- What is reflux?
- The importance of treating the problem
- Who is most susceptible to reflux
- How to treat reflux
- Why stop eating 3 hours before going to sleep?
- Nutrition and dietary factors
- Using herbs to treat reflux
- How to reinforce the Sphincter muscle
- Conventional treatment and side effects
- Is surgery an option?
What is reflux?
Reflux is a very common condition among adults. In the USA more than 60 million people suffer from reflux – at least once a month. With such a high occurrence, what is the underlying cause of this condition?
What causes Reflux?
At the point where the stomach and esophagus meet there is a circular muscle called the Lower Esophagus Sphincter (LES). Its task is to prevent the food we swallow from floating back up from the stomach to the esophagus. When this muscle weakens part of the digested food plus stomach acids, digestive enzymes and gall bladder juice can find their way back up the esophagus.
Whilst the stomach is designed to cope with acid and produces a special juice that protects its mucous tissue, the esophagus tissue is sensitive to stomach acids. The presence of acid in the esophagus irritates its inner tissue and causes a burning sensation.
Symptoms of acid reflux include:
- a burning feeling
- dryness in the mouth
- a bitter or acidic flavor in the mouth
Some people may experience reflux without any discomfort.
2. The Importance of Treating Reflux
Although reflux is common, it shouldn't be underestimated or ignored and most importantly treatment should not be postponed.
Stomach acids can damage esophagus tissue and lead to the following symptoms:
- difficulty swallowing
- inflammation of the esophagus tissue
- Bart Esophagus – a change of Epithelial cells of the esophagus – in rare cases it is possible for cancer cells to develop.
People who suffer from constant irritation of the esophagus tissue have a higher risk of esophagus cancer.
3. Who is most susceptible to reflux?
A research project led by a group of Korean researchers looked at the characteristics of reflux sufferers – both with and without esophagus tissue damage.
They found that non-smoking women with a low BMI and without a hiatal hernia were characterized by reflux and normal esophagus tissue, NERD.
They identified another group of obese men with a high BMI, a high level of glycerides, a tendency for alcohol and smoking, who had a hiatal hernia and who tended to suffer from reflux with damaged esophagus tissue, GERD.
Research results: The research concluded that there is a correlation between excess of fat in the belly area to reflux that results in damaged esophagus tissue.
Drugs that effect Reflux
It is known that certain medications can contribute to reflux or cause people who already suffer from reflux to experience increased discomfort.
Medications known to increase reflux (1) are:
- Alendronate sodium – Fosamax, Binosto
- Anticholinergic medications – atropine (Atropen), belladonna alkaloids, Cogentin, clidinium.
- Narcotic drugs – codeine, Vicodin
- Beta blockers – Normiten, Normalol, Cardiloc
- Calcium Channel Blockers – vasodip
- Hormones – estrogen, testosterone
- NSAIS – aspirin, Advil, Ibuprofen
- Valium, Assival, Diazepam, Vaben, Lorivan, Restoril
- TriCyclic Antidepressant – Imipramine
Some supplements are also known to increase reflux:
- Vitamin C
- Potassium supplements
- Iron supplements
4. How to treat Acid Reflux
Change of lifestyle
The first step to treating reflux is to review your lifestyle and consider making simple changes that will improve your quality of life, including:
- relief of reflux
- better sleep
- maintaining a healthy weight
- balancing cholesterol levels
Here are a few golden rules that may help:
Avoid the following types of food and drink, all of which increase the secreting of stomach acids:
- caffeinated drinks
- spicy food
- fatty food
Other recommended advice to treat reflux:
- eat small meals. When we eat big meals the stomach muscles tend to expand, and the sphincter muscle loosens. TIP! A simple trick to reduce portion size is to use smaller plates!
- eat slowly!
