Marcelle Pick Site

 by Marcelle Pick, OB/GYN NP

Women with irritable bowel syndrome (IBS) often tell me their lives are being run by their bowels. They’ve stopped going out to dinner, taking trips or doing much of anything. It feels like they have tried everything — from increasing fiber and loading up on Metamucil to finally filling a prescription for antidepressants out of desperation. By the time these women get to my door, they’re fed up and don’t know what else to do.

The US Department of Health and Human Services reports that up to one in five Americans has irritable bowel syndrome (sometimes also called “spastic colon”) and 75% of them are women. But the problem is poorly understood by general practitioners, and many women with IBS come away from their doctors feeling little is being offered to truly help them. Instead of getting at root causes, conventional medicine too often depends on medications that simply mask the symptoms. What’s worse is the fact that some practitioners are claiming irritable bowel syndrome is all in the patient’s head.

I know irritable bowel syndrome can completely rule a woman’s life. I also know that it stems from more than just our thoughts or from daily stress. While there is clearly a mind-body connection at play, IBS arises for many different reasons, and in the same way, there are many successful alternative approaches to relieve it. You don’t have to focus your life around irritable bowel syndrome anymore. Your life can be different — I promise.

Let’s go beyond the symptoms and take a closer look at what might be leading to your discomfort, so you can begin to heal your gut problems at the source and enjoy the health you deserve.

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Irritable bowel syndrome: a catch-all diagnosis

Irritable bowel syndrome is just what the phrase implies — a syndrome. That means that not only is the bowel irritated, but a whole constellation of symptoms and causes is found in association with IBS, not just one specific pathology. Scientists haven’t discovered physiological evidence of disease in the bowel, so a clear-cut definition has yet to be developed. Without recognizable pathology, IBS has been classified as a functional disease — an umbrella term encompassing bowel dysfunction that can play out in numerous ways, for numerous underlying reasons. This is why the functional medicine model provides the most useful approach for treating it.

Some scientists propose that IBS might exist on a continuum with inflammatory bowel disease (IBD). IBD, which includes ulcerative colitis and Crohn’s disease, is known to cause visible changes to the body: the intestines become inflamed to the point where they are red and swollen. Some studies are now being done to pinpoint molecular and structural changes within the bowels of various IBS patients, but there are still no definitive answers. As Dr. Michael Gershon writes in his book, The Second Brain, “Today functional bowel disease is a complex of symptoms lacking a link to pathology. Tomorrow, I am sure the list will vanish and be replaced by an assortment of evident disease entities.”

In an attempt to organize a complicated problem, conventional providers have different preferences for diagnostic criteria (see list at right), and there are at least four main types of IBS to choose from. There is diarrhea predominant IBS (IBS-D),constipation predominant IBS (IBS-C), IBS with alternating stool patterns (IBS-A) andpostinfectious IBS (IBS-PI) — and the newest criteria divide IBS subgroups differently again. With so many criteria and categories to keep track of, it’s no wonder women and their clinicians are confused!

Conventional diagnostic criteria for irritable bowel syndrome

Below you’ll find the criteria conventional healthcare practitioners consult when making an IBS diagnosis. With several different sets of criteria plus a range of additional associated symptoms, it’s no wonder IBS is often poorly understood and misdiagnosed.

Manning criteria:

• Abdominal distention
• Relief of pain after bowel movement
• More frequent and looser stools at onset of pain
• A sense of incomplete rectal evacuation
• Passage of mucus with the stool

Rome criteria (includes above bullets plus the following):

• Constant presence of abdominal pain and altered bowel habits
• Presence of remaining symptoms 25% of the time

Here are some other symptoms frequently associated with IBS:

• Constipation
• Pain with bowel movements
• Painless diarrhea
• Alternating constipation and diarrhea
• Flatulence
• Nausea
• Vomiting
• Headaches
• Loss of appetite
• Early satiety
• Anxiety
• Depression
• Poor nutrient absorption
• Bloating

So what causes irritable bowel syndrome?

While conventional practitioners do their best to address IBS symptoms, we at Women to Women have learned that true healing of functional bowel disease can take place only when you treat the root causes. We take this approach because there is wide overlap between the causes and symptoms seen in irritable bowel syndrome and those of other problems, including yeast overgrowth, endometriosis, and food sensitivities, to name just a few. All these other disorders can cause, influence, or exacerbate IBS, and they also lead to frequent misdiagnosis. For example, celiac is frequently overlooked when an IBS diagnosis is handed down, and it’s worth investigating carefully before you rule out celiac disease as a causal factor of your symptoms.

Eventually mainstream providers will catch up and recognize that IBS can arise for many different reasons, and when we address all the factors one by one, patients can see real results.

Here are some of the major triggers I’ve seen for irritable bowel syndrome:

Imbalanced gut flora. The flora that populate our guts are so important to every aspect of our health. Many women don’t realize that when they take an antibiotic, especially repeatedly, it can wipe out their bacteria — good and bad. Once the friendly bacteria that help digest your food and protect the gut lining become imbalanced, digestive and immune capabilities are compromised, potentially leading to IBS. Certain steroid medications can also disturb floral balance in the gut, as does an overgrowth of yeast such as Candida in the intestines. Both can lead to or worsen IBS.

GI infection. Along the same track, research clearly shows a much higher incidence of IBS following GI infection — twice as high, by some reports. Some women develop IBS after contracting a case of food poisoning or any one of numerous other intestinal parasites. Most of these pathogens can be easily treated with herbs or antibiotics once recognized, but resistance in certain bugs is becoming increasingly worrisome, so I generally don’t hand out antibiotics to patients complaining of IBS without first sending a stool sample for testing.

