Gastric Surgery & Heartburn

Heartburn after gastric surgery is a troublesome side effect after gastric sleeve & gastric bypass surgery.

Dawn 00:00:

Hello and welcome to the gastric health show. My name is Dawn Boxell and we are here to discuss a pretty big topic for me. I’m really excited to share this information. I feel like some of this might be some new information and some of this might be confirmation for some of you, but in general, I think you’ve got to think out of the box and think of are there alternatives or are, is there a better way? Is there a better way to approach this? So let’s dig into gastric surgery and heartburn considerations.

Dawn (01:07):

So if we think about heartburn, it’s also known as reflux, so like acid reflux it’s, you know, thought of when you have heartburn that you have too much acid. Correct. So that’s usually the first thought. So I just wanna go through a few things with you though, so we can kind of really look at the big picture of heartburn and what are your options and how prevalent is it after gastric sleeve, gastric bypass, even adjustable band or Duodenal switch.

Dawn (01:22):

So we’ll kind of dig into some of those and give you a different view and have you look through the lens of functional medicine and using functional nutrition to really offer some solutions that can really work. And sometimes do a better job. And for some it’s, it’s going to help you eliminate the need, even the need for support. So, so let’s kind of dig into the actual history of it. You may not be aware, but more than 60 million Americans suffer with this every month, so pretty big deal. So of course they need to have solutions because we can’t have acid in our esophagus that is long-term that becomes problematic. You can get Barretts, esophagus can lead to cancer. You cannot have that erosion, it impacts your teeth. So overall health it’s going to be impactful.

1989 heartburn and acid solution 

Dawn (02:26):

So rightfully so, solutions needed to be made. And we kind of just take a stroll back to the late 1980s and how everything changed in 1989. that is when PPIs or proton pump inhibitors were introduced to the world. this radically changed how we handle heartburn and acid reflux all great solutions and I’m not opposed to PPIs.

Dawn (03:10):

But I just want you to see that there are some other tools you can use in your toolbox to help with heartburn. And also getting to kind of the looking at the big picture. So 1989 came PPIs were delivered to the world and they were a success. They have provided great relief for so many people. And I think it’s fabulous. There was a need, it was filled. So if you think of proton pump inhibitors, they are just potent agents that reduce the acid secretion of the stomach.

Dawn (03:40):

So you’re going to lower. It helps lower the amount of acid that is being released. So heartburn, too much acid, lower the stomach acid. Problems go away. So it was a great way to help those sufferers. That felt like they had too much stomach acid because they had so much heartburn. Now PPIs quickly became a top selling prescription medication.

Heartburn relief

Dawn (04:10):

And in fact, there was a study published in the Therapeutic Advances in Gastroenterology in 2018, and it’s titled “proton pump inhibitors among adults, a nationwide drug utilization study.” And they observed between the years of 2003 and 2015 that over 1 million prescriptions were filled during this time. And not to mention the 10 billion dollars that it netted in sales. So pretty big deal. So goes to show that this was received very well. Offered and solved lots of problems. So what are the most common PPIs that are used today?

Dawn (04:57):

Prevacid, Prilosec, Protonix, AcipHex, Nexium and then a newer one is Dexilant. So those are the PPIs that we’re talking about that will help lower the amount of acid that your stomach is secreting. Then from the late 1980s to 2003 they had felt that they were safe to be approved or granted approval for being sold over the counter. So back in 2003, that is when the heartburn medications became OTC or over-the-counter. So now you no longer need a prescription to get heartburn relief. Great. Right. some of the over the counter PPIs are Prevacid 24 hours Nexium 24 hours, Prilosec OTC and Zegrid which is a PPI with an antacid. those are the most common ones.  here’s what I want you to think about. Although I truly believe there is a time and place for PPIs and I am not against them.

Dawn (06:09):

But what I’m against is the disconnection in treatment. I feel like if you go to your doctor’s office and you say, Hey, I’ve been having heartburn lately. They’ll either have you do an over the counter one or you’ll probably migrate up to a prescription one if over the counter ones just don’t seem to be effective. So where I feel like there’s a disconnect is no one is asking a very important question.

