the fire within: digestion and botanical medicine · epilepsy, blood clot prevention, and nail bed...

Applied Phytotherapeutics The Fire Within: Digestion By Terry Willard ClH PhD Unit One

© 2019 Wild Rose College of Natural Healing And Terry Willard ClH, PhD

1

The Fire Within: Digestion and Botanical

Medicine

Gastroesophageal reflux disease (GERD) Gastroesophageal reflux disease (GERD) is one of the most common health issues that we see in patients and clients -over 70 million North Americans experience it at least once a month. It is not an exaggeration to say GERD has skyrocketed in the last three decades. The symptom of acid reflux (heartburn) is the most common, but many have other symptoms that do not include any sensation of pain or irritation. A person with silent symptoms often displays a dry cough or seems as though they are perpetually trying to clear mucus in their throat. Other symptoms of GERD can include:



2

• Asthma • Bad breath • Belching • Chronic cough • Chronic sore throat • Difficulty or pain when swallowing (dysphagia) • Erosion of tooth enamel • Hoarseness • Inflammation of the gums • Postnasal drip • Sleep disorders • Sour taste in the mouth • Throat clearing (one of the most common symptoms) • Water brash (sudden excessive saliva)

If a person has the following symptoms, they require immediate medical attention:

• Severe difficulty swallowing (dysphagia) • Vomiting of blood • Black stool • Weight loss

Although many of the preceding symptoms can be a result of other unrelated conditions, when accompanied by severe and chronic heartburn, there is a good chance they may be connected. At least 14% of North Americans suffer from heartburn once a week, 21% suffer monthly, and 50% experience it annually. GERD is one of the primary reasons people visit emergency rooms across North America. It is quite frightening when you consider the profound health complications that can come with GERD. These include: Barrett’s Esophagus (changes in esophageal cells that are precancerous, in some cases), Dysphagia (difficulty swallowing), Esophagitis (irritation and inflammation of the esophagus), and Esophageal cancer.



3

Most episodes of GERD occur during the day, usually after eating, although some sufferers will also experience reflux during sleep. The nocturnal form of GERD is associated with a higher risk and more severe indications of esophagitis because the sleeping patient produces less saliva and swallows less often, to clear out and neutralize the acid.1,2 The typical etiology of GERD is usually attributed to a dysfunction of the lower esophageal sphincter (LES), with delayed stomach emptying, ineffective esophageal clearance, and decreased salivation. Pathologists recognize smoking, caffeine, chocolate, fatty foods, overeating, tight clothing, a hiatal hernia,

and certain medications as being associated risk factors. In herbal medicine, GERD is recognized as an issue of poor gastric tone, with poor motility. Fundamentally, GERD is recognized as a stomach deficiency in TCM. CAM practitioners recognize and remove detrimental contributing factors to GERD. Additional factors that are recognized and treated by herbalists are the consumption of flour products, which has a glue-like consistency and promotes poor motility, as well as poor food combinations, i.e., animal proteins with carbohydrates, which similarly impairs gastric function. Patients with GERD often complain of a mucus patch in the back of the throat (‘frog in the throat’). This can be caused by the reflux irritation in the esophagus and the sinus producing excess mucus (in the form of post nasal drip) to create a mucus protection for the upper esophagus. This is often accompanied by a cough because such exertion contracts the abdominal muscles and forces food through the weakened LES. It is also beneficial for patients with GERD eat smaller meals - in a relaxed manner. There comes that mindful eating again. Throat clearing has become so common for many people (especially frequent travelers) that some think it is the new normal. If throat clearing is a chronic condition, consider GERD. In some cases, gastric impairment is a symptom associated with pathologies such as scleroderma in which the dysfunction of the LES is attributed to autoimmune-induced fibrosis. 3,4



4

M e d i c a l T r e a t m e n t The medical treatment of GERD consists of lifestyle modifications, drug treatments, and surgery. Modern medicine recognizes that diet can play a role, and encourage patients to become aware of which foods or activities tend to make the problem worse, such as smoking, and the consumption of caffeinated foods and beverages, chocolate, fatty foods. It is suggested that tight clothing be avoided. As mentioned, body position is also considered to be an essential aspect in managing GERD, and recommendations might be made to maintain an

upright posture -ensuring that the ingested food does not reflux back into the esophagus. Some patients may be counseled to insert a wedge under their back at night to keep the esophagus above the stomach while sleeping. A very useful mechanism is to sleep on one’s side with a pillow between the knees. Often nocturnal

