Food Sensitivities - Food Is Not The Root Cause Of The Problem

I am honored to have been a guest to talk about food sensitivities on Facebook Live with NourishDoc!

We covered a lot of ground, including:

What are food sensitivity, Food Allergy, and Food intolerance?

Food sensitivity is an IgG immune response, and it can cause gut symptoms (nausea, bloating, gas, belching, stomach pain, cramps), headaches, skin rashes and flares, brain fog, irritability, fatigue, nervousness, trouble sleeping, joint aches and pains (and more), and points to gut dysfunction and leaky gut. Reactions are not life-threatening and tend to be delayed. They can be delayed by 2-3 days! Food sensitivities often are dose-related; people with food sensitivities may not have symptoms unless they eat a large portion of the food or eat the food frequently. 

Food allergy is an IgE immune response, and it can cause hives, rash, itching, rashes and flares, gut symptoms (nausea, cramping, stomach pain, vomiting), trouble breathing, swelling of the airways to the lungs, and anaphylaxis (a serious and potentially fatal allergic reaction), and can be life-threatening. Reactions are typically immediate or within an hour.  Food allergies can be triggered by even a small amount of food and occur every time the food is consumed. People with food allergies are generally advised to avoid the offending foods completely, depending on the severity of the allergy.

Food intolerance is a digestive system response rather than an immune system response. Food intolerance can cause symptoms like an IgG reaction and also isn’t life-threatening. It results from an inability of your body to appropriately metabolize (break down) a food or foods, and it won’t show up on IgE or IgG testing. A common example is lactose intolerance which occurs when your small intestine doesn't produce enough of an enzyme (lactase) to digest milk sugar (lactose). Food intolerances often are dose-related; people with food intolerance may not have symptoms unless they eat a large portion of the food or eat the food frequently. 

What are the causes of food sensitivities?

If there are food sensitivities, there is increased gut permeability. When there are gut problems (problems with digestion and absorption and/or gut dysbiosis, which means abnormal, imbalanced gut flora, and can involve viral/bacterial/fungal/parasitic overgrowth, for example), and keep in mind there might not even be any gut symptoms, inflammation can develop in there leading to hyperpermeability of the gut lining. This allows toxins to escape from the gastrointestinal tract and enter the bloodstream (including endotoxins from gut bugs, and food proteins), leading to an environment of systemic inflammation. Once these toxins and food proteins are in the bloodstream they can trigger the immune system, and all sorts of health problems, including skin conditions, food allergies, and food sensitivities.  

And because it’s not just food proteins in the bloodstream, it’s also endotoxins, we may be erroneously blaming food! A study in a 2019 paper in Nature, by Reddel and colleagues, found that higher levels of certain gut bugs lead to the ongoing production of endotoxins called lipopolysaccharides (LPS). LPS trigger those inflammatory responses and increase gut permeability, underlying problems with eczema.

Something else to keep in mind is that our bodies run off of nutrients from the foods we eat. We need nutrients in order to build and repair healthy skin, as well as to grow, develop, repair, function, and thrive. When nutrients are missing the body doesn't have the fuel it needs to do everything that it needs to do, including building and repairing healthy skin. It's counterintuitive what we're led to believe. We are led to believe that if we take more and more foods out of our diet that we will get a resolution of symptoms and health problems, and this is simply not the case. 

Many clients I see, by the time I see them, have been on limited diets for extended periods of time, and their symptoms have gotten worse. This is not a coincidence. What happens is someone takes foods out of the diet and has improvements for a time. But the underlying issue which is gut hyperpermeability is still present. Over time more food sensitivities are going to develop, and the diet will get smaller and smaller. That's because food is not the root cause of the problem. 

How are food sensitivities Identified?

There is a wide range of IgG tests available. An elimination diet is also often used to identify food sensitivities.

A true elimination diet is undertaken for somewhere between 21 to 30 days in order to identify foods that trigger symptoms.  After that amount of time, the idea is to reintroduce foods one at a time and in a controlled manner to determine if they are symptom triggers. Because reactions can be delayed it can be tricky to identify offending foods. Keeping a food diary can help. Record what you eat and when you get symptoms, and then look for common factors.

