Reflux, or Gastroesophageal reflux disease (GORD) is a chronic condition where stomach acid frequently flows back into the oesophagus, leading to mucosal damage and symptoms such as heartburn, regurgitation of food or acid, chest pain, chronic cough, difficulty swallowing and dental erosion.

There are many factors that contribute to the onset of GORD, the most common being reduced tone in the lower oesophageal sphincter (LOS). This can be caused by certain medications, such as NSAIDs, calcium channel blockers, barbiturates, and anticholinergics. Decreased saliva production and delayed stomach emptying are also contributing factors, as are lifestyle factors such as smoking, obesity, a diet high in fatty and processed foods, and alcohol consumption.

Gut dysbiosis contributes to both reflux and GORD symptoms and slow transit time and methane overgrowth can increase symptoms. Gut dysbiosis occurs when there is an imbalance between beneficial bacteria and harmful bacteria in the gut microbiome. Certain species of Proteobacteria and Fusobacteria produce lipopolysaccharides (LPS) which contribute to systemic inflammation and are thought to promote reflux by oesophageal sphincter relaxation. Research shows that high levels of Proteobacteria and Fusobacteria are more evident in people with GORD.

Conventional medicine includes proton pump inhibitors (PPI), H2 Receptor Antagonists (H2RAs) and other antacids which reduce stomach acid and can help with symptom management. However, they fail to address the cause of the reflux and are associated with many side effects such as diarrhoea, nausea, and abdominal pain. They also increase the risk of Small Intestine Bacteria Overgrowth (SIBO), Colonic Methane Overgrowth (CMO), nutrient malabsorption, and gut dysbiosis.

We use Microbiome testing to identify and treat any underlying drivers of reflux. We develop individual treatment plans based on your unique microbiome profile and your symptoms. Our holistic approach includes dietary and lifestyle recommendations and targeted supplements where necessary.

Here are a few of my recommendations.

Dietary modifications:

1. Eat a fibre-rich, plant-based, Mediterranean style diet.
2. Avoid trigger foods such as chocolate, fatty foods, and processed foods.
3. Avoid alcohol, sugar, and minimise coffee.
4. Have a 3-hour window between dinner and bedtime.
5. Do not consume fluid with meals or immediately after meals.

Lifestyle changes:

1. Elevating the head of the bed by 20-30 cm can reduce night-time reflux.
2. Stop smoking or vaping.
3. Reducing weight can alleviate symptoms.
4. Managing stress through breathing and nervous system support.

If you want to know more, please make an appointment or book in a discovery call.

REFERENCES:

De Bastiani et al. (2023) Assessment of small intestinal bacterial overgrowth and methane production in patients on chronic proton-pump inhibitor treatment: prevalence and role of rifaximin in its management in primary care. Minerva Gastroenterol 2023;69:523-8.
DOI: 10.23736/S2724-5985.21.03118-1

Baumeister et al. (2019) Gut microbiota and oesophageal disease – an update Microbiota Health Dis 1: e207 1 II.
DOI: 10.26355/mhd_20201_207

First of all, it is important to know that not all inflammation is bad.

Inflammation is the immune system’s response to injury or infection. It is a protective mechanism which helps to contain and limit the amount of damage caused when the body is affected by pathogens, environmental chemicals, physical injury (cuts, scrapes, bites, stings etc) or radiation. This is acute inflammation and it helps the body heal and fight infection. Acute inflammation presents as pain, redness, swelling, heat or loss of function and usually resolves in a few days to a couple of weeks.

Chronic inflammation is long-term inflammation that may not resolve for a period of months to years. Instead of healing, chronic inflammation can actually be the cause of the disease.

What causes chronic inflammation?

• Persistence of an acute inflammation such as injury or infection.
• Diet high in processed foods and sugar
• Unresolved leaky gut.
• Prolonged exposure to environmental irritants such as chemicals or pollution.
• A defect in the cells that mediate and regulate the immune response.
• Autoimmune disorders, in which damage is caused when the immune system mistakenly attacks the body’s own, healthy tissue.