Gastric surgery heartburn treatment disconnection

Dawn (06:40):

No one is asking why? Why are you having heartburn? This doesn’t just happen for no reason. And I’m really hoping that having this conversation, that it really gives you the ability to say, okay, let’s pause and really ask that question of, why is heartburn such an issue? And it’s your body’s way of telling you that something is out of balance. So I want to kind of dig into this more specifically, but I think that is where I, I struggle the most with just the knee-jerk reaction of PPI use again, I think they have a time and a place and they’re great.

Dawn (07:30):

But when you don’t ask any questions, it’s just a pill for every ill. You just throw a, a prescription or an OTC medication at the symptom, but you don’t dig deeper. That’s when, to me it’s problematic. So, so that’s where I feel like we have to look at it from a different angle. And cause I don’t believe that we all wanna be on 15 prescription medications and call that health.

Dawn (08:10):

I think health is different for all of us, but you know, I think some medications will be lifelong for some people and maybe PPIs will be one of them for you. I don’t know. But I would say in, in a lot of cases, it’s, it’s probably not something that you would have to be on lifelong. And in essence it was never designed for people to be on them. Lifelong. If you look at the insert, it says 14 days or two weeks is what the, the maximum length of time.

Health care & heartburn treatment

Dawn (08:43):

Now there’s been studies show that up up to six months of being on a PPI is really not that harmful. So I think you, you, you evaluate, okay, what if I have the heartburn and I go on this medication, then, you know, if I, as long as I can get off of it pretty quickly then, you know, resolve the problem then that’s, you know, that seems approachable.

Dawn (09:13):

That seems doable. So the negative is what they find is that’s usually not how it, how it plays out. A study that was published in 2003, it was, yes, 2003, they found that patients were increasingly treated for longer durations than recommended by clinical guidelines and mainly with higher doses. So what they find is that the people who get put on the PPIs, maybe get some relief and then it works for a period of time and now it doesn’t work.

Dawn (09:47):

So they increase the dose and continue on this path until they find the dose that helps suppress their symptoms. So during that phase, no one is saying, okay, why are we having heartburn. Why, why do we feel like you have too much acid? Why are, why is this such an issue? So again, that is the disconnect in how it, how our healthcare model is working. So, and I think a lot of people agree with this. I feel like we are all kind of in a place where we know it has to change. We don’t know how and we don’t know the best way cause it can be painful. Anyway, we look at it. So none of us wants to go through any pain, but yet we know we can’t continue doing this type of healthcare. Because it’s not really healthcare, it’s more sick care.

Inflammation of your GI tract

Dawn (10:40):

So healthcare is what you do outside of the doctor’s office to prevent the need for going to the doctor’s office. what have they found are the risks after 33 years? PPIs from 1989 to 2022 is 33 years. And what has the research kind of shown us now? What do we understand? That could be the risks by continuing this long term.

Dawn (11:00):

And it’s not the short term, none of these are risk factors on the short term use. And I would use the short term as six months or less. So anytime in that period, although I think there can be some dysbiosis in that time with your gut. You would just need to clean that up and fix it. But overall a six months is something that you would want.. Not want to exceed. So ideally I think there are better strategies than even just being on them for six months.

Dawn (11:47):

I think there are definitely better solutions and we’ll get to that in a minute, but you know, again, if, if six months is the time, that’s nothing compared to what you know, lifelong would be. So the long term, so the, what the studies are showing with the long term use is, fractures, C-diff pneumonia and norovirus infections, gut dysbiosis and then low levels of magnesium and calcium, B12, Iron deficiency and then acute gastroenteritis. Which is kind of like an inflammation of your GI tract. So all of those have been vetted as these are the consequences of taking this lifelong. You are going to have some of these problems by being on them for decades. So you know, as we age, the risk factors sometimes increase a little bit more, you know, genetics play a role?

Experiencing heartburn

Dawn (12:53):

Also just the aging process because, you know, as, as we age our B12, our ability to have adequate B12 lessens. So the need to supplement increases or to get adequate amounts or support that. Stomach acid lowers as we age. So again, those are things that will contribute to, you know, messing with this balance. But you can see there are significant health considerations that you have to not forget and you need to think through, is this a good thing?