A short-term elimination diet carried out appropriately can be helpful to identify trigger foods. You can remove triggering foods from the diet while working to address the underlying cause of the problem. I do not advocate for long-term restrictive diets of any kind. They can be devastating in children who are growing and developing. Of course, processed foods, added sugars, IgE foods are exceptions. If whole, real foods are triggering symptoms, it's important to explore why. Again food isn't the root cause of the problem, and removing food after food from the diet is not the answer! 

When it comes to food sensitivity testing, I do not typically recommend it. If someone is sensitive to many different foods taking more and more of them out of the diet is not the solution to the problem, and too often I see a fear of food developing in people of all ages, including very young children. We need to set our children up from the beginning for a healthy relationship with food. We've got to look deeper, at the gut. I recommend that deeper look at gut health as the place to focus resources, rather than on food sensitivity testing.  Also, I find that food sensitivity testing often picks up foods people never eat!

How are food allergies Identified?

Allergic reactions can be IgE, non-IgE (like IgG sensitivity), or both. 

There’s also a difference between sensitization and actual allergy. Sensitization is when someone makes IgE antibodies against an allergen. This can be tested for by skin prick, or specific IgE in the blood. BUT the person may not actually have a clinical allergy, which is when there are symptoms when exposed to the allergen. 

Skin prick testing is considered the gold standard for identifying allergens like pollen or spores. The gold standard for identifying food allergens is an oral food challenge, but doctors use skin prick and blood testing to identify food allergy too.

Blood testing for total IgE and absolute eosinophil count aren’t helpful for identifying allergies because they can be high with other health problems.

You can blood test for specific IgE allergens, BUT false positives are common because of cross-reactivity between them (proteins in different allergens resemble each other). 

For skin testing, the patch test is used for identifying delayed hypersensitivity reactions like contact dermatitis. The skin prick test is used when IgE reactions are suspected, like eczema, hives, food allergies, and anaphylaxis. 

What foods are good for someone with food sensitivities?

A diet of whole real foods is good for everyone! You can remove identified, only identified, trigger foods from the diet while you work to address the underlying cause of the problem. If you aren’t sure if a food is causing symptoms or not, don’t blame the food.

How do diet and nutrition help food sensitivities?

Diet diversity = microbiome diversity = gut health/gut integrity = less chance for food sensitivities!

Diet diversity means eating a variety of foods from all food groups and categories of foods. Vary protein sources (eggs, chicken, fish, beef, pork, etc.), vegetables (different colors and textures), and carbs (starchy vegetables and root vegetables, quinoa, rice, and other whole grains). A diverse diet feeds good gut bugs, and a diverse gut microbiome confers health benefits, including a healthy gut and gut integrity. This results in a lower risk for food sensitivities.

Guide To Probiotics For Skin Rashes

Gut-Skin Connection

When we say “gut microbiome” we are referring to all the microbes, like bacteria, fungi, protozoa, and viruses, that live on and inside the digestive tract.

Our gut microbiome is essential for digestion, nutrition, detoxification, immune function, and overall health and wellness.

The gut microbiome plays a role in whether or not other organ systems, like the skin, function the way they should. Check this out:

• Gut bacteria play a role in the development of a strong, healthy immune system, especially during the first 3 years of life. If this process is interrupted, it can result in allergic conditions like eczema, and food allergies, and asthma.(1)

• Levels of good gut bugs tend to be lower and levels of not-so-good ones higher in people with eczema when compared to levels in people without eczema.(1)

• Colonization of the gut with C. difficile early in life can lead to eczema.(1)

• Rashes like eczema are inflammatory conditions. Good gut bugs and "stuff" they produce lower inflammation, and not-so-good gut bugs produce "stuff" that increases inflammation.(2) 

Short-chain fatty acids (SCFAs) are an example. They are anti-inflammatory and made by gut bugs when they ferment dietary fiber. This is why it's important to eat prebiotic foods like quinoa, sweet potatoes, and other starchy and non-starchy vegetables. 

