Fasting

Fasting is voluntarily not eating food for varying lengths of time. Fasting is used as a medical therapy for many conditions. It is also a spiritual practice in many religions.

Origins

Used for thousands of years, fasting is one of the oldest therapies in medicine. Many of the great doctors of ancient times and many of the oldest healing systems have recommended it as an integral method of healing and prevention.

Hippocrates, the father of Western medicine, believed fasting enabled the body to heal itself. Paracelsus, another great healer in the Western tradition, wrote 500 years ago that “fasting is the greatest remedy, the physician within.” Ayurvedic medicine, the world’s oldest healing system, has long advocated fasting as a major treatment.


Fasting has also been used in nearly every religion in the world, including Christianity, Judaism, Buddhism, and Islam. Many of history’s great spiritual leaders fasted for mental and spiritual clarity, including Jesus, Buddha, and Mohammed. In one of the famous political acts of the last century, the Indian leader Mahatma Gandhi fasted for 21 days to promote peace.

Fasting has been used in Europe as a medical treatment for years. Many spas and treatment centers, particularly those in Germany, Sweden, and Russia, use medically supervised fasting. Fasting has gained popularity in American alternative medicine over the past several decades, and many doctors feel it is beneficial. Fasting is a central therapy in detoxification, a healing method founded on the principle that the build up of toxic substances in the body is responsible for many illnesses and conditions.

Benefits

Fasting can be used for nearly every chronic condition, including allergies, anxiety, arthritis, asthma, depression, diabetes, headaches, heart disease, high cholesterol, low blood sugar, digestive disorders, mental illness, and obesity. Fasting is an effective and safe weight loss method. It is frequently prescribed as a detoxification treatment for those with conditions that may be influenced by environmental factors, such as cancer and multiple chemical sensitivity. Fasting has been used successfully to help treat people who have been exposed to high levels of toxic materials due to accident or occupation. Fasting is thought to be beneficial as a preventative measure to increase overall health, vitality, and resistance to disease. Fasting is also used as a method of mental and spiritual rejuvenation.

Description

The principle of fasting is simple. When the intake of food is temporarily stopped, many systems of the body are given a break from the hard work of digestion. The extra energy gives the body the chance to heal and restore itself, and burning stored calories gets rid of toxic substances stored in the body.

The digestive tract is the part of the body most exposed to environmental threats, including bacteria, viruses, parasites, and toxins. It requires the most immune system support. When food is broken down in the intestines, it travels through the blood to the liver, the largest organ of the body’s natural detoxification system. The liver breaks down and removes the toxic by-products produced by digestion, including natural ones and the chemicals now present in the food supply. During fasting, the liver and immune system are essentially freed to detoxify and heal other parts of the body.

Many healers claim that fasting is a particularly useful therapy for Americans and for the modern lifestyle, subjected to heavy diets, overeating, and constant exposure to food additives and chemicals. Some alternative practitioners have gone so far as to estimate that the average American is carrying 5-10 pounds of toxic substances in their bodies, for which fasting is the quickest and most effective means of removal.

Physiology of fasting

Through evolution, the body became very efficient at storing energy and handling situations when no food was available. For many centuries, fasting was probably a normal occurrence for most people, and the body adapted to it. It is estimated that even very thin people can survive for 40 days or more without food.

The body has a special mechanism that is initiated when no food is eaten. Fasting is not starvation, but rather the body’s burning of stored energy. Starvation occurs when the body no longer has any stored energy and begins using essential tissues such as organs for an energy source. Therapeutic fasts are stopped long before this happens.

Many physiological changes occur in the body during fasting. During the first day or so, the body uses its glycogen reserves, the sugars that are the basic energy supply. After these are depleted, the body begins using fat. However, the brain, which has high fuel requirements, still needs glucose (sugars converted from glycogen).

To obtain glucose for the brain, the body begins to break down muscle tissue during the second day of the fast. Thus, during fasting some muscle loss will occur. To fuel the brain, the body would need to burn over a pound of muscle a day, but the body has developed another way to create energy that saves important muscle mass. This protein-sparing process is called ketosis, which occurs during the third day of a fast for men and the second day for women.

In this highly efficient state, the liver begins converting stored fat and other nonessential tissues into ketones, which can be used by the brain, muscles, and heart as energy. It is at this point in the fast that sensations of hunger generally go away, and many people experience normal or even increased energy levels. Hormone levels and certain functions become more stable in this state as well. The goal of most fasts is to allow the body to reach the ketosis state in order to burn excess fat and unneeded or damaged tissue. Thus, fasts longer than three days are generally recommended as therapy.

Weight loss occurs most rapidly during the first few days of a fast, up to 2 pounds per day. In following days, the figure drops to around 0.5 pound per day. An average weight loss of a pound a day for an entire fast can be expected. Studies show that cutting back just once a month can jump-start healthier eating and help rid one’s body of a lifetime of extra calories.

Performing a fast

Fasts can be performed for varying lengths of time, depending on the person and his or her health requirements. For chronic conditions, therapists recommend from two to four weeks to get the most benefits. Sevenday fasts are also commonly performed. A popular fasting program for prevention and general health is a threeday fast taken four times per year, at the change of each season. These can be easily performed over long weekends. Preventative fasts of one day per week are used by many people as well.

Juice fasts are also used by many people, although these are not technically fasts. Juice fasts are less intensive than water fasts because the body doesn’t reach the ketosis stage. The advantage of juice fasts is that fruit and vegetable drinks can supply extra energy and nutrients.

People can fit a few days of juice fasting into their normal schedules without significant drops in energy. Juice fasts are also said to have cleansing and detoxifying effects. The disadvantage of juice fasts is that the body never gets to the ketosis stage, so these fasters are thought to lack the deep detoxification and healing effects of the water fast.

Medical supervision is recommended for any fast over three days. Most alternative medicine practitioners, such as homeopaths, naturopathic doctors, and ayurvedic doctors, can supervise and monitor patients during fasts. Those performing extended fasts and those with health conditions may require blood, urine, and other tests during fasting. There are many alternative health clinics that perform medically supervised fasts as well. Some conventional medical doctors may also supervise patients during fasts. Costs and insurance coverage vary, depending on the doctor, clinic, and requirements of the patient.

Preparations

Fasts must be entered and exited with care. To enter a fast, the diet should be gradually lightened over a few days. First, heavy foods such as meats and dairy products should be eliminated for a day or two. Grains, nuts, and beans should then be reduced for several days. The day before a fast, only easily digested foods like fruits, light salads, and soups should be eaten. During the fast, only pure water and occasional herbal teas should be drunk. If you exercise, keep your workouts during fasting light and relatively brief, stopping immediately if you feel dizzy, lightheaded or short of breath.

Fasts should be ended as gradually as they are entered, going from lighter to heavier foods progressively. The diet after a fast should emphasize fresh, wholesome foods. Fasters should particularly take care not to overeat when they complete a fast.

Precautions

Fasting isn’t appropriate for everyone and, in some cases, could be harmful. Any person undertaking a first fast longer than three days should seek medical supervision. Those with health conditions should always have medical support during fasting. Plenty of water should be taken by fasters since dehydration can occur. Saunas and sweating therapies are sometimes recommended to assist detoxification, but should be used sparingly. Those fasting should significantly slow down their lifestyles. Taking time off of work is helpful, or at least reducing the work load. Fasters should also get plenty of rest. Exercise should be kept light, such as walking and gentle stretching.

Side effects

Those fasting may experience side effects of fatigue, malaise, aches and pains, emotional duress, acne, headaches, allergies, swelling, vomiting, bad breath, and symptoms of colds and flu. These reactions are sometimes called healing crises, which are caused by temporarily increased levels of toxins in the body due to elimination and cleansing. Lower energy levels should be expected during a fast.