Chronic inflammation can lead to significant damage to cells, tissues and organs. The extent of the damage varies depending on the cause of the injury that initiated the inflammation, and the body’s ability to repair and overcome it.

Inflammation is associated with chronic diseases such as Type 2 Diabetes, Stroke, Heart disease, Cancer and Autoimmune diseases including Inflammatory Bowel Disease (IBD), Rheumatoid Arthritis, Multiple Sclerosis, Type 1 Diabetes and Systemic Lupus Erythematosus (SLE).

Inflammation can be both the cause of a health condition or else it may be a symptom, but either way, reducing inflammation is crucial to managing and overcoming chronic illness.

Inflammation in Autoimmune Disease

Autoimmune Disease (AID) is caused by immune system dysfunction and like all chronic illness, inflammation plays a central role in the severity of the symptoms.

Each AID may be characterized by different symptoms however the common link between them all is that they are driven by chronic inflammation.

So, what causes inflammation in AID?

In AID, inflammation may be triggered by poor nutrition, excessive stress, lack of quality sleep and physical activity.

• Foods including processed and fried foods, refined carbohydrates (sugar, flour etc), gluten, grains, and dairy can promote inflammation.
• Physical inactivity can lead to the accumulation of visceral fat which promotes inflammation. Conversely, over-exercising can also create inflammation.
• Stress and lack of Sleep can create an imbalance in the immune system causing it to become overactive, attacking healthy tissue and causing inflammation.

How Does the Autoimmune Protocol (AIP) help to reduce inflammation?

The AIP is designed to reduce inflammation by removing those diet and lifestyle factors that promote inflammation.

Top 5 Strategies to reduce inflammation:

1. Eat the rainbow. Include a colourful variety of fruits and vegetables, including plenty of dark green leafy vegetables. Phytonutrients are natural compounds which impart colour, flavour and aroma in plant foods. These phytonutrients provide immune-supportive antioxidants which can suppress inflammation.
2. Add culinary spices. Turmeric, ginger, garlic, cloves, cinnamon. Add these anti-inflammatory and antioxidant spices into your cooking to reduce inflammation. These spices are from flowers, roots, bark or leaves of plants and are safe to have on the AIP diet, while spices made from seeds, berries and fruits (cumin, coriander, pepper, cardamom, chilli etc), are to be avoided during the elimination phase of the AIP diet.
3. Don’t forget Vitamin D. Vitamin D plays an essential role in modulating immune function and regulating the biochemical pathways that are involved in inflammation. Low vitamin D levels may cause symptoms to worsen in people with chronic illness such as AID. Vitamin D may be absorbed through the skin directly from the sun. During the Southern Hemisphere’s Spring and Summer months 10-15 minutes of unprotected sun exposure before 10am or after 3pm provides a good, safe dose of vitamin D. Vitamin D is also found in foods such as salmon, cod liver (and cod liver oil), sardines, brewer’s yeast and eggs.
4. Quality of Sleep. During sleep the body and brain repairs, restores, regenerates and reduces inflammation. In Autoimmune disease, sleep is essential. Aim for 8-9 hours sleep per night. Try to go to sleep by 10 or 10.30 pm as the 90 minutes before midnight is believed to be the most restorative, regenerative sleep phase. Avoid blue light from devices for 1 hour before sleep. Use meditation techniques, relaxation music, essential oils or counting sheep, whatever helps you quieten your mind to allow you to achieve good quality sleep.
5. Mindfulness-Based Stress Reduction. In recent years, mind-body practices such as mindfulness meditation, yoga and tai chi have gained recognition for their role in reducing stress and improving stress resilience. Research findings suggest that mindfulness practices may reduce inflammation in people with chronic inflammatory disease.