Long-term reflux also known as gastrointestinal oesophageal reflux disease (GORD) affects approximately one in five Australians.  

GORD is described as a burning sensation (or heartburn) from stomach acid that moves up into the oesophagus.  GORD is a chronic condition and common medical treatment is to prescribe Proton Pump Inhibitors (PPI).  However, as this case demonstrates, dietary and lifestyle changes along with a focus on gut healing, can result in our patients experiencing relief from these distressing symptoms.

Initial Consultation

A 56 year old female presented with Barrett’s oesophagus concerned for her health having used a PPI (Nexium) long term.  She had not found any symptomatic relief from her medication and experienced great digestive discomfort as well as unwanted weight gain.  She reported having developed ulcerative oesophagus in her first pregnancy 30 years ago and since this time had taken Nexium intermittently.   Her symptoms reported were digestive discomfort described as mild reflux, halitosis, abdominal bloating and irregular bowel movements.

In addition to her gastrointestinal issues, she was also experiencing:

• Lethargy and fatigue, reporting her energy as 3/10
• Musculoskeletal pain, cervical, upper thoracic and lumbar daily rated as 6/10
• Sleep – restless at night, waking unrefreshed
• Sweet cravings in the afternoon
• High caffeine consumption: 1-2 coffees daily with dairy milk, and up to 5 black teas with dairy milk
• Alcohol consumption up to 10-12 units each weekend
• Diet consisted of high starch and protein meals and she missed breakfast daily

Initial Treatment Goals

The initial prescription was focused on improving her lifestyle and diet and inspiring her with simple ideas to begin to make small achievable changes.  The initial remedies prescribed were simple and conservative to encourage adherence.   A gut formula containing slippery elm was prescribed for gastrointestinal support whilst weaning her off her PPI medication.

Initial Prescription

• A magnesium powder, which the client had at home, was prescribed at 150mg twice daily to assist with restlessness in the evening and replenish her magnesium levels from the high caffeine consumption.
• Ulmus rubra (Slippery elm) gut formula containing pectin, Saccharomyces boulardii (SB) and glutamine, 5mg twice daily mixed with the magnesium powder. Slippery elm was prescribed to heal oesophageal tissue and ease irritation with its demulcent action.  Additionally it is nutritive and a pre-biotic to modulate gut bacteria and reduce opportunistic infections.  Combined with SB to increase secretary IgA to improve gut immune function and healing.
• Cease coffee consumption and reduce tea to 1-2 cups daily and replace dairy milk with nut or coconut milk.
• Cease dairy products – to rule out casein or lactose intolerance.
• A food combining information sheet including a focus on mastication of foods; avoid combining starch and protein as well as eating before 6.30pm daily to optimise digestion.
• A meal plan template, to assist her in planning her meals.

2-Week Follow-Up

The client reported losing 1kg, she reduced her caffeine consumption to 1 cappuccino daily, was eating breakfast every morning, and had reduced her alcohol consumption over the weekend.  She had daily bowel movements and sleep had improved greatly.  She was still on her PPI medication and reported a slight improvement in her symptoms, however was still experiencing halitosis.  Her back pain was defined in the iliosacral region, worse in the mornings, with a pain level of 8/10.

The prescription was changed slightly to include additional nutrients to support oesphogeal healing and support musculoskeletal health:

• Continue slippery elm gut formula 5mg twice daily.
• Additional slippery elm, 2 capsules twice daily (total 1.8g of slippery elm)
• Changed magnesium formula to a magnesium citrate blend that included glutamine and vitamins A, D, E and K for further intestinal mucous membrane healing – 8g daily.
• A joint powder formulation of hydrolysed gelatin 10g, glucosamine sulfate 2g, lysine 500mg, proline 200mg, ascorbic acid 200mg, silica 40.4mg, zinc amino acid chelate 50mg, manganese amino acid chelate 50mg and borox 26.4mg at 13.15g daily with magnesium powder for joint support, anti-inflammatory, pain relief and support healthy connective tissue and collagen production for bones, joints and gut tissue.
• A zinc tablet including: zinc amino acid chelate 90mg, zinc ascorbate monohydrate 79.5mg, vitamin B6 40mg, vitamin C 114.2mg, vitamin E - d-alpha Tocopheryl acid succinate 41.3mg, Dunaliella salina 50mg, manganese amino acid chelate 10mg and selenomethionine 65mg at 1 tablet daily, to correct deficiency and assist in further tissue healing of oesophagus as well as antioxidant support.

6-Week Follow-Up

At this consultation the patient reported she had lost another 4kg in weight and could notice the change in her body shape.  While caffeine consumption, had reduced, she was still drinking 1 cup of coffee and 3 cups of tea weekly.  She had only taken her PPI medication six times since her initial appointment and reported complete symptomatic relief, although she still experienced halitosis.  Overall, she reported that she was coping much better with stress, with an increase in energy 8-9/10 and was sleeping well and waking refreshed, no longer needing the evening dose of magnesium to sleep well.  Alcohol intake had reduced to 3 drinks in the last 4 weeks and she was no longer eating sweets during the day. Additionally, there was no bloating after meals, no back or musculoskeletal pain and she was adhering to the dietary and lifestyle advice with ease. 

At this appointment her prescription was:

• Continue with the slippery elm herbal capsules 2-3 capsules, twice daily
• Probiotic including the strains: Bifidobacterium bifidum W23, Bifidobacterium lactis W51, Bifidobacterium lactis W52, Lactobacillus acidophilus W37, Lactobacillus brevis W63, Lactobacillus casei W56, Lactobacillus salivarius W24, Lactococcus lactis W19, Lactococcus lactis W58. One sachet in water daily combined with the magnesium formula. The probiotic formula was prescribed to improve gut dysbiosis, improve intestinal barrier function and improve bowel movements.
• Herbal tablet formulation containing Boswellia serrata (boswellia) 1.9g; Curcuma longa (turmeric) 2.0g ; Apium graveolents (celery) 1.0g and Zingiber officinale (ginger) 300mg, one tablet, twice daily to reduce musculoskeletal and oesophageal inflammation and to aid continued gut healing.
• Continue with the magnesium citrate blend to further encourage gut tissue healing, at a dose of 8g daily.
• Recommended she eliminate caffeine to assist with reducing halitosis

10-Week Follow-Up

At this consultation the patient reported that her mother had passed away so her diet had become more relaxed, and as a result she had gained a small amount of weight and her energy levels had reduced.  She had eliminated coffee and tea, reported no halitosis, and was no longer taking her PPI medication. Her bowel movements she described as ‘the best in my ENTIRE life!’ and had no musculoskeletal pain. 

Treatment will now remain similar to her last prescription with a continual focus on diet and lifestyle to support her long-term health and wellbeing.

Conclusion

Hippocrates encouraged physicians to study the patient rather than the disease.  This case is no exception, through listening attentively to her needs and capabilities and simplifying her prescription, this gave her the time and space to make necessary adjustments in her life and to fully adhere to her treatment.  Then with the right choice of herbs, nutrients and probiotics to support her healing she experienced a swift improvement to her health and wellbeing.