Research & general acceptance

The physiology of fasting has been widely studied and documented by medical science. Beneficial effects such as lowered cholesterol and improved general functioning have been shown. Fasting as a treatment for illness and disease has been studied less, although some studies around the world have shown beneficial results.

A 1984 study showed that workers in Taiwan who had severe chemical poisoning had dramatic improvement after a ten-day fast. In Russia and Japan, studies have demonstrated fasting to be an effective treatment for mental illness. A few years ago, fasting was featured on the cover of the New England Journal of Medicine, although mainstream medicine has generally ignored fasting and detoxification treatments as valid medical procedures.

The majority of research that exists on fasting is testimonial, consisting of individual personal accounts of healing without statistics or controlled scientific experiments. In the alternative medical community, fasting is an essential and widely accepted treatment for many illnesses and chronic conditions.

Training & certification

The International Association of Professional Natural Hygienists (IAPNH) is an organization of healthcare professionals who specialize in therapeutic fasting. It certifies doctors who have completed approved residencies in therapeutic fasting, including conventional medical doctors, naturopaths, and osteopathic doctors.

Food poisoning

Food poisoning is a general term for health problems arising from eating food contaminated by viruses, chemicals, or bacterial toxins. Types of food poisoning include bacterial food poisoning, shellfish poisoning, and mushroom poisoning. The medical term for food poisoning is gastroenteritis.

The Centers for Disease Control and Prevention (CDC) estimates that there are up to 33 million cases of food poisoning in the United States each year. Many cases are mild, and they pass so rapidly that they are never diagnosed. Occasionally, a severe outbreak creates a newsworthy public health hazard, but these instances are rare. Anyone can get food poisoning, but the very young, the very old, and those with compromised immune systems have the most severe and life-threatening cases.

Causes & symptoms

General indications of food poisoning include diarrhea, stomach pain or cramps, gurgling sounds in the stomach, fever, nausea, and vomiting. Dehydration is a common complication, since fluids and electrolytes are lost through vomiting and diarrhea. Dehydration is more likely to happen in the very young, the elderly, and people who are taking diuretics.


Bacterial sources of food poisoning

Bacteria are major causes of food poisoning. Symptoms of bacterial food poisoning occur because foodborne bacteria release enterotoxins, or poisons, as a byproduct of their growth in the body. These toxins often diminish the absorptive ability of the intestines and cause the secretion of water and electrolytes that leads to dehydration. The severity of symptoms depends on the type of bacteria, the amount of bacteria and food consumed, and the individual’s health and sensitivity to the bacteria’s toxin.

SALMONELLA. Symptoms of poisoning begin 12–72 hours after eating food contaminated with Salmonella. Classic food poisoning symptoms, including fever, occur for about two to five days. Salmonella is usually transmitted through the consumption of food contaminated by human or other animal feces. This contamination is mostly due to lack of hand washing by food handlers.

ESCHERICHIA COLI (E. COLI). Symptoms of food poisoning from E. coli 0157:H7 and similar strains of E. coli are slower to appear than those caused by some of the other foodborne bacteria. One to three days after eating contaminated food, the victim begins to have severe abdominal cramps and watery diarrhea that usually becomes bloody. The diarrhea may consist mostly of blood and very little stool, so the condition is sometimes called hemorrhagic colitis. There is little or no fever, the bloody diarrhea lasts from one to eight days, and the condition usually resolves by itself. Food contamination from E. coli O157:H7 has mostly been found in raw or undercooked ground beef. Raw milk has also been a source of food poisoning by E. coli.

CAMPYLOBACTER JEJUNI. C. jejuni infections are most often caused by contaminated chicken, but unchlorinated water and raw milk may also be sources of infection. Classic symptoms of food poisoning, including fever and diarrhea, begin two to five days after consuming food or water contaminated with C. jejuni. The diarrhea may be watery and may contain blood. Symptoms last from seven to 10 days, and relapses occur in about one quarter of the people who are infected.

STAPHYLOCOCCUS AUREUS (STAPH). Staph is spread primarily by food handlers with Staph infections on their skin. However, contaminated equipment and food preparation surfaces may also be at fault. Almost any food can be contaminated, but salad dressings, milk products, cream pastries, and food kept at room temperature, rather than hot or cold, are likely candidates. Classic symptoms of food poisoning appear rapidly, usually two to eight hours after the contaminated food is eaten. Such symptoms usually last only three to six hours and rarely more than two days. Most cases are mild and the victim recovers without any assistance.

SHIGELLA. Symptoms of food poisoning by Shigella appear 36–72 hours after eating contaminated food. These symptoms are slightly different from those associated with most foodborne bacteria. In addition to the familiar symptoms of food poisoning, up to 40% of children with severe infections show neurological symptoms. These include seizures, confusion, headache, lethargy, and a stiff, sore neck. The disease runs its course in two to three days.

CLOSTRIDIUM BOTULINUM. C. botulinum (commonly known as botulism) is the deadliest of the bacterial foodborne illnesses. Sources for adult botulism are often improperly canned or preserved food. Symptoms of adult botulism appear about 18 to 36 hours after the contaminated food is eaten, although there are documented times of onset ranging from four hours to eight days. Unlike other foodborne illnesses, there is no vomiting and diarrhea associated with botulism. Initially, a person suffering from botulism feels weakness, dizziness, and double vision. Symptoms progress to difficulty with speaking and swallowing. The toxins from C. botulinum are neurotoxins—they poison the nervous system, causing paralysis. If the disease proceeds unchecked, paralysis will move throughout the body. Eventually, without medical intervention, the respiratory muscles will become paralyzed and the victim will suffocate.

With infant botulism, the spores of C. botulinum lodge in the infant’s intestinal tract. Honey, especially when consumed by infants younger than 12 months, is sometimes the source of these spores. Onset of the symptoms is gradual. The infant initially has constipation, followed by poor feeding, lethargy, weakness, drooling, and a distinctive wailing cry. Eventually the baby loses the ability to control its head muscles. Paralysis then progresses to the rest of the body.

Fish-associated food poisoning

Ciguatera fish poisoning is caused by toxins accumulated in the tissues of certain tropical fish, including groupers, barracudas, snappers, and mackerel. Signs of poisoning occur about six hours after eating the fish. Around the mouth, there may be numbness and tingling, which may spread to other places including the hands and feet.

There is often muscle pain and weakness, headache, dizziness, joint pain, sensitivity to temperature, heart arrhythmias, dramatic changes in heart rate, and reduced blood pressure. Reef fish contaminated with ciguatoxin are being exported all over the world, occurrence of ciguatera is becoming more likely in colder climates.

Pufferfish, or fugu, is a traditional gourmet dish served mostly in Japan. The skin and other organs of the pufferfish contain a strong poison called tetradotoxin. The first stage of tetradotoxin poisoning is indicated by numbness of the lips and tongue, which may occur 20–180 minutes after eating the fish. This is followed by tingling and numbness of the face, hands, and feet.


Classic symptoms of food poisoning are accompanied by other neurological symptoms such as light-headedness, headache, and unsteady gait. The second stage of tetradotoxin poisoning brings on a progressive paralysis. Breathing, talking, and other movement becomes difficult. Cyanosis (bluish or purplish skin discoloration), low blood pressure, and arrhythmias may occur.

Convulsions and mental impairment may happen right before death, or the person may be completely lucid, though unmoving. Death usually occurs four to six hours after ingestion of the fish if there is no proper intervention; that time, however, has been known to be as little as 20 minutes.

Shellfish poisoning is caused by toxins made by certain algae eaten by shellfish. The toxins are then accumulated in the bodies of the shellfish. Cockles, mussels, clams, oysters, and scallops are most often affected. Sometimes the toxin-producing algae multiply to such an extent that they cause the waters they live in to take on the reddish color of their bodies. This phenomenon is known as a red tide.

Warnings are often given against eating shellfish from such areas. Symptoms of food poisoning show up within a half an hour to two hours of eating the shellfish, depending on the amount and type eaten. There may be burning and tingling in the face and mouth, numbness, drowsiness, muscular pain, dizziness, diarrhea, stomachache, confusion, nausea, vomiting, odd temperature sensations, difficulty breathing, and possibly coma. The symptoms may last from a few hours to a few days.

Histamine poisoning can occur from eating fish whose body tissues have begun to produce high levels of histamine. Mackerel, tuna, and mahi mahi are most often the sources. After consumption of the fish, immediate facial flushing and hives may occur, as well as classic symptoms of food poisoning becoming evident a few minutes later. Symptoms usually last less than 24 hours.

Mushroom poisoning

Mushroom poisoning is classified by the effects of the poisons. Protoplasmic poisons result in cell destruction, often in the liver, which progresses to complete organ failure. Neurotoxins cause neurological symptoms such as sweating, convulsions, hallucinations, excitement, depression, coma, and colon spasms.

Gastrointestinal (G/I) irritants rapidly bring on the classic symptoms of food poisoning and then resolve just as quickly. Disulfiram-like poisons are generally nontoxic, except when alcohol is consumed within 72 hours of eating them. In these cases, the poisons cause headache, nausea, vomiting, flushing, and cardiac disturbances for two to three hours.

Other possible sources

Other possible sources of food poisoning include ingestion of green or sprouting raw potatoes, ingestion of fava beans by susceptible persons, and ergot poisoning from ingestion of contaminated grain. Chemical contaminant food poisoning may result from the ingestion of unwashed produce sprayed with arsenic, lead, or insecticides. Food served or stored in lead-glazed pottery cadmium- lined containers may also lead to food poisoning.

Diagnosis

An important aspect of diagnosing food poisoning is the clinical interview. A history of the illness should be thoroughly traced to include ingestion of food, recent travel, and contact with those showing similar symptoms of illness. Because it may take 30 minutes to three days for symptoms to develop, it is not necessarily the most recent food eaten that is the cause of the symptoms. Diagnosis is confirmed with a stool culture.

Other laboratory tests may be used to examine vomitus, blood, or the contaminated food. A blood chemistry panel may be performed to determine the extent of any tissue damage or electrolyte imbalances. Many cases of food poisoning go undiagnosed, and treatment focuses on the short-lived G/I symptoms.

Botulism is usually diagnosed from its distinctive neurological symptoms, since rapid treatment is essential to save the patient’s life. Electromyography, a test analyzing the electrical activity of muscles, may later be done to further confirm diagnosis. The test shows abnormal muscle activity in most cases of botulism.

Treatment

Those suffering from food poisoning should reduce all sugar and normal food for eight to 24 hours, and increase fluids to avoid dehydration. Charcoal tablets, Lactobacillus acidophilus, Lactobacillus bulgaricus, and citrus seed extract are all recommended.

For mild cases of food poisoning, the homeopathic remedies Arsenicum album, Veratrum album, Podophyllum, or Nux vomica are recommended. The remedy should be given in 12c potency every three to four hours until symptoms subside. If a ready-made electrolyte replacement is not available, a homemade one can be made by dissolving exactly 1 tsp (5 ml) of salt and 4 tsp (20 ml) of sugar in 1 qt (1 l) of water.

Cinnamon (Cinnamonum zeylanicum), cloves (Syzigium aromaticum), oregano (Origanum vulgare), and sage (Salvia officinalis) are food herbs that are also strong inhibitors of bacteria. Liberal amounts can be added to foods, especially when traveling. Grapefruit seed extract has a natural antibiotic effect and may be of help. Large amounts of garlic, in food and in supplement form, are also recommended for the same reason.

Allopathic treatment

In serious cases of food poisoning, medications may be given to stop abdominal cramping and vomiting. Medications are not usually given for the diarrhea, since stopping it might keep toxins in the body longer and prolong the illness. Severe bacterial food poisonings are sometimes treated with antibiotics, but their use is controversial.

Washing out the stomach contents to remove the toxic substances may be required. This procedure is called gastric lavage, familiarly known as having the stomach pumped. Neurotoxins often interfere with the breathing process. If the ability to breathe is affected, patients may have to be put on a mechanical ventilator to assist their breathing and are fed intravenously until the paralysis passes.

People who show any signs of botulism poisoning must receive immediate emergency medical care. Both infants and adults suffering from food poisoning by C. botulinum require hospitalization, often in the intensive care unit. A botulism antitoxin is given to adults, if it can be administered within 72 hours after symptoms are first observed. If given later, it provides no benefit. Nasogastric intubation is recommended for the feeding of infants with active botulism. As well as supplying nutrition, it will stimulate peristalsis, helping in the elimination of C. botulinum.

Treatment of food poisoning that is usually not an emergency situation may include drugs such as ipecac syrup to induce vomiting or laxatives to empty the intestines. Intravenous fluids containing salts and dextrose may be given to correct dehydration and electrolyte imbalances. Pain medications are given for severe stomach pain.

Atropine is given for muscarine-type mushroom poisoning. If illness comes on after eating unidentified mushrooms, vomiting should be induced immediately, and the vomitus saved for laboratory testing. Intravenous mannitol is sometimes used to treat severe ciguatera poisoning. Antihistamines may be effective in reducing the symptoms of histamine fish poisoning. In 2001, Japanese scientists made a synthetic version of ciguatoxin, an important step in developing an antibody to help diagnose ciguatera.

In mild cases of food poisoning, dietary modifications are often the only treatment necessary. During periods of active vomiting and diarrhea, people with food poisoning should avoid solid food for eight to 24 hours, and should increase fluids. Clear liquids should be consumed in small quantities. Once active symptoms stop, a diet of bland, easily digested foods such as broth, eggs, rice and other cooked grains, and toast is recommended for two to three days. Milk products, spicy food, alcohol, sweets, raw vegetables, and fresh fruit should be avoided.

Expected results

Many cases of food poisoning clear up on their own within a week without medical assistance. There are usually few complications once possible dehydration has been addressed. Fatigue may continue for a few days after active symptoms stop, however.

In the more severe types of poisoning, especially those involving neurotoxins, the respiratory muscles may become paralyzed. In such cases, death will result from asphyxiation unless there is medical intervention. Deaths due to food poisoning are rare and tend to occur in the very young, the very old, and in people whose immune systems are already weakened.

C. botulinum, is likely to cause serious illness or fatalities, even when ingested in very small quantities. Children affected by food poisoning from E. coli often need to be hospitalized. In some cases, E. coli toxins may be absorbed into the blood stream where they destroy red blood cells and platelets, which are important in blood clotting. About 5% of victims, regardless of age, develop hemolytic uremia syndrome, which results in kidney failure.

Prevention

Eighty-four percent of adults surveyed in 2001 were unaware that feces on beef and poultry was the main carrier of salmonella, campylobacter, and E. coli. Other than informing the public, food poisoning prevention efforts include:

• hot foods should be kept hot, and cold foods should be kept cold
• meat should be cooked to the recommended internal temperature; eggs should be cooked until no longer runny
• leftovers should be refrigerated promptly and food should never be left to stand at room temperature
• contact of utensils and surfaces with the juices of raw meats should be avoided
• fruits and vegetables should be washed before using
• unpasteurized dairy products and fruit juices should be avoided
• bulging or leaking canned foods or any food that smells spoiled should be discarded
• hands should be washed with soap before food preparation and after using the bathroom
• food preparation surfaces should be sanitized regularly
• infants under 12 months should not be fed honey, which may contain spores of C. botulinum
• proper canning and adequate heating of home-canned food before serving are essential (boiling for three minutes is recommended)

Taking Lactobacillus acidophilus or L. bulgaricus may help prevent food poisoning, especially when traveling. Populating the intestines with these bacteria will make it less likely that harmful bacteria are able to gain a foothold.