- chew properly and pause between each bite
- drink a lot of water between meals
- avoid laying down after meals
- raise your head and shoulders in bed – use a large pillow
- stop eating at least 3 hours before going to bed (more on this to follow)
- take a short walk after meals
- wear loose clothing that doesn’t press the on the stomach
- quit smoking – cigarettes decrease the secretion of saliva and weaken the lower esophagus sphincter
5. Why it is Important to Stop Eating 3 hours before Bed?
Researchers from the University of Osaka, Japan found a correlation between two factors and the occurrence of reflux, these were:
- the time taken to eat meals
- the length of time between eating and going to bed
They set up two groups.
- The reflux test group consisted of 147 people under the age of 70 who suffered from severe reflux.
- The control group consisted of 294 healthy people. The age and gender of both groups were similar.
All those tested completed a questionnaire about the interval between eating dinner and going to sleep.
Research results: No significant difference was found between the two groups regarding the interval between the time they ate dinner and the time they went to sleep. However the reflux group were more likely to have a shorter interval between their last meal and going to sleep (less than 3 hours).
- 44% of the reflux test group had a shorter interval between eating and sleeping compared to just 21.4% in the control group.
- Those who fell asleep less than 3 hours after their meal were 7.45 times more likely to suffer from reflux than those who kept more than 4 hours between their last meal and going to bed.
These findings applied to those who suffered from reflux but did not have damaged esophagus tissue (NERD) as well as for those whose esophagus tissue was inflamed.
6. Nutrition and Dietary Factors
It’s not only when you eat it’s what you eat. Adopting an alkaline-rich diet can help moderate the secretion of acids. To achieve a better acidic balance, a diet should consist of foods that are 80% alkaline.
Food can be divided into four categories:
- food that are rich in alkaline – eg. green vegetables
- foods that are acidic – eg. plums
- acidic foods that turn to alkaline after digestion – eg. lemons
- foods that turn acidic after digestion – eg. meat.
The following is a list of two groups of food – one to avoid and the other to incorporate into your diet.
Your diet need not be restricted just to the foods listed here – the advice is not carved in stone. People react differently to one food or another, so this list should just be treated as general guidance.
Avoid foods that encourage acid secretion in the stomach:
- citrus fruits and juices – eg. oranges
- tomatoes, ketchup and other tomato products
- Mustard and vinegar
- spicy food
- chocolate, cocoa, sweeteners, jams, ice-cream
- brazil nuts, peanuts, walnuts, hazelnuts
- drinks containing caffeine like Coke, coffee, black tea (green tea has 10% caffeine).
- alcoholic drinks and beer.
- dairy products
- mint, vinegar, onion, garlic
- fried food, spicy or fatty, meat sausage
- it is recommended to decrease consumption of carbohydrates (bread, potatoes, pasta, cereal)
Foods highlighted in green are most recommended.
- Persimmon, nectarine, lemon, grapefruit, melon, pear, apple, mango, papaya, ginger, apricot, avocado
- Pumpkin seeds, seaweed, fennel, cauliflower, cucumber, broccoli, lettuce, kohlrabi, asparagus, green beans, celery, parsley, dill, carrot, yam, turmeric.
- Soda water
- Gently seasoned food
- Natural almonds
- Water, including with chamomile, ginger or fennel infusion
- Low fat fish, low fat parts of poultry and turkey (definitely without the skin)
- Lentils, oats
7. Using Herbs to Treat Reflux
Herbs and spices are well known for their therapeutic qualities. Including certain herbs in your diet can help reduce reflux symptoms.
Research conducted by Louisville Medical School shows that Curcumin – the active agent in turmeric's rhizome – protects esophagus tissue from stomach acid – preventing inflammation and perhaps even helping to treat it.
Researchers checked samples of esophagus tissue that had been damaged by stomach acid.
Research results: They found high levels of free radicals and oxidative stress. Consuming strong antioxidants, like curcumin, can inhibit the commencement of inflammation. Curcumin neutralizes the free radicals, stopping oxidative damage and protecting the esophagus tissue. (2)
A team of researchers from Wisconsin Medical College found that contact by stomach acids on esophagus tissue increases the production of Interleukins 6 and 8.