GERD is caused by rolling on one’s bloated abdomen, thus causing pressure creating the reflux action. Similarly, avoiding exertion after a meal, such as bending or lifting is considered necessary, as this contracts the abdominal muscles and forces food through the weakened LES. Patients are also advised to eat in a relaxed manner and eat smaller meals. Patients that are obese are often at a greater risk of GERD because excess abdominal fat puts pressure on the stomach. Similarly, pregnant women often complain of heartburn, simply because of the pressure placed upon the stomach from the growing fetus, but also because hormonal fluctuations tend to make the esophageal and gastric mucosa more sensitive and therefore more reactive. Some commonly used oral medications have been linked to GERD and gastric disease, including acetylsalicylic acid (ASA) which is directly toxic to the gastric mucosa, and well as potassium supplements and the antibiotic tetracycline that often promote burning sensations in the esophagus. The classical medical approach to treating GERD is the usage of antacids such as calcium carbonate that neutralize stomach acid. Although recommended for only occasional use, many patients are encouraged or end up using them on a chronic basis, which has an adverse effect upon gastric secretion and weakens stomach function. Another similar regimen is the use of bismuth



5

subsalicylate (e.g. Peptobismol®) that acts to coat the lining of the stomach and suppress acid secretion. Like other salicylates, however, it is likely that bismuth subsalicylate is also toxic to the gastric mucosa. Prescription medications include promotility agents, H2 blockers, and proton pump inhibitors. Promotility drugs such as the drugs cisapride, metoclopramide, and bethanechol are used to promote gastric motility. Cisapride, in particular, has since been recognized to have some dangerous effects including ventricular tachycardia and ventricular fibrillation, as well as diarrhea, gastric pain, headaches, and somewhat quizzically, constipation. Due to the concern over the effects of cisapride it is no longer available to the vast majority of patients, although doctors can still prescribe it in certain circumstances. More commonly, H2 blockers (e.g., cimetidine, famotidine, nizatidine, ranitidine) and proton pump inhibitors (PPIs, e.g., omeprazole, lansoprazole, rabeprazole, and pantoprazole) are commonly prescribed to reduce the amount of acid produced in the stomach, which refluxes into the esophagus. You might want to watch some videos showing this action: http://sunmarkbrandtmhb.com/relief.html The theory behind the usage of these drugs appears to be that there is an excess secretion of stomach acid (Stomach Excess) and it is this that underlies GERD. This theory is largely unsupported and exists in direct contrast to widely supported research. Dr. Wright wrote a book on the topic and stated that in his clinic over ninety percent of people who show up with heartburn symptoms were actually found to have low stomach acidity5. I have found similar numbers in his practice over the last 2 – 3 decades. There are indeed people who make too much stomach acid but this is, in reality, a much less common scenario. Despite the messages we are bombarded with by antacid companies on television, it turns out that low stomach acid is a vastly more common condition than high acid. The condition of low stomach acid is called “hypochlorhydria.” This has been an enigma for modern medicine for decades. How is it that someone can have low stomach acidity and yet have acid regurgitating into their esophagus? This question has perplexed medical professionals for years, and because they do not know the answer, they seem to be stuck on the “solution” of giving out antacids even though this strategy has proven to be problematic and, at best, is only a short-term. If you watch television ads for heartburn, you could get the impression that low stomach acidity is caused by a deficiency of ‘acid-blocking drugs’ How absurd, any



6

pharmacist will tell you that these acid acid-lowering drugs are designed to be used for a short duration. Yet we often run into people who double up on several antacid medications and have been on them for years despite the warnings. According to research, these drugs have a poor track record; about a third of people report they do not work at all. About two thirds still report symptoms several times per week, and almost three quarters are doubling up with several over-the-counter drugs. It is clear that this is a “Band-Aid” approach. Not only that, these acid-reducing medications cause further Stomach deficiency -the initial underlying problem. The other common recommended strategy in the allopathic world is, eating small carefully selected meals, and propping up the bed at night are just more band-aid approaches. Sadly, the reality is that there is no magic bullet solution to reflux; the real path to healing involves diet and lifestyle changes. The crux of this whole issue is that the pharmaceutical industry cannot help anyone achieve diet and lifestyle changes. Drugs simply don’t do that. GERD is a multifactorial condition and is much more complex than most people know.

The problem, of course, is that acid is refluxed into the esophagus and the esophagus does not have the same kind of mucosal protection as the stomach. Although the use of acid-suppressing drugs can give the esophageal epithelium time to heal, they may indeed bolster the underlying problem because the drugs weaken gastric function, and have a questionable success rate. Further, if these drugs are resorted to on a long-term basis, the chronic diminishment of acid production can result in a decreased production of ‘gastric intrinsic factor’ and, therefore, can lead to pernicious anemia (lack of B12). Unfortunately, there is little research on this issue, and while the drug manufacturers recommend that H2 inhibitors and PPIs be used short term, many patients, especially elderly patients who suffer from impaired digestive activity, take them on a continuing basis. In addition, PPIs may interact with some over-the-counter herbal remedies, as well as medications such as Valium or those taken for epilepsy, blood clot prevention, and nail bed fungus, by either increasing or decreasing their effectiveness. People should always let their doctor know about all medications and remedies they are taking. Both H2 and PPIs can reduce the effectiveness of many herbal or nutritional supplements, as they reduce digestive capacity and can slow down their activity. People can often get a reduced nutritional yield from food consumed for the same reason.