Dawn (13:35):

Is this something that will that I will regret by not digging deeper? So then there’s some additional studies, although they’re weaker they have shown some connections. Not a cause effect type thing. But they have shown some studies with a correlation with weight gain as well as dementia. Again, like I said, these are weaker studies, so it’s not like these others that I, I mentioned. Those are pretty vetted and those are definitely risks that you have by being on those PPIs long-term.

Dawn (14:15):

So again, those are all important things when you’re making health decisions about what you’re doing to protect yourself or prevent or just having better health. You have to consider these as a risk factor. So let’s kind of dig into what are some potential causes of heartburn. So if we really wanted to pause and say, okay, why am I having heartburn? Let’s dig into some of those drivers or some of those reasons that contribute to, to people experiencing heartburn. 1. is a Hiatal hernia, 2. H. Pylori. 3. ulcers 4. SIBO 5.is pathogenic bacteria. 6.

Symptoms that come with eating too fast

Dawn (15:15):

Is poor chewing 7. Low Stomach acid 8. Zollinger Ellis syndrome. 9. Is stress 10. Is obesity and 11. bile reflux. So all of those can be a reason why you are experiencing heartburn, reflux. Let’s talk about fixing the obvious first because if you fix the things you can control and then work on the things that maybe you have less control of. Clean those up, fix those or determine if this is something I’m gonna need.

Dawn (15:49):

Then you can make other.. your other health decisions after that. So what I mean is when I talk about fix the obvious first, I am talking about stress, so better stress management and chewing. those two alone.  if you are slowing down at your meal times, you’re being intentional. You’re being mindful. You are conversing, you’re not just shoveling it in. You are enjoying the food and taking your time. That will allow you time to chew well.

Dawn (16:05):

So that you’re doing some of the work for your stomach. So one, it’s, it’s kind of triggering some of those things to be released, to help support you better with digestion. But then it’s also breaking things down into a, a better size. So then you don’t have some of the kickback and some of the symptoms that come with eating too fast. So chewing and then stress management.

Stress management

Dawn (16:59):

So stress management, I don’t think there’s anybody who isn’t experiencing stress. it’s all about how you manage it. figuring out what you need to do to manage your stress better is the best thing. Because there’s no way that any of us are getting out of here without stress. So, but you can learn how to turn off that stress. So stress is the sympathetic.

Dawn (17:39):

That is your fight or flight. The parasympathetic is the rest and digest. And that’s where you’ve got to click that on. You have to learn how to do it with even just a sound, a word, a picture. There are ways that you can get yourself out of it very quickly. So really just supporting yourself in those two things is where I would start. So if you have heartburn address the stress and address your chewing, those are the first two things.

Dawn (18:03):

I’ll give you some support on how to get relief while you’re improving your stress management. And while you’re improving, chewing, because living in America, everything is go, go, go fast, fast, fast. So that takes a minute to fix. So it’s not gonna happen overnight, but you can support yourself and I’ll give you those strategies shortly. Okay. So the second thing to consider after gastric surgery, the one of them I’m not covering all of these causes of heartburn.

Gastric surgeries

Dawn (18:33):

I’m only gonna cover a few of them, and I’m gonna show you the connection with you know, gastric sleeve, gastric bypass the different types of surgeries and what they say about these. So the next one is going to be hiatal hernias after gastric surgery. So hiatal hernias are when the stomach kind of migrates above the diaphragm and really no matter you know, what percentage of your stomach is above the diaphragm, you’ll usually experience some type of heartburn.

Dawn (19:04):

So some people.. The cool thing is it actually kind of, they can slide in and out. So some people, it will, it will resolve itself, but there are, there are a lot of people that will have to be surgically corrected. So fixing that, especially if you have gastric bypass or gastric sleeve, if you’re just having chronic heartburn and you are struggling to eat that you just may need to get it fixed.

Dawn (19:40):

If it’s not, if it’s big enough and high enough, there’s enough of the stomach up there that you are not gonna get relief from anything, then, you know, it’s just time to make that decision. So in the end, hiatal hernias are not uncommon after gastric sleeve or gastric bypass. One thing that we do know is that gastric sleeve patients do experience more heartburn than gastric bypass patients, but both patients experience heartburn.

H Pylori bacteria

Dawn (20:05):

So it’s even Duodenal switch and adjustable band can experience heartburn. So I think the prevalence is there and one of the causes can be hiatal hernias for the sleeve or the bypass as well as our next one. Which is H Pylori. So H Pylori is just a bacteria that resides in our stomach. And when this gets out of control or there’s too much of it, then it causes problems.