Research results: Their findings also found that curcumin inhibits esophagitis by significantly decreasing interleukin 6 and 8, as well as cytokines – all of which stimulate the immune system into action and play a part in turning acute inflammation into chronic.
Curcumin provides reflux sufferers with a safe and effective remedy. (3)
Pomegranates are rich in phenols, which are full of medicinal virtues. One of the phenols found in abundance in pomegranates is ellagic acid. All parts of the fruit contain ellagic acid, but the highest concentration is found in the peel.
Balanceherbs® scientists developed a special process to extract pomegranate peel so that the extract is extra rich with ellagic acid. Don't be afraid of the word acid, ellagic acid is a mild organic acid in comparison to the stomach acids and can contribute a lot to good health.
How can Ellagic acid help those who suffer from reflux?
Ellagic acid slows down the creation of hydro-chlorine to the stomach.
It is known to:
- protect the esophagus tissue
- inhibit inflammation
- inhibit oxidative stress
Inhibiting oxidative stress and inflammation is important; these are both caused by the constant irritation of epithelium cells in the esophagus. The combination of inflammation and oxidative stress is harmful and can cause changes in the structure of these cells.
- helps the healing of the esophagus from inflammation (Esophagitis)
- is a prebiotic, enriching the good bacteria in the bowl and improving digestion.
Taking a combination of turmeric extract and ellagic acid is more effective than taking either of them alone. The synergy between the two magnifies their anti-oxidative and anti-inflammatory impact.
A 2011 research project by a group of Brazilian scientists found that ellagic acid has the ability to protect the stomach from developing ulcers. The researchers used Indomethacin (NSAID), ethanol (found in alcoholic drinks) and acetic acid (found in vinegar and products containing vinegar like ketchup, pickles etc) which induced ulcers. The use of ethanol and Indomethacin led to severe inflammation in the stomach while the use of acetic acid led to chronic inflammation.
Research Findings: The researchers showed that ellagic acid prevented the development of stomach ulcers due to two main factors. They noted it "strengthening the defensive factors and attenuating the offensive factors." (4)
Further research carried out in India in 2012 reaffirmed the Brazilian research findings and even pointed at accelerated recovery from ulcers due to the use of Ellagic acid. (5)
Nutritional Supplement to Treat Reflux
CurcuminForte Balance – integration of curcumin and pomegranate peel extract, enriched with ellagic acid
The nutritional supplement, Curcumin Forte Balance®, Contains concentrated dried extracts of turmeric (curcumin) and pomegranate peel, both anti-inflammatory substances that may help to reduce reflux symptoms, inhibit esophagitis and speed its recovery.
The high concentration of active agents in Curcumin Forte Balance®, means that it is sufficient to take just one capsule a day with a meal. The effect of taking this nutritional supplement can usually be felt in 8-12 weeks. If you are strict about applying dietary changes too, then you will feel the benefits even sooner.
- Many people ask us if they will need to take the capsules for the rest of their life. The answer is no!
- Curcumin Forte Balance® is for inhibiting and treating esophagitis. If you take our advice and adopt the recommendations in this article then it is likely that you won't develop esophagitis. After all, prevention is even better than cure!
Where can I buy Curcumin Forte Balance®,?
- On our website
- By telephone +972-9-7402584
- By Email firstname.lastname@example.org
Customer Case Study:
On May 2014, a short time after this article was originally published, we received a telephone call from Atara, a woman of around 50 years old who suffers from reflux on a daily basis. She was using an anti-acid drug and was interested of hearing more about Curcumin Forte Balance. We explained that the product is a supplement to the diet that we recommend in this article. Atara decided to purchase the product. After 3 weeks we called Atara to hear how she felt, her answer was: "I don't feel any improvement." When we asked her if she had followed the recommended diet and took one capsule per day, she said: ‘I took the capsules, but did not follow the recommended diet. I thought Curcumin Forte Balance replaced the ant-acid drug. You see, I work from 14:00 until 22:00, when I return from work I'm so tired and so hungry that I open the refrigerator and eat whatever I find in it. In the meantime, I talk with my husband and kids and around 23:00 we all go to sleep."