Gas

Gas, or flatus, is produced when naturally occurring bacteria in the gastrointestinal tract begin to break down, or digest, food. When an excess of air builds up in the tract from swallowing air or a disorder that prevents digestion, it is released as gas. Gastrointestinal gases include methane, carbon dioxide, nitrogen, and hydrogen.

Description

Gas production is an essential, normal function of the gastrointesinal tract, and most healthy individuals pass up to 1,200 cc (over 40 oz) of gas each day. However, when gas causes excessive pain and cramping (colic) then evaluation and treatment are appropriate.

Causes & symptoms

Gastrointestinal gas production can be increased by certain foods, illnesses, and some medications. Common causes of excessive gas include:

• Gas-producing foods. Onions, beans, the cabbage family, and other fibrous foods can cause excessive gas or intestinal spasms in some individuals. 
• Gastrointestinal diseases and disorders. Increased flatulence is a defining symptom of irritable bowel syndrome, diverticulitis, lactose intolerance, malabsorption problems, dysbiosis (digestive problems), and other gastrointestinal disorders. 
• Air swallowing. Swallowing too much air while eating or chewing gum can introduce extra gas to the gastrointestinal tract. 
• Medications. Certain prescription and over-the-counter medications may cause gas as a side-effect. 
• Stress and food allergies can also cause gas. 

Symptoms of excessive gas production include:

• flatulence 
• belching, or burping 
• abdominal cramping, or colic 
• abdominal pain

Diagnosis

A thorough medical and dietary history and physical examination performed by a healthcare professional can usually identify the cause of gas pains resulting from changes to diet or medication. Gas problems triggered by gastrointestinal disease may be harder to diagnose, and will typically require additional medical testing such as colonoscopy, barium enema, or an upper and/or lower gastrointestinal (GI) series.

Treatment

For excessive gas caused by a particular food or beverage, adjustments to diet can relieve most symptoms. Gas caused by air swallowing can be alleviated by eating more slowly and avoiding gum chewing.

An herbalist or naturopathic healthcare professional may recommend a preparation of a carminative (gas reducing) herb such as valerian (Valeriana officinalis), or peppermint (Mentha piperita), which may be helpful in eliminating discomfort and gas-related bloating.

Homeopathic remedies for excessive intestinal gas include Carbo vegetabilis, Nux vomica, and Chamomilla. The prescription of a specific homeopathic remedy will depend on an individual’s overall symptom picture, mood, and temperament, and should only be prescribed by a qualified homeopathic physician.

Hydrotherapy, acupressure, acupuncture, yoga, reflexology, and mild exercise can also help to relieve the pain and discomfort of excessive gas.

Allopathic treatment

Over-the-counter preparations of the enzyme alpha- D-galactosidase (Beano) can alleviate gas symptoms caused by ingestion of certain foods in some individuals. These preparations are typically available in liquid or tablet form. Other non-prescription medications such as Gas-X, Phazyme, and Mylanta contain the ingredient simethicone, which can reduce gas bubbles within the gastrointestinal tract.

Expected results

Mild excess gas is typically easy to treat, especially that triggered by dietary causes. Gas caused by gastrointestinal disease may be more difficult to manage, and successful treatment depends on the type and severity of the disorder.

Prevention

Avoiding fermented foods, drastic increases in fiber intake, and excessive air intake can prevent gas in some individuals. Lactose intolerant individuals should avoid dairy products.

Gastritis

Gastritis commonly refers to inflammation of the lining of the stomach, but the term is often used to cover a variety of symptoms resulting from this inflammation, as well as symptoms of burning or discomfort. True gastritis comes in several forms and is diagnosed using a combination of tests. In the 1990s, scientists discovered that the main cause of most gastritis is infection by a bacterium called Helicobacter pylori.

Description

Gastritis should not be confused with common symptoms of upper abdominal discomfort. It has been associated with ulcers, particularly peptic ulcers, and in some cases, chronic gastritis can lead to more serious complications.

Nonerosive H. pylori gastritis

Under current theory, the main cause of true gastritis is H. pylori infection, which is found in an average of 90% of patients with chronic gastritis. H. pylori is a bacterium whose outer layer is resistant to the normal effects of stomach acid in breaking down bacteria. The resistance of H. pylori means that the bacterium may remain in the stomach for long periods of times, even years, and eventually cause symptoms of gastritis or ulcers when other factors are introduced, such as the presence of specific genes or the use of nonsteroidal anti-inflammatory drugs (NSAIDs).


Studies of the role of H. pylori in the development of gastritis and peptic ulcers have disproved the former belief that stress leads to most stomach and duodenal ulcers. The newer findings have resulted in improved treatment and reduction of stomach ulcers. H. pylori is most likely transmitted between humans, although the specific routes of transmission are still under study. Studies were also underway to determine the role of H. pylori and resulting chronic gastritis in the development of gastric cancers.

Erosive and hemorrhagic gastritis

After H. pylori, the second most common cause of chronic gastritis is the use of NSAIDs. These commonly used pain killers, including aspirin, fenoprofen, ibuprofen and naproxen, can lead to gastritis and peptic ulcers. Other forms of erosive gastritis are caused by alcohol or corrosive agents, or by injuries to the stomach tissues from the ingestion of foreign bodies.

Other forms of gastritis

Clinicians differ on the classification of the less common and specific forms of gastritis, particularly since there is so much overlap with H. pylori in development of chronic gastritis and complications of gastritis.

Other types of gastritis that may be diagnosed include:

• Acute stress gastritis. This is the most serious form of gastritis. It usually occurs in critically ill patients, such as those in intensive care. Stress erosions may develop suddenly as a result of severe trauma or stresses on the stomach lining. 
• Atrophic gastritis. This form of gastritis results from chronic gastritis. It is characterized by atrophy, or a decrease in size and wasting away of the gastric lining. Gastric atrophy is the final stage of chronic gastritis and may be a precursor of gastric cancer. 
• Superficial gastritis. This term is often used to describe the initial stages of chronic gastritis. 
• Uncommon specific forms of gastritis include granulomatous, eosiniphilic, and lymphocytic gastritis.

Causes & symptoms

Nonerosive H. pylori gastritis

H. pylori gastritis is caused by infection from the H. pylori bacterium. It is believed that most infection occurs in childhood. Clinicians think that there may be more than one route for the bacterium. Its prevalence and distribution differs in nations around the world.

The presence of H. pylori has been detected in 86–99% of patients with chronic superficial gastritis. Physicians are still learning about the link of H. pylori to chronic gastritis and peptic ulcers, since many patients with H. pylori infection do not develop symptoms or peptic ulcers. H. pylori is also seen in 90–100% of patients with duodenal ulcers.

The symptoms of H. pylori gastritis include abdominal pain and reduced acid secretion in the stomach. The majority of patients with H. pylori infection, however, suffer no symptoms, even though the infection may lead to ulcers and resulting symptoms. Ulcer symptoms include dull, gnawing pain, often two to three hours after meals; and pain in the middle of the night when the stomach is empty.


Erosive and hemorrhagic gastritis

The most common cause of this form of gastritis is the use of NSAIDs. Other causes may be alcoholism or stress from surgery or critical illness. The role of NSAIDs in development of gastritis and peptic ulcers depends on the dose level. Although even low doses of aspirin or other nonsteroidal anti-inflammatory drugs may cause some gastric upset, low doses generally will not lead to gastritis.

However, as many as 10–30% of patients on higher and more frequent doses of NSAIDs, such as those with chronic arthritis, may develop gastric ulcers. Patients with H. pylori already present in the stomach who are treated with NSAIDs are much more susceptible to ulcers and other gastrointestinal effects of these pain killers.