SCFAs play an important role in determining the makeup of the skin bugs you have too (we have a skin microbiome also), which then influences the immune function of the skin. When these bugs are out of balance the skin barrier can become damaged, and a damaged skin barrier is a problem with rashes like eczema.(2) 

Also, in cases of leaky gut (an underlying problem with skin rashes), gut bacteria and "stuff" they produce can get out of the gut and into the bloodstream, accumulate in the skin, and disrupt your skin's healthy balance leading to rashes and rash flares.(2)  

This process causes inflammation throughout the body too, triggering the immune system to go nutty, leading to inflammatory conditions like eczema.(2) 

Not only does "stuff" from gut bugs get into the bloodstream, so do food particles and this is what causes food sensitivities. That's right, food sensitivities are really just another symptom of gut problems. They are a trigger for rashes, but not a root cause.

Probiotics For Chronic Skin Disease

Probiotics are live microorganisms (typically bacteria or yeast) that can provide health benefits when consumed, generally by improving or restoring the gut microbiome. Probiotics are considered generally safe but may cause problems in some people and in some cases.

Probiotic benefits include reducing skin inflammation,(3) and lessening the severity of illness and disease when taken in high enough doses.(4)

Probiotics for atopic dermatitis

The establishment of the gut microbiome early in life plays an important role in the activation of the immune system. If this process is compromised, an imbalanced immune response can result, leading to inflammation, and this can contribute to the development of eczema.(5) 

Probiotics can suppress this inflammatory response.

The benefits of probiotics have been widely explored for the prevention and treatment of eczema. For example, supplementing mom with Bifidobacterium breve M-16V and Bifidobacterium longum BB536 during pregnancy, and mom and baby during the first 18 months of life may lower the incidence of eczema.(6,7)

L. rhamnosus supplementation for mom during pregnancy may lower chances of baby developing eczema for the first 11 years of life, and may protect children from developing other atopic conditions like asthma, hay fever, and allergies.(8) 

Probiotics for psoriasis

Lactobacillus pentosus GMNL-77 supplementation in an animal study led to improved skin symptoms with psoriasis. This probiotic strain also suppressed inflammation associated with psoriasis.(9)

Supplementation with Bifidobacterium infantis 35624, also may decrease levels of inflammation in psoriasis.(10) 

Another probiotic to show promise in psoriasis is Lactobacillus sporogenes. There was a case study on this where a woman with psoriasis that wasn’t getting improvements with typical, conventional treatments (like steroids and methotrexate) did get improvement in her skin symptoms after supplementing with this strain for 2 weeks, and then with ongoing use, symptoms continued to improve.(11)

Probiotics for acne

A small Italian study found that supplementing with a probiotic combination of Lactobacillus acidophilus and Bifidobacterium bifidum reduced acne in study participants.(12)

It has been shown that probiotic supplementation in addition to an antibiotics (like tetracycline, often used for acne) may reduce acne more than using antibiotics alone.(13) 

Probiotics for rosacea

More research is needed to better understand how probiotics could support people with rosacea. There are connections between gut dysbiosis and rosacea(14), so addressing gut imbalances, including using probiotics, can be helpful.

Using Food To Support The Gut Microbiome

Probiotic Foods

Fermented foods are probiotics and they contain live active microbes. Examples are yogurt, kefir, miso, kimchi, and sauerkraut.(15) Baby and child can even have a teaspoon or so of the liquid from sauerkraut and kimchi for example.

Prebiotic Foods

Prebiotics are non-digestible components of food, like fiber, that feed gut microbes. Prebiotics can influence the activity of gut microbes, and therefore influence our health.(16) 

For example, anti-inflammatory SCFAs are made by good gut bugs when they ferment prebiotics. SCFAs lower the production of toxins from gut bugs, suppress inflammatory immune responses, and increase IgA levels in the gut, which helps strengthen the immune system.(17) All of this is important to consider with skin conditions because of the gut skin connection.

