Gastroesophageal Reflux Disease (GERD)
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According to Ayurvedic texts, Amlapitta is considered to be a GI disorder that closely resembles with Gastritis and can lead to ulcerative conditions in the chronic stage. Acid reflux may be caused due to aggravation of pitta dosha that leads to an increase of acidic content in stomach fluids. 

What is GERD or acid reflux?

Is your heartburn affecting you more than twice a week? Then you are probably suffering from Gastro-esophageal reflux disease (GERD). GERD is the most common digestive disorder characterized as chronic acid reflux. In this type of disorder the contents of the stomach reflux back into the esophagus causing irritation and heartburn. This occurs when the muscles at the end of the esophagus do not close properly.

According to various epidemiological studies on GERD, the prevalence of the disease is found to be around 5% in Asian countries and about 10% to 20% of people are affected in the Western countries. There are various factors that can lead to GERD, aging is considered to be the major risk factor, and people suffering from irritable bowel syndrome, functional dyspepsia, bowel movement disorders, and chronic constipation are more prone to develop GERD as a systemic disorder.

There is no definite cure for GERD. However, the symptoms of GERD can be controlled by lifestyle modification, which includes avoiding spicy foods, smoking, limiting caffeine and chocolate intake, weight loss, medical therapy, and surgical therapy. There are various other natural therapies like Ayurveda, traditional Chinese medicine, and Yoga which can help relieve the heartburn caused by acid reflux.

See: GERD Cough Natural Treatment

How does Ayurveda view GERD or acidity?

Ayurveda mentions GERD/Acid reflux as Urdhwaga Amlapitta which is a very common disease caused by Vidagdha Pitta with features such as Amlodgara (Sour belching), Hrid Kantha Daha (burning sensation in the throat and chest), and Avipaka (indigestion).

According to Ayurvedic texts, Amlapitta is considered to be a GI disorder that closely resembles with Gastritis and can lead to ulcerative conditions in the chronic stage. Acid reflux may be caused due to aggravation of pitta dosha that leads to an increase of acidic content in stomach fluids. Aggravated pitta occurs due to irregular food habits, busy stressful lifestyles, and abuse of certain analgesic drugs.

Ayurveda believes in treating acid reflux by improving digestion through a holistic approach. Ayurveda for acid reflux includes having timely meals, avoiding spicy foods that contain excessive garlic, salt, oil, chilies, and certain acidic fruit juices like lemon juice, sweet lime juice, and kokum juice.

See: What does heartburn feel like

Ayurvedic remedies for treating GERD

Many of us know what is good for our body and what not; however we do not tend to follow a healthy diet due to our busy lifestyle habits and stressful lives. There are several home remedies available for a plethora of diseases and similarly one can find a simple home remedy for GERD as well in their kitchen. Ayurveda believes that reflux occurs when an individual has an imbalance of Pitta, or qualities of water and fire. An imbalanced Pitta may include higher blood pressure, anger, or diarrhea. Ayurvedic deals with reflux by balancing the fiery Pitta with attributes that are cooling.

Ayurvedic practitioners focus on these basic recommendations for bettering its consequences.

- Avoid Eating Just Before Bedtime: Complete your meal at least two to three hours before lying down to sleep for the night. This helps ensure that the food in your stomach is digested before lying, where stomach contents have more of a chance of going back into the esophagus.

- Reduce Alcohol and Caffeine Intake: Alcohol and caffeine are often reported to precede heartburn. One theory is that they relax the esophageal sphincter, resulting in a higher prospect of reflux into the esophagus. Some scientists also think that the acidic nature of alcoholic or caffeinated drinks leads to high gastric acidity and, thus, reflux.

- Elevate your head while sleeping: You can take this one step farther by elevating your upper body while sleeping instead of lying flat. If you don't have an adjustable bed, try propping yourself up on pillows to keep your chest and head higher than your waist.

- Eat Smaller Meals: The more food and drink in the gut, the greater chance there is of it"splashing" upward and to the esophagus. Avoid pressuring the sphincter by eating to the point of being full and then quitting. Eat three meals or more every day to keep from getting too hungry and then overeating.

- Lose Weight If You're Overweight: Similar to a lot of factors associated with reflux, the specific mechanism which links being overweight and fat with greater reflux is largely speculative. Whatever the cause, find that symptoms of reflux are positively correlated with body mass index or BMI. Likewise, losing weight often contributes to an improvement in reflux symptoms.

- Drink For Digestion: Aim to drink the vast majority of your fluids between meals, rather than with your meal. This will help to keep the quantity on your stomach down at mealtimes. You might also try avoiding carbonated drinks.

- Reduce Stress: Although it's not known precisely how stress exacerbates acid reflux, it has demonstrated that both are undeniably linked. Identify the causes of anxiety in your life, and brainstorm sustainable coping strategies. Ideas may include deep breathing & meditation.

- Dietary regimens should emphasize avoidance of particular acidity-engendering foods: fried, fatty, junk foods, onions, citrus fruits, hot (pungent) foods, and excess chocolate. Dairy products or nut butter may also provoke acidity. Regimens should emphasize the consumption of complicated carbohydrate-rich foods such as rice because these are easily digested and engender small acid formation.

- Fruits that will aid in relieving from acidity include cucumber, watermelon, papaya, and bananas. Cool whole milk, almonds, coconut water, or raw garlic will often relieve heartburn and acidity. Jaggery, on an hourly basis during acute episodes of acidity, will often provide relief from acidity.

- Buttermilk with a little coriander juice is effective in cases of acidity and indigestion. The tradition of drinking one to two glass of water in the early morning is beneficial in acidity control. 

- Eating dinner no more than two to three hours before sleeping, eating smaller meals in the day as opposed to the conventional bigger breakfast, lunch, and dinner, & keeping reasonable body weight are helpful in preventing reflux.

- Consuming a few Tulsi (Basil) leaves provide prompt relief from acidity as does one tbsp of Amla (Amalaki) with a tbsp Haritaki (chebulic myroblan). Additionally, often helpful is taking two tablespoons of honey mixed with two tablespoons of pure apple cider vinegar before meals.

Ayurvedic home remedies that can help fight GERD/acid reflux include:

1.       Consume fruits like cucumber, watermelon, papaya, and coconut water that maintains the acid levels in your stomach. Consