There recently have been newspaper articles and references to the challenging problem of GERD (gastroesophageal reflux disease). So much has changed over the years, and while some treatment philosophies are controversial, I hope to illuminate the distinction between hyper and hypo gastric acidity.

For years, heartburn has been treated with proton pump inhibitors such as omeprazole. These acid inhibitors certainly can offer relief, however, with years of research and data gathering, it is now known that these medications, when used long term, may have serious consequences. Some of the conditions increased with their use include osteopenia and osteoporosis, and SIBO or small intestinal bacterial overgrowth.

As time has passed, it has been found that many people suffering with GERD are actually hypoacidic, indicating that the gut cells (parietal cells) are not secreting adequate acid for digestion, thus food and byproducts sit, ferment and can backfire.

One may ask what causes hypoacidity and this is caused by stress, both physiological and psychological. Maldigestion caused by IBS, constipation, slow motility, low fiber and high sugar diets can also contribute to this condition. Antibiotic use disrupts the good quality flora, thus exacerbating any number of GI-related conditions, including GERD.

In my practice, I often collaborate closely with gastroenterologists to rule out more serious disorders, such as Barrett’s Esophagus or a sphincter issue wherein the acid contents regurgitate back up into the espophagus. However, in more benign cases, I will start with the “burp test,” having my client drink a cup of water with baking soda for a few days. I have a specific protocol and am happy to meet with a client to determine this quick test for stomach acid adequacy.

There are a number of digestive supports in the natural healing world that work beautifully, but it is also important to look at total gut health before creating an individualized treatment plan. Some of my favorites include aloe juice — very healing and soothing to the gut, also assists with bowel regularity; mastic gum with DGL (deglycerrhinized licorice) — soothing and healing to the gut lining as well without blocking stomach acid; betaine hydrochloride — hydrochloric acid that adds and stimulates gut secretion for digesting especially proteins; good old Bragg’s apple cider vinegar — also stimulates stomach acid, but may be too acidic for some; a multistrain probiotic, often with s boulardi for those who do have SIBO.

Now to the diet. Years ago, all acid foods were omitted from the diet. However, as time has passed, it is more important to be sure that there is bowel regularity and to keep the fat content of the diet moderate with little to no fried foods. Fat stays in the gut longer, thus delays stomach emptying and can result in reflux.

If symptoms persist, I may suggest food sensitivity testing. This can prove very helpful if the other treatment options do not work.

Nutrition is an ever-evolving science, but there is the art to it all as well. One must enjoy his or her food while honoring the internal environment. Enjoy Fish Amandine from Feel Great Look Great — Balanced Eating for a Balanced Life.

Fish Amandine

Serves 4

Ingredients

» 1 egg, beaten

» ¼ cup 1 percent milk

» ¼ cup flour

» 2 teaspoons lemon peel, grated

» ¼ teaspoon paprika

» 4 (4 ounce fillets) haddock, flounder, cod or scrod

» Cooking spray

» 1 teaspoon butter or margarine, no added salt

» ¼ cup sliced almonds

» ½ cup green onion, sliced

» 3 tablespoons fresh lemon juice

» 4 sprigs fresh parsley, chopped

Directions

» In a shallow plate, combine egg and milk. In a second shallow plate, combine flour, lemon peel and paprika.

» Coat each fish fillet one at a time in egg mixture, then coat evenly with flour mixture. Place on plate lined with wax paper.

» Cover and chill at least 15 minutes.

» Heat large, nonstick skillet over medium heat and add cooking spray. Add fillets and cook about 4 minutes on each side until golden brown, crisp and fish flakes with a fork. Remove fish and keep warm.

» Wipe out skillet and add cooking spray and butter. Add sliced almonds to skillet and cook until golden brown, stirring often. Stir in green onion and lemon juice. Heat, stirring.

» Serve sauce over fillets and sprinkle with parsley.

Make It a Meal

» Serve with 1 cup steamed green beans and 1 serving (½ cup) of herbed grains

— Julie Freeman, MA, RD, LD, RYT, is a licensed integrative nutritionist with advanced training in counseling and functional medicine. Her “toolbox” includes certifications in yoga, reiki, mind-body medicine, modeling and finishing for personal development, and she has written two cookbooks, Balanced Eating for a Balanced Life and Sweets n’ Treats. Click here to read previous columns, or contact her at juliefreeman57@gmail.com. The opinions expressed are her own.