While there are prebiotic supplements available like inulin,(18) arabinogalactan,(19) and guar gum,(20) a food first approach is preferred. Foods rich in prebiotics include chicory, Jerusalem artichoke, garlic,(21) onions, shallots, and spring onion, leeks, chickpeas, lentils, beans, bananas, grapefruit, almonds, flaxseed, bran, and oats.(22) 

Many prebiotic-rich foods are considered fermentable FODMAP foods, thus they can contribute to gastrointestinal symptoms and maybe contraindicated in certain people for a period of time.(23) This can be the case in people that have small intestinal bacterial overgrowth (SIBO) for example.

Applying The Research In Clinical Practice

Babies and Children, versus adults

What we do in babies and children is very different from what we do in adults. Additionally, the gut microbiome changes throughout life, and certainly changes during different life stages. This is why it's important to work with a practitioner familiar with these factors rather than making a go at it on your own.  No supplement is benign!

What probiotics I use most and why 

Did you know the wrong probiotic can make your child’s rashes worse? True story! Certain bacteria strains, including those found in many probiotic supplements, can increase levels of histamine in the body. When your child is struggling with rashes (and food reactions), histamine is already a problem. Adding more can throw fuel on the fire and make symptoms worse. Stop guessing which probiotic to use, get my FREE Guide “The probiotic mistake you’re making that’s flaring your child’s rashes” to find out which probiotics to avoid, and which to try instead.

We can also dial in even more specifically which probiotic is right for your child when we use a comprehensive digestive stool test (GI Map is my go-to here) to find out what’s happening in the gut. This testing is so essential that I include it with my one-on-one services, and you can get it at a discount with Conquer Your Child’s Rashesᵀᴹ (CYCRᵀᴹ) Online.

What About prebiotics

While probiotics introduce bacteria into the gut, prebiotics feed what's already there.

Prebiotic supplements are available. Some that I use with clients include inulin,(18) arabinogalactan,(19) and guar gum.(20)

I don’t always recommend a prebiotic supplement for my clients. It's dependent on our test findings. I do always recommend eating prebiotic foods like chicory, Jerusalem artichoke, garlic,(21) onions, shallots, and spring onion, leeks, chickpeas, lentils, beans, bananas, grapefruit, almonds, flaxseed, bran, and oats.(22) 

Also, different prebiotic sources, whether from supplements or foods, could be symptom triggering with some gut imbalances. Many prebiotic foods are considered fermentable FODMAP foods, thus they can contribute to symptoms and may be contraindicated in certain people for a period of time.(23) This can be the case in people that have small intestinal bacterial overgrowth (SIBO) for example.

This is why testing to see what’s in there first is always a good idea.

Why we start with food 

You can’t out supplement a diet lacking in the first place. Food, barring food allergies and/or sensitivities, is a safe way to introduce nutrients, including probiotics (and prebiotics).

Some people however do struggle with histamine issues, in which case fermented foods might be triggering (this includes foods typically recommended for gut healing like bone broth, kefir, and sauerkraut).

However, even in my clients with histamine issues, there is a threshold (usually) so raw fermented foods like sauerkraut can be ok.

Certain probiotic supplements can increase histamine too (more on this below).

I find that typically in those with histamine sensitivities, it’s due to gut bug imbalances because certain bacteria produce histamine, and others degrade it. When we resolve gut imbalances, histamine can become a non-issue.

What to do/use if pregnant and/or nursing

Based on the research for eczema, supplementing mom with Bifidobacterium breve M-16V and Bifidobacterium longum BB536 during pregnancy, and mom and baby during the first 18 months of life may lower the incidence of eczema.(6,7)

L. rhamnosus supplementation for mom during pregnancy may lower chances of the baby developing eczema for the first 11 years of life, and may protect children from developing other atopic conditions like asthma, hay fever, and allergies.(8) 

Why we need to test

Preferably even before starting a probiotic (because no supplement is benign) we test. Depending on what's happening in the gut, the wrong probiotic can make things worse by contributing to overgrowth for example, or by increasing histamine levels.

