Dr. Tieraona Low Dog Protocol

Managing Heartburn and Indigestion

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More than 2,000 years ago, the Greek physician Hippocrates declared that “all disease begins in the gut.” The cycle of eating, digesting, and elimination goes on day after day, year after year, without us paying much attention until something goes awry. And something often does. More than 30 million Americans have persistent symptoms of gas, bloating, and/or constipation. Another 60 million Americans experience heartburn at least weekly, with 15 million experiencing heartburn daily. Those are big numbers.

Numerous integrative approaches can optimize digestive health, including a glycemic load diet, avoidance of triggers, proper sleep position, as well as optimizing digestion of macronutrients and supporting healthy gut motility, lower esophageal function, and gastric and intestinal barriers.

The following protocol should be offered for eight weeks, and then re-evaluate the patient’s symptoms.

*Occasional heartburn or indigestion.

Pure Encapsulations Melatonin 3 mg

Take 1 to 2 capsules 90 minutes before bed

Pure Encapsulations Digestive Enzymes Ultra 

Take 1 to 2 capsules with the main meal of the day

Metagenics Ultraflora Spectrum

Take 1 capsule per day

Rightful Daily Digestive Relief and Repair

Take 1 ounce after main meals and at bedtime if needed

Supplemental Material

  • Recommend that the patient follow a low glycemic load diet to reduce heartburn symptoms. Dietary sugar and high glycemic load diets are more strongly linked to acid reflux than fats.
  • Have your patient keep a diet journal to determine what foods/beverages may be triggering their heartburn. These often include alcohol, peppermint, chocolate, deep-fried foods, and spicy foods.
  • Instruct the patient not to eat any food or drink carbonated beverages within three hours of bedtime. Instruct patients to sleep on their left side to reduce nocturnal heartburn. Using a body pillow and/or putting blocks under the head of the bed can be helpful.
  • Melatonin promotes restorative sleep and supports normal lower esophageal sphincter tone and gastric barrier function.
  • Botanicals have long been used for promoting healthy digestion, many of which are supported by modern science. Aloe vera gel, marshmallow root, chamomile flower, deglycyrrhizinated licorice (DGL), and mastic gum are effective botanical demulcents, soothing the esophagus and stomach. Artichoke leaf and amla (Indian gooseberry) are prokinetics, supporting healthy gastric motility while aiding digestion and elimination. Amla supports normal lower esophageal sphincter tone and gastric barrier function. Aloe vera gel, artichoke leaf, and marshmallow root have prebiotic effects, supporting a healthy gut microbiome.
  • Digestive enzymes promote the healthy digestion of macronutrients.
  • Healing Heartburn Naturally: A Guide to Managing Acid Reflux and Restoring Gut Health by Tieraona Low Dog, MD, is a great resource for practitioners and patients. This eBook is completely referenced with evidence-based recommendations for managing heartburn, tapering protocols for weaning off PPIs, and strategies for supporting patients who must take long-term PPI therapy.

Disclaimer

The Fullscript Integrative Medical Advisory team has developed or collected these protocols from practitioners and supplier partners to help health care practitioners make decisions when building treatment plans. By adding this protocol to your Fullscript template library, you understand and accept that the recommendations in the protocol are for initial guidance and may not be appropriate for every patient.

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References

  1. Cheng J, et al. Gastroesophageal Reflux Disease and Probiotics: A Systematic Review. Nutrients 2020 Jan; 12(1): 132.
  2. European Medicines Agency. Assessment Report on Pistacia lentiscus L. resin (mastix). July 2015
  3. European Medicines Agency. European Union herbal monograph on Althaea officinalis L., radix. July 2016
  4. European Medicines Agency. European Union herbal monograph on Cynara cardunculus L. (syn. Cynara scolymus L.), folium. March 2018
  5. Kandil TS, et al. The potential therapeutic effect of melatonin in Gastro-Esophageal Reflux Disease. BMC Gastroenterol 2010 Jan 18;10:7.
  6. Kaźmierczak-Siedlecka K, et al. The role of Lactobacillus plantarum 299v in supporting treatment of selected disease. Cent Eur J Immunol 2020;45(4):488-493.
  7. Keshteli AH, et al. Dietary glycaemic index and glycaemic load and upper gastrointestinal disorders: results from the SEPAHAN study. J Hum Nutr Diet 2017 Dec;30(6):714-723.
  8. Kim MW, et al. Processed Aloe vera gel attenuates non-steroidal anti-inflammatory drug (NSAID)-induced small intestinal injury by enhancing mucin expression. Food Funct 2019 Sep 1;10(9):6088-6097.
  9. Leiman DA, et al. Alginate therapy is effective treatment for GERD symptoms: a systematic review and meta-analysis. Dis Esophagus 2017 May 1;30(5):1-9.
  10. Levine ME, et al. Lipase Supplementation before a High-Fat Meal Reduces Perceptions of Fullness in Healthy Subjects. Gut Liver 2015 Jul; Jul;9(4):464-9
  11. Majka J, et al. Melatonin in Prevention of the Sequence from Reflux Esophagitis to Barrett’s Esophagus and Esophageal Adenocarcinoma: Experimental and Clinical Perspectives. Int J Mol Sci 2018 Jul 13;19(7):2033.
  12. Murray M. Glycyrrhiza glabra (Licorice). Textbook of Natural Medicine 2020; 641–647.e3.
  13. Panahi Y, et al. Efficacy and safety of Aloe vera syrup for the treatment of gastroesophageal reflux disease: a pilot randomized positive-controlled trial. J Tradit Chin Med 2015 Dec;35(6):632-6.
  14. Panahi Y, et al. Efficacy of artichoke leaf extract in non-alcoholic fatty liver disease: A pilot double-blind randomized controlled trial. Phytother Res 2018 Jul;32(7):1382-1387.
  15. Person E, et al. A Novel Sleep Positioning Device Reduces Gastroesophageal Reflux: A Randomized Controlled Trial. J Clin Gastroenterol 2015 Sep;49(8):655-9.
  16. Raveendra KR, et al. An Extract of Glycyrrhiza glabra (GutGard) Alleviates Symptoms of Functional Dyspepsia: A Randomized, Double-Blind, Placebo-Controlled Study. Evidence-Based Complementary and Alternative Medicine 2012; 216970
  17. Tuck CJ, et al. Increasing Symptoms in Irritable Bowel Symptoms With Ingestion of Galacto-Oligosaccharides Are Mitigated by α-Galactosidase Treatment. Am J Gastroenterol 2018 Jan;113(1):124-134.

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