7

Unfortunately, they do not reduce absorption of simple carbohydrates, meaning that there will be absorbing fewer nutrients absorbed, but the same amount of carbohydrates that lead to weight gain will be absorbed. In some cases, in the allopathic world, surgery is an alternative to prescription drugs when treatment is unsuccessful, or when certain complications of GERD are present. Adverse effects of surgery can occur for up to 20% of patients -such as difficulty in swallowing or impairment in the ability to belch or vomit. Another problem is that the surgery can break down over time – this happens in approximately 30% of patients who then require continued use of the medications to control symptoms. Significantly reduced stomach acid can also lead to an increased possibility of gastrointestinal infections and parasites because the acid in the stomach is one of the first lines of defense against unwanted organisms. This, of course, becomes more significant in the elderly. H o l i s t i c T r e a t m e n t From a herbalist’s perspective, GERD is a form of digestive deficiency, manifesting as poor motility and a commensurate weakening of the LES as the ingested food is caused to reflux back into the esophagus. Thus, the most important element of treatment is to restore gastric motility, through dietary re-education and herbal therapies. Bitter-tasting botanicals are particularly helpful in this regard and are thought to promote the secretion of gastrin by stimulating chemoreceptors on the tongue, and as a result stimulate the secretion of gastric juices, closing of the LES and the opening of the ileocecal valve, thereby promoting proper motility. Bitter herbs also appear to modulate the secretion of CCK, which allows for proper gastric churning and the secretion of bile and pancreatic juices in anticipation of the chyme moving into the duodenum. Even though in the past it was felt that you had to taste the bitter herbs for them to work, we now know that encapsulated herbs also work quite well. The compliance with the encapsulated botanicals is much higher. However, when the herb is tasted, the reaction is much faster.

To help determine if digestive enzymes are low, be on the lookout for a coated, or, “furry” tongue, as this is a common sign of low stomach acidity. This symptom can be a clue for us to address the fundamental need to acidify our mucous membranes. Acidifying our mucous membranes makes sure fungal organisms cannot grow.



8

The tongue can also show scalloping, or teeth marks, along its edge. Sometimes the center of the tongue is slightly sunken with a deep line through it. The tongue’s coating is sometimes referred to vaguely as a collection of “biofilms”. Biofilms are similar to the extra-cellular matrix built by microbes, in the intestine. In some cases, these biofilms will travel up the twenty-three feet of small intestine and actually create a mucous-like film that slows down acid secretion in the stomach and also slows down pancreatic enzyme delivery into the small intestine. This can have a cyclic effect on acid production once the biofilms mechanically block the parietal cells that pump acid into the stomach. The reduction in acid being pumped into the stomach can then allow more fungus to grow. This sets in motion a vicious cycle; if someone has low stomach acidity then their immune system will have to work much harder. This is a hidden source of profound chronic inflammation and it usually does not get talked about.

Dietary therapies are important, and specifically, the patient should be counseled to eat less, and observe the rules of food combining -where protein foods are never mixed with starchy foods, and fruits are always eaten on an empty stomach. In acute cases, the best course is a bland diet of steamed vegetables and basmati rice, with minimal oil and spices, eventually followed by meals consisting of steamed, baked or broiled animal proteins and steamed above-ground vegetables. The management of acute symptoms, however, is critical, and is effectively served by herbal remedies which soothe the irritated esophageal mucosa and provide nutrients to promote tissue healing. We most commonly use Wonder Digestive Bitters for these situations. It is best to use these and other effective herbs at the outset of treatment, and then discontinue them as both they and the dietary re-education begin to resolve the underlying condition. The following is a list of the basic approaches and examples of each: 1. Reduce esophageal inflammation

§ Demulcents: cold infusions of Ulmus, Althaea or Symphytum, 50 g per 1 liter, taken as needed, up to 1-2 liters daily; OR powders of Glycyrrhiza, Althaea or Ulmus, 5-10 g mixed with cool water, taken as needed; OR De-glycyrrhized Glycyrrhiza (DGL), suitable in patients where obesity or hypertension is an issue, in doses of 2-3 tablets

Stomach Tonic 2 parts Meadowsweet Spirea ulmaria 1 part Gentian Gentiana lutea 1 part Goldenseal Hydrastis canadensis 1 part Fennel Seed Anethum foeniculum 1 part Fenugreek Seed Trigonella foenum-graecum 1 part Lobelia Lobelia inflate Dosage: 1 - 2 capsule or 15 drop of tincture at the beginning of the meal



9

as needed; OR Aloe juice, up to one liter daily, may promote diarrhea

§ Flavonoid-rich vulneraries: Calendula, Phyllanthus, Rubus § Astringing vulneraries, to promote muscular tone of the

LES, check hemorrhaging and heal ulcerations, e.g., Geum, Quercus, Hydrastis, etc.