Patients with erosive gastritis may also show no symptoms. When symptoms do occur, they may include anorexia nervosa, gastric pain, nausea, and vomiting.

Other forms of gastritis

Less common forms of gastritis may result from a number of generalized diseases or from complications of chronic gastritis. Any number of mechanisms may cause various less common forms of gastritis and they may differ slightly in their symptoms and clinical signs. However, they all have inflammation of the gastric mucosa in common. Research recently found that severe gastritis may occur rarely as a result of infectious mononucleosis.

Diagnosis

Nonerosive H. pylori gastritis

H. pylori gastritis is easily diagnosed through the use of the urea breath test. This test detects active presence of H. pylori infection. Other serological tests, which may be readily available in a physician’s office, may be used to detect H. pylori infection. Newly developed versions offer rapid diagnosis.

New stool antigen tests were developed and made available in 2002. The choice of test will depend on cost, availability and the physician’s experience, since nearly all of the available tests have an accuracy rate of 90% or better. Endoscopy, or the examination of the stomach area using a hollow tube inserted through the mouth, may be ordered to confirm the diagnosis. A biopsy of the gastric lining also may be ordered.

Erosive or hemorrhagic gastritis

The patient’s clinical history may be particularly important in the diagnosis of this type of gastritis, since its cause is most often the result of chronic use of NSAIDs, alcoholism, or abuse of other substances.

Other forms of gastritis

Gastritis that has developed to the stage of duodenal or gastric ulcers usually requires endoscopy for diagnosis. It allows the physician to perform a biopsy for possible malignancy and for H. pylori. Sometimes, an upper gastrointestinal x-ray study with barium is ordered. Some diseases such as Zollinger-Ellison syndrome, an ulcer disease of the upper gastrointestinal tract, may show large mucosal folds in the stomach and duodenum on radiographs or in endoscopy. Other tests check for changes in gastric function.

Treatment

Some alternative treatments for gastritis follow mainstream medical practice in distinguishing between gastritis and other digestive disorders; others treat all disorders originating in the stomach in similar fashion.

Dietary supplements

Of all the alternative treatments for gastritis, dietary supplements of various types are the most likely to have been tested in clinical research. Some alternative practitioners have used the following supplements:

• Capsaicin. Capsaicin is the active ingredient in chili peppers. One study in human subjects indicates that capsaicin offers some protection against gastritis caused by aspirin. 
• Antioxidants. Vitamin C and beta-carotene given in combination appear to be beneficial to most patients with chronic atrophic gastritis. 
• Amino acids. Several studies indicate that cysteine speeds healing in bleeding gastritis related to NSAIDs and in atrophic gastritis. Glutamine appears to protect against the development of stress-related gastritis. 
• Vitamins. Preliminary research suggests that large doses of vitamin A may reduce or eliminate erosive gastritis. Vitamin B12 is helpful for patients with prenicious anemia related to atrophic gastritis. 
• Gamma oryzanol. In one study, 87% of patients with various types of gastritis reported at least some improvement from a daily dose of 300 mg of gamma oryzanol.

Herbal therapy

Herbs that have been recommended for gastritis include:

• Licorice. Licorice is a traditional remedy for stomach inflammation. It also appears to inhibit the growth of H. pylori. People who gain water weight or develop high blood pressure as side effects of taking licorice can be treated with licorice that has had the glycyrrhizin removed. 
• Goldenseal. This herb contains berberine, a compound with antibiotic properties. There is some evidence that berberine is active against H. pylori. 
• Chamomile. Chamomile contains apigenin, a bioflavonoid that inhibits H. pylori, and chamazulene, a compound that counteracts free radicals. 
• Marsh mallow and slippery elm. These herbs have demulcent properties, which means that they soothe irritated mucous membranes. 
• Echinacea and geranium. These herbs are recommended by some practitioners for their antiseptic and analgesic (pain-relieving) properties.

Naturopathic practitioners also advise patients with gastritis to eat certain categories of food separately. Patients are advised to eat protein foods by themselves or with green leafy vegetables; to eat fruits alone; and to avoid combining proteins and starches.

Acupuncture/acupressure

One source recommends applying gentle pressure to a point on the abdomen known as CV (conception vessel) 12, midway between the navel and the breastbone. Pressure should be applied when the stomach is empty. Trained acupuncturists treat stomach problems by releasing energy from the spleen and from other energy points associated with digestion.

Yoga

The Bow Pose is recommended by some teachers of yoga for stomach disorders because it puts pressure on a number of acupoints on the abdomen associated with the digestive process and with the stomach meridian. Chinese herbal medicine The Chinese traditionally use a tea made from ginger (Zingiber officinale) as a stomachic, to improve digestive functions.

Reflexology

A trained reflexologist will gently massage the stomach reflexes located on the hands and feet. On the hands, the stomach reflexes are on the palms, below the pads of the middle and index fingers. On the feet, the stomach reflexes are located on the sole just below the pad of the big toe.

Allopathic treatment

H. pylori gastritis

The discovery of H. pylori’s role in the development of gastritis and ulcers has led to improved treatment of chronic gastritis. Since the infection can be treated with antibiotics, the bacterium can be completely eliminated up to 90% of the time. The treatment, however, may be uncomfortable for patients and relies heavily on patient compliance. No single antibiotic has been found that would eliminate H. pylori on its own, so various combinations of antibiotics have been prescribed to treat the infection.

TRIPLE THERAPY. As of early 1998, triple therapy was the preferred treatment for patients with H. pylori gastritis. This treatment regimen usually involves a twoweek course of three drugs. An antibiotic such as amoxicillin or tetracycline, and another antibiotic such as clarithromycin or metronidazole are used in combination with bismuth subsalicylate, a substance that helps protect the lining of the stomach from acid. However, this treatment often fails due to poor patient compliance and quadruple therapy is required.

DUAL THERAPY. Dual therapy involves the use of an antibiotic and a proton pump inhibitor. Proton pump inhibitors help reduce stomach acid by halting the mechanism that pumps acid into the stomach. Dual therapy has not been proven to be as effective as triple therapy, but may be ordered for some patients who can more comfortably handle the use of fewer drugs.

OTHER TREATMENTS. Scientists have experimented with quadruple therapy, which adds an antisecretory drug, or one that suppresses gastric secretion, to the standard triple therapy. One study showed this therapy to be effective with only a week’s course of treatment in more than 90% of patients. The goal is to develop the most effective therapy combination that can work in one week of treatment or less.

Treatment of erosive gastritis

Patients with erosive gastritis may be given treatments similar to those for H. pylori, especially since some studies have demonstrated a link between H. pylori and NSAIDs in causing ulcers. The patient will most likely be advised to avoid NSAIDs.

Other forms of gastritis

Specific treatment will depend on the cause and type of gastritis. These may include prednisone or antibiotics. Critically ill patients at high risk for bleeding may be treated with preventive drugs to reduce the risk of acute stress gastritis. Sometimes surgery is recommended, but is weighed against the possibility of surgical complications or death. Once heavy bleeding occurs in acute stress gastritis, mortality is as high as 60%.

Expected results

The results expected from alternative treatments for gastritis include accelerated healing from some of the dietary therapies, and some symptomatic relief from acupressure, yoga, and reflexology.

The discovery of H. pylori has improved the prognosis for patients with gastritis and ulcers. Since treatment exists to eradicate the infection, recurrence is much less common. The prognosis for patients with acute stress gastritis is much poorer, with a 60% or higher mortality rate among those bleeding heavily. Recent studies have shown that infection with H. pylori and resulting gastritis may lead to such complications as chronic gastritis or as serious as gastric adenoma, a form of stomach cancer.

Prevention

The widespread detection and treatment of H. pylori as a preventive measure in gastritis has been discussed but not resolved. Until more is known about the routes through which H.pylori is spread, specific prevention recommendations are not available.

