Kelsey Marksteiner: Usually when I hear that, that someone has reflux immediately after eating carbohydrates, I do think SIBO, but if it’s been ruled out and H. pylori has been ruled out, my next thought would probably be that they’re potentially eating something within their carbohydrate intake that they may be sensitive to. So you could do some Cyrex testing if you haven’t already, or you could have them kind of … I always like to ask my clients, “Are there any foods that you’re eating that you think you might be sensitive to?” A lot of times people do have some idea that there are certain foods that just don’t sit too well with them, but they don’t mind it enough that they do anything about it, so I think that’s always a good question to ask if you have someone who is at least somewhat aware of their body functions and how things affect them. More often than not, they’ll at least have an inkling of things that might be bothering them, so that’s a good place to start because if they do answer yes … Maybe they’ve noticed that when they eat sweet potatoes, they’re getting some sort of reflux reaction. Then I’d say, “OK, let’s just take those out for a week or so and see how you fare.” If the reflux gets better, then we know it was just really a food sensitivity versus a reaction to carbs on their own. Really anytime someone’s saying that they are reacting to carbs as a whole, my immediate thought goes to SIBO because that’s really common as that type of reaction, but then if there’s no SIBO, I do start to worry that there’s just some sensitivity that they haven’t pinned down yet.
If they don’t have an idea of what might be bothering them specifically, I would ask them to create a food and symptom diary. Have them write down what they’re eating when they’re getting reflux. They may be getting it more often than they think as well. They may be getting reflux after other meals, but it’s just maybe a little bit worse after carbohydrate meals. This can give you a little bit more insight. It will make them more aware of things as well. And you as the practitioner will sometimes be able to see things that they won’t, but you need that information. If you feel like you can’t get enough information just from what they are telling you, it’s a really good idea to have them track their own intake of food and their symptoms because you might be able to put two and two together where they can’t. That would be my immediate thought.
The other thing that I would think about here, just in terms of how to treat reflux, is that there might be some inflammation there just from reflux coming up consistently, and maybe they’re noticing more after carbohydrate intake, and we want to just fix that inflammation that’s already happened. I don’t know what you’ve done with this person prior to testing for SIBO and H. pylori, like if that was the first thing you did with them and there was no other treatment or anything before that, but if there was any sort of treatment, especially if you were dealing, like, with anything in the large intestine, the microbiome, and you gave them any sort of antimicrobial or something like that, that could have dealt with potential SIBO as well. So it sort of depends on what you’ve done previously, but if there’s any inflammation left, even a small amount of reflux is going to sort of irritate that inflammation that’s already there, so I would really put a strong focus on decreasing inflammation, healing the tissue of the esophagus, and making them feel better so even if reflux is coming up somewhat, they don’t feel it as much.
The way that I like to deal with reflux is to use demulcent herbs. Those are things like slippery elm root, marshmallow root, and DGL. That essentially creates sort of a barrier in between anything that’s coming up, so the refluxate coming up, and the tissue itself in the esophagus. It not only creates that barrier, but it also actually heals tissue that’s already irritated and inflamed, so it serves a dual purpose for GERD, and it’s one of the first things that I recommend for people with reflux because it works really quite quickly and people feel a lot better, and then they’re on board with anything else you’re going to recommend because they’ve gotten this immediate benefit. If you work with reflux patients a lot and especially if you’ve kind of ruled out all these other things and you feel like, What the heck am I going to recommend to this person?! I don’t feel like I can fix this, I would focus on reducing the inflammation and healing the tissue and go from there. You may notice that once you’ve had them on some demulcent herbs for a month or so, they can come off of them and not really have any problems and it was just sort of this lingering inflammatory condition that was there, and once that inflammation is healed, they don’t have any issues anymore. That’s a really, really great thing to recommend right off the bat anytime you have a reflux client.
Yeah, if you’ve ruled out SIBO and H. pylori, the thing that would come to mind next for me would be the food sensitivity. I’m sure there are other things that might play a role here, but that would be my first guess. The only other thing I could think of here is maybe that … and again, I would think this would often be caused by SIBO just because of the pressure differences, but that lower sphincter can kind of just become a little bit floppy and not work as well. There was a study that I saw that … I think they used 3 milligrams of melatonin every night, and that showed that it could make that sphincter close more tightly or just that it functioned better. That could be something to try too. If there’s nothing that you can find that seems to be causing that to happen, you could at least give that a try and see if it helps. But my first thought would be the demulcent herbs. Give that a shot, and then see if you can track down any sensitivity to a particular carb because most of the time, if someone’s just saying that they are reacting to carbs as a whole, I would think SIBO. If you’ve ruled out SIBO, my next thought would really be that there’s something in particular that they’re responding to that they just haven’t picked up on yet.