2. Promote healing of the epithelium

§ Vitamin A, 25,000-50,000 IU daily § Vitamin C, 1-2 g bid-tid, to bowel tolerance § Vitamin E, 800-1200 IU daily § Zinc, 50 mg daily § Methylsulfonylmethane (MSM), 2-3 g, bid-tid; OR 500-

1000 mL of freshly juiced cabbage daily; OR the Chinese patent formula Vitamin U (Fare for U), 3 tabs tid, all of which are alternatives to MSM

3. Promote proper gastric digestion and motility

§ Bitters, taken in small doses before meals, e.g., Berberis, Gentiana, Spirea, Centaurium, Menyanthes, Hydrastis, etc. NOTE: Depending on the severity of the condition, the usage of bitters is often avoided at the outset of treatment because the initial stimulation of acid production may worsen any esophageal ulceration. Since Spirea will regulate more than stimulate is the preferred herb. Stomach Tonic (containing Spirea) can be equally used in this case, 1 – 3 capsule with each meal. Robert’s Formula, has also been effective, 20 gtt tid before meals, to stimulate proper GI motility and decrease inflammation. § Digestive enzymes, full spectrum (i.e. HCl, pancreatic enzymes, ox bile), 2-3 caps with meals § Food combining: avoid mixing animal proteins with starchy food, fruit should only be consumed on an empty stomach § Avoid dairy and flour products, which due to their sticky and heavy properties impair gastric motility § Avoid overeating, do not eat within three hours of bedtime

§ Avoid alcohol § Avoid tobacco § Avoid deep-fried foods, e.g. French fries, potato chips, etc. § Weight loss, to reduce intra-abdominal pressure The use of bitters, commonly used in the UK and Europe, can often bring fast relief to a GERD sufferer.

Robert’s Formula (modified) • 8 parts Althea officinalis • 4 parts Baptisia tinctora • 8 parts Echinacea

angustifolia • 8 parts Geranium

maculatum • 8 parts Hydrastis

canadensis • 8 parts Phytolacca

americana • 8 parts Ulmus fulva • 8 parts cabbage powder • 2 parts pancreatin • 1 part niacinamide • 1parts duodenal substance

Dosage: 2 capsule or 20 drop at beginning of meal

Digestive Enzymes Glutamic Acid HCl Betaine HCl 100 mg Calcium ascorbate 50 mg Pancreatin N.F. 360 mg Bromelain 1:1 80 mg Papain 75 mg Dosage: 1 – 4 capsule at the beginning of each meal



10

If the problem seems to become chronic, often a 12 day D-tox will set things right. Not only is it a good and simple diet, it gets things moving in the right direction -downwards instead of upwards. Contraindications Pungent botanicals such as Zingiber, and Capsicum, and especially aromatics such as Mentha, Carum, Lavandula should be avoided (unless in specific formulas) as they can worsen the condition.

Suggested Program Wonder Digestive Bitters: ½-1 tsp. before or after meals. Stomach Tonic: 1-3 capsules with each meal. Digestive enzymes: e.g., 1-3 capsules with meals. Probiotics Daily

Hiatus Hernia

Any time an internal body part pushes into an area where it does not belong, it is called a hernia. The term hiatus hernia refers to a protrusion of the stomach above the diaphragm. The hiatus is an opening in the diaphragm (the muscular wall separating the chest cavity from the abdomen). Normally, the esophagus goes through the hiatus and attaches to the stomach. In a hiatus hernia (also called hiatal hernia), the stomach bulges up into the chest through that opening.

There are two main types of hiatus hernias: sliding hiatus hernias

Seaweed Alginate for GERD Sodium or magnesium alginate derive from seaweed can help form a gel to reduce reflux from GERD. By taking Alginate at the end of a meal along with Calcium carbonate and or Coptis chinensis has had great effect on reducing GERD, while protecting gastric mucosa



11

and rolling paraesophageal (next to the esophagus) hernias. In a sliding hiatus hernia (the more common of the two), the stomach and the section of the esophagus that joins the stomach, slide up into the chest through the hiatus. The paraesophageal hernia is less common but is more of a cause for concern. Here, the esophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus, landing it next to the esophagus. People can have this type of hernia without any symptoms, but the danger is that the stomach can become "strangled," or have its blood supply shut off.