Dawn (20:53):

And technically that bacteria H Pylori bacteria actually suppresses stomach acid, and then it can lead to like a gastritis because a stomach acid is so low. H Pylori infections I will tell you is it has a, a very wide range on what they find in obese individuals. One of the studies found that prior to bariatric surgery and I would say most programs do test for H Pylori because having H Pylori bacteria out of balance is a risk factor for ulcers.

Dawn (21:21):

So we don’t want you having ulcers after gastric bypass or gastric sleeve. We want to make sure that it re resolved before you go into surgery. So it, a lot of programs will do a breath test. A Urea breath test that will detect the.. the H Pylori bacteria. And that if they do, make sure you do the full protocol, because that will help reduce the presence of that and get rid of it. Cause it is truly more of an infection and cause you don’t want to put the risks higher if you don’t do the treatment.

Untreated H Pylori

Dawn (22:03):

Your risks for getting ulcers after surgery are gonna be really high. And that is a concern, but the range for having just obese people in general is anywhere from 8.7%, all the way up to 85.5% of all patients preoperatively. So that’s a huge range, but even if you just land in the middle you’re landing at like 50% of you have H Pylori pretty significant deal.

Dawn (22:31):

So you can’t ignore that because H Pylori, you are going to have heartburn. You are going to have that symptom. And if left untreated H Pylori can leave to stomach cancer if you just ignore it or if it’s never been identified. So again, that’s where digging in and finding out why you’re having heartburn is advisable. Okay. So the breath test is usually how you do it, but you also can do it in a stool test. And they can pick up the presence of the H Pylori in your poop.

Dawn (23:03):

So this is one of the reasons why I, I use the GI map stool test because it can.. this test actually is measuring the presence of the DNA of these types of bacteria. it has H Pylori on there and in the stool it can measure it, it can quantify it. It can also identify virulence factors and it can also tell us about the antibiotic resistant genes. Because we’re looking at the genes of H Pylori.

Dawn (23:47):

So we can, with the GI map stool test, you can actually determine which type of antibiotic is best. As a side note, you don’t always have to do antibiotics. There are evidence based solutions using herbs that work equally as effectively. So antibiotics, if you have been on a lot of them and you’re having lots of digestive issues, adding another antibiotic sometimes is risky and scary and concerning.

Dawn (24:07):

So there are other ways to do it if you just work like a, with a provider like myself.  treating H Pylori prior to surgery is definitely a hundred percent needed. If you find out after surgery, which again, that is a potential, you can have that potential of that re returning the H Pylori, if you did not get it resolved enough then it can come back.

Dawn (24:57):

They also ha.. Some studies find that it can be passed between family members. So again, if sometimes you have to treat the whole family. I’ve even had colleagues have to treat pets like their dog because they had it as well and they were continually passing things back and forth. So again, something to consider if you’re having chronic heartburn, that nothing seems to really help with. But I will say. I find it interesting.

Treatment with the antibiotics

Dawn (25:27):

They use PPIs for part of the treatment protocol with the antibiotics. And I don’t remember all of them now, what they, the medications used to treat H Pylori infection. But I find that interesting because H Pylori actually suppresses stomach acid. So it’s interesting that we would wanna suppress it more so, and I know that you know, PPIs can help heal tissue. So that’s probably the main reason why they utilize it, but I just find that interesting.

Dawn (25:56):

So the next one I’m gonna discuss that was on that list of 11 causes is low stomach acid. And just like we’ve talked about with the H Pylori, it really suppresses your stomach acid, but you can also have low stomach acid from other causes. So that’s another reason why, you know, you understanding why you’re having the heartburn, because it’s, it’s almost like you’re using the wrong tool for the job.

Dawn (26:07):

Because, if you already have low stomach acid because of, of various different drivers adding a PPI, that’s going to, again, lower the release of stomach acid seems counterproductive. It does not seem like it’s maybe again, the right tool for the job. So even though low stomach acid sounds like a really good thing for most people. I, I want you to see the importance of stomach acid and why you really need it.