It was estimated in late 2002 that the organism was present in 80% of middle- aged adults in developing countries and about 20% of those in industrialized countries. Erosive gastritis from NSAIDs can be prevented with cessation of use of these drugs. An education campaign was launched in 1998 to educate patients, particularly an aging population of arthritis sufferers, about the risk of developing ulcers from NSAIDs and alternative drugs.

Gastroenteritis

Gastroenteritis is a general term for infection or irritation of the digestive tract, particularly the stomach and intestine. It is frequently referred to as stomach or intestinal flu, although the influenza virus does not cause this illness.

Major symptoms include nausea, vomiting, diarrhea, and abdominal cramps. Fever and overall weakness sometimes accompany these symptoms. Gastroenteritis typically lasts about three days. Adults usually recover without problem, but children, the elderly, and persons with an underlying disease are more vulnerable to complications such as dehydration.

Description

Gastroenteritis is an uncomfortable and inconvenient ailment, but it is rarely life-threatening in the United States and other developed nations. However, in the United States an estimated 220,000 children younger than age five are hospitalized annually with gastroenteritis symptoms. Of these children, 300 die as a result of severe diarrhea and dehydration. In developing nations, diarrhea- related illnesses are a major source of mortality. In 1990, approximately three million deaths occurred worldwide as a result of diarrheal illness.


Viral gastroenteritis

Gastroenteritis is usually caused by infection with one of these viruses: rotavirus, adenovirus, astrovirus, calicivirus, and small round-structured viruses (SRSVs). These viruses are found all over the world and are particularly problematic where sanitation is poor.

Typical exposure to these viruses occurs through the fecal-to-oral route, by ingesting food that is contaminated with fecal material or by coming in contact with an infected person’s vomit or diarrhea and then inadvertently bringing the contaminant to the mouth. Other routes of transmission are quite likely, because exposure to as few as 100 virus particles can cause an infection.

Typically, children are more vulnerable to rotaviruses— the most common cause of acute watery diarrhea. It is estimated that each year rotaviruses cause 800,000 deaths worldwide in children younger than age five. For this reason, much research has gone into developing a vaccine to protect children from this virus. Adults can be infected with rotaviruses, but these infections typically have minimal or no symptoms.

Adenoviruses and astroviruses are minor causes of childhood gastroenteritis, and children may become infected with caliciviruses and SRSVs. Adults experience illness from astroviruses as well, but the major causes of adult viral gastroenteritis are the caliciviruses and SRSVs. The SRSVs are a type of calicivirus and include the Norwalk, Southhampton, and Lonsdale viruses. SRSVs are the most likely to produce vomiting as a major symptom.

Bacterial gastroenteritis

Bacterial gastroenteritis is frequently a result of poor sanitation, the lack of safe drinking water, or contaminated food—conditions that are common in developing nations. Natural or man-made disasters can worsen underlying sanitation and food-safety problems. In developed nations, modern food production, handling, and distribution systems and methods may expose millions of people to disease-causing bacteria.

Common types of bacterial gastroenteritis can be linked to Salmonella and Campylobacter bacteria; however, Escherichia coli 0157 and Listeria monocytogenes are creating increased concern in developed nations. Cholera and shigella remain two diseases of great concern in developing countries, and research to develop long-term vaccines against them is underway.

Causes & symptoms

Gastroenteritis arises from ingestion of viruses, certain bacteria, or parasites. Spoiled food may also cause illness. Certain medications and excessive alcohol can irritate the digestive tract to the point of inducing gastroenteritis. Regardless of the cause, the symptoms of gastroenteritis include diarrhea, nausea, vomiting, abdominal pain, and cramps. Sufferers may also experience bloating, low fever, and overall tiredness. Typically, the symptoms last only two to three days, but some viruses may last up to a week.


A typical bout of gastroenteritis should not require a visit to the doctor. However, medical treatment is essential if symptoms worsen or if there are complications. Infants, young children, the elderly, and persons with underlying disease require special attention in this regard.

Dehydration is the greatest danger presented by gastroenteritis. The loss of fluids through diarrhea and vomiting can upset the body’s electrolyte balance, leading to potentially life-threatening problems, such as heart beat abnormalities (arrhythmia). The risk of dehydration increases the longer that symptoms are present. Signs of dehydration include a dry mouth, increased or excessive thirst, or scanty urination.

Symptoms that do not clear up within a week may point to an infection or disorder more serious than gastroenteritis. Symptoms of great concern include a fever of 102°F (38.9°C) or above, blood or mucus in the diarrhea, blood in the vomit, and severe abdominal pain or swelling. Persons experiencing these symptoms should seek prompt medical attention.

Diagnosis

The symptoms of gastroenteritis are usually sufficient for identifying the illness. Unless there are complications or there is an outbreak that affects several people, identifying the specific cause of the illness is not a priority. However, if it is necessary to identify the infectious agent, a stool sample will be collected and analyzed for the presence of viruses, disease-causing (pathogenic) bacteria, or parasites.

Treatment

Gastroenteritis is a self-limiting illness that will resolve by itself. Symptoms of uncomplicated gastroenteritis can be relieved with adjustments in diet, herbal remedies, and homeopathy. An infusion of meadowsweet (Filipendula ulmaria) may be effective in reducing nausea and stomach acidity. Once the worst symptoms are relieved, slippery elm (Ulmus fulva) can be used to calm the digestive tract.

The homeopathic remedies Arsenicum album, ipecac, and Nux vomica are also believed to relieve the symptoms of gastroenteritis. In Chinese herbal medicine, the patent remedies Po Chai and Pill Curing can be effective for relieving nausea and diarrhea.

Supplementing the bacteria that are beneficial to a person’s health (probiotics) is recommended during the recovery phase of gastroenteritis. Specifically, live cultures of Lactobacillus acidophilus are said to be effective in soothing the digestive tract and returning the intestinal flora to normal.

In fact, in 2002, a new study found it was reasonably effective in treating children with acute infectious diarrhea. L. acidophilus is found in live-culture yogurt and in capsule or powder form at health food stores. Castor oil packs applied to the abdomen can reduce inflammation, spasms, and discomfort.

It is important to stay hydrated and nourished during a bout of gastroenteritis. In the absence of dehydration, it should be sufficient to drink generous amounts of nonalcoholic fluids, such as water or juice. Caffeine should be avoided, since it increases urine output.

The traditional BRAT diet—bananas, rice, applesauce, and toast—is tolerated by the tender gastrointestinal system, but it is not particularly nutritious. Many, but not all, medical researchers recommend a diet that includes complex carbohydrates (rice, wheat, potatoes, bread, and cereal, for example), lean meats, yogurt, fruit, and vegetables.

Milk and other dairy products shouldn’t create problems if they are part of the normal diet. Fatty foods or foods with a lot of sugar should be avoided. These recommendations are based on clinical experience and controlled trials, but are not universally accepted.

Allopathic treatment

Over-the-counter medications such as Pepto Bismol are useful in relieving the symptoms of gastroenteritis. These medications work by altering the intestine’s ability to move or secrete spontaneously, by absorbing toxins and water, or by altering intestinal microflora. Some over-the-counter medicines use more than one element to treat symptoms, and this information should be included on the label.

If over-the-counter medications are ineffective, a doctor may prescribe a more powerful anti-diarrheal drug, such as motofen or lomotil. If pathogenic bacteria or parasites are found in the patient’s stool sample, medications such as antibiotics will be prescribed.

Minimal to moderate dehydration is treated with oral rehydrating solutions that contain glucose and electrolytes. These solutions are commercially available under names such as Naturalyte, Pedialyte, Infalyte, and Rehydralyte. If vomiting prevents the patient from taking a full dose of solution, he or she may better tolerate fluid taken in small, frequent amounts.

