NMT150 Nut Week 11 PDF

PERSISTENT GERD & GI symptoms AUTHOR: DR. MARYAM YAVARI, MD, PH.D., ND NMT150 2023 LEARNING OBJECTIVES Considerations for providing nutritional guidance as it relates to this week’s case presentation: Addressing underlying causes Improving gut health Promoting health...

PERSISTENT GERD & GI symptoms AUTHOR: DR. MARYAM YAVARI, MD, PH.D., ND NMT150 2023 LEARNING OBJECTIVES Considerations for providing nutritional guidance as it relates to this week’s case presentation: Addressing underlying causes Improving gut health Promoting healthy digestion TREATMENT GOALS Addressing underlying causes (e.g., food sensitivities, stress) Improving gut health Promoting healthy digestion DIETARY STRATEGIES FOR MANAGING GERD Avoiding trigger foods (e.g., acidic, spicy, fatty) Eating smaller, more frequent meals Consuming low-allergen, nutrient-dense foods General Recommendations Avoid eating before bed Eat slowly and chew thoroughly Sit up straight while eating Wait to exercise after eating General Recommendations Avoid trigger foods: Certain foods can trigger GERD symptoms. Some common trigger foods include spicy or fatty foods, acidic foods (such as citrus fruits and tomatoes), caffeine, and chocolate. It's best to avoid these foods or limit the intake. Limit alcohol and carbonated beverages General Recommendations Avoid eating before bedtime: eating a large meal before bedtime can increase the likelihood of acid reflux symptoms. It's best to avoid eating at least three hours before bedtime. Raise the head of the bed Chew gum Drink water  RECOMMENDED FOODS A systematic review of dietary interventions for GERD: The study included 72 articles from 10 Western countries and 9 Eastern countries. Dietary factors were categorized into 20 items and lifestyle factors into 11 items. GERD is related to irregular dietary and lifestyle habits, such as midnight snacking, skipping breakfast, eating quickly, eating very hot foods, and eating beyond fullness. https://pubmed.ncbi.nlm.nih.gov/33883899/  RECOMMENDED FOODS Vegetarian diets and no intake of meat were negatively related to GERD, while daily meat, fish, and egg intake, as well as high-fat diet consumption, were positively related to GERD. An interval of less than three hours between dinner and bedtime was positively related to GERD, while proper physical exercise was negatively correlated with GERD. Smoking, alcohol consumption, and poor mental state were positively correlated with GERD. Antioxidant intake was generally negatively correlated with GERD. https://pubmed.ncbi.nlm.nih.gov/33883899/  RECOMMENDED FOODS Intermittent fasting may be recommended, especially in overweight-obese patients with GERD symptoms who are poor responders to gastric acid inhibitors. https://www.medscape.com/viewarticle/984377#:~:text=%22Intermittent%20fasting%20may%20be%20recommended,work%20in %20patients%20with%20GERD.%22 SPECIFIC NUTRIENTS FOR GERD MANAGEMENT Magnesium Zinc Carnosine Vitamin 12  MAGNESIUM A population-based case–control study: individuals consuming the highest amounts of Mg from foods had significant reductions in the odds of reflux oesophagitis and Barrett’s oesophagus compared with individuals consuming the lowest amounts of Mg. Dai Q, Cantwell MM, Murray LJ, Zheng W, Anderson LA, Coleman HG. Dietary magnesium, calcium: magnesium ratio and risk of reflux oesophagitis, Barrett’s oesophagus and oesophageal adenocarcinoma: a population-based case–control study. British Journal of Nutrition. 2016 Jan;115(2):342-50.  Zinc Carnosine Zinc carnosine supports the gastrointestinal system by protecting its mucus membrane , aiding in the repair of damaged epithelial cells, inhibiting inflammation, and exhibiting antioxidant-like properties. https://www.sciencedirect.com/science/article/pii/S2210740122000912 VITAMIN B12 Some studies have found an association between heartburn medications and increased risk of vitamin B-12 deficiency. OTHER SUPPLEMENTS FOR GERD MANAGEMENT Licorice root Slippery elm Ginger  ROLE OF PROBIOTICS Specific strains for GERD management Lactobacillus acidophilus and other Lactobacillus strains including: L. gasseri L. casei L. plantarum L. rhamnosus L. reuteri Bifidobacterium strains https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019778/#:~:text=In%20conclusion%2C%20probiotic%20use%20can,efficacy%20i n%20alleviating%20these%20symptoms. Summary Eating Habits Trigger foods Magnesium, Zinc Carnosine, B12 Probiotics Clinical case David, A 35-year-old male presents with symptoms of heartburn, acid regurgitation, and a sour taste in his mouth. He has been experiencing these symptoms for the past few weeks and they seem to be worse after eating spicy or fatty foods. He has been taking over-the-counter antacids, but they only provide temporary relief. You recommend: High fiber diet Low fat diet Low spicy food diet All options are correct REFERENCES CDC: https://www.cdc.gov/ Online source Center for Disease Control and Prevention Updates 2022 Prousky J. Textbook of Integrative Clinical Nutrition. CCNM Press Inc.; 2012. Katz D. Nutrition in Clinical Practice. 2nd Edition. Lippincott Williams & Wilkins; 2008. Katsilambros N. Clinical Nutrition in Practice. WileyBlackwell; 2010. Pizzorno J and Katzinger J. Clinical Pathophysiology. Mind Publishing; 2012. Marz RB. Medical Nutrition from Marz. 2nd edition. Quiet Lion Press; 1999. Murray MT. Encyclopedia of Nutritional Supplements. Prima Health; 1996. Gropper S, Smith J. Advanced Nutrition and Human Metabolism. 7th Ed. Cengage Learning; 2018.  Cheng J, Ouwehand AC. Gastroesophageal reflux disease and probiotics: a systematic review. Nutrients. 2020 Jan 2;12(1):132. Pereira RD. Regression of gastroesophageal reflux disease symptoms using dietary supplementation with melatonin, vitamins and aminoacids: comparison with omeprazole. Journal of Pineal Research. 2006 Oct;41(3):195-200. Meletis CD, Zabriskie N. Natural approaches for gastroesophageal reflux disease and related disorders. Alternative & Complementary Therapies. 2007 Apr 1;13(2):64-70. Dore MP, Maragkoudakis E, Fraley K, Pedroni A, Tadeu V, Realdi G, Graham DY, Delitala G, Malaty HM. Diet, lifestyle and gender in gastro-esophageal reflux disease. Digestive diseases and sciences. 2008 Aug;53:2027-32. Gaby A. Nutritional Medicine.; Perlberg Publishing 2011. Hoffer A, Prousky J. Naturopathic Nutrition: A Guide to Nutrient-Rich Food & Nutritional Supplements for Optimal Health. CCNM Press; 2006. THANK YOU!