The incidence of hiatus hernias increases with age; approximately 60% of individuals aged 50 or older have a hiatal hernia, of these: 9% are symptomatic, depending on the competence of the lower esophageal sphincter (LES), 95% of these are ‘sliding’ hiatus hernias, and only 5% are the ‘rolling’ type (paraesophageal). People of all ages can get this condition, but it is more common in older people.

Hiatus hernias are highest in economically developed communities in North America and Western Europe. They are rare in situations typified by rural African communities. Many attribute the disease to insufficient dietary fiber and the use of the unnatural sitting position for bowel movements. Both factors create the need for straining at stool, which increases internal pressure, which then pushes the stomach through the esophageal hiatus in the diaphragm.

Signs and symptoms

Hiatus hernia can mimic many other disorders. It can cause pains in the chest, shortness of breath (caused by the hernia's effect on the diaphragm), heart palpitations (due to irritation of the vagus nerve), and swallowed food "balling up" and causing discomfort in lower esophagus until it passes on to stomach. Most often though, hiatus hernias do not cause any symptoms.

M e d i c a l T r e a t m e n t The medical treatment of a hiatus hernia is in large part similar to the treatment of GERD, relying upon the use of antacids, acid-secretion inhibitors, and surgery. In the latter case, surgical options have a minimal rate of success. But in most cases, sufferers experience no discomfort and no treatment is sought or given. If there is pain or discomfort, 3 or 4 sips of room temperature water will usually relieve it.



12

Where hernia symptoms are severe and chronic acid reflux is involved, surgery similar to GERD or Barrett’s esophagus is sometimes recommended.

H o l i s t i c T r e a t m e n t From a herbalist’s perspective the etiology of hiatus hernia is similar to that of GERD, and thus all approaches indicated under GERD are applied here as well. The term “hernia” confuses the diagnosis and therefore the treatment options. Fundamentally, there are two primary components to the condition: a structural weakness and misalignment of the muscles in the mediastinum, and either an acute or chronic increase in the intra-abdominal pressure. If you rule out inherent constitutional weaknesses or a physical injury due to a bad fall, the primary cause of structural problems is typically poor gastric motility, often associated with overeating, which stretches and weakens the muscles that hold the esophagus firmly in the esophageal hiatus. The cause of a chronic increase in intra-abdominal pressure is similar: poor motility and the excessive fullness of the stomach. In the latter case, this can be caused by eating to excess, or from poor food combinations that impair gastric motility and promotes fermentation and gas, which distends the stomach causing it to rise above the esophageal hiatus. Other causes of a chronic increase in intra-abdominal pressure are chronic adrenal stress, which causes the diaphragm to chronically contract and results in abdominal obesity. Thus, measures are taken to ensure proper gastric motility through herbs and diet, reducing sympathetic stress, and implementing a weight loss regimen. Strong emotions have also been associated with hiatal hernias. This is why it is wise to also consider the uses of Flower Essences to aid in balancing emotional stress. If the hiatus hernia was caused by injury, such as the tearing of the diaphragm, the underlying mechanism is usually an inherent weakness in these tissues, once again, caused by similar factors as in GERD. Although dietary modifications and herbal and supplemental therapies can be highly effective in treating a hiatus hernia, there are some additional physical techniques that can be employed to push the stomach back down below the esophageal hiatus. One technique is to have the patient drink 500-1000 mL of water upon awakening while sitting in bed, and then immediately standing erect on his or her toes, and then allowing all the weight of the body to come down upon the heels. This is repeated ten times, and



13

every morning over several weeks. The idea here is to use the weight of the water to pull the protrusion down and slip the stomach back under the diaphragm. Another technique is massage, working on the surface of the surrounding tissues with the fingers, and gradually working deeper, softening any muscular tension, ensuring that the patient is able to release any muscle tension in thorax. Care must be taken not to place pressure upon the xyphoid process or the floating ribs during massage. Once the patient has relaxed sufficiently the practitioner can stand behind the patient, place a tennis ball under the ribs, and role it back and forth along the edge of the diaphragm, pushing into and down against the stomach, once again being careful not to push directly on the xyphoid process. This technique often brings about immediately relief, but must be accompanied by the dietary modifications outlined under GERD.

Suggested Program Follow GERD program. Consider Flower Essence (check out free Flower Essence Questionnaire @ wrc.net http://wrc.net/questionnaires/flower-essence-questionnaire/ or information on various flower essences: http://wrc.net/encyclopaedia_section/flower-essences/

Gastritis, and gastric and duodenal ulcers Gastritis refers to inflammation of the gastric mucosa. You might want to review the cause of the various form of gastritis. They can be classified in several different ways: 1. severity: gastritis can be either erosive or non-erosive based

on the severity of damage to the mucus membranes 2. location: gastritis can be classified on the basis of what part of

the stomach is involved, including the cardia (upper stomach), corpus (middle stomach), and antrum (lower stomach)