Gut bacteria, Histamine, and Probiotics

Gut bacteria might be contributing to your histamine-related symptoms, or might even be the root cause of them!

Bacteria play a role in producing and breaking down histamine. This ability is strain-specific and doesn’t apply to all strains within a species(29,30). Many probiotics purchased over the counter contain strains of bacteria that make histamine(29,30). This is why I’ve seen some clients’ symptoms worsen when they start taking a probiotic that is wrong for what’s happening with them.

Stop guessing which probiotic to use, get my FREE Guide “The probiotic mistake you’re making that’s flaring your child’s rashes” to find out which probiotics to avoid, and which to try instead.

Because bacteria play such a prominent role in histamine levels in the body, resolving imbalances in gut bacteria can address the root cause of histamine intolerance.

Why too much of a good thing is not a good thing

Excessive intake of probiotics can cause overgrowths/dysbiosis. I’ve had clients excessively consume probiotic foods and supplements, and induce gut symptoms and problems.  

References 

1. Kim J, Kim H. Microbiome of the Skin and Gut in Atopic Dermatitis (AD): Understanding the Pathophysiology and Finding Novel Management Strategies. J Clin Med. 2019;8(4):444. doi:10.3390/jcm8040444

2. Salem I, Ramser A, Isham N, Ghannoum MA. The Gut Microbiome as a Major Regulator of the Gut-Skin Axis. Front Microbiol. 2018;9:1459. doi:10.3389/fmicb.2018.01459

3. Arck P, Handjiski B, Hagen E, et al. Is there a ‘gut-brain-skin axis’? Exp Dermatol. 2010;19(5):401-405. doi:10.1111/j.1600-0625.2009.01060.x

4. Hill C, Guarner F, Reid G, et al. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol. 2014;11(8):506-514. doi:10.1038/nrgastro.2014.66

5. Rather IA, Bajpai VK, Kumar S, Lim J, Paek WK, Park Y-H. Probiotics and Atopic Dermatitis: An Overview. Front Microbiol. 2016;7. doi:10.3389/fmicb.2016.00507

6. Rautava S, Kainonen E, Salminen S, Isolauri E. Maternal probiotic supplementation during pregnancy and breast-feeding reduces the risk of eczema in the infant. J Allergy Clin Immunol. 2012;130(6):1355-1360. doi:10.1016/j.jaci.2012.09.003

7. Enomoto T, Sowa M, Nishimori K, et al. Effects of Bifidobacterial Supplementation to Pregnant Women and Infants in the Prevention of Allergy Development in Infants and on Fecal Microbiota. Allergol Int. 2014;63(4):575-585. doi:10.2332/allergolint.13-OA-0683

8. Wickens K, Barthow C, Mitchell EA, et al. Effects of Lactobacillus rhamnosus HN001 in early life on the cumulative prevalence of allergic disease to 11 years. Pediatr Allergy Immunol. 2018;29(8):808-814. doi:10.1111/pai.12982

9. Chen Y-H, Wu C-S, Chao Y-H, et al. Lactobacillus pentosus GMNL-77 inhibits skin lesions in imiquimod-induced psoriasis-like mice. J Food Drug Anal. 2017;25(3):559-566. doi:10.1016/j.jfda.2016.06.003

10. Groeger D, O’Mahony L, Murphy EF, et al. Bifidobacterium infantis  35624 modulates host inflammatory processes beyond the gut. Gut Microbes. 2013;4(4):325-339. doi:10.4161/gmic.25487

11. Vijayashankar M, Raghunath N. Pustular psoriasis responding to Probiotics – a new insight. Our Dermatol Online. 2012;3(4):326-329. doi:10.7241/ourd.20124.71

12. Marchetti F, Capizzi R, Tulli A. [Efficacy of regulators of the intestinal bacterial flora in the therapy of acne vulgaris]. Clin Ter. 1987;122(5):339-343.