Should oral rehydration fail or severe dehydration occur, medical treatment in the form of intravenous (IV) therapy is required. IV therapy can be followed with oral rehydration as the patient’s condition improves. Once normal hydration is achieved, the patient can return to a regular diet.

Sometimes, a child’s dehydration is so severe that it requires hospitalization with IV therapy. However, a study published in 2002 informed pediatricians that often, rapid intravenous rehydration and rapid nasogastric hydration in the emergency department are safe and effective alternatives to hospitalization for many children with viral gastroenteritis. Not only does this save money, it also saves a child the more frightening experience of being in a hospital overnight and the routine laboratory testing he or she would endure in the hospital setting.

Expected results

Gastroenteritis usually clears up within two to three days and there are no long-term effects. If dehydration occurs, recovery is extended by a few days.

Prevention

Gastroenteritis can be avoided by practicing good hygiene, which includes washing hands thoroughly after using the bathroom or coming in contact with an infected person, using disinfectants to clean areas the infected person has come in contact with, and washing infected linens in hot water. Making sure that food is well-cooked and unspoiled can prevent bacterial gastroenteritis, but may not be effective against viral gastroenteritis.

Heartburn

Heartburn is a burning sensation in the chest that can extend to the neck, throat, and face. It usually occurs after eating and is worsened by bending, lifting, or lying down.

Heartburn, sometimes called acid indigestion or gastroesophageal reflux, is very common. More than one third of the population suffers from occasional heartburn, as do about one half of pregnant women. Some 50 million adult Americans complain of frequent heartburn. The occurrence of heartburn generally increases with age; however, it is common—and often overlooked—in infants and children.

Heartburn occurs when digestive juices from the stomach move back up into the esophagus, the tube connecting the throat to the stomach. The upper third of the esophagus consists of skeletal muscle that propels the food downward. The lower two-thirds of the esophagus is smooth muscle. The lower esophageal sphincter (LES) is a thick band of muscle that encircles the esophagus just above the uppermost part of the stomach.


This sphincter is usually tightly closed—opening only when food passes from the esophagus into the stomach—and prevents the contents of the stomach from moving back into the delicate esophageal tissue. The stomach has a thick mucous coating that protects it from the strong hydrochloric acid it secretes to digest food. However the much-thinner esophageal mucous coating does not protect against stomach acid. Thus, if the LES opens inappropriately or fails to close completely, stomach acids can back up and burn the esophagus, causing heartburn.

Occasional heartburn is usually harmless. However, frequent or chronic heartburn (recurring more than twice per week) is called gastroesophageal reflux disease (GERD) and requires early management. Repeated episodes of GERD can lead to esophageal inflammation (esophagitis).

If the esophagus is repeatedly subjected to stomach acid and digestive enzymes, ulcerations, scarring, and thickening of the esophageal walls can result. This causes a narrowing of the interior of the esophagus that can affect swallowing and the peristaltic movements that send food downward. Repeated esophageal irritation also can result in Barrett’s syndrome—changes in the types of cells lining the esophagus. Barrett’s esophagus can develop into esophageal cancer.

Nighttime heartburn, affecting about 80% of heartburn sufferers, is more damaging to the esophagus than daytime heartburn. It often interferes with sleep and may trigger symptoms in asthma sufferers.

Gastroesophageal reflux may occur in children under age one, particularly pre-term babies or those with cerebral palsy. It also may be a cause of some migraine headaches. In addition, chronic heartburn can be a symptom of a gastric ulcer or coronary artery disease.

Causes & symptoms

Causes

Heartburn is caused by:

• a relaxed LES that does not close properly
• over-production of stomach acid
• increased stomach pressure
• a damaged esophagus with increased acid sensitivity

Many factors can contribute to LES malfunction:

• irregular eating, skipping meals
• smoking
• caffeine
• stress
• some medications, including diazepam (Valium), meperidine (Demerol), theophylline, morphine, prostaglandins, calcium channel blockers, nitrate heart medications, progesterone, and anticholinergic and adrenergic drugs (drugs that limit nerve reactions)
• paralysis and scleroderma (an autoimmune disease that hardens body organs)
• large meals that distend the stomach and prevent the LES from closing
• alcohol, which lowers the pressure on the LES, allowing it to relax and open. Alcohol also may irritate the esophageal lining
• weakening LES and loss of LES muscle tone with increasing age

Hiatal hernias are common among pregnant women, smokers, the obese, and those over age 50. The hiatus is an opening in the diaphragm (the large muscle that separates the chest cavity and the abdomen) through which the esophagus connects to the stomach.


If the hiatus loses its tautness and shape, the stomach may protrude through, forming a pocket just below the LES where stomach acid can be trapped. These hiatal hernias can cause the LES to relax and open. Hiatal hernias may result in frequent and severe heartburn and GERD.

Various factors can increase stomach pressure, causing gastroesophageal reflux:

• obesity
• lying down within one or two hours of eating
• tight clothing
• Pregnancy, which causes the enlarged uterus to displace the stomach, delaying the removal of stomach contents

Eating too fast, chewing insufficiently, and smoking all increase stomach acid production. Smoking also dries up saliva that protects the esophagus from acid.

Many foods are known to contribute to heartburn:

• greasy, fried, or fatty foods
• spicy foods
• black pepper
• such acidic foods as tomatoes, pickles, and vinegar
• chocolate
• coffee with or without caffeine
• Peppermint or other mints

Symptoms

Heartburn itself is a symptom of gastroesophageal reflux and GERD. Heartburn sufferers may salivate excessively or regurgitate stomach contents into their mouths, leaving a sour or bitter taste. Other symptoms of GERD include:

• difficult or painful swallowing
• sore throat
• hoarseness, laryngitis, wheezing, coughing
• pneumonia
• gingivitis, bad breath
• earache

Diagnosis

Heartburn usually is diagnosed by patient histories, symptoms, and clinical assessments. Additional procedures may be used to confirm the diagnosis, assess damage to the esophagus, and monitor the healing progress. The following diagnostic procedures are appropriate for anyone with frequent, chronic, or difficult-to-treat heartburn, or complicating GERD symptoms as listed above.

Esophageal manometry uses a thin flexible catheter placed down the esophagus. Small openings in the catheter sense pressure at various points on the esophagus while the muscle is at rest and during swallowing. The pressures are transmitted to a computer that analyzes the wave patterns.

An upper gastrointestinal (GI) series, or “barium swallow,” can reveal esophageal narrowing, ulcerations, tumors, hiatal hernia, or reflux episodes as they occur. X rays are taken after a patient swallows a barium (a chemical element) suspension. This procedure takes about 15 minutes. However, it cannot detect structural changes associated with different degrees of esophagitis.

Upper GI endoscopy uses a thin flexible tube to view the inside of the esophagus directly. It is performed by a gastroenterologist, a physician specializing in diagnosis and treatment of disorders of the gastrointestinal tract, or by a gastrointestinal endoscopist. Upper GI endoscopy enables the physician to distinguish the degree of esophagitis and provides an accurate profile of esophageal damage. This procedure may include a biopsy— the removal of a small piece of tissue—to examine for Barrett’s syndrome or malignancies. Patients with Barrett’s esophagus may have frequent examinations of the esophageal lining for early detection of precancerous cells.

Other diagnostic tests include measurements of esophageal acidity (pH), usually over a 24-hour period, using an ambulatory acid probe. The patient is given a large capsule containing an acid-sensing probe, a battery, and a transmitter. Acid in the esophagus is measured by the probe, which then transmits the information to a recorder that the patient is wearing on his belt.

Note: A burning sensation in the chest is usually heartburn and is not associated with the heart itself. About 15 percent of the annual six million U. S. emergency room visits for chest pain are due to heartburn. However, angina (one type of temporary chest pain, pressure, or discomfort) sometimes is mistaken for severe heartburn. Chest pain that radiates into the arms and is not accompanied by regurgitation is a warning sign of a possible serious heart problem. Persistent chest pain should always be evaluated by a physician.

