Gastroesophageal Reflux DiseaseTreatment Protocol
Mark Sandoval, M.D.
Lifestyle Medicine
Lifestyle Medicine
Water
- Drink at least 1 ounce of water daily for every 2 pounds that you weigh. (If you weigh 128 pounds, you need to drink at least 64 ounces, or 8 cups of water, daily)
- Drink at least 2 cups of water upon arising in the morning.
- Do not drink within ½ hour before meals and 1 hour after meals.
- Avoid very hot or very cold water.
- Avoid other drinks (like sodas, coffee, juice, milk, beer, wine, etc.) other than water and herbal teas.
Exercise
- Take a walk after each meal, even if you can only walk for 10-15 minutes. A thirty-minute walk would be great.
- Maintain a regular exercise routine (walking, swimming, biking, hiking, gardening, resistance bands, weights, etc.).
- Avoid very vigorous exercise within a couple hours of meal times.
Live Temperately
- Avoid even a drop of caffeinated or alcoholic beverages.
- Avoid overeating at any meal. Only eat until you feel satisfied, not “full” or “stuffed.”
Love
- Spend time every morning in nature with God. Stay in prayer until you know you have given Him your burdens and you are not carrying them any more. Ask Him to reveal Himself and His love to you.
- Read from the Bible with the purpose to know who God is and what His love looks like.
- Get involved in outreach activities (ministering to those in nursing homes, hospitals, orphanages, homeless shelters, etc.). Helping others who have it “worse off” than you helps you to heal.
- Try to be the most loving person on the planet, with God helping you to accomplish it.
Nutrition
- Start with a 3-day fast (only drinking water). But check with your doctor first. Some health conditions and medications will cause serious problems if you fast.
- Eat a whole-foods, plant-based diet (whole grains, fruits, vegetables, nuts, seeds, beans, peas, lentils, and starchy roots).
- Avoid processed foods (white flour/bread/pastries, white rice, sugary or fatty foods, etc.).
- Avoid spicy foods (hot curry, cayenne, black/white pepper, jalapeño, etc.).
- Avoid high-fat foods (oils, dressings, meat, margarines, butter, cheese, etc.).
- Avoid caffeine, alcohol, and chocolate, as these worsen reflux.
- Also avoid if possible, citrus juices, milk, and tomato or tomato products.
- Eat only two meals daily, with a larger breakfast, medium lunch, and if you have to have it, a very light supper.
- No meals within 3 hours of bedtime or naps.
- No snacks (except water or herbal teas without sweetener).
- Eat only enough to feel satisfied, but not “full” or “stuffed.”
Environment
Sunshine
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- Get 15-30 minutes (minimum) of sunshine during the day, depending upon your complexion.
- Do not burn.
- Avoid the use of creams, oils, etc. on the skin during sun exposure.
- The following factors increase the amount of vitamin D production:
- More skin exposed
- Lying down or sitting
- Mid-day sunshine
- Summer time
- Lighter skin
Thought Life
- “Let this mind be in you which was also in Christ Jesus.” Philippians 2:5
- “Finally, brethren, whatever things are true, whatever things are noble, whatever things are just, whatever things are pure, whatever things are lovely, whatever things are of good report, if there is any virtue and if there is anything praiseworthy—meditate on these things.” Philippians 4:8
- “…bringing every thought into captivity to the obedience of Christ…” 2 Corinthians 10:5
- “in everything give thanks; for this is the will of God in Christ Jesus for you.” 1 Thessalonians 5:18
- There is a strong connection between the mind and the digestive tract. There are more neurons in the digestive tract than there are in the spinal cord. One’s thinking (stress, loss, etc.) has a direct impact upon the function and health of the digestive system. So choose positive thoughts.
- Thoughts generate electricity in the cortex of the brain, and those electrical signals are carried via axons/nerves to the various parts of the body. Those electrical signals provide the energy stimulation needed by the cells of the body to function properly. If the thoughts are right, the electrical signals will provide the proper stimulation for the proper function of the cells. If the thoughts are not right, the improper stimulation of the cells can lead to dysfunction.
