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Digestive System


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I've heard that some medications can aggravate the symptoms of GERD. Can you tell me more?

Anonymous (Male, 35)

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from Michael Picco, M.D.

Certain medications and dietary supplements can irritate the lining of your esophagus, causing heartburn pain, and others can increase the severity of gastroesophageal reflux disease (GERD). GERD is a chronic condition in which stomach acid flows back (refluxes) into your esophagus. This backwash of acid causes irritation and inflammation of the lining of your esophagus.

Medications and dietary supplements that can irritate your esophagus and cause heartburn pain include:

■Antibiotics such as tetracycline
■Bisphosphonates, such as alendronate (Fosamax), ibandronate (Boniva) and risedronate (Actonel)
■Iron supplements
■Nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen (Advil, Motrin, others)
■Potassium supplements
Medications and dietary supplements that can increase acid reflux and worsen GERD include:

■Anticholinergics such as oxybutynin (Ditropan)
■Calcium channel b...


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Heartburn

BACKGROUND

Do you think your problem is too much stomach acid? If you think so, keep this in mind. The older people get the more likely they are to use antacids. This is interesting as stomach acid production decreases dramatically as people get older!

We seem to forget that having stomach acid is both necessary and normal. In fact, the body has gone to great lengths to be able to produce stomach acid without digesting the stomach itself! Your body needs to have proper nutrition, however, to make the mucous lining that protects the stomach. Instead of giving your stomach what it needs to heal, we sometimes make the mistake of turning off our stomach acid to solve the problem.

What goes on in real life is that most of the enzymes we need to digest the food we eat are naturally present in the food. This occurs because enzymes are what a fruit or vegetable uses to ripen.

Many decades ago, food processors realized that they could prolong the shelf life of food from days to years by destroying the enzymes present in the food. Because of this, most of the enzymes present in processed foods, which we need in order to digest our food, have been eliminated over the last 30 plus years. This corresponds to the period of time in which we have seen a dramatic increase in degenerative diseases and indigestion.

When you can’t digest your food properly, the acid starts to reflux up into your chest and you get burning in your solar plexus (just below the bottom of your ribs) and mid chest (called indigestion or “acid reflux”). As a simple hint, food should be past the stomach less than an hour after eating it. If you’re still tasting what you ate over an hour ago when you burp or have acid reflux, you’re not digesting properly and should take digestive enzymes.

An additional cause of indigestion and ulcers is a stomach infection with bacteria called H. Pylori.

TREATMENT

General Diet Advice

Drink warm liquids

Drink warm liquids with meals instead of ice drinks. Cold temperatures inactivate your digestive enzymes. Save ice drinks for between meals.

Recommended Supplements

Plant based enzymes

Take plant based enzymes (not animal sourced) to help digest your food. Complete GEST enzymes (Enzymatic Therapy) are excellent. Take 2 capsules with each meal to help digest your food properly. If the enzymes are irritating to the stomach, wait till your stomach feels better on the licorice and mastic gum before resuming the enzymes.

Licorice

Licorice 380 mg (not the sugar free one; use DGL Licorice from Enzymatic Therapy or Rhizinate from PhytoPharmica). Chew 2 tablets 20 minutes before meals.

Mastic gum

Mastic gum 1,000 mg twice a day for 1-2 months, then as needed. Can kill the H Pylori infection in your stomach.

Herbal remedies for heartburn relief

Use an herbal remedy for heartburn relief, such as Heartburn Free (Enzymatic Therapy). 1 every other day for 20 days may initially aggravate reflux, but can give long term relief.

Vitamin C

If your test shows that you have an H Pylori infection in your stomach, your physician will give you an antibiotic regimen to take which may end the indigestion and is a good idea to use. Take 500-1,000 mg a day of vitamin C with the antibiotics to increase their effectiveness.

Medications

Tagamet

After a month on this regimen (can use either the plant based enzyme or licorice treatment recommendation above by itself, instead of both together, if you’d like), you will often be able to stop your acid blocker medicine if you’ve been on these. Instead of stopping them suddenly, I recommend you switch to Tagamet (an over the counter medicine) for a month. By month 2, you’ll usually be able to stop all treatments, but may choose to continue the digestive enzymes. The treatments above can be used intermittently if you have a recurrence of the indigestion.

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