3. onset and duration: gastritis can also be classified on the basis of either an acute onset or chronic manifestation, based in part on the case history, but also from a histological examination of the inflammatory cells.6



14

The various forms of gastritis to review are: acute gastritis, chronic erosive gastritis, nonerosive gastritis, superficial gastritis, atrophic gastritis, gastric metaplasia, and peptic ulcer disease . M e d i c a l T r e a t m e n t The medical treatment of gastritis and peptic ulcer disease are similar to the treatments for GERD or hiatus hernia, i.e., a reliance on suppressing acid secretion through the use of antacids, bismuth subsalicylate, H2 antagonists and proton pump inhibitors. This is even though patients with gastritis and ulcers have been shown to have lower acid levels than normal. With the discovery of the role of H. pylori plays in the etiology of peptic ulcers, however, it is now common for these drugs to be used along with one or more antibiotics such as metronidazole, tetracycline, clarithromycin, and amoxicillin. This is referred to as “triple therapy.” The claim that this treatment has an 80-90% cure rate must be regarded with some skepticism, as even though the supposed etiological agent has been removed, the symptoms may continue: such is the danger of defining a disease based upon the etiology alone. In 1997, a follow-up study of patients that had received antibiotic therapy for H. pylori over a two-year period indicated an overall treatment failure rate of 23%, with H. pylori showing high levels of resistance to clarithromycin (30%),



15

metronidazole (66%), or to both antibiotics (23%).7 Even patients that have undergone successful treatment for H. pylori may find that the initially positive results are replaced by a gradual onset of recurring symptoms. As for the usage of antibiotics, treatment will almost certainly result in the destruction of beneficial bacterial strains and in some cases, may provoke esophageal disease or gastric cancer of the cardia.8 The larger issue of antibiotic resistance, which is increasingly shown to be an important and vital issue, must also be considered. H o l i s t i c t r e a t m e n t The treatment of gastritis and peptic ulcer disease is once again like that of GERD and hiatus hernia, with an acknowledgment of the increased severity of symptoms and the inherent difficulty in treating a condition that can be life-threatening, as is the case of a perforating ulcer. Another important factor to consider is the loss of intrinsic factor and chronic bleeding, which leads to anemia. In Ayurvedic medicine, peptic and duodenal ulcers are generally classified under the term Amla-pitta, and are caused by eating incompatible foods, foods that promote a burning sensation, and the aggravation of Pitta. In Chinese medicine, often the inflammation and stress are reduced with patent medicines: Wei Te Ling (Os Sepiae, Rhizoma Corydalis, Honey) or Fare for You (cabbage root juice extract, high in glutamine). Reishi extract can often reduce emotional/mental tension on the digestive tract. Among the various treatments for gastritis, peptic and duodenal ulcer are: 1. Reduce insult to gastric and duodenal epithelium

§ eliminate NSAIDs and, if required, replace with anti-inflammatory compounds that are not toxic to the gastric mucosa, e.g., Curcuma, Harpagophytum, EPA/DHA, MSM, and glucosamine sulfate

§ reduce exposure to xenobiotics such as pesticides, insecticides and herbicides, emphasizing organically grown vegetables and free range, hormone/antibiotic-free animal produce

§ increase intake of high fiber foods and foods rich in antioxidant phytochemicals such as broccoli, cabbage, cauliflower, beets, carrots, and onions

Reishi Extract Reishi extract 15:1 Ganoderma lucidum Echinacea purpurea Echinacea angustifolia Ginger Root Zingiber officinalis Barberry Berberis vulgaris 2-3 capsule twice daily



16

§ increase intake of omega 3 fatty acids —found in foods such as wild salmon, halibut and arctic char— or supplement with EPA/DHA, 2000 mg daily.

§ supplement with a chelated multimineral and trace mineral supplement to provide for the manufacture of detoxification enzymes and antioxidants

2. Treat underlying anemia

§ avoid direct iron supplementation as this tends to promote intestinal infection; instead use herbs (e.g. Rumex, Urtica), foods (red meat, eggs, yams, prunes, figs), Vitamin C (to bowel tolerance), Vitamin B (50-100 mg daily), and low-iron supplements (e.g., Floradix®). Chelated Iron has also proven beneficial.

3. Reduce gastric inflammation

§ Cold infusions of Ulmus, Althaea or Symphytum, 50 g per 1 liter, taken as needed, up to 1-2 liters daily; OR powders of Glycyrrhiza, Althaea or Ulmus, 5-10 g mixed with cool water, taken as needed; OR De-glycyrrhized Glycyrrhiza (DGL), suitable in patients where obesity or hypertension is an issue, in doses of 2-3 tablets as needed; OR Aloe juice, up to one liter daily, may promote diarrhea

§ Banana (Musa paradisiacal), as ripened fruit, banana chips, or leaf powder, ad. lib.