Food sensitivities/intolerances. Over half of the women I see with irritable bowel syndrome have unidentified food sensitivities or intolerances. Some of the most common food triggers are wheat, gluten, dairy, corn, sugar, chocolate, coffee, tea and citrus fruits. Although food sensitivities and allergies can be complex and change over time, we use sensitive allergy antibody tests and an elimination diet to identify and treat them effectively. Once the problematic foods are discovered and eliminated from the diet, the gut will quiet down and the symptoms of IBS often disappear.

Hormonal imbalance. Lots of women notice that their IBS symptoms are worst just before their periods. Why this occurs is not clear, but it may have to do with the pattern of hormonal fluctuation in the second half of the cycle: estrogen is lower for several days, whereas progesterone is relatively high at the end of the cycle, then drops off suddenly just before menses. Progesterone in general slows gut motility, and lower-than-normal estrogen levels have been identified in women with IBS. It’s possible that when the ratio between these two sex hormones is off, sluggish bowels could in turn worsen pelvic congestion, cramping, and abdominal distention.

Stress and anxiety. As anyone with IBS knows, stress and anxiety can affect the body in many ways. When we’re stressed, changes occur in the autonomic nervous system — the system of nerves that make up the sympathetic (governs our “fight or flight” responses) and parasympathetic (regulates the “rest and digest” responses) nervous systems. In patients with irritable bowel syndrome, input from the brain sends a message to decrease digestion and increase motility of the colon, resulting in the rapid passage of incompletely digested stool.

But there are many other disease processes that can lead to IBS-like symptoms, and we practitioners and our patients have to be mindful about checking that nothing more serious is at the core of an irritated bowel. For example, endometriosis, ovarian and colon cancer, and inflammatory bowel disease can often cause or exacerbate bloating and other symptoms that resemble IBS, which can lead to a misdiagnosis. To be safe, these more serious disorders should always be ruled out by your healthcare practitioner before settling on a diagnosis of irritable bowel syndrome.

The gut–brain connection — a piece of the picture

Patients often ask me if it’s true that IBS stems from imbalances in the brain. And the answer is yes — and no. Most women know what it feels like to get butterflies before an important event, or to run to the women’s room before a test or interview. It’s no surprise that the things on our minds can affect what happens in our guts — we’ve known this since the beginning of time. Perhaps more intriguing are the similarities researchers describe between the nervous system of the brain and the nervous system of the gut (also known as the enteric nervous system) and how this may play out for irritable bowel syndrome.

For one thing, 95% percent of our serotonin, the neurotransmitter most of us associate with mood and brain function, is manufactured in the gut. Its main role there is to stimulate intestinal movement and contraction, as well as to help with mucus secretion. Women may find that eating too much of the kinds of food that cause a spike in serotonin levels — food high in refined carbs — will trigger an episode of IBS, especially if there are other pieces of the IBS picture already in place (stress, a lack of digestive enzymes, floral imbalance, or other problems).

But the connection between gut and brain may not be as direct as it first appears. The nervous system is divided into two broad categories: the central nervous system, which is comprised of the brain and spinal cord, and the peripheral nervous system, which makes up all the other nerves in the body and follows commands from the central nervous system. The enteric nervous system is technically a part of the peripheral nervous system, but it doesn’t always follow commands from the brain and spinal cord, and it doesn’t necessarily send input back to the brain as the rest of the peripheral nervous system does.

Some scientists even argue that the enteric nervous system is more of an equal to the brain than its inferior. Dr. Gershon writes that the enteric nervous system is “an independent site of neural integration and processing,” and can keep the gut working without input from the brain. This is why it is called “the second brain”. These insights raise the question of whether irritable bowel syndrome has anything to do with the brain at all. Could it be simply caused by a disturbance in the second brain? From what I’ve seen in practice — and as brain imaging studies by neuroscientists are bearing out — this is an oversimplification. IBS is often multifactorial, and it takes a combination of healing the gut and the mind to get results.

Developing a healthy gut — the Women to Women way

Many years ago it was routine for healthcare practitioners to ask patients detailed questions about their digestion and bowel health. The digestive system was considered an excellent window through which they could view an individual’s whole health picture. Though practitioners in Europe and in the East still place a primary focus on the digestive system, here in the West many pay little heed to our bowels. Unless we complain or something is identified on routine screening, most conventional practitioners assume everything is working as it should. And some conventional practitioners will consider it adequate if you move your bowels at least once a week. But this isn’t normal — what goes in must come out! A woman with a healthy digestive system should have a bowel movement once or twice a day.

At the clinic, we always ask women about their digestive health because we understand it is central to nutrition, immunity, and overall balance in the body. When I see a woman with symptoms of IBS, it tells me there are larger issues at play, and that we need to explore the problem rather than covering it up or telling a woman it’s all in her head. Solving irritable bowel syndrome takes time because it involves some investigation and trial and error.

The bottom line is that each woman heals differently, particularly when it comes to the gut, and the best course of action has to be tailored to her unique physiology and situation. Here are some of the measures I’ve found helpful for women with IBS:

• Add a probiotic. Research shows that healthy probiotic flora like acidophilus, bifidobacteria, and saccharomyces boulardii may alleviate some cases of IBS. If a trial of regular probiotic use relieves your irritable bowel, your gut flora may have been out of balance. But if you don’t get good results with your first choice within two weeks, you may want to try another type of probiotic, because there is tremendous range in the flora that play a part in IBS. Probiotics can also be found in fermented foods like yogurt, kefir, and miso, as well as in combination supplements. When floral balance is restored to your gut, you will enjoy all the benefits of better digestion and improved immunity.