Symptoms of low stomach acid

Dawn (27:07):

But first let me give you the most.. Because it is so confusing. I want to share the symptoms of low stomach acid so that you can see how tricky sometimes it can be to just do it off of symptoms and not dig deep, deeper. So if you have low stomach acid, these are the symptoms that you could experience. You can experience heartburn, reflux, abdominal pain, bloating, gas, diarrhea, constipation, undigested, food in your poop and excess burping.

Dawn (27:27):

All of those are signs of low stomach acid.  again, if somebody’s having reflux and heartburn, it’s automatically believed that you have too much. So that’s when the PPIs come into to play.  again, it’s one of those things where if you dig deeper, you might be surprised of what you find. So why do you need stomach acid?  two important things to just think of stomach acid.

Dawn (28:11):

It is a protector and a signaler.  your stomach acid protects you in a way because because of it’s ability to kill off bacteria. So our first exposure or the ability to kill off is going to be the stomach acid.  when you get bacteria in your food or from the environment, because it’s exposed everywhere. You go to shopping carts or door handles or light switches and there’s, you know, MRSA, C-diff, Staph, pneumonia, norovirus. You name it. The flu.

H Pylori or SIBO

Dawn (28:41):

All of those things are all over our world. So you’re not gonna escape it, but you can learn how to protect yourself so that you’re not impacted. And your body can fight off way better. So think of stomach acid as your first line of defense. It is your first, it’s the first area that can really help lower that bacterial exposure just right out of the gate.

Dawn (29:18):

So it protects you from the bacteria. And what happens is if you don’t have adequate stomach acid and it’s not killing off the bacteria, then guess what? You’ll likely have bacterial overgrowth issues like H Pylori or SIBO or other pathogens that can take over because you have no ability to fight them. You’re not killing them off. And now your immune system has to do all the work. So you didn’t kill ’em off firsthand, and now it’s your body’s dealing with it.

Dawn (29:51):

The protector piece is something that you can’t discount. It is pretty important, especially with our immune system. You want, you want to have a strong immune system, but if it’s chronically being bombarded, it’s hard to support everything. So how is stomach acid a signaler? So stomach acid is really your, your body’s way of signaling the other organs to release their enzymes and properties to digest food.

Hydrochloric acid

Dawn (30:31):

So once you start chewing, then there’s signals that are saying, okay, we need some hydrochloric acid, we need some Pepsin. We need some you know, amylase and lipase and proteases to break down carbohydrates, proteins, and fats. So it starts releasing all that when you start eating. So it kind of it’s it’s job will signal or trigger those other organs involved in digestion to work. To do their job. Also stomach acid plays a role in your body’s ability to absorb certain minerals.

Dawn (31:02):

So it’s part of the process to absorb like iron magnesium, calcium, potassium, zinc. All of those need stomach, adequate stomach acid. So you need to have that stomach acid piece to make sure that you can benefit from those vitamins and minerals and things. So let’s dig just a little bit deeper into pH stomach pH, and I want you to see how this really changes after gastrics sleeve and gastric bypass surgeries.

Dawn (31:48):

So, and, and I think it will make it super obvious that maybe we are using the wrong tool for the job. So I want you to see that. And then I’ll go into the solution. So I, you can see that, Hey, I do have options. I do have better alternatives that I won’t have those risk factors with.  when you have low stomach acid, that means that the pH is high.

Stomach pH

Dawn (32:11):

 ideally your stomach pH should be anywhere from a 1-3.  1-3 pH for optimal digestion. Above that is considered alkaline. And then that’s when you’re not going to have the ability to kill off or signal or prepare for those mineral absorptions. So important piece. One fun fact is that battery acid is the pH of 0.8. So pretty cool that your stomach can house something as acidic, as close to acidic as battery acid and not erode your stomach.

Dawn (33:06):

It actually is capable of, of housing that low of, of an acid. So pretty cool in my, in my science brain. Now to dig a little bit deeper. I want to explain you have these two flaps or two sphincters that are at the bottom of your esophagus and at the bottom of your stomach. And these play a role in how acid gets back up into your esophagus. So you have, what’s called the Lower Esophageal Sphincter. And that is at the bottom of your esophagus leading into your stomach.

