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Signs and symptoms of poor digestion and gastrointestinal imbalance are extremely common, can be debilitating and can be caused by a multitude of factors. Acid reflux and gastro-oesophageal reflux disease (GORD), the most chronic and severe form of acid reflux, are two of the most common conditions affecting large portions of the population. Acid reflux and GORD is where acid from the stomach leaks up into the oesophagus resulting in a burning sensation and can lead to irritation which feels like a lump in the throat causing the need to cough frequently. It can lead to upper gastrointestinal problems such as ulcers, oesophagitis (inflamed oesophagus) and gastritis (inflamed stomach) and cause a variety of unpleasant symptoms including:

• Heartburn
• Belching
• Bloating
• Nausea
• Vomiting
• Regurgitation
• Early satiety
• Loss of appetite
• Gastric pain

One of the treatments for acid reflux and GORD is usually a type of medication called a proton pump inhibitor (PPI) which are widely prescribed and include omeprazole, lansoprazole, pantoprazole, rabeprazole and esomeprazole. They are commonly prescribed for the management of acid reflux, GORD, gastritis, part of H. pylori treatment, or as a co-treatment alongside other medications - including non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen - that can increase the risk of a gastrointestinal bleed. PPIs work by blocking the gastric acid production by as much as 90%.

Gastric hydrochloric acid (HCl) secretion is a vital part of the early stages of digestion, particularly for protein breakdown and vitamin and mineral absorption; it also sets in motion a chain of events, triggering essential digestive processes further down the line.

Gastric hydrochloric acid (HCl):
• Initiates protein digestion (converts pepsinogen to pepsin)
• Triggers duodenal hormones (Cholecystokinin and secretin)
• Enables Vitamin B12 and folate absorption
• Prepares minerals for absorption
• Prevents bacterial overgrowth in the small intestine

Therefore, supporting digestion is crucial when taking PPIs and there are some simple steps that can be implemented which may also manage symptoms associated with acid reflux and GORD. It is important to note that the discontinuation of prescribed PPIs should not be done unless recommended by your GP.

Reconnect with our food

Modern living means we have lost that connection with food as many people are in a constant state of stress and are just looking for fast food without taking the time to prepare and enjoy a meal. The first stage of digestion is called the cephalic phase and is triggered before food even hits the mouth. The cephalic phase is initiated by the sight, smell, thought or taste of food. This stage is crucial; and gets the stomach ready to receive food. Amongst other essential processes, one crucial change that happens in the cephalic phase is the secretion of gastric HCl. Eating on the run, whilst stressed or in a rush, or whilst doing other things (like watching TV or working) means that the cephalic phase may be compromised - food then hits an unprepared stomach, before the brain has even registered that it is on the way. It is important to instate some healthy habits around mealtimes to optimise the cephalic phase of digestion and reconnect with our food, including:

• Get involved in the food preparation stage of a meal; take time to smell and savour food as it is being cooked.
• Sit down to eat, at a table, not on the run. If eating at work, try eating away from your desk and computer and outside in nature if possible.
• Chew! This is the first phase of physical digestion and each mouthful should be chewed 20-30 times until it is liquified.
• Keep mealtimes stress-free, relaxed and free from other distractions including TV, screens and phones.
• Take time to eat, a meal should be enjoyed for 20-30 minutes or longer if possible.

Stress management

If you’re suffering from chronic stress, your body spends too much time in “fight or flight” mode, carried out by the sympathetic nervous system, and not enough time in “rest and digest” mode, facilitated by the parasympathetic nervous system. Supporting stress management in general can support effective digestion and it is important to implement strategies throughout the day, not just at mealtimes. Here are some strategies which can easily be implemented:

• Meditative practices including yoga, meditation, journaling, gratitude, deep breathing, relaxation, me-time.
• Incorporate regular gentle exercise into your week - swimming, walking, jogging, and pilates are all highly beneficial.
• Pay particular attention to sleep hygiene. See some of our tips here.
• If stressed at mealtimes, take 5 deep abdominal breaths before you pick up your knife and fork.

Support/stimulate vagal tone

Part of stress management is supporting the vagus nerve as chronic stress impairs vagal tone. The vagus nerve is the longest nerve in your body, travelling from the base of your brain down your body and into your abdomen. The vagus nerve has a major influence on our parasympathetic nervous system and therefore our “rest and digest” mode. There are several simple activities we can do daily to increase vagal tone, including:

• Chanting/singing loudly
• Deep breathing
• Laughing
• Intermittent fasting
• Massage
• Yoga
• Gargling
• Cold water therapy

Avoid trigger foods

Whilst how we eat is extremely important, so too is the food we eat and acid reflux can be triggered by eating the wrong kinds of food. It is therefore worth avoiding the following:

• Fried foods
• Spicy foods
• Citrus foods
• Tomato-based foods
• Processed foods
• Alcohol
• Caffeine

Nutrients and botanicals to support digestion and mucous membranes

• Liquorice – supports the health of mucous membranes. It is important to choose a deglycyrrhizinised liquorice (DGL) if you have high blood pressure or take blood pressure lowering medications.
• Marshmallow & Chamomile – have soothing effects on mucous membranes.
• Slippery Elm – contains mucilage components, which can help to coat and soothe the tissues of the gastrointestinal tract soothing irritation.
• Gamma Oryzanol – inhibits gastric secretions via its effect on the vagus nerve.
• Glutamine – stimulates intestinal cell proliferation involved in mucosal protection.
• Lemon Balm & Ginger – both help to support digestion.

These simple healthy habits can be implemented daily and at mealtimes to optimise digestion and support mucous membranes if suffering from acid reflux/GORD or currently taking acid-suppressing medications like PPIs.

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