• Experiment with food allergy testing or an elimination diet. Many of my patients eliminate certain trigger foods, especially gluten and lactose, and start to feel much better. So many women have undiagnosed food allergies or sensitivities because of our increasingly toxic environment. You might visit a holistic allergist for food testing or try an elimination diet. If you decide on an elimination diet, be sure to first eliminate all possible trigger foods, including gluten (wheat), lactose (dairy), corn, sugar, chocolate, coffee, tea and citrus fruits, and then add one food or food group back in at a time. Keep track of how you feel for two weeks with each added food or food group. Keep in mind that many women report feeling worse when they first remove foods to which they’re reacting, so this approach takes commitment and patience for both women and their healthcare providers.

• Get a stool analysis. Talk with your healthcare provider about a digestive stool analysis with comprehensive parasitology. This may provide answers about malabsorption, pH imbalance, parasites, or yeast overgrowth. If your provider can’t perform such tests, you can work with a lab on your own (see our articles on testing options for labs we recommend). When parasites or an abundance of yeast are treated, it can dramatically reduce your IBS symptoms. Likewise, a practitioner versed in functional medicine may recommend a protocol of functional foods and digestive enzymes to reverse inflammation in the bowel and other causal and related problems further up the digestive tract.

• Make stress relief a real priority. Stress is the IBS trigger that is often most difficult to remove. If we’ve gotten into the habit of feeling stressed and anxious, it’s difficult to simply stop — especially if we’re dreading the onset of pain, discomfort, or embarrassment so common in irritable bowel syndrome. Getting to the root of our stress can require a dramatic change in the way we think about things. What we think and feel has so much impact on our bodies. Give yourself permission to experiment with new ways of relieving anxiety and stress. Consider meditation, EFT, enrolling in a yoga class or getting regular massages. If you have the time and money, many of my patients have had success with the Quadrinity Process as a way to change old ways of thinking. Another form of behavior modification known as cognitive behavioral therapy has also been helpful for some women.

• Take a quality multivitamin. Digestive health is paramount to extracting essential nutrients from the food we eat. If your digestive process is compromised, you’re simply not receiving the micronutrients your body needs every day for the basic functions of living. It’s always a good idea to shore up your nutrition with a high quality multivitamin-mineral complex, and even more important for women with IBS. Keep in mind that some women with IBS or other digestive disorders may have difficulty tolerating a multivitamin at first. We recommend women introduce vitamin supplements slowly when treating GI problems. Once the digestive issue is addressed, a multivitamin can be taken without a problem.

• Eat fresh whole foods with plenty of fiber. Our bodies were made to eat fresh whole foods, foods without hormones and additives, foods that are not genetically modified or refined. The bacteria in our gut need dietary fiber to do their jobs. They ferment dietary fiber to produce short-chain fatty acids, including butyric acid, which is the primary source of fuel for our colonic cells. So if you’re not eating enough fiber, you’re starving both your beneficial flora and the cells in your colon!

• Try natural herbs. Herbs like deglycyrrhizinated licorice root (DGL), enteric-coated peppermint, slippery elm bark, ginger, marshmallow, Swedish bitters, and fennel seed can all be very helpful in calming the symptoms of IBS. Many of these healing herbs have been used for generations and come with few side effects. You may want to do some research to familiarize yourself with their use, however, or seek consultation with a qualified practitioner, for best results.

Living with IBS — it doesn’t have to be this way

Not long ago one of my patients with IBS, Janine, who lives just two hours from the clinic, rented an RV so she could come and see me. She told me she was afraid to make the trip without having a bathroom nearby at all times. After our visit, I told her I hoped she would never need to rent another RV unless she wanted to take a driving vacation. So many women like Janine think they have to live with the consequences of irritable bowel syndrome. But I remind them: This is an issue we can do something about.

IBS is not a simple cause-and-effect disorder. Its intricacies reflect the complexities of our own lives and bodies. To treat it, we have to look deeper than high-fiber diets, Metamucil, antispasmodics and antidepressants. It’s neither just in your head nor just in your gut. IBS can result from numerous stressors in our environments, our diets, even our thoughts — and the best way to begin the healing process is by understanding that your own symptoms have their own solutions. My clinical experience proves that you don’t have to live with IBS forever. It may feel like you’re stuck with the discomfort, but with some careful attention and time, I know you can find your path to healthy, happy bowel function — naturally. And I can promise the time and attention you invest will be worth it, because healthy digestion delivers a healthier life on every level.

by Marcelle Pick, OB/GYN NP

Is your body burning to tell you something? In functional medicine, practitioners consider the health of your digestive system to be as crucial as the health of your brain. In fact, many chronic conditions start with poor digestion, sending out clues in the form of indigestion and heartburn. For many women, ignoring these signs over time can lead to a more severe condition, such as acid reflux.

Scientists estimate that more than 15 million Americans suffer from acid reflux disease, also known as gastroesophageal reflux disease or GERD, in which acid from the stomach flows up into the esophagus, causing discomfort, inflammation and sometimes scarring. Thanks to incessant advertising, many people go to their doctors looking for an antacid or proton pump inhibitor (PPI) when they have acid reflux. But using these pills long-term could mask the signals your body is sending out and keep you from finding the real cause of your acid indigestion.

If you think you may have acid reflux symptoms or you’ve already received a diagnosis, it’s important to know that you have much more control than popping a pill gives you. It may take urging your healthcare practitioner to help you find the root cause. It may take doing the investigating yourself. Either way, the good news is that symptoms of acid reflux respond extremely well to natural changes in diet and lifestyle — and you just may not need that prescription for a PPI to stop your body’s acid production. It’s simply a matter of figuring out where to begin.

