Acid Reflux is one of the most common gastrointestinal disorders, with a prevalence of approximately 20% of adults in western culture. A conventional approach to acid reflux is prescribing Proton Pump Inhibitors (PPIs).
Prolonged use of these medicines can cause long-term side effects, including mineral deficiencies, kidney disease, certain cancers, and bone fractures.
A Functional Medicine Approach to Acid Reflux includes specialty labs and lifestyle adjustments to treat the root cause.
Below is an excellent example.
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Chief Complaint: Acid Reflux, Bloating after eating, Fatigue, Gas
Taylor* was a 45-year-old female complaining of acid reflux that had started 5-6 years ago. Initially, she had felt some relief with an omeprazole prescription from her primary care provider, but her medication no longer seemed to help. Within the past two years, she developed fatigue, gas, and bloating after meals.
She had tried to eliminate acidic foods (such as tomato sauce, hot sauce, citrus) from her diet, which seemed to help a little, but she was now experiencing reflux regardless of what she ate. The reflux was the worst at night when she was lying in bed, and she sometimes woke up with a burning sensation in her throat.
Taylor reported regular bowel movements every morning. Her fatigue seemed to last all day, no matter how much she slept, and she admitted to "pushing herself" a lot through the day, as she had a high-stress corporate position and was also a mom of 2.
Her recent blood work at the time was unremarkable, including a negative H. pylori test and endoscopy. While her general physician did not seem concerned, Taylor was worried because she "knew something wasn't right." She was frustrated that her reflux had only temporarily subsided, and the ongoing fatigue, gas, and bloating only added to her frustration.
Additional History
Taylor's lifestyle was an "on the go" lifestyle. She woke up early, went for a HIIT workout, came home to get her kids up and ready for school, then she and her husband both went to work at high-paced jobs.
Because her job was demanding, she admitted she often ate while working or on the go between meetings - the quicker, the better. She kept Justin's nut butter packets, almonds, and Rx bars at her desk to get her through the day when she didn't have time to eat an actual lunch.
When she got home from work, she immediately rushed into kids' extracurricular activities and household chores, with dinner often coming around 8 or 8:30 pm.
Since Taylor started experiencing more acid reflux at night, it took her a while to get comfortable and fall asleep. She was always up early to make sure she got a workout in before her day started, so her total hours of sleep were becoming reduced.
She had started drinking more coffee now to get through her day and was up to 4 cups per day, which she often took Tums with to make sure she didn't experience any heartburn.
Initial Lab Work
GI Effects Comprehensive Stool Test Results
- Pancreatic elastase LOW
- Products of protein breakdown HIGH
- Beneficial SCFA's LOW
- Secondary bile acids LOW
- Fecal Fat HIGH
- Lactobacillus LOW
- Bifidobacterium LOW
- Zonulin Family Peptide HIGH
Other Relevant Lab Findings
From her primary care: Unremarkable endoscopy, negative H. pylori in endoscopy sample
Lab Analysis
Taylor's lab work points to a few core issues that contribute to her acid reflux and her more recent symptoms of fatigue, bloating, and gas.
Malabsorption and Impaired Digestion
Taylor's comprehensive stool analysis showed impaired digestion and
malabsorption, as evidenced by higher amounts of fecal fat and products of protein breakdown, which we wouldn't expect to see if her digestive system was working at full capacity.
Additionally, low pancreatic elastase and bile acids suggest that her system is not making enough digestive enzymes to properly break down her food in the first place.
Dysbiosis
She also has low beneficial gut bacteria, such as Lactobacillus spp. and Bifidobacterium spp, which could indicate dysbiosis as an additional cause of her gastrointestinal symptoms.
Leaky Gut
Last, Taylor has elevated levels of the Zonulin family peptide, which has been associated with inflammation, dysbiosis, and increased intestinal permeability, resulting in a higher risk of developing autoimmunity and other inflammatory conditions.
Thyroid/Cortisol
Taylor's TSH is borderline high, while her free T3 is low. Taylor's high-stress, fast-paced lifestyle, lack of sleep, and early morning high-intensity workouts could negatively impact her thyroid, contributing to her symptoms of fatigue.
Additionally, her 24-hour cortisol test showed elevated morning, afternoon, evening cortisol, and low waking cortisol, suggesting her stress response is not ideal.
Not being able to shift from a sympathetic to a parasympathetic state could further exacerbate digestive issues and contribute to fatigue.
Food Intolerances
Several foods that Taylor is commonly eating - including almond butter, nuts, eggs (Rx bars), and coffee - all came back with high reactivity on an IgG food intolerance test.
Her convenience foods are likely contributing to worsening her symptoms, even though she had been trying to "avoid" acidic foods per general acid reflux guidelines given to her by her primary care doctor.
Omega-3 & Vitamin D
All the above, paired with a low Omega-3 index and a low vitamin D level, shows that Taylor is dealing with systemic inflammation impacting her health.
Functional Medicine Approach to Acid Reflux: Interventions
Nutrition
First and foremost, we worked on slowing down around meals, chewing food intentionally, and scheduling out some short breaks so that Taylor wasn't multi-tasking at work while she was eating.
- We set her up with a meal prep service that delivered "work lunches" 2x per week to her home so that she could take a balanced meal with her.
- We focused on cooked vegetables, broth-based soups, lean protein, and healthy fats like avocado, salmon, coconut oil, and olive oil.
- We adjusted her dinner time so that she wasn't eating dinner so close to bedtime, aiming for at least 2.5-3 hours between her last meal and going to sleep.
- Encouraged her to switch from coffee to matcha green tea to help her gut (coffee was a highly reactive food sensitivity) and her hormone function.
Supplements
We added in a few things to support her gut health, including:
- Apex-Energetics Repairvite SE: which contains zinc carnosine to help with reflux and healing of the intestinal lining.
- Pure Encapsulations DGL Plus: 1 capsule before a meal. DGL helps coat the stomach and reduce acid reflux, while aloe vera and slippery elm help heal the gastric lining.
- Thorne L-Glutamine, 500mg per day: L-Glutamine has been shown to help repair leaky gut.
- Digestive enzyme with meals: To assist with breaking down fats, carbohydrates, and proteins.
- Magnesium glycinate, 250mg at night: Taylor's Magnesium RBC levels were bordering low. Magnesium is a vital nutrient for regulating many body processes. Magnesium glycinate in particular is good for sleep and stress reduction.
- Apex Energetics Adaptocrine: contains ashwagandha (helps with T4-T3 conversion), as well as several other adaptogenic herbs to help with the body's stress response.
- Fish oil supplement, 2-4g per day: Her Omega 3 Index was low. Increasing her Omega 3's can help reduce inflammation.
- Vitamin D, 5000 IU per day: Her vitamin D levels were low.
Workouts
Workouts were modified: We planned out 2-3 days of more traditional strength training, with only one day of higher-intensity workouts, to help better regulate her hormones, stress, and inflammation. Taylor was encouraged to walk as much as she wanted to as well.
Sleep Hygiene
Last, I recommended that Taylor consider a wedge pillow at night if she was experiencing reflux while her therapeutic protocol started to kick in. She used it for about a week until her symptoms began to go away at night and now uses it just as needed.
4 Months Follow Up Labs
Follow Up Lab Analysis
When we re-ran labs and intake at four months, we saw several things trending in the right direction. By this point, Taylor was feeling significant improvement in her digestive symptoms and mainly only experienced reflux now if she ate too late at night or had too many of her "trigger foods" in a given meal.
She still felt low energy levels in the morning, but she was comfortable with her exercise routine and felt she could easily get through the day without the coffee.
She was falling asleep earlier since her reflux had improved as well.
Within a few weeks of removing the foods sensitivities, her gas and bloating had essentially disappeared.
She was consistent with her supplements, though she occasionally forgot her digestive enzymes if she was out to dinner or had a hectic day. She noted that she could feel a significant difference, mostly bloated if she didn't take them with meals.
We also added in a comprehensive probiotic supplement at this point to help support a healthy microbiome.
At this point, Taylor was interested in re-introducing some of the foods we had removed based on her labs, so I started her with a re-introduction tracker, adding in one food at a time and monitoring her energy levels and symptoms.
We checked in regularly over the next eight weeks. Taylor found that almonds caused a mild return of her symptoms of reflux and bloating, while corn resulted in bloating and gas, so she continued to leave those out of her diet.
We continued with her current supplement routine since she was doing so well, and at the 6-month mark, she decided she felt comfortable starting to remove the DGL gradually. She did not experience a return in her symptoms.
Last, we continued to focus on supporting healthy cortisol production through a combination of lifestyle, nutrition, and supplements: allowing time to unwind at night, a dark, quiet sleeping environment, not having caffeine first thing in the morning, ashwagandha, including enough protein and fat in her diet to keep blood sugar balanced.
Summary
This case highlights the need for a more integrative approach to acid reflux. For many, PPIs and other medications only provide temporary relief and don't often address the condition's root cause.
For Taylor, her acid reflux symptoms indicated underlying inadequate digestion and malabsorption and inflammation and dysbiosis in her gut. This placed additional stress on her body, only adding to the existing stress-related hormonal dysfunction and fatigue she was experiencing.
Functional medicine strategies can effectively help patients with acid reflux and find long-lasting relief while supporting a healthy gut.
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