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April 14, 2004

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Palo Alto Online

Publication Date: Wednesday, April 14, 2004

Coping with acid reflux Coping with acid reflux (April 14, 2004)

Health professionals disagree on best way to treat disease

by Avital Binshtock

Acid reflux sounds like an unassuming disorder, mild and treatable. But it has become a burden in millions of Americans' lives, affecting food choices, sleep patterns, even moods. In fact, acid reflux can be so debilitating that the National Institutes of Health calls it a disease: gastroesophageal reflux disease (GERD).

If a patient has heartburn more than two times per week, they likely have GERD, a disorder of the esophagus. It's caused when stomach acid leaks up into the esophagus through a weakened valve, leading to such symptoms as burning in the chest, a sour taste in the mouth and coughing. In rare cases, it can lead to develop esophageal cancer.

Despite GERD's commonness, medical professionals disagree on effective treatments. Some feel the best way to deal with the problem is to prescribe medicine, while others favor solutions such as lifestyle changes, nutritional therapies and alternative treatments.

Dr. George Triadafilopoulos, director of Stanford University Hospital's Esophagus Center, prefers treating acid reflux with antacids. He said 80 percent of people with GERD use acid-suppressing medication.

"They're very safe drugs with very few side effects. We've been using them for over 20 years," he said. "The reality is that, sooner or later, you'll end up using medicines."

Triadafilopoulos is concerned about the rise of untreated GERD cases developing into cancer. "People who have frequent heartburn are at more risk for esophageal cancer," he said, adding that it's the fastest growing cancer in the western hemisphere, with a rate that has almost tripled over the last 30 years.

But not all experts see medication as the best way to treat acid reflux. Palo Alto-based nutritionist Gerda Endemann, Ph.D., worries about the rate at which doctors prescribe antacids. "I find it disturbing. Anytime we take medicines for years and years, it becomes risky," she said.

Endemann suspects that research may someday reveal that antacids have harmful effects. "Antacids lower the level of acid in the stomach, and that acid is there for a reason," she explained. Reducing stomach acids makes absorbing vitamins more difficult, she added.

She recommends lifestyle changes such as avoiding unhealthy food, cigarettes, alcohol, caffeine and carbonated beverages. She tells her GERD patients to avoid laying down three hours after meals.

"It's always good to try non-medical approaches first," she said.

Indeed, there is widespread consensus that people who suffer from GERD should cut out culprits like fatty or spicy foods, soda, citrus, mustard and vinegar. Losing weight can also help.

Chris Macie, an acupuncturist and herbalist in Palo Alto, agrees with Endemann's more natural approach. "Antacids are just a Band-Aid. They don't change a situation, they just manage it," he said.

Macie believes that acid reflux is a "Western-abstracted condition" and, like Endemann, feels that it stems from the qualities inherent to American foods.

"Digestion is the center of life. You keep putting that stuff in your stomach and no wonder it doesn't work," Macie said.

Macie takes a holistic approach to addressing heartburn, treating the whole patient instead of the separate mechanical parts. He determines patients' physical and emotional problems, then customizes an individual herbal prescription for each person.

About a third of Macie's clients come to him complaining of heartburn.

Although some people consider herbal supplements outside of the mainstream, Macie said, "It's not something new and strange. It's more how your grandparents and great-grandparents used to live."

But he warns people against taking unfamiliar herbs without consulting a professional, since they can be as potent as manufactured drugs.

In addition to herbal remedies, Macie uses acupuncture to treat GERD. Stress causes too much stomach acid, and acupuncture, he said, reduces stress and therefore prevents conditions like acid reflux.

Although the stressed, the overweight and those with imperfect diets are most likely to have GERD, other people can suffer, according to Endemann. Pregnant women, babies and bulimics can have it because they either have too much stomach pressure or vomit often or both.

But GERD can affect anybody. Regardless of the exact cause, sufferers have multiple options for regaining their quality of life. Avital Binshtock can be reached at [email protected]

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