13. Jung GW, Tse JE, Guiha I, Rao J. Prospective, Randomized, Open-Label Trial Comparing the Safety, Efficacy, and Tolerability of an Acne Treatment Regimen with and without a Probiotic Supplement and Minocycline in Subjects with Mild to Moderate Acne. J Cutan Med Surg. 2013;17(2):114-122. doi:10.2310/7750.2012.12026

14. Weiss E, Katta R. Diet and rosacea: the role of dietary change in the management of rosacea. Dermatol Pract Concept. 2017;7(4):31-37. doi:10.5826/dpc.0704a08

15. Scourboutakos MJ, Franco-Arellano B, Murphy SA, Norsen S, Comelli EM, L’Abbé MR. Mismatch between Probiotic Benefits in Trials versus Food Products. Nutrients. 2017;9(4). doi:10.3390/nu9040400

16. Tuohy KM, Brown DT, Klinder A, Costabile A, Fava F. Chapter 5 - Shaping the Human Microbiome with Prebiotic Foods – Current Perspectives for Continued Development**This is an update of: “Shaping the human microbiome with prebiotic foods – current perspectives for continued development.” Food Science and Technology Bulletin 2010; 7(4): 49–64. Available from: http://dx.doi.org/10.1616/1476-2137.15989 handle: http://hdl.handle.net/10449/19776. Re-published with the permission of International Food Information Service (IFIS Publishing). In: Tuohy K, Del Rio D, eds. Diet-Microbe Interactions in the Gut. Academic Press; 2015:53-71. doi:10.1016/B978-0-12-407825-3.00005-8

17. Rusu E, Enache G, Cursaru R, et al. Prebiotics and probiotics in atopic dermatitis (Review). Exp Ther Med. Published online June 14, 2019. doi:10.3892/etm.2019.7678

18. Spritzler F. What to know about inulin 101, a powerful prebiotic. Medical News Today. Published August 1, 2017. Accessed April 22, 2020. https://www.medicalnewstoday.com/articles/318593

19. Larch Arabinogalactan. WebMD. Accessed April 22, 2020. https://www.webmd.com/vitamins/ai/ingredientmono-974/larch-arabinogalactan

20. Mudgil D, Barak S, Patel A, Shah N. Partially hydrolyzed guar gum as a potential prebiotic source. Int J Biol Macromol. 2018;112:207-210. doi:10.1016/j.ijbiomac.2018.01.164

21. Chen K, Xie K, Liu Z, et al. Preventive Effects and Mechanisms of Garlic on Dyslipidemia and Gut Microbiome Dysbiosis. Nutrients. 2019;11(6):1225. doi:10.3390/nu11061225

22. What prebiotic foods should people eat? Medical News Today. Published October 1, 2018. Accessed April 22, 2020. https://www.medicalnewstoday.com/articles/323214

23. Sloan TJ, Jalanka J, Major GAD, et al. A low FODMAP diet is associated with changes in the microbiota and reduction in breath hydrogen but not colonic volume in healthy subjects. Green J, ed. PLOS ONE. 2018;13(7):e0201410. doi:10.1371/journal.pone.0201410

24. Tung JM, Dolovich LR, Lee CH. Prevention of Clostridium difficile Infection with Saccharomyces boulardii : A Systematic Review. Can J Gastroenterol. 2009;23(12):817-821. doi:10.1155/2009/915847

25. Namkin K, Zardast M, Basirinejad F. Saccharomyces Boulardii in Helicobacter Pylori Eradication in Children: A Randomized Trial From Iran. Iran J Pediatr. 2016;26(1). doi:10.5812/ijp.3768

26. Vitetta L, Saltzman E, Nikov T, Ibrahim I, Hall S. Modulating the Gut Micro-Environment in the Treatment of Intestinal Parasites. J Clin Med. 2016;5(11):102. doi:10.3390/jcm5110102

27. Stier H, Bischoff S. Influence of Saccharomyces boulardii CNCM I-745 on the gut-associated immune system. Clin Exp Gastroenterol. 2016;Volume 9:269-279. doi:10.2147/CEG.S111003

28. McFarlin BK, Henning AL, Bowman EM, Gary MA, Carbajal KM. Oral spore-based probiotic supplementation was associated with reduced incidence of post-prandial dietary endotoxin, triglycerides, and disease risk biomarkers. World J Gastrointest Pathophysiol. 2017;8(3):117. doi:10.4291/wjgp.v8.i3.117

29. Tee A. Probiotics for Histamine Intolerance: What You Need to Know. Available from https://factvsfitness.com/probiotics-histamine-intolerance/. Accessed June 1, 2021.

