INTELLIGENT QUESTIONS TO ASK YOUR PATIENT WITH ACID REFLUX WITH REBECCA SNOW

In the Mentorship Program, interns will ask the CNS Supervisors what to do for acid reflux or gastroesophageal reflux disease (GERD)? 

And while there are universal things we can do to support the client with GERD, specific remedies are best used for physiological patterns.  Refining your questioning helps you identify those physiological patterns.  This is why I coach nutrition interns to gather details on the chief complaint or key symptoms.  We want to start to recognize patterns to understand what is happening physiologically.  My vlog on the 7 qualities of a symptom is a great place to start.

There are universal things that the nutritionist can do to support someone with GERD.  

We can reduce foods and triggers that harm the esophagus, like very hot liquids, smoking, alcohol, and minimize overly spicy foods.  

We can support tone in the lower esophageal sphincter and improve gastric emptying.

• Avoid high fat meals and eat fat in moderation

• Avoid very large meals that slow gastric emptying

• Eat in a relaxed state to stimulate motility

• Increase protein and fiber intake to tone the lower esophageal sphincter

• Avoid foods that loosen the LES like peppermint, tomato, and other nightshade veggies

We can educate our clients on healthy eating habits to shift out of fight or flight mode.

• Take a break to enjoy the meal 

• Eat sitting down 

• Chew food well

• Avoid distractions

These eating practices help turn on the parasympathetic nervous system, which promotes healthy secretions, motility, and digestion.

We can provide symptomatic relief for GERD symptoms.  As many clients are looking for indigestion relief over the counter.  Remedies like DGL (Deglycyrrhizinated licorice root) in tablet or powder form can soothe and calm an irritated stomach or esophagus.  Best taken after meals.  I like 2 chewable tablets whenever symptoms arise.  Unlike licorice root, DGL has few contraindicates. The glycyrrhizin is removed, which does interact with some medications.  DGL is an easy OTC heartburn relief. 

Further detailed protocols require deeper inquiry, in my opinion.  You are trying to ascertain antecedents, triggers, and mediators for the reflux.  

Is there high or low stomach acid?

Questions to ask:  

• Do sour or spicy foods aggravate symptoms?  

• Does cold water make symptoms better or worse?  

• What time of day do they experience symptoms? 

• Do you experience reflux 2 hours after a meal or prior to the meal? 

• Has this problem gotten worse over time?

Low vs. High Stomach Acid

Low stomach acid:

If this pattern is present, clients might skip breakfast due to low appetite.  They may avoid cold water with meals, prefer sour/spicy foods, feel indigestion 1-2 hours after a meal because the food sits in stomach longer triggering reflux.  Tongue will be paler.  People with hypochlorhydria are prone to eczema and asthma.  Aging is associated with a higher risk of hypochloridria.  

For low stomach acid, I would consider bitters, betaine hcl, zinc, and vagal innervation.

High stomach acid:

This pattern is much less common in the general population, but can exist and is the primary reason I don’t do the Betaine HCL challenge or give Betaine HCL without further inquiry.  I know two people that had symptoms for months and months after doing the Betaine HCL challenge.  Symptoms for high acid might include red pointy tongue, red tongue, strong appetite, salivation, worse symptoms prior to eating, spice and sour aggravate.

For high stomach acid, I would consider neutralizing cordial, meadowsweet, slippery elm, and marshmallow root.

To be sure, do the baking soda test, which is preferred to the Betaine HCL challenge.

Could there be zinc deficiency?

Zinc is an essential cofactor for stomach acid production.  You might see a low alkaline phosphatase on blood work.  Ask your clients into these symptoms that could suggest a need for more zinc.   Symptoms include slow wound healing, rashes, fatigue, hair loss, low appetite.  Do the zinc tally test.

For low zinc with reflux, I would consider zinc carnosine.

Is there poor mucus production?

• Does food get stuck in the esophagus? 

• Does food cause distress as it passes through?

Consider mucilaginous remedies like marshmallow root, slippery elm gruel or DGL.  I like Happy Belly Nutrition’s slippery elm gruel recipe.

Is motility slow?

Ascertain their transit time  Do the beet test.   

• How often do you have a bowel movement?  

• Does it feel like a complete evacuation?

• How full do you feel after meals?

Consider ginger to enhance motility.

How much does stress play a role?

• Was there a stressful event that preceded the symptoms? 

• Did anything happen around the same time these symptoms started?

• How do you cope with stress?

Consider chamomile tea for folks with high stress, anxiety, and indigestion.

Rebecca Snow has been a CNS Supervisor for 10 years and a clinical nutritionist for 20. She is owner and founder of the Nutrition & Herbal Collective. As a CNS Supervisor, and nutrition mentor, Rebecca gives generously of her wisdom and experience to build up new nutritionists for success. She specializes in chronic illness and has worked in academia, group and private practice.  Come meet the supervisors of our internship for nutrition students, and learn about who they are.

Our private Heartbeat Discussion Forum is a supportive community of nutrition interns and CNS’s who have graduated from our Mentorship Program and passed the CNS exam.  The forum is monitored by a rotation of CNS Supervisors offering guidance and answering herbal, lab testing & nutrition questions for students. Come be a part of our community, and learn more about the other exclusive benefits of our personalized nutrition Mentorship Program.