What is GERD?

GERD — or gastroesophageal reflux disease — is the medical term for acid reflux. And it can cause, among other symptoms, heartburn in the chest. Occasional heartburn can happen after a large meal or with foods you are sensitive to, but GERD is diagnosed when the burning happens frequently or even continuously.

The problem of acid reflux begins when the gradient of pressure between the lower esophageal sphincter (the valve between the esophagus and the stomach) and the stomach is altered. Under normal circumstances, our muscles act with gravity to create pressure to push the food we eat downward from the esophagus into the stomach. With GERD, the pressure from the stomach below increases over the pressure from above, and the mixture of food and acid that should stay in the stomach comes splashing back up. A similar pressure gradient effect applies whenever we belch.

This reverse in flow can happen for many reasons, the most common being a loss of tone in the lower esophageal sphincter or LES. Think of the LES as a one-way valve similar to what controls the flow of water out of the spigot in your sink. When you turn the handle, the valve opens and water flows out. Likewise, when you eat, the LES opens to allow the contents of your meal to flow down into the stomach. The water should never reverse back into the faucet, and neither should the gastric contents in your stomach splash back up into the esophagus. But when the valve loses its tone, it can’t keep the acidic mixture down and you begin to feel the symptoms.

Some of the acid reflux symptoms you may experience include:

• Burning pain in your chest (heartburn) or upper abdomen
• Irritation in your throat
• Acid taste in your mouth
• Bad breath
• Laryngitis
• Chronic cough
• Difficulty swallowing
• Nausea
• Belching

Although acid reflux is common, it can be serious. Over time, regurgitation of acidic stomach contents can wear away the esophagus, eroding the delicate tissue, and causing inflammation and scarring. It can sometimes even lead to erosion of tooth enamel and, in extreme cases, to esophageal cancer. In fact, one in ten people with GERD go on to develop dangerous changes in the esophagus (known as Barrett’s esophagus) that can increase their chances of esophageal cancer.

Because of these long-term effects and because the symptoms are associated with many other diseases, including heart disease, H. pylori infection, gastritis (inflammation of the stomach lining), and ulcers, it is important to heed your body’s signals and discuss your symptoms with your healthcare practitioner early. If your practitioner does diagnose you with GERD, be wary of easy solutions.

Just the tip of the acid iceberg

Conventional Western medicine treats acid reflux on the premise that if we can stop or neutralize the hydrochloric acid (HCl) produced in our stomachs, we can solve the problem. If the acid is causing the burning, then take away the acid — right? This can certainly help some people in the short-term. But in truth, the approach only solves a portion of the problem: the symptoms. And inappropriate or long-term use of antacids (like TUMS or Mylanta), proton pump inhibitors (like Nexium — the “Purple Pill,” Protonix, and Prilosec), or H2-receptor antagonists (like Tagamet, Pepcid or Zantac) can set you up for more problems down the road.

In my experience, most patients with GERD or acid reflux are suffering from too little acid, not too much. Let me explain. During healthy digestion, your stomach uses an acid cocktail made up of hydrochloric acid (HCl) and the powerful digestive enzyme pepsin to break down food into the vital nutrients your body needs. Pepsin requires a highly acidic environment to do its job, and when HCl is low — which can happen for many reasons, including age, poor diet, infection and overusing antacids or other medications — it becomes increasingly difficult for your stomach to fully process your food.

Wanting to get the job done, the stomach may initially respond to low acidity by releasing more gastric acid. This effect, sometimes referred to as acid rebound, can also occur after taking antacids such as TUMS: in response to the acid-neutralizing effect of the tablets, the stomach works to replenish its acid supply. But ultimately, prolonged use of acid-inhibiting medications such as PPI’s or H(2)-receptor blockers can induce a state of hypochlorhydria, or chronic low acid, perpetuating the cycle of indigestion. And once you stop the meds, you may yet face the issue of acid indigestion because you have not yet addressed its underlying causes.

So, even if medication to block acid production helps in the short-term, it’s not a solution, and over time it can actually exacerbate the problem. Instead of masking your symptoms, investigate the root causes. This is the best way to prevent GERD from worsening — and even cure it.

Finding the root cause of acid reflux

In my practice, the health of a woman’s stomach and gut is paramount. For patients with digestive complaints, we often recommend in-depth diagnostic tests. In the case of acid reflux, for example, testing for the presence of antigens from the bacterium H. pylori or IgE and IgG testing for food sensitivities may be useful. In some women, we may also check to see if hormone levels such as estrogen, progesterone, or cortisol are unusually high or otherwise off-balance. Be forewarned, however, that conventional doctors may be unfamiliar with this type of testing and look askance when you request it. That said, I have seen the information that this kind of testing provides totally transform people’s health!

Because we are all individuals, the path back to where your GERD began can be different for everyone. Here are some common causes to investigate:

Hiatal hernia. A hiatal hernia is a structural problem that occurs when the lower esophageal sphincter (LES) and stomach wall below it partially bulge up through the opening in the diaphragm. Normally, the diaphragm muscles serve as an extra barrier for the LES. In a hiatal hernia, the diaphragm encircles and impinges on the upper stomach wall, throwing off the pressure gradient at the LES and allowing the acidic contents of the stomach up into the esophagus.

Research shows that the larger the hernia, the greater the acid reflux. Some people can have a hernia and never experience symptoms, but persistent heartburn and chest pain are common complaints of hiatal hernia patients.

Hernia pain can be misconstrued as a heart attack, so it’s important to get an accurate diagnosis from your doctor. There is also a danger that the stricture can cause the upwardly bulging portion of the stomach to become strangled and its blood supply cut off completely. Osteopathic treatments or surgery can help shift organs back into place.