§ Neutralizing cordial, prepared as follows: Rheum officinalis radix tincture 80 mL Cinnamon cassia cortex tincture 64 mL Hydrastis canadensis radix tincture 40 mL Peppermint E.O. 20 gtt. Potassium carbonate (KCO3) 16 gm Sugar Syrup 250 mL Diluted alcohol (50%) 550 mL Dissolve 16 grams of potassium carbonate in 250 mL of sugar syrup in a jar. Mix the tinctures, peppermint oil, and diluted alcohol in a mason jarAdd the syrup/KCO3 solution to the tincture solution and stir until the KCO3 is dissolved. Neutralizing Cordial is used in the treatment of nausea, gas pains, dyspepsia, intestinal spasm, diarrhea and constipation. Not appropriate for intestinal candidiasis. It is especially useful however, for those going through chemotherapy. Dosage is 5 mL, 4 – 6 times daily.

§ Astringent vulneraries, to promote muscular tone of the LES, check hemorrhaging and heal ulcerations, e.g., Geum, Quercus, Hydrastis, Myrica, Abies, etc.

§ Flavonoids and flavonoid-containing botanicals to limit acid production via inhibiting histamine release, e.g., Urtica, Calendula, Spirea, Matricaria, Scutellaria baicalensis, Buplerum, quercitin, catechin, etc.

Gastritis Althaea offic. 3 prts Spirea 1 prt Matricaria 1 prt Dosage: 2 ml TID, also sip on Matricaria or Melissa tea, slowly throughout the day.

Aloe, Licorice (Glycyrrhiza), Ulmus, Calendula, seaweed, glutamine helps the healthy production of gastric mucous

Gastric Ulcer Tea Equal Parts: Matricaria chamomilla Mentha piperita Foeniculum vulgare Glycyrrhiza Ulmus Steep 1 Tbsp. per cup for 10 – 15 min and strain Drink a minimum of 3 cups daily



17

§ Laxative botanicals to purge excess heat, used for a short period during the initial stages of treatment, e.g., Rheum, Rhamnus, Scutellaria baicalensis, Operculina etc.

4. Promote healing of epithelium

§ Vitamin A, 25,000-50,000 IU daily § Vitamin C, 1-2 g bid-tid, to bowel tolerance § Vitamin E, 800-1200 IU daily § Methylsulfonylmethionine (MSM), 2-3 g, bid-tid; OR 500-

1000 mL of freshly juiced cabbage daily; OR the Chinese patent formula Vitamin U (Fare You), 3 tabs tid are alternatives to MSM

§ Essential Fatty Acids: 2–3 grams daily. In vitro and in vivo evidence suggests that polyunsaturated fatty acids (PUFAs) inhibit the growth of H. pylori and may heal gastric ulcers.

§ Probiotics may be useful to assist with H. pylori eradication and to help re-inoculate the gastrointestinal tract after conventional treatment. In vivo data has shown that L. rhamnosus GG enhances gastric ulcer healing. A recent review of the efficacy of probiotics in the treatment of peptic ulceration found that seven out of nine human studies showed a decrease in the symptoms and population of H. pylori. The use of probiotics with standard treatment improved eradication rates (81% vs. 71%) and antibiotic associated side-effects (23% with probiotics vs. 46% with combination therapy alone). Lactobacillus casei and Lactobacillus johnsonii La1 appear to be the most researched strains.

§

5. Promote proper gastric digestion § Bitters, taken in small doses before meals, e.g., Berberis,

Gentiana, Spirea, Centaurium, Menyanthes, Hydrastis, Coptidis, Andrographis, Picrorrhiza etc. NOTE: the usage of bitters are often avoided at the outset of treatment because the initial stimulation of acid production may worsen any ulceration

§ Aromatics, used in chronic conditions to ease spasm, pain and cramping, e.g., Acorus, Carum, Foeniculum, Mentha, Matricaria, Angelica, Pimpinella, Elettaria, Citrus; care must be taken if acid reflux is a part of the clinical presentation

§ Antispasmodics, e.g., Valeriana, Viburnum, Piper methysticum, Dioscorea, etc.