Atara had completely forgotten the 4 main rules:
- Eat small portions
- Eat slowly
- Eat alkaline foods
- Stop eating 3 hours before sleep
We suggested to Atara that she took plastic containers containing Alkaline food with her to work each day (vegetables, fruits, lentils, etc) and that she stopped eating at 19:00. We recommended that when she arrived home that she just drunk an infusion of chamomile or fennel seeds.
Atara listened and said she would do her best to follow our suggestions, although "it is very difficult."
About 3 weeks later we called Atara, the hoarseness had disappeared from her voice, she sounded more energetic and hopeful. "It wasn't as hard to implement as I thought," she admitted.
Researchers from the Central Food Technological Research Institute in Mysore India discovered that a small dosage of ginger extract reduces the secretion of stomach acids more efficiently than Lansoprazole (Lanton), exhibiting six- to eight-fold better potency over lansoprazole.
Ginger is a strong antioxidant; it inhibits lipid peroxidation and protects the DNA from oxidative stress. These properties led the researchers to the conclusion that some active agents in the ginger root, probably the gingerols, are anti-ulcer.
A small dosage of ginger extract is sufficient to achieve the required effect. (6)
Sshhh! Here is a secret that we’d like to share – one that may help you deal with reflux. Incorporate the regular intake of herbs and spices into your day – drink a cup of ginger infusion at the end of each meal or eat one or two small cubes of ginger root, or lightly sweetened dried ginger. Other herbs or infusions that may help you treat your reflux are: Echinacea, chamomile, aloe Vera, fennel seeds and geranium.
8. How to Strengthen the Lower Esophagus Sphincter (LES)
You will recall that reflux is caused by the weakening of the LES (Lower Esophagus Sphincter). Many people wonder if it is possible to strengthen the LES. Scientists actually do say that it is possible!
The LES is part of the thoracic diaphragm muscle. The diaphragm muscle consists of 2 muscles:
- The sternal muscle located at both sides of the chest bone, contributing to the breathing process
- The crural diaphragm muscle which extends below the diaphragm to the vertebral column and serves as an external lower esophageal sphincter.
A group of scientists from the faculty of Medicine at the University of Charles in Prague says that a weakened LES results from incorrect use of the diaphragm. In order to breathe properly and strengthen the LES we should breathe from the lower part of the diaphragm, from the abdomen. (7)
Misuse of the diaphragm muscle might be the result of:
- wearing tight clothes
- trying to achieve a thinner look by pulling the belly inwards or
- a protruding abdomen which pushes the diaphragm upwards.
A team of scientists from Graz University led by Dr. J Eherer showed that active training of the diaphragm via breathing exercises can improve GERD.
A practice of breathing from your abdomen for half an hour 4 times a week will lessen your reflux symptoms.
Dr. Eherer says that most people who suffer from reflux prefer using anti-acid drugs, but for those who prefer the alternative approach, the breathing exercises are a good solution too.
A recommended breathing exercise:
Inhale and fill the chest and the abdomen with air, feel how the air extends forward, backwards and the sides, then exhale. Repeat slowly several times per day.
9. Conventional Treatment and Side Effects
Antacid medication alleviates reflux symptoms by using different modes of action. However you should note that the minute you stop using antacid drugs the reflux will return in full force. It is important to note that extended use of antacid drugs has its drawbacks – side effects and permanent damage.
Medication type: Over the counter antacid drugs for heartburn and light relief from reflux.
Brands: Tums, Maalox
Possible side effects: diarrhea, constipation
Medication type: H2 Blockers – drugs which reduce the secretion of stomach acids
Brands: nizatidine (Axid), famotidine (Pepcid, Pepcid AC), cimetidine (Tagamet, Tagamet HB), ranitidine (Zantac)
Possible side effects: headaches, constipation, diarrhea, nausea, vomiting.