Hypochlorhydria. This is the scientific term for chronic low stomach acid, as we discussed above. Remember that acid is essential in the digestion of food. Without it, you can compromise your ability to fully break down and absorb nutrients, as well as set yourself up for prolonged indigestion and possibly GERD. Many health problems are associated with hypochlorhydria, including vitamin B12 deficiency, anemia, skin conditions and autoimmune disorders, so it’s important that it be diagnosed and addressed as early as possible.

Food allergies and intolerances. If you’re allergic or intolerant to certain foods, for example wheat or dairy, your gastric juices can’t break the proteins and sugars in those foods into their useable and non-reactive subcomponents. This can cause a host of allergic symptoms as well as post-meal discomfort in the form of gas, bloating, or acid reflux.

Age. Like many of the muscles in our bodies, the LES can lose tone and mobility as we age, making it more likely for stomach contents to push up through the weakened valve. The parietal cells in the stomach can also become less responsive as we age, so HCl levels naturally tend to decline and digestion becomes more sensitive.

Pregnancy. The pressure of a growing fetus within the expanding womb can push up on our digestive organs, putting added pressure on the LES and forcing the pressure gradient to shift and allow stomach contents into the esophagus. There is also a theory that the changes in estrogen and progesterone (along with other hormones) during pregnancy allow the LES to relax more than it generally would. Whether or not this is the precise mechanism, a hormonal component to GERD symptoms in women has been suggested.

Obesity. A Scandinavian study published in 2003 in the Journal of the American Medical Association showed a direct link between obesity and acid reflux. This may have something to do with larger meals or extra weight increasing pressure on the LES, causing it to remain partially open and allowing regurgitation. Weight loss is obviously an effective treatment.

Prescription medication. Certain medications can directly or indirectly lead to GERD. For example, anticholinergic agents (such as those used for IBS and chronic diarrhea) can slow the muscular waves of digestion and reduce the pressure gradient in the esophagus. Similarly, codeine and other opiates slow down the action of smooth muscle tissue and affect LES tone. Tricyclic antidepressants have also been linked with GERD, most likely because the neurotransmitters they work on in the brain are the same as those in the gut. And for women in perimenopause and menopause, it’s important to note that hormone replacement therapy has also been found to be strongly associated with gastroesophageal reflux. Studies suggest that elevated levels of estrogen and progesterone, whether they’re the body’s own hormones or coming from sources outside the body, such as supplemental HRT or SERM’s (selective estrogen receptor modulators), can increase GERD symptoms.

Alcohol and tobacco. Likewise, alcohol and nicotine are non-prescription drugs that can influence your digestive system. While the connection between nicotine and GERD is not entirely clear, smoking appears to be associated with a decrease in LES pressure. Alcohol, on the other hand, is directly linked to GERD because of its role in delaying gastric emptying and lowering LES pressure.

Chronic conditions. It’s also possible for your reflux symptoms to arise from an abnormal arrangement of your internal organs, an injury, or some other unusual condition that needs to be ruled out, such as scleroderma, Zollinger–Ellison syndrome, or post-surgical scarring.

As you can see, there are many potential factors leading to GERD and its ensuing discomfort. Look carefully at your history and lifestyle to address causal issues over which you may have some control. And while you’re tuning into these physical pieces, don’t forget that your emotions are intrinsically linked to your health. In the case of acid reflux, it’s usually something “burning” to be discovered.

Stress and acid reflux

Women with acid reflux often report that symptoms worsen during times of increased stress. Stress can impact our bodies in multiple ways. The digestive and immune systems can both be compromised and may contribute to acid reflux. We know that production of cortisol, the stress hormone, inhibits your digestion. And your immune system isn’t as strong during times of stress either, leaving it less equipped to fend off the infectious agents you come into regular contact with in your food and drink. Both of these things can increase the likelihood of acid reflux.

So ask yourself, “What’s eating me?” Is there a loss you need to grieve or forgiveness you need to grant? Is your job stressful or are your finances a wreck? The answers may not come easily, but a thorough investigation of your emotional state may help your system “digest” the emotions that are stuck and making you sick.

Posture is another important signal of your emotional state. Are you literally weighed down by the burden of your emotional life? Are your shoulders rounded with stress, your abdomen curved into a “C?” Your inner organs need space to function. If your posture or body structure is cramping your stomach, this will exacerbate poor digestion and possibly lead to more severe issues, such as a hiatal hernia.

Acid reflux relief — the Women to Women approach

Natural prevention and treatment can be very useful when it comes to acid reflux. I encourage you to give priority to the natural approach, using any medication or antacid as a temporary bridge, with the hope that you can wean yourself of those little purple pills in time. In my experience, use of antacids is not a long-term answer — whereas employing optimal nutrition, healthy digestive habits, good quality supplements, and emotional well-being provide long-term solutions. Note that these measures all promote healthy hormonal balance, and help soothe other digestive disorders as well, such as IBS, ulcers, and gastritis.

First, address your eating habits. How and when you eat do matter! Shifting your meal pattern from three meals a day to five smaller meals puts less pressure on your digestive system — and keeps your stress hormones on an even keel. Try to eat your largest meal earlier in the day and have a light dinner. This will allow your system ample time to digest before you go to bed. Try not to eat for three hours before going to bed, but if you do have a snack make it light and easy to digest. Eat plenty of high-fiber fruits and vegetables to keep your intestinal flora happy and your bowels moving. Keep greasy foods to a minimum, as digesting fat can prolong the digestive process and exacerbate GERD. Remember to enjoy your meals without rushing. For more information on creating healthy eating habits, read our Nutritional and Lifestyle Guidelines.