§ Digestive enzymes, full spectrum (HCl, pancreatic enzymes, ox bile), 2-3 caps with meals

Spirea

Slippery Elm Gruel for Ulcer and gastric pain 1 cup (60g) slippery elm powder 1 cup (240 ml) chamomile tea cool or tepid ¼ tsp. fennel (optional) honey to taste (optional) Banana slices (optional) Place slippery elm in bowl and slow add in chamomile tea and whisk until gravy to porridge consistency



18

§ Food combining: avoid mixing animal proteins with starchy food, and fruit should only be consumed on an empty stomach

§ Avoid dairy and flour products, which due to their sticky and heavy properties impair gastric motility

§ Avoid overeating, do not eat within three hours of bedtime § Avoid alcohol § Avoid tobacco § Avoid deep-fried foods, e.g., French fries, potato chips, etc. § Weight loss, to reduce intra-abdominal pressure

6. Restore the bowel ecology We often start with a 12 daily d-tox and follow with:

§ Probiotics: e.g., lactobacilli, bifidobacterium § Prebiotics: e.g., fructo-oligosaccharides, inulin (found in,

amongst other things, Inula and Taraxacum root) 7. Specific formulations

§ Stomach Tonic (1 – 3 capsule with meals), Robert’s Formula, 20 gtt, tid in water, before meals,

§ Shatavari ghrita, 6-12 g, tid before meals § Avipattikara churna, 3-6 g tid before meals, with honey § Sai Mei An, for pain and burning sensations, without

bleeding, 3 pills tid § Fare 4 You; Yunnan Pai Yao, for ulceration with bleeding,

2 capsules tid-qid Pernicious Anemia: gastritis can result in a condition known as pernicious anemia. An essential substance called intrinsic factor, which is necessary for the absorption of vitamin B12, is greatly reduced along with stomach acid and enzymes. A deficiency of this essential vitamin, which can only be obtained through diet, results in subsequent anemia. Determining whether pernicious anemia is present can be tricky, although extensive blood tests, including a check for antibodies, usually results in a diagnosis. Supplements that require digestion are of no help because the digestive process is disrupted. However, injections of B12 as well as sublingual or nasal supplements help to replenish the supply.

Suggested Program Wonder Digestive Bitters: ½-1 tsp. before or after meals. Reishi extract: 2 capsules twice daily.



19

Stomach Tonic: 1-3 capsules with each meal. Probiotics: Daily EPA: 1-2 per day

Nausea

Nausea refers to the sensation that one is about to vomit. It can be caused by vertigo, morning sickness, food poisoning, emotional disturbance, improper eating, and bacterial infections (especially of the intestinal tract). R e c o m m e n d e d A c t i o n Anti-emetic herbs will generally relieve nausea, unless it is caused by an acute case of food poisoning or infection. The cause is often the presence of putrid or undigested matter in the stomach, in which case, it is best to cleanse the stomach by using an emetic to induce vomiting. If the emetic is preceded by a stimulant such as cayenne, peppermint, or elder, it will prevent undue strain on the body from the ‘upward purge’. Single Herbs: Lobelia Extract (3-5 drops), Meadowsweet, Cloves, Catnip, Chamomile, Cannabis, Peppermint, Spearmint, Peach leaves, Ginger root tea, Red Raspberry leaves (anti-emetic). Any one of the following, in large amounts, causes emesis (vomiting): Lobelia Extract, Cayenne, Bayberry, Blessed Thistle, Dry Mustard. Combinations: Chronic: Stomach Formula, Wonder Digestive Bitters, Digestive Enzymes, Lower Bowel Tonic.

Suggested Program Acute: Ginger or Chamomile tea. Chronic: Herbal D-tox 12 day program. Wonder Digestive Bitters: ½-1 tsp. before or after meals. Reishi extract: 2 capsules, twice daily. Stomach Tonic: 1-3 capsules with each meal. Probiotics: DAILY

Marijuana and GI symptoms Cannabis sativa has been used since ancient times to treat nausea, vomiting and other GIT issues. The endocannabinoid system is quite rich in the GIT, playing a role in motility, secretion, and epithelial barrier functions.



20

1 Berkow, Robert ed. et al. 1992. The Merck Manual of Diagnosis and Therapy. 17th ed. Rahway, NJ: Merck and Co, p 749 2 Rubin, E. ed. 2001. Essential Pathology. 3rd ed. Philadelphia: J.B. Lippinocott. 3 Berkow, Robert ed. et al. 1992. The Merck Manual of Diagnosis and Therapy. 17th ed. Rahway, NJ: Merck and Co, p 749 4 Rubin, E. ed. 2001. Essential Pathology. 3rd ed. Philadelphia: J.B. Lippinocott. 5 (Why Stomach Acid is Good For You, by Wright 2001) 6 Berkow, Robert ed. et al. 1992. The Merck Manual of Diagnosis and Therapy. 17th ed. Rahway, NJ: Merck and Co, 7 McMahon BJ, Hennessy T, et al. 2002. Antimicrobial Resistance in Patients with Helicobacter pylori Infection: Relationship to Prior Antimicrobial Use and Outcome after Treatment. Presented at the Digestive Disease Week Meeting, San Francisco, California 8 Hunt RH, Sumanac K, Huang JQ. 2001. Review article: should we kill or should we save Helicobacter pylori? Aliment Pharmacol Ther. Jun;15 Suppl 1:51-9

the fire within: digestion and botanical medicine · epilepsy, blood clot prevention, and nail bed...

Documents