Dawn (33:41):

Now, gastric sleeve gastric bypass Duodenal switch, adjustable band. None of those surgeries alter that Sphincter. So no changes with the, the lower esophageal sphincter. But the Pyloric Sphincter is. Which is at the bottom of your stomach with the Roux-en-Y gastric bypass. You just have a small hole. And it’s where the food just empties directly into your small intestines without delay.

PH after gastric surgery

Dawn (34:16):

So nothing stops it, whereas, you know, naturally you would have a, a sphincter or a flap. that is one thing that you have to keep in mind. So this kind of leads us into the pH after gastric surgery. stomach pH after gastric surgery and why this matters. Because when, think of it this way, if someone says they have low stomach acid, then that means they have a high pH. Ideally you want to make sure that your stomach is acidic.

Dawn (34:56):

It, we need it to be acidic, so it can do these things. It has a role and we need that. So there is a study published in 2021, and they found there are differences with bariatric surgery in your stomach pH. So what they found pre-surgery is that you had an acidic pH at 1.8. And then one day post gastric bypass, your stomach pH was 6.4, which is considered alkaline.

Alkaline environment

Dawn (35:27):

And then one day post gastric sleeve pH is 4.9. Which is considered alkaline. Which is totally amazing because you, as a sleeve, you still have both sphincters. That has not changed. So interesting why that pH has risen. The majority of bariatric surgeons will utilize some form of PPI after surgery, not a hundred percent, but a high percentage.

Dawn (35:59):

And some of them are really good at just doing it short-term, like three months and then weaning you off. And then other people they struggle to get off. You might be put on it and then you try to get off and you can’t. But again, I think if you’re looking at this picture of stomach acid, are we, are we using the right tool for the job? And that’s that’s, that is my concern that we’re not using the right tool for the job.

Dawn (36:22):

Yes. We could use a PPI for healing, but aren’t there other things we could also use for healing. And the answer is yes. There are other things that can provide the same type of environment and properties that a PPI does that you potentially would never really even need to have one after surgery. So if you, if you look at this, we’re seeing that you have an alkaline environment. So adding a PPI is not going to help that. You, what you really need is you need an acid.

Heartburn & Non-PPI alternatives

Dawn (37:16):

That’s where we’re gonna go into the different PPI alternatives. So you have an an idea of what other things you can do to help yourself. So hopefully this is where you’ll find a little hope. And we will give you strategies that you can prevent yourself from having those consequences or risks or side effects from being on a PPI long-term, just to clarify, no one should ever stop a medication without their doctor’s permission.

Dawn (37:33):

But I also wanna say that you should never abruptly stop a PPI. Because you’ll get rebound reflux and you’ll feel like I’m never gonna get off of this. So if you’ve tried to get off of the PPI by just stopping them, and you had rebound reflux. That’s probably why. You have to do a wean off protocol in order to really get yourself off. Where should you start?

Dawn (38:06):

First off, I would say you really need to work with a provider work with someone like myself who can help you dig into the root cause, but then offer some relief with different strategies so that you can have options and feel better quicker. After you find a provider. I would then work on restoring the pH balance. To me, that would be first and foremost for any gastric sleeve or Roux-en-Y gastric bypass. And then I also throw in the duodenal switch because you have a sleeve as your pouch.

PH by adding acid

Dawn (38:31):

So that is where I would say restoring the pH balance would be step one. You can restore the pH by adding acid. And that seems so scary for many people because that seems like you’re going to be making the pain worse. You’re going to make the heartburn worse by adding that. And I would say the only contraindication that you really have to think about is ulcers. If you have an ulcer, or if you think you might have an ulcer. Then adding acid is not what you need. So you need to work on strategies to heal the ulcer. But to lower the pH and increase the acid to make your stomach, the perfect environment for digestion, you can add something called Betaine HCL or it’s Betaine hydrochloride. And actually it does a great job at lowering the pH and it will get that acidic environment going.

Dawn (40:31):

Our WLS formulated digestive enzymes does use Betaine HCL as a core ingredient. And as well as additional ingredients that help digest fats, proteins, carbohydrates, all of those in a better way. But it’s all about creating that environment, that good environment for digestion and absorption. So, and, and some of you may need higher doses of Betaine HCL. So you have to kind of work with a provider and really find the sweet spot for what you need.

