Reflux of bile past the pyloric valve and into the stomach. Bile from the gallbladder is supposed to enter the small intestine and move downward, never back up into the pancreas or stomach. Bile is acidic and can cause pain and damage.

Non-Dietary Recommendations
1. Consult with your physician and pharmacist to make sure you?re not taking any medications that increase GERD. There are several types of medication which can, including calcium channel blockers.
2. Gentle massage to the abdomen and solar plexus may be helpful. Tension in these areas can further inhibit digestion and distort the Lower Esophageal Sphincter. Ask for a list of licensed massage practitioners.
3. Consider a few sessions of Visceral Manipulation. These are usually done by a PT, OT or LMP. They should have considerable additional training, not just a class or two. Synergy Healthcare, in Spokane, has practitioners who specialize in this. Visceral manipulation gently moves the internal organs into their rightful positions. Internal organs can be thrown out of position, and fractions of an inch can pull on the tissues surrounding the LES, distorting its configuration so it leaks more easily. The ducts from the gallbladder and pancreas can also be distorted, further worsening digestion and increasing chances of more serious inflammation of pancreas or gallbladder. Visceral manipulation can greatly help to pull a hiatal hernia back down below the diaphragm, so that it no longer causes distortion of the Lower Esophageal Sphincter (this distortion causes the sphincter to leak).
4. Be sure your upper body is angled during sleep to allow gravity to aid in reducing reflux. Either elevate the two legs at the head of your bed (preferably at least 2?; you can slip a 2 x 4 under the legs) or sleep with a wedge of foam or pillows under your torso and head. It?s not enough to elevate just your head. Elevate starting at the waist. Many people with GERD reflux at night, even if they do not have any symptoms.
5. Stop smoking, if you smoke. This worsens GERD and increases the risk of developing adenocarcinoma, the cancer which can develop if you have Barrett?s Esophagus. Chewing tobacco is even worse than smoking.
6. Exercise gently, but regularly, to help lose weight if you are overweight ? extra abdominal fat weakens and distorts the Lower Esophageal Sphincter (LES).
7. If diet and other measures don?t correct GERD, acid suppression medications may be necessary, at least for a period of time. Although these medications inhibit normal acid production by the stomach, this is necessary if the acid is damaging the stomach lining or esophagus. With persistence in following dietary and non-dietary recommendations, you may be able to lower or discontinue the meds. Damage to the lining of the esophagus is dangerous, so the benefit of medication has to be considered.

Dietary Recommendations
1. Consider using mastic gum (not a chewing gum). This supplement is easy to find on the internet. Take the recommended doses for the full treatment time and perhaps longer. This kills Helicobacter pylori (a bacteria that causes stomach ulcers) and can reduce the symptoms of GERD as well. According to many researchers and the physicians at medicinenet.com, GERD is often the result of H. pylori bacteria in the stomach.
2. Avoid or greatly limit alcohol. This worsens GERD and increases the risk of developing adenocarcinoma.
3. Avoid or greatly limit chocolate, peppermint, alcohol and all caffeinated drinks ? these reduce the ability of the LES to remain closed under normal pressure.
4. Avoid or greatly limit acid-containing foods (such as citrus and tomatoes), spicy or minty foods, and any other foods which you know cause reflux symptoms. You may tolerate ketchup, fresh tomatoes and canned tomatoes; but maybe not spaghetti sauce, barbecue sauce, chili, etc., which may be spiced.
5. Eat only small servings of starchy foods and chew starches extra-long. This includes all breads, cereals, grains, pasta, potatoes and rice. Saliva has starch-digesting enzymes, but stomach juices don?t. Under-chewed starches are undigested, so they have to sit in the stomach much longer than digested starch. Slower stomach emptying increases the chances of reflux. Ideally, you?ll start to taste a slight sweetness before swallowing, indicating that the starch is breaking down into sugar.
6. Avoid or greatly limit white sugar, brown sugar, raw sugar, corn syrups, honey, and sweet dried fruits such as raisins.. Raw honey is easier to digest than all other sugars, but it shouldn?t be used frequently either.
7. Avoid eating for two, even three, hours prior to getting in bed or lying down on the couch.
8. Decrease fats ? especially partially hydrogenated fats, which are less digestible. Fats slow the emptying time of the stomach. Slower emptying time increases the chances of GERD symptoms. Fats are important in the diet, so find which fats agree with you ? possibly including olive oil, safflower oil, sunflower oil, coconut oil, real butter and nut butters.
9. Eat small meals and snacks. Eat more frequently, if necessary, to get adequate calories. Larger meals distend the stomach, creating pressure and possibly causing further distortion of the Lower Esophageal Sphincter. Pressure in the stomach pushes upward, pressing on the LES and worsening the hiatal hernia that almost always accompanies GERD.
10. Take 1 ? 2 full-spectrum digestive enzyme capsules (with at least proteases, lipases and amylases) with each meal, especially with dinners or evening snacks.
11. Some people develop GERD because of low hydrochloric acid. Especially if caught early, taking a betaine hydrochloride supplement can be helpful. You will usually know in only one or two doses whether or not this will work. Do not take betaine hydrochloride if you are taking aspirin or any Non-Steroidal Anti-Inflammatories (known as NSAID?s) or have an ulcer. Start with a very low dose, such as only 75 or 150 mg. and take mid-meal. If your symptoms decrease, this may help your condition improve and even heal. If your symptoms increase, stop immediately and do not use.
12. Take supplements which heal the stomach and the esophageal lining; such as Glutagenics, a high quality aloe, deglycerized licorice, orange peel, or others especially designed for healing these delicate tissues.
13. Avoid constipation. Anything that slows the normal transit time of the bowel increases the chances of GERD. Two to three, or more, bowel movements a day is normal. A minimum of once a day is essential. Use digestive enzymes, extra cooked vegetables, ground flaxseed or other fibers, extra magnesium, and even gentle laxatives and stool softeners if needed, to keep the bowels moving.
14. Try chewing gum after meals to create a larger volume of alkaline saliva, which then moves down the esophagus, neutralizing excess acids and carrying them back into the stomach. Waiting several minutes after eating may work better than chewing gum right after eating. Experiment with timing and different brands of gum. Avoid sugar-free gums sweetened with aspartame.
15. Improve your diet to help lose weight if you are overweight ? extra abdominal fat weakens and distorts the Lower Esophageal Sphincter (LES). Protein, such as tender meats (chicken thighs rather than breast) usually agrees with the stomach more than starch or sugar. Cooked vegetables are often better tolerated than salads. Keep meals and snacks balanced, but lean more toward simple proteins and vegetables, fruits and small amounts of grains and more away from refined starches, sugary foods, and highly processed foods. Learn which foods and combinations agree with you, and avoid those that don?t.
16. Avoid aspartame, also known as NutriSweet and Equal. Aspartame can actually contribute to weight gain, which in turn increases GERD. Limit your intake of Splenda and other non-nutritive sweeteners.
17. Use over-the-counter (OTC) antacids sparingly. If you need them more than once a week, you probably need medication. Contrary to popular press, the calcium in these is not well-assimilated. Calcium needs acid for assimilation and antacids make the stomach more alkaline. Most GERD medications inhibit stomach acid production, but OTC antacids go further and make the stomach even more alkaline.
18. Only a small percentage of people with Barrett?s Esophagus develop adenocarcinoma, but if you are diagnosed with Barrett?s, take selenium. Selenium is known to be cancer-protective. Doses of 200 mcg daily for prevention to 1000 mcg (1 gram) daily for acute treatment are appropriate.

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