Chew your food thoroughly. Just like your mother said, digestion begins in your mouth! The digestive enzyme amylase targets starches in the mouth and gets the whole digestive cycle going, signaling production of gastric juices in the stomach, which then trigger production of pancreatic enzymes that go to work further down. When we eat on the go, we practically inhale food instead of breaking it down, which puts added stress on the stomach. The smaller the pieces are when they get swallowed, the easier it is for your digestive system to break them down and absorb their valuable nutrients. And speaking of chewing, if you think you have a problem with your teeth or the way your teeth fit together, consider seeing a dentist to help you correct the problem.

Work with gravity. Try not to lie down within three hours of eating, when acid production is at its height. Gravity helps keep your stomach contents down where they belong. When you lie down to sleep or rest after a meal, you lose this assistance. Some patients find relief from nighttime GERD by simply elevating the head of their beds. Others find that taking a casual walk after a meal helps move digestion along.

Find your triggers. Try an elimination diet for a few weeks to root out the trigger foods that upset your system. Keep a food journal to record what you eat and when, as some foods may bother you only if you eat them at certain times, like close to bedtime. Some of the most common problem foods to avoid with acid reflux are stimulants such as chocolate, coffee and tea (even decaf), soda, alcohol, dairy and wheat. Others include fatty foods, onions, tobacco, and acidic juices like orange and tomato. Simply avoiding these foods can often clear up the problem. People assume that spicy foods cause heartburn, yet there is little evidence to support this. But we are all individuals, and if avoiding certain spices helps you, this is what you should do.

Examine your stress levels. Whether it’s through meditation, reading or getting more exercise, finding ways to cut back on stress will help your symptoms. It’s especially important to relax when you eat and for a while afterward. Think about what’s eating you before you sit down to a meal. Consider talking with a therapist or another trusted individual to help you learn to cope with your stress.

Consider digestive support. At Women to Women, we’ve had great success improving digestion and acid reflux by boosting stomach function naturally with digestive enzymes and supplemental fiber. Talk to your practitioner about a trial of digestive enzymes or visit your local health food store for bitters or probiotics to restore your natural acid balance and digestive function.

Enrich your diet. Try a high-quality nutritional supplement to give yourself the nutrients you need as you are working through your acid reflux. One of the concerns with undigested food is that your body never gets the important nutrients it needs to function well. This can send you on a downward spiral quickly.

Please visit our online Women to Women store to view our high-quality, specially formulated supplements to enhance your health needs.

Acid reflux — the mystery solved

Years ago, the first thing a patient would be asked about was her digestion. Today conventional practitioners hardly explore this topic at all. That’s unfortunate because our nutrition and digestion are the foundation of our health.

In the end, your body is burning to tell you something. You just have to pay close enough attention to hear the story. Remember that you are your greatest healer — and acid reflux doesn’t have to rule your life. Listen to your body, talk to your practitioner and call us — we are here to help.

by Marcelle Pick, OB/GYN NP

Think fast: what’s your pH?

If you are like a lot of my patients, you might be familiar with the term “pH” from biology class or a skin cleanser commercial. And the idea of balancing your inner pH has become trendy these days, being featured in magazines and spawning an assortment of products in health food stores. But beneath the “trendiness” lies an important concern: the fact that the diet of most Americans is overloaded with foods that are acid-forming — that tip the body’s pH toward acidity. And while our bodies are equipped to counterbalance a certain amount of acidity, what we’re seeing is that the standard American diet overwhelms our ability to buffer the acids in our diets — particularly when other acid-promoting factors such as stress enter the picture.

When they learn about the pH trend, my patients often ask, “When it comes to health, what role does pH really play?” Some proponents would have you believe that balancing your pH will cure all health woes. While pH is one of many factors I look at when considering a woman’s health, I never consider it in isolation. That would be too simplistic an approach, and would fail to take into account the complex role pH plays in our physiology. That said, it is an essential factor in our overall health equation, so let’s take a look at how pH imbalance affects us — and what we can do to correct it.

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Understanding the pH scale

The derivation of the “pH” is variously traced to terms meaning potential for hydrogen or hydrogen power.

The pH scale measures acidity in terms of hydrogen ion (H+) activity in a solution. A solution is acidic when it has more free hydrogen activity, and alkaline when there is a lack of free hydrogen activity.

The lower the pH reading, the more acidic the solution. Readings from 0–7 are considered acidic, and numbers from 7.0–14 are considered basic, or alkaline. Pure water, in the very middle of the (logarithmic) pH scale, has a pH of 7.0, which is considered neutral.

Body pH balance

In terms of body pH balance, there is no one “correct” reading for the entire body. For instance, healthy human skin has an approximate pH of 5.5 (slightly acidic). Saliva, on the other hand, has a pH of around 6.5–7.4 (teetering on either side of neutral). Your digestive tract’s pH can range from 1.5 to 7.0, depending on what stage of digestion is underway. And when the body is in good working order, human blood reveals a narrow pH window of about 7.35–7.45 (slightly alkaline). Other parts of a healthy, well-functioning body will show still other pH readings.

Why is this? It’s all part of the same body, so why wouldn’t a person’s acid–alkaline balance be the same all over? Because different parts of our bodies serve different purposes. Each of these purposes and their related processes requires a particular acid–alkaline environment for optimum function.

Skin needs to be slightly acidic in order to deal with environmental factors like bacteria and other toxins. Likewise, the vagina maintains an acidic environment to protect itself, and when the pH is raised too high, infections like bacterial vaginosis and yeast infections can result. The stomach and other parts of the digestive system are highly acidic out of biological necessity. The digestive acids are part of how we process and use the foods we eat as fuel. They are part of our internal combustion for nutrition.