30. Ahmed S. Which probiotics for histamine intolerance? November 29, 2018. Available from https://www.optibacprobiotics.com/professionals/latest-research/general-health/which-probiotic-for-histamine-intolerance#:~:text=Certain%20types%20of%20bacteria%20can,no%20direct%20effect%20on%20histamine.&text=The%20ability%20to%20produce%20or,all%20strains%20within%20one%20species. Accessed June 1, 2021.

Relief From Reflux

Photo credit: freestocks.org

What is reflux:

Reflux is the backward flow of stomach acid and other contents from your gut into your esophagus (the tube that connects your throat and stomach), and it’s a sign of gut problems. It can cause chronic symptoms and damage to the delicate mucosal tissue of your esophagus.

Reflux symptoms are one of the most common complaints to primary care doctors in Western countries, and reflux is a risk factor for erosive esophagitis, and Barrett’s esophagus (which is associated with an increased risk for esophageal cancer).

Acid blocking and acid reducing medications:

Because reflux is so common, its treatment has been the target of aggressive pharmaceutical marketing to healthcare professionals and consumers. You’re likely familiar with acid blocking and acid reducing medications like Zantac, Prilosec, Tagamet, and Pepcid (PPIs and H2 blockers).

Medications that block and lower stomach acid are often considered a first line of defense against reflux symptoms. These medications however do not address the root cause of the reflux, leaving it unchecked and able to continue to cause damage.

Long term use of acid blocking and reducing medications, and low stomach acid levels impairs gut health and your ability to digest and absorb nutrients from foods you eat.

Use of these medications is associated with osteoporosis, depression, deficiencies of vitamin B12 and a variety of minerals, small intestinal bacterial overgrowth (SIBO), irritable bowel syndrome (IBS), pneumonia, and an increased risk of a variety of gut pathogens.

Reflux is often due to low stomach acid rather than high, and the symptoms are similar. Lowering acid levels further with medications makes the problem worse, and increases your risk for additional health problems.

You need stomach acid:

Without adequate stomach acid you can’t digest and absorb nutrients from foods you eat. Amino acids from proteins, vitamin B12, iron and zinc are examples of important nutrients you can become deficient in with low stomach acid levels.

Amino acids are the building blocks for everything in your body, down to the intracellular level. Even your DNA.

Vitamin B12 deficiency can result in irreversible nerve damage.

You need adequate iron levels to help your blood cells carry oxygen to all the tissues in your body.

Zinc is necessary for wound healing, the production of hormones, and for a strong immune system.

Your body runs off of nutrients from foods you eat. They are your fuel. When they are missing, imbalances develop and symptoms and health problems follow. Gut problems and low stomach acid can cause nutrient insufficiency and deficiency, because if you can’t digest, and absorb nutrients from foods you eat, no nutrition plan will help meet your body’s need for fuel. The fact is, you aren’t what you eat, you are what your body can do with what you eat.

Respiratory reflux:

Respiratory reflux occurs when contents from your gut irritate respiratory structures and cause symptoms like chronic coughing, feeling like something is stuck in your throat, frequent throat clearing, a bitter taste in the back of your throat, and difficulty swallowing. You may have symptoms like these, and not make the connection to reflux and your gut health, because you aren’t experiencing typical reflux symptoms.

Respiratory reflux symptoms can be caused by refluxed acid, and also by nonacid contents like pepsin that come up with the acid. If you suffer from symptoms like these and find that acid reducing and acid blocking medications and the typical reflux treatments don't help much, it might be that the nonacid contents are causing the symptoms you’re experiencing.