According to an article published in JAMA, extended use for over 2 years increases the risk for vitamin B12 deficiency. Stomach acids play an important role in extracting vitamin B12 from the proteins we eat. Once you stop usage of this type of drug, the vitamin B12 level returns to normal.
Medication type: PPI- proton pump inhibitors – reduce the secretion of stomach acids.
This type is considered stronger than the H2 Blockers. It enables the esophagus epithelial tissue to heal.
Brands: omeprazole (Prilosec), lansoprazole (Prevacid), esomeprazole (Nexium)
Possible side effects: diarrhea, constipation, nausea, vomiting, abdominal pain, headache, Flatulence
This type of drug increases the risk of osteoporosis and bone fractures. According to an article published in JAMA, extended use (over 2 years) increases the risk of vitamin B12 deficiency.
Stomach acids play an important role in extracting vitamin B12 from the proteins we eat. Once you stop usage of this type of medication, the B12 level returns to normal.
Medication type: Prokinetic drugs enhance the frequency or strength of peristaltic contractions.
This expedites the emptying of the stomach allowing less time for acid reflux to develop.
Brands: cisapride, metoclopramide, Metozolv ODT, Propulsid, Reglan
Possible side effects: diarrhea, nausea, fatigue, drowsiness, dizziness
10. Is Surgery an Option?
The option of surgery is usually reserved for severe cases of acid reflux. Surgery doesn't always solve the problem and in some cases patients to need to continue taking antacid drugs. Endoscopic surgery is relatively new and its success rate and associated risks are not entirely clear.
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- Matthew R Bower, Harini S Aiyer, Yan Li, and Robert CG Martin. "Chemoprotective effects of curcumin in esophageal epithelial cells exposed to bile acids." World Journal of Gastroenterology 2010 Sep 7; 16(33): 4152–4158.
- Parvaneh Rafiee, Victoria M. Nelson, Sharon Manley, Michael Wellner, Martin Floer, David G. Binion, Reza Shaker. "Effect of curcumin on acidic pH-induced expression of IL-6 and IL-8 in human esophageal epithelial cells (HET-1A): role of PKC, MAPKs, and NF-κB." American Journal of Physiology – Gastrointestinal and Liver Physiology Published 1 February 2009 Vol. 296 no. 2, G388-G398
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- Chatterjee A, Chatterjee S, Das S, Saha A, Chattopadhyay S, Bandyopadhyay SK. "Ellagic acid facilitates indomethacin-induced gastric ulcer healing via COX-2 up-regulation." Acta biochimica et biophysica Sinica (Shanghai). 2012 Jul;44(7):565-76.
- Siddaraju MN, Dharmesh SM. "Inhibition of gastric H+, K+-ATPase and Helicobacter pylori growth by phenolic antioxidants of Zingiber officinale." Molecular nutrition and food research 2007 Mar;51(3):324-32.
- Treatment Options for GERD or Acid Reflux Disease: A Review of the Research for Adults
- Na Rae Ha, Hang Lak Lee, Oh Young Lee, Byung Chul Yoon, Ho Soon Choi, Joon Soo Hahm, You Hern Ahn, and Dong Hee Koh. "Differences in Clinical Characteristics between Patients with Non-Erosive Reflux Disease and Erosive Esophagitis in Korea." Journal of Korean Medical Science 2010 Sep; 25(9): 1318–1322.
- צרבת ורפלוקס, החזר קיבתי ושטי
- תרופות לצרבת, עד כמה הן בטוחות, ynet בריאות
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- Kirk Stokel. "Block Acid Reflux to Prevent Esophageal Problems!" www.ProHealth.com. November 15, 2013
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- בואו נדבר על זה: איך מטפלים בעצירות וגיהוקים
- רפלוקס קיבתי-ושטי
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