Part of the confusion over body pH arises from the close-to-neutral pH balance of our blood, saliva, and urine — substances we can test easily. This has led to the mistaken belief that pH levels are static throughout the body, when in fact they are not. Eating more alkalizing foods (such as leafy greens and dried fruits) can help balance and maintain the pH level of your body and ultimately promote better well-being, but this doesn’t happen in a vacuum, and it also doesn’t happen overnight. Along with a diet rich in alkalizing plant foods, it takes time and commitment to certain lifestyle changes, including exercise and regular detoxification. It also takes knowing whether or not your pH is truly off-balance.

Enthusiasts of the “pH miracle” say that simply living in the modern world — with its reliance on refined grains and sugars, corn-fed beef, and unhealthy fats — means we are all overly acidic. To rectify this, we should focus all our attention on restoring “healthy pH,” by which they mean a blood pH of 7.35–7.45. I fully agree that most people could benefit by addressing their acid–base balance, but before anyone begins megadosing on supplements or downing gallons of “green” water, they need to define their individual needs. (Remember, the key to pH is balance!) And the best way to do this? Test your pH.

Testing your pH

Physicians use esophageal and gastric pH meters to help identify the causes of heartburn and gastroesophageal reflux disorder (GERD). Such tests determine the amount of acid in the environment being tested. Similarly, you can test the pH of your saliva and/or your urine with simple litmus strips, which are available in most pharmacies. Keep in mind that in order to get the full picture of your body’s pH, you’ll need to carry out the test not just on one day, but daily for a period of time.

Tracking your urine or salivary pH over the course of a week or so will provide a window into what is going on in your internal world. A diet that lacks essential vitamins and nutrients and is high in acid–forming foods will show up in acidic urine. This is a good indicator that your body is struggling to maintain an optimal digestive environment (also affected by your intestinal flora and immune system), which could be contributing to systemic inflammation — that ubiquitous bugaboo at the root of so many chronic health concerns, including heart disease, high blood pressure and obesity.

If conditions of hyperacidity and inflammation are occurring in your body, the next step is to take a look at the source of the acidity — and food is the first place to start. Imbalanced pH is primarily a product of what you eat — although this might not mean what you think it does.

You may think it’s acid — but it’s not

Considering whether a food is acidifying or alkalizing in the diet can require some mind-bending, because some foods that we think of as “acidic” are, in fact, alkalizing in the diet. It’s actually better to look at whether the food is acid–forming or alkaline–forming, not where the food itself falls on the pH scale. So even though we think of citrus as acidic, fruits like lemons and tangerines are alkalizing because when they’re consumed, they break down and donate alkaline mineral salt compounds like citrates and ascorbates.

Similarly, foods we might normally think of as meek and mild in nature are acid-forming when ingested. Grains and milk are two examples. What’s important is not so much the pH of the food as it goes into our bodies, but the resultant pH once the food is broken down — and this is dictated by the residues the broken-down nutrients leave behind, particularly sulfates and phosphates.

But this isn’t the sort of association most of us can readily make, so we have compiled a list of common acidic and alkalizing foods to guide you (refer to our Acid Alkaline Food Chart). But why is it important to have a certain acid–alkaline balance in our diets? The answer has to do with the dance that occurs between acid and alkaline elements in our digestion.

Digestive enzymes, microbes, nutrients, and pH balance

As mentioned earlier, pH within the digestive tract isn’t a constant, and in each zone of increasing acidity, there are different digestive enzymes and beneficial microbes present. In the mouth, where the process begins, the pH is only mildly acidic, and the enzyme amylase is present. Amylase, responsible for breaking down starch, works in a fairly neutral environment, so when the pH falls below 6.5 it is no longer active.

Acid isn’t all bad…

The acidic environment of the stomach is not only necessary for processing food, but it also helps to protect your body from pathogenic organisms or food antigens that shouldn’t be there.

Interestingly, many people with acid reflux and heartburn — a condition conventional medicine blames on acid-containing foods like fruits and vegetables — actually have too little acid in their stomachs, a problem that’s compounded by medications like Pepcid and TUMS that increase alkalinity in the stomach.

In my experience, many of my patients get rid of their heartburn and acid reflux by adding more acid to their diets. For more on this, please see our article on the link between IBS, acid reflux, and antacids.

As food makes its way from your mouth to your stomach, the digestive tract becomes more acidic. Pepsin, the enzyme responsible for protein breakdown, needs an acidic environment and therefore gets released into the stomach, where pH is very low (about 2.0–1.5). Your small intestine is where most of the nutrients in your food get absorbed, and where the pH increases from 2.0 to 6.5 as the food travels from the stomach to the small and large intestines.

Protein — particularly in the form of red meats — requires huge amounts of alkaline minerals for complete digestive processing. When the system goes looking for the alkalinity needed to offset the acid load, it looks first to the minerals currently in the digestive tract. If it fails to find alkaline nourishment there, it draws on the calcium, magnesium, phosphorus and potassium minerals stored in our bones.

This is where the good greens and essential vitamins and minerals come in. When we eat a diet that is rich in nutrients, there’s no need to draw on the stored minerals in the bones. It’s when we don’t consume a nutrient-rich diet — or, worse, when we over consume foods that promote acidity in the body — that we start tapping our bone resources. In the short term, this isn’t an issue, but in the long run, it can have serious consequences, not just for our bone health but for our overall health.

pH and disease

It make sense, given that the bones are the storehouse for alkalizing minerals, that when the body has to drain the stores to offset acid overload in the digestive tract, the net result can be loss of bone density, which can lead to osteopenia and ultimately osteoporosis. We talk about this at length in our bone health section. But bone loss is not the only health issue that stems from overdrawing our account at the bones mineral bank.