Natural approach:

You can address reflux naturally with diet, lifestyle, and other nutritional interventions that identify root causes of the problem, and restore your gut health.

Diet:

Diet changes can be helpful for managing symptoms. Common reflux trigger foods:

• Caffeine

• Alcohol

• Chocolate

• Garlic

• Onions

• Mint

• Spicy foods

• Fried foods

• Fatty foods

• Citrus

• Tomato based products

• Highly processed foods

• Junk food

• Carbonated beverages including fizzy water

A diet of whole, real foods, rich in plant foods and high in fiber often can resolve the problem. If you need guidance on what to eat, my nutrition recommendations can help.

Specific foods that may help with symptoms:

• Bananas

• Oatmeal

• Leafy greens

• Yogurt

• Ginger

Food sensitivities:

Keep in mind that food sensitivities are not the root cause of your symptoms and health problems. They are a symptom of gut problems. Continuing to remove foods from your diet can lead to nutrient insufficiency and deficiency over time. Your body runs off of nutrients from foods you eat, and when they are missing because they are not being included in your diet, imbalances will develop and symptoms and health problems follow. Elimination diets, and ‘healthy’ diets that remove foods, food groups and categories of foods may be guilty of robbing your body of the fuel it needs to function.

Lifestyle interventions:

• Maintain a healthy weight

• Stop smoking

• Don’t lie down after a meal, wait at least 3 hours

• Eat slowly and chew thoroughly

• Avoid tight fitting clothing, which may put pressure on your abdomen and LES (lower esophageal sphincter)

• Elevate the head of your bed when sleeping by 6 to 9 inches, a mattress elevator can be helpful:

• ‘Cooling’ may help, in particular a cooling pillow for sleeping:

Stress:

Stress management is important when it comes to reflux and gut health. Stress can cause reflux, the severity of reflux correlates with the degree of stress, and stress causes changes in stomach acid secretion (can increase it or lower it, depending on the individual).

Stress can lead to leaky gut, and nutrient insufficiency and deficiency. Chronic physical, chemical, and emotional stress burns through nutrients and steals them from other needs your body has.

Other medications:

There are many medications that can worsen reflux symptoms by altering gut motility, contributing to dysbiosis (abnormal gut bacteria, overgrowths, undergrowths and infections in the gut), and reducing LES tone (the valve that stops gastric contents from coming back up into the esophagus becomes weak).

Medications that make reflux worse:

• Antibiotics like tetracycline and clindamycin

• Anticholinergics

• Sedative/hypnotics (benzodiazepines)

• Tricyclic antidepressants

• Theophylline

• Prostaglandins

• Calcium channel blockers

• Alpha adrenergic blockers

• Beta adrenergic blockers

• Nitrates

• Progesterone

• Steroids

• Aspirin

• NSAIDs

• Sustained release potassium

• Bisphosphonates

• Iron and potassium supplements

If you are on medications that you suspect are worsening your symptoms, talk to your doctor.

Gut problems:

H. pylori (a normal bacterial inhabitant in your gut) has been identified as a cause of stomach ulcers, but also is linked to reflux. H. pylori can be benign, but it can overgrow and cause symptomatic infection. Infection with H. pylori can lead to chronic gastritis, which can progress to stomach cancer.

Dysbiosis can be caused by a variety of factors. Low stomach acid levels is a common one. It allows gut flora to become imbalanced, overgrown, and infected. This causes inflammation in your gut, which increases permeability of your gut lining leading to leaky gut. Leaky gut causes food sensitivities, digestive symptoms, skin rashes, chronic fatigue, autoimmune disease, and a variety of chronic symptoms and health problems. This scenario also can cause, and aggravate reflux.

Restore your gut health:

Restoring normal gut function is a cornerstone of overall health and wellness. Eighty percent of your immune system is located in your gut microbiome, so when your gut health is impaired it can negatively impact your entire body, and cause symptoms and health problems like those mentioned, including others that don’t seem to involve your gut at all.

If you struggle with reflux and haven’t been able to get relief, get professional guidance.