Treatment

Herbal remedies

These herbal remedies may be used to treat heartburn:

• ginger (Zingiber officinalis) as a tea or candied. (Ginger may cause heartburn in some people.)
• chamomile (Matricaria chamomilla) tea
• slippery elm (Ulmus fulva) tea
• cinnamon tea
• anise (Pimpinella anisum), caraway, dill, and/or fennel seed tea
• cardamom (Elettaria cardamomum) on buttered raisin toast
• turmeric (Curcuma domestica) added to warm water
• marsh mallow root (Althaea officinalis)
• licorice (Glycyrrhiza glabra), especially deglycyrrhizinated licorice (DGL) (The capsules or tablets may be dissolved in the mouth or in tea or two to four chewable 380-mg. wafers are taken about 20 minutes before eating. DGL should not be used more than three times per week, as repeated use can be toxic.)
• peppermint tea (Peppermint also can cause heartburn by relaxing the LES.)
• Ayurvedic (traditional East Indian) herbs

Homeopathic remedies

Homeopathic remedies for heartburn include:

• Calcarea carbonica
• Nux vomica after eating spicy foods
• Carbo vegetalis after eating rich foods
• Arsenicum album (for burning pain)
• Natrum muriaticum (for nervousness, tension, and pain)
• Zinc metallicum after eating too fast

Other remedies

A variety of other remedies and therapies may be used to treat heartburn:

• Sodium bicarbonate (baking soda) reduces esophageal acidity immediately. However, its effect is short-lived and it should not be used by people on sodium-restricted diets.
• Nutritional remedies include carrots, celery, angelica, fennel, and/or parsley. These can be combined in a juice taken before meals.
• Acupressure points Stomach 36, Spleen 6, Pericardium 6, and Conception Vessel 12. CV 12 should not be pressed just after eating or during pregnancy.
• In Chinese medicine, foods and herbs that balance and cool the qi (Chinese term for universal life energy), including radishes, radish seed, citrus fruit peels, and cardamom.
• Walking after a meal.
• Chewing gum after eating to help produce saliva for soothing the esophagus and washing acid back into the stomach.
• Relaxation therapy, visualization, and deep breathing.

Allopathic treatment

Drugs

Occasional heartburn is commonly treated with nonprescription antacids that neutralize the pH of stomach acid. The neutralized acid does not burn the esophagus. Antacids usually work within 15 minutes and their effects last one to two hours. Liquid or dissolving antacids usually act faster than tablets. However, antacids, if taken for too long, can cause side effects, including diarrhea or constipation.

Some antacids interfere with medications for kidney or heart disease. Heartburn sufferers with two or more episodes per week, or with an episode lasting more three weeks, should not rely on antacids as the sole treatment, since they may be at risk of kidney damage or other metabolic changes.

Common antacids include Maalox, Mylanta, Alka-Seltzer, Pepto-Bismol, Riopan, and Rolaids. The active ingredient in antacids such as Tums is calcium carbonate. Alginate (Gaviscon) is a foaming agent that coats the esophagus and the stomach to help prevent reflux. Other antacids are made from aluminum hydroxide, magaldrate, or magnesium hydroxide. Some antacids contain baking soda (sodium bicarbonate), which may interfere with vitamin and mineral absorption during pregnancy.

Histamine receptor (H2) blockers, such as famotidine (Pepcid), ranitidine (Zantac), nizatidine (Axid), and cimetidine (Tagamet), decrease stomach acid secretion. They relieve heartburn in about 75% of users. However, they take 30 to 45 minutes to act and usually are taken two to four times daily for several weeks. H2 blockers are both over-the-counter (OTC) and prescription medicines. They may have side effects or interactions with other medications.

Proton pump inhibitors (PPI) are for severe heartburn. They are the most effective drugs for inhibiting acid production and allowing the esophagus to heal in GERD. It may take up to five days for PPIs to take effect. They cannot be used by people with kidney or liver problems. Although it appears safe to take PPIs for at least 10 years, the lowest effective dosage reduces the risk of side effects that may include headache, diarrhea, stomach pain, and interactions with other medications. Common PPIs include lansoprazole (Prevacid), omeprazole (Prilosec), rabeprazole (Aciphex), pantoprazole (Protonix), and esomeprazole (Nexium). Prilosec OTC is available in 20-milligram doses to be taken once a day for 14 days to treat frequent heartburn.

Prokinetics are drugs that strengthen the LES (lower esophageal sphincter) and increase the rate of stomach emptying. These include metoclopramide (Reglan) and bethanechol (Urecholine). These drugs frequently have side effects.

Surgery

Laparoscopic Nissen fundoplication is a surgical procedure to increase pressure on the LES by stretching and wrapping the upper part of the stomach around it. It is performed under general anesthetic and takes one to two hours. The complete recovery period is less than two weeks.

GERD (gastroesophageal reflux disease) may be treated successfully by endoscopic suturing of the weakened LES to stop acid reflux. Studies have shown that symptoms usually improve with this procedure and the use of medications declines. Another procedure involves using electrodes to make tiny cuts in the LES tissues. The resulting scarring tightens the LES. These outpatient procedures take less than an hour. They are not used in cases of hiatal hernia or Barrett’s esophagus.

If the esophagus has become narrowed and badly scarred from stomach acid, a procedure that stretches and widens the esophageal tissue may be used along with acid-suppressing medication. Enteryx is a liquid that can be injected into the LES where it forms a spongy muscle implant that strengthens the LES.

Prognosis

Occasional heartburn without esophageal damage has an excellent prognosis. Esophageal damage that is treated with a program that promotes healing also has an excellent prognosis. Infants usually outgrow gastroesophageal reflux by age one.

Untreated heartburn and GERD may lead to bleeding, esophageal ulcers, and infections. With treatment, the damaged tissue that forms ulcers can heal. About ten percent of patients with GERD experience esophageal narrowing from acid damage that leads to the formation of scar tissue in the lower esophagus. GERD also can cause laryngitis, bronchitis, and aspiration pneumonia.

After five years of heartburn, the risk of developing Barrett’s esophagus increases. About five percent of GERD patients have Barrett’s syndrome. This condition is incurable and may lead to cancer. The prognosis for esophageal cancer is very poor. There is a strong likelihood of painful illness and a less than five percent chance of survival for more than five years.

Prevention

Due to the risk of GERD, Barrett’s syndrome, and esophageal cancer, prevention of heartburn is very important. Heartburn usually is preventable with dietary and lifestyle changes.

Dietary adjustments to eliminate many causes of heartburn include:

• eating smaller, more frequent meals to reduce pressure on the LES
• eating slowly, chew thoroughly, and take deep breaths between bites
• avoiding caffeine, chocolate, onions, spicy foods, and mint, all of which tend to increase stomach acid and relax the LES
• avoiding fatty, fried, and greasy foods. Fatty foods relax the LES and slow stomach emptying, and fat consumption has been linked to GERD
• avoiding milk, garlic, peppers, and carbonated beverages
• avoiding nicotine
• avoiding citrus fruits and juices and tomato-based foods, which are acidic and can irritate an inflamed esophagus
• replacing meat at dinner with carbohydrates and easier to digest proteins such as rice, beans, and pastas
• avoiding alcohol
• adding the spice annato (Bix orellana) or bouquet garni to foods
• drinking tea made with crushed caraway seeds with meals
• controling body weight

Lifestyle changes that can alleviate heartburn include:

• avoiding drugs known to contribute to heartburn, including aspirin or other nonsteroidal anti-inflammatories
• avoiding clothing that fits tightly around the abdomen
• not lying down until the stomach is empty—within about three hours of eating
• elevating the head of the bed six to nine inches to prevent nighttime heartburn
• avoiding strenuous exercise for two to three hours after a meal