As I mentioned earlier, when your body struggles to maintain the relatively tight blood pH required for survival, it can result in inflammation. Over time, this struggle may be mirrored by a steady rise of the pro-inflammatory blood acid homocysteine in your blood. Studies show that high levels of homocysteine in the blood double the risk of osteoporosis–related fractures, along with other inflammatory conditions like heart attack, stroke, fuzzy thinking, and Alzheimer’s disease. A recent report published in the New England Journal of Medicine explains how elevated homocysteine levels inhibit new bone formation by interrupting the cross-linking of collagen fibers in bone tissue.

Homocysteine levels can be stabilized by eating foods and taking a vitamin supplement rich in folic acid, B12, and B6. Some researchers also describe a beneficial synergistic effect on homocysteine levels between omega–3 fatty acids and the metabolism of these vitamins.

Be aware that a minority of the population cannot convert folic acid due to certain enzyme deficiencies. If your homocysteine levels remain high even after a few weeks of B supplementation, you may want to ask your practitioner about adding a more bioavailable form of folate called 5-methyl-tetrahydrofolate (MTHFT) to your diet.

Naturally improving your pH balance

Proponents of alkaline diets sometimes talk as though eating alkaline is the only step to good health. It’s true that our bodies know intuitively where balance lies, and they can maintain balance on their own if provided what they need through healthy diet and nutritional supplements. But it’s important to understand that you can’t simply load up on alkalizing foods and supplements and presume they’ll offset any amount of acid you consume or create. To restore pH balance, you must address other sources of metabolic acidity as well, because in most situations, no amount of alkalizing can balance a toxically acidic environment. And to cap it off, detoxification takes place more slowly in an overly acidic environment.

Here are some ideas on how to restore pH balance to your diet, support healthy digestion, keep blood pH levels on track, and protect your bones and kidneys, too.

• Take a high-quality daily multivitamin. This will offset any nutritional gaps and insure that your body has the reserves it needs. Your supplement should contain essential vitamins and minerals, including calcium and magnesium in their most bioavailable, alkalizing forms. In addition, I recommend an essential fatty acid supplement and a top-quality probiotic to help the body absorb the minerals that are all-important to your bones. Women to Women has formulated high-quality and pure supplements to assist you with this goal.

• Fill your plate with fresh vegetables, particularly the dark green leafy kind. Add fresh lemon or lime juice to foods and beverages as a highly alkalizing flavor accent. Enjoy plenty of fruit, especially fruit with a low glycemic index. Women in perimenopause and menopause, particularly, benefit more from fruits that are lower in sugars, to avoid concerns about insulin resistance. Again, foods that are fresh, organic, and deeply pigmented or brightly colored are the kinds that benefit you the most!

• Choose root vegetables, too, as excellent sources of alkalizing mineral compounds. Eating foods such as slow-roasted sweet potatoes, onions, and leeks, which are also high in inulin, can optimize your body’s ability to fully absorb the calcium present in your food and thereby decrease your risk for osteoporosis. Inulin is a type of prebiotic — it is believed to serve as a welcoming “fuel” for friendly gut flora, paving the way for beneficial bacteria to thrive further down into the colon, where it lowers the pH and improves the solubility and absorption of calcium by the body.

• Consider boosting your diet with “green foods” or “green drinks,” which contain the pigment chlorophyll in abundance. The plant world’s equivalent of the hemoglobin in our blood, we can thank chlorophyll as the original source of all our food (except perhaps fungi!) It works in the body as a strong detoxifier and immunity–building agent. Foods that contain high levels of chlorophyll include the algae spirulina and chlorella and the juice of wheat grass and other sprouted grains. These foods offer high levels of other micronutrients as well, and their neat packaging can be especially helpful for those who lack time to prepare whole balanced meals or people recovering from illness.

• Eat plenty of vegetable protein, watch your red meat intake, and keep your servings of the acidifying animal proteins down to four ounces per meal (the size of a deck of cards).

• Avoid refined carbohydrates whenever you can, including sugar, and when you include grains, be sure to emphasize the “whole” in whole grains. Eliminate all processed foods, particularly those that contain partially hydrogenated oils (trans fats).

• Clear the digestive slate with a gentle detox plan, to get a better reading on how your diet — and pH — are affecting your sense of well-being. You may be surprised at how well you feel!

• If you suffer from IBS, acid reflux, or regular heartburn, consider testing your pH. Remember that you may have too little acid in your stomach, not too much. Don’t just assume that an acid stomach means you’re too acidic.

• Chew your food slowly and thoroughly. Enjoy every bite!

The beauty of balance

The subject of body pH may be having it’s 15 minutes of fame — but if it helps you to tune in to what’s going on in your body and eat a healthier diet, I’m all for that. Indeed, there are some people whose pH levels warrant attention — but you won’t know until you test your pH, and you may need a good functional medicine practitioner to guide you. Even so, pH is only one, albeit fundamental piece of the puzzle. To my mind, pH is a helpful indicator of overall balance in the body. But it’s just the tip of the iceberg, and no amount of trendy drinks or diet plans will make it more than that.

That being said, paying attention to your pH is one place you can begin to make an immediate positive change to preserve your long-term health. If it feels like a good place for you to start taking better care of yourself, I encourage you to do so. From there, it’s my hope that you will continue to listen to your body and help it find balance on all fronts, including your hormones, your emotions, and your lifestyle.