Dawn (41:00):

But I will tell you, we’ve used our formula with thousands of bariatric patients, improving digestion and heartburn many times. So if you have heartburn and you want a relief strategy, one that I would consider is DGL. DGL is deglycyrrhizinated licorice. So it’s all about that glycyrrhizin that you have to think about though. So licorice as itself has great properties and it does, it can actually help heal H Pylori or, you know, get rid of that bacteria and some other infections and, and just really help soothe the GI tract. Because DGL is just a blend of herbs that help protect your stomach by promoting mucus secretions.

DGL for heartburn

Dawn (41:30):

So DGL just really brings more mucus out, which is kind of your, your ultimate scenario when it comes to a healthy digestive tract. You want lots of mucus for everything to work appropriately. And so the, the DGL stimulates normal defense mechanisms. And this can help prevent ulcer formations and actually stimulate healing of the mucus membranes. So it’s a great way. Adding a DGL is a great way to kind of help support you. If you do have heartburn. You definitely want it in the chewable form. The capsules have not been shown to be as effective. So you want it in a chewable form. let me dig in a little bit more about DGL. So DGL actually increases the blood supply to the damaged mucosa. It also increases the number of cells producing the mucus that protect the mucus membranes.

Dawn (42:20):

And then it also increases the amount of mucus the cells produce, and it increases the lifespan of the intestinal cell. So you can see that DGL has a lot of beneficial properties that could help someone that is struggling with their digestion, but especially even with heartburn. If you feel like I have maybe some damage. Even if it’s reflux back up into your esophagus, this can also helped restore that damage as well. They’ve actually done several head-to-head comparison studies on DGL, and they have shown that DGL is more effective than Tagamet, Zantac or antacids in both short-term and maintenance peptic ulcers. An easy strategy that don’t have the side effects. Again, you’re utilizing a tool that actually boosts the things you need. Not suppresses the things you need. So it’s a great consideration and can be used to help even wean off of PPIs.

Dawn (43:38):

So the next one is digestive bitters and digestive bitters are just distilled down, concentrated blends of bitter herbs and plants. And and the bitter, the bitterness of the herbs or the plants is what stimulate the digestive system. And when you take them before meals, it helps signal the release of bile and hydrochloric acid. So that, again, you’re naturally doing this, you’re think of it. You’re just going in a, at a back way. And usually they’re in little tincture forms and you just take a little dropper full before a meal or a spray. But it’s another great way that you can really just support the natural process.  adding the bitters can help you, you release the bile for better fat breakdown, and then also it acts, increases the acid. then it can trigger everything else. So it’s a perfect formula.

Heartburn solutions with digestive bitters

Dawn (44:44):

And there’s a study that found that digestive bitter, with digestive bitters certain herbs can be used to prevent and relieve dypepsia or like heartburn type scenarios. Another study found that plants that have substantial body of data to support their digestion enhancing activities, mainly belong to three groups. The bitter, the aromatic, and the pungent plants. So those bitter plants and bitter herbs have some evidence in their ability to support digestion better. So what’s, what’s the difference between digestive bitters and digestive enzymes.

Dawn (45:44):

Think of it as digestive bitters is you are just providing a tool to increase the release of things naturally. Whereas digestive enzymes, you’re actually adding ingredients that will help create the environment. And the cool thing is you might need both. For some of you, it may require both. Especially if you have H Pylori or SIBO or just a low stomach acid or even have no stomach acid that may require additional angles of approach.

Dawn (46:05):

So you could safely use digestive enzymes and digestive bitters without any problems. The next one is D-Limonene and D-Limonene is just a, it’s a terpene that’s been extracted from the citrus essential oil. And in, in a number of animal and in-vitro trials, they have been able to highlight that it has a gastroprotective effect, and it has the ability to kind of get rid of GERD. There’s been also two additional separate clinical studies performed under a US patent. And they found that people suffering from chronic, chronic heartburn and GERD significantly benefited from the D-Limonene supplementation. So it was definitely found beneficial with the test group. The next one is Aloe and this is just straight Aloe vera. And seems so simple, but it does have some really cool studies to back it up to show you that it has some benefits as well.

