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Gastroesophageal Reflux Disease (GERD)


GERD occurs when stomach contents, which normally move down through the digestive system, flow back into the esophagus (the tube that carries food between the throat and stomach). The most common symptom of GERD is frequent heartburn, although other symptoms such as difficulty swallowing, indigestion and coughing may also occur. All of us have some acid reflux from time to time, but when it occurs more frequently, or causes symptoms, it is important to consult your medical provider. He or she will usually diagnose GERD based on certain signs and symptoms you report.

What causes GERD?

The lower esophageal sphincter (LES) is located at the very bottom of the esophagus where it joins the stomach. The LES completely closes to prevent stomach contents from moving back into the esophagus. A majority of patients with GERD have an LES tone that is "relaxed", or "loose", allowing stomach contents to enter back into the esophagus, which results in heartburn. Factors that can cause a reduced LES tone include:

• Certain medications • Dietary factors: foods with high fat, chocolate, caffeine, low fiber, food allergies (especially to dairy) • Lifestyle habits: alcohol intake and smoking • Lying down or bending over after eating, overeating, obesity, hiatal hernia and pregnancy can all increase pressure on the LES • Delayed gastric emptying (due to inadequate acid secretion and improper digestion) • Peppermint consumption • Genetics (rare) • A low (acidic) PH • A vata and pitta imbalance (in Ayurvedic medicine) which leads to heat and inflammation which then rises instead of moving down and out of the body with the natural flow. • Stress! • Hypochlorhydria (not enough stomach acid produced). Too little stomach acid causes reflux as well.

Diagnosing GERD:

It is very important that you have a complete diagnostic stool analysis test to assess other underlying problems within the digestive tract (with digestion, elimination, microflora balance, and gut integrity) that could be causing your GERD. Always treat the root cause and not just settle for symptom relief! Genova Diagnostics has a CDSA that is part of their Pay Assured program (meaning most insurance companies will pay all except $149.00 of the cost of this very comprehensive test. Aetna insurance is not part of Pay Assured). Regular laboratories cannot offer the same level of diagnostics (including validity and specificity) that functional medicine labs specialize in.

How is GERD commonly treated?

Proton Pump Inhibitors, like Prilosec, are the gold standard for GERD treatment. Histamine Receptor Blockers and over the counter antacids are also commonly used to treat GERD symptoms. All of these medications work by reducing the acidity of the stomach so that stomach contents flowing back into the esophagus no longer cause irritation. However, it is important to remember that antacids do not fix the problem with inadequate LES tone and they can cause side effects if used for a long period of time. If acid-blocking therapies fail, surgery is often recommended in severe cases. Consequences of reducing the acidity of the stomach include:    • Interfering with the digestion of important nutrients    • Increasing the risk of developing infections    • Possibly increasing the risk of stomach cancer

How SHOULD GERD be treated?

By addressing the root problem. There are some common lifestyle adjustments and supplements that can be helpful, but ultimately the most important treatment plan is individualized to your body type and the results of your stool analysis. See a qualified integrative medical provider who knows how to treat the whole system rather than just the part that hurts.

Simple lifestyle adjustments that can help decrease the frequency and severity of GERD:    • Lose weight for obese and overweight patients    • Eat smaller meal portions    • Avoid large meals close to bedtime    • Elevate the head of the bed six inches    • Avoid lying down immediately after eating a meal    • Increase fiber intake    • Learn a stress coping tool like meditation, REIKI, the Heart Math Solution, Centering Prayer    • Avoiding factors that relax LES including       o High fat foods, simple sugars, chocolate and caffeine       o Beverages that contain acid (red wine, colas, orange juice and other citrus fruits)       o Alcohol intake       o Smoking       o Strong mints that may relax LES (however enteric-coated peppermint capsules can be used for other conditions)

My protocol for GERD includes an elimination diet for 28 days, natural supplements, and a treatment plan to address the results of the stool analysis. You can count on 4-6 months of treatment for full resolution. But you will likely be cured GERD and not just band-aided over.

Keesha Ewers is the owner of Fern Life Center and is a Certified Advanced Registered Nurse Practitioner (ARNP) with a specialty in primary care or family practice (FNP). She also has a Master's degree in Ayurveda and is a certified Functional Medicine Practitioner.


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