- Negative thought patterns include—but are not limited to—thoughts of guilt (I brought this upon myself… I’m such a bad person… What did I do to deserve this… etc.), thoughts of fear (What if I die… What if this gets worse and I can’t do anything… What will my family do without me… etc.), thoughts of failure (I just can’t do it… It seems impossible for me to get well… this isn’t going to work… etc.), and thoughts of isolation (I’m all alone in this thing… No one understands what I’m going through… I just want to be alone… etc.).
- Overcoming negative thought patterns is not accomplished by trying to not think about the negative thoughts. It is accomplished by actively thinking about something else. This is because you cannot empty your mind (your mind was created to be occupied), nor can you focus on two things at one time (no matter how good of a multitasker you believe you are). To overcome negative thinking, you must actively practice positive thinking. You must think about something else. There is nothing that we know of that serves this purpose better than Bible promises.
- Do you feel guilty? Try 1 John 1:9, John 3:16, or Romans 5:6. Do you fear? Try Isaiah 41:10, Psalm 34:7, or Isaiah 54:17. Do you worry about failing? Try Philippians 4:13, Jude 24, or 1 Corinthians 10:13. Do you feel isolated? Try Jeremiah 31:3, Hebrews 13:5, or Nehemiah 9:31. In essence, identify the negative thoughts or thought patterns that you deal with, and then look for Bible promises that speak to your heart the truth, which is opposite of the negative thoughts.
- Write the Bible promise on a 3X5 card, and below it, write a prayer of faith. You could use this pattern: “Lord, thank you for giving me the truth of Your Word. I choose to believe __________________ (that I am forgiven… that I have no need to fear… that I can overcome… that I am not alone… etc.) because You said so. Thank you for ______________.” (forgiving me… giving me your peace… helping me to overcome… always being with me… etc.). Every time you recognize that you have the negative thought or feeling, you have 4 seconds to pull out your 3X5 card and begin reading it out loud, concentrating on what you just read. If you finish reading and the thought/feeling is still there, do it again, and again, and again until it is gone or until you are distracted by something else. Consistency is important in overcoming negative thought patterns.
Air
- Get outside in the fresh air and breathe deeply.
- Maintain proper posture at all times.
- Practice deep breathing regularly. For this, breathe in for a moderately slow count of 4, hold your breath for a count of 7, and breathe out for a count of 9. Repeat 10 times in a row. Do this exercise 3-5 times daily.
Nature
- If possible, get out into nature and spend time relaxing in God’s creation.
- If you can’t get out, buy plants and flowers for the home to beautify your surroundings and clean the air inside.
Dress
- Avoid any clothing that is tight on the abdomen (tight belts, garters, body shapers, etc.).
- Wear clothing that covers the extremities as well as it covers the body. This allows for even circulation of the blood, and decreases the amount of congestion of blood in the central organs, including the stomach.
Sufficient Rest
- Research indicates that adults need between 7 and 9 hours of sleep each night to maintain proper health. Teenagers need about 9-10 hours, children need 11-12 hours, and infants need even more.
- Sleep before midnight is twice as restorative than sleep after midnight, so get to bed early (around 9 pm). This matches best with the natural variations in the secretion of melatonin, your circadian rhythm “hormone.”
- Have a regular time for sleep, and stick to it, even on weekends and vacations.
- Develop a restful bedtime routine that helps you to “wind down.” This may include spiritual or inspirational reading, but nothing exciting or distressing.
- Avoid electronics within 1 hour of bedtime, as research indicates that looking at electronics during that time disrupts one’s ability to go to sleep.
- Make sure your room is cool, dark, quiet, and comfortable.
- If you still have difficulty sleeping, you can try a foot massage or warm bath before bedtime, or you can put an ice pack behind your neck as you are going to sleep.
- Avoid vigorous exercise within 3 hours of bedtime, as this will make it more difficult to go to sleep.
- You can also try some “sleepy teas,” including hops, lavender, chamomile, peppermint, skullcap, passion flower, wild lettuce, and/or valerian.
Simple Trust in God
- Research indicates that those who belong to a faith community and attend religious services at least 4 times monthly live on average 4-14 years longer than their counterparts. So, believe, attend, and live.
- Trust in God is the most important component of health. You and I cannot maintain a consistent healthy lifestyle on our own, we need a power outside and above ourselves to help us to be successful, and that power is God, and God is love.
- Trust in God gives us the proper perspective for maintaining a healthy lifestyle – specifically that God loves you, created you, died to save you, and wants you to love Him in return and take good care of the body that He made and died for, so that you can show your love to Him by loving and serving others. And our ability to love and serve others is directly tied to our health.
- Like any relationship, your relationship with God requires time and effort to grow. God is interested in you, and wants to spend that time with you, and He is looking for you to be interested in Him and want to spend that time with Him as well. Remember when you were dating, how you would sacrifice to spend time with the one you loved. It didn’t seem like a sacrifice, because you were in love with them. The same will be true of you and God when you love Him—you will want to spend time with Him and learn more about Him.
- Early in the morning, spend time in prayer, talking to God about your wants, needs, and concerns. Ask for forgiveness for your sins, and recite His promises of forgiveness and help. Trust that His promises are true for you, and accept His help in your life. Don’t leave that prayer time until you know you are forgiven, that He is helping you, and that you have His peace.
- Spend time every day reading from the Bible, seeing it as God’s love letter to you.
- Memorize at least one Bible promise weekly. You can write the promise on a card and carry it with you, reading it whenever you have free time, and concentrating on what it means.
- Ask the Lord to give you opportunities to help/serve others, and then be active in finding/initiating service opportunities. Those who help others find that they are helped tremendously themselves.
- Learn some songs of praise to God and sing them during your day. You can even make up some songs of your own.
- Give thanks to God for His blessings. Keep a journal, and every day, write down 10 things you will be thankful for today. Try to not repeat items and see how big of a list you can generate. Research shows that gratefulness is healing.
Herbs
- The following herbs may come in various forms. For herbs used in tea, typical doses are one teaspoon to one tablespoon of herb per cup of water. If several herbs are used together, it is still one teaspoon to tablespoon of herb per cup of water (if you have two herbs, you put one teaspoon of herb #1 and one teaspoon of herb #2 in two cups of water, if three herbs, you put one teaspoon of herb #1, one teaspoon of herb #2, and one teaspoon of herb #3 in 3 cups of water). Usually, one drinks about 4 cups of herbal tea daily.
- Roots and barks are boiled for 20 minutes, leaves and stems are simmered for 20 minutes, and others (powders, flowers, etc.) are steeped for 20 minutes.
- If you are using a tincture, the typical dose is one dropper full.
- If you are using capsules or tablets, you simply refer to the directions on the bottle, unless otherwise specified.
- The following are a list of different herbs that have been shown to treat GERD or reduce its symptoms.
- Iberogast – (which includes angelica plus peppermint leaf, clown’s mustard plant, German chamomile, caraway, licorice, milk thistle, celandine, and lemon balm) 1ml three times daily for at least 4 weeks. Research shows this significantly reduces the severity of acid reflux, epigastric pain, cramping, and nausea and vomiting.
- Aloe
- Angelica
- Artichoke leaf extract2
- Caraway oil
- Chamomile
- Greater Celandine
- Lemon Balm
- Licorice (deglycerized)
- Mastic gum 350mg 3 times per day
- Milk Thistle
- Peppermint
- Slippery Elm
Treatments
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- Activated charcoal, 3 tablets chewed 90 minutes after meals.
Other Considerations
- Elevate the head of your bed by placing a brick or something equivalent under the feet at the head of the bed. This will prevent as much of the stomach contents coming up into the esophagus while you lay down.
- Lose weight, as this decreases the amount of pressure on the abdomen. Less pressure means less pushing of the stomach contents back up into the esophagus.
- Avoid constipation. Straining with going to the bathroom will increase abdominal pressure and lead to reflux of stomach acid into the esophagus.
References
- Melzer J, Rosch W, Reichling J, et al. Meta-analysis: phytotherapy of functional dyspepsia with the herbal drug preparation STW 5 (Iberogast). Aliment Pharmacol Ther 2004;20:1279-87.
- Fintelmann V. Antidyspeptic and lipid-lowering effects of artichoke leaf extract – results of clinical studies into the efficacy and tolerance of Hepar-SL forte involving 553 patients. J Gen Med 1996;2:3-19.