GERD and Aloe vera

Dawn (47:18):

There is a study published in 2015 and it’s an open label, randomized controlled trial, and they found that Aloe vera syrup in adjunct to your omeprazole therapy was significantly more effective in reducing GERD symptoms than just the omeprazole alone. So, pretty cool that just combining that therapy with the omeprazole, that you had better results. And then a second randomized open label trial conducted in 2016, found that aloe vera syrups compared to Ranitidine tablets and omeprazole were equally effective in reducing GERD symptoms and subjects.

Dawn (48:18):

So they compared it to the omeprazole and the ranitidine. So head to head, it did good. It was just as effective in reducing the equally effective, I should say, at reducing GERD symptoms. So pretty cool that, that something so simple as Aloe vera syrup has, is an alternative to use. And then the next is papaya. Papaya has been found in animal and in vitro studies that has ability to inhibit gastric secretion through histamine reduction.

Dawn (48:48):

And it acts directly upon the gastric smooth muscle to impact its motility. So papaya is something that you use after a meal, and they’re just chewable tablets that you can chew up. And this will kind of activate the excess secretion of acid. So if you truly have some elevation of acid, then lowering that with papaya is an option. The next one is melatonin and this one has a lot of studies behind it. I’m just sharing a few.

GERD and melatonin

Dawn (49:08):

But melatonin, we know it more as a sleep aid but they do find that it has benefits in GERD and functional dyspepsia. One trial studied patients with, and without GERD and they receive four interventions, the control, melatonin, omeprazole, and then a combination of melatonin and omeprazole. And they found that the two groups receiving melatonin supplements alone, or in addition to the omeprazole yielded a significant increase in the lower esophageal sphincter pressure.

Dawn (50:07):

And that just means that that lower esophageal sphincter at the bottom of your esophagus. Sealed tighter. So that made it seal better so that no acid could get into esophagus. And then a single blind randomized study found 100% of the participants who took a supplement that contained melatonin, L-tryptophan, vitamin B6, folic acid, B12, methionine, and betaine reported complete regression of their GERD symptoms. Whereas the group that just took 20 milligrams of Omeprazole only reported 65% success with this regression of their GERD symptoms.

Dawn (51:18):

So you can see that melatonin has a good impact on that lower esophageal sphincter and really resolving that heartburn. And gas pressure can make that lower esophageal sphincter relax and not stay tight. So utilizing something like melatonin or like this supplement that had melatonin in it. Is a alternative. And then lastly is a low FODMAP diet. Cause in reality, bacteria..gut bacteria love to eat carbohydrates and after they eat it, they release gas. And the problem lies in sometimes too much gas and then gas causes the bloating, the stomach pain and the pressure.

Low FODMAP diet & heartburn

Dawn (51:51):

So when gas pressure is coming up, then that’s when that lower esophageal sphincter is going to be relaxed and not tight like it should be. And then that’s when you can have acid go back into your esophagus. And again, that pressure is also a thing with.. They, they find with gastric sleeve patients, they feel like that pressure from having such a, a small pouch with both sphincters. You don’t have you, you get a build up of pressure and then you have all these fibers and you don’t digest them well and you release all this gas and then that downward pressure then creates that relaxing, the gas pressure, I should say. It makes that, so that it’s not as tight. So, so you can see following a low FODMAP diet actually lowers the gas production. Cause you are removing the fermentable carbohydrates.

Dawn (53:01):

So working with someone to help you work through a low FODMAP diet for a short window of time, may help get things going in the right direction and then getting to the root cause of why you’re having the heartburn. Is kind of, you know, where you would go while you’re doing the low FODMAP. So I, I really hope this has given you some strategies, some thoughts on, okay. I have heartburn and I need an, a different option. And I have given you nine strategies to, and hopefully I’ve given you a deeper understanding of why you are experiencing it and then what you do to help yourself. So, and more, I guess, a better way to put it is you’re using the right tool for the job.

Dawn (54:18):

So if you already know you have low stomach acid after a gastric sleeve and gastric bypass, the majority of the time. I’m not gonna say some of you wouldn’t have high stomach acid because that is a potential. But with this you know, in these studies, they are consistently showing that the pH is high. So you have a low stomach acid, not a high.  showing up with the right tool is an important piece.  I hope you will consider some of these options and really work on utilizing one or more of these strategies and work with a provider like myself to help you get to the root of what is driving your heartburn. I hope it helps you guys have a great day. See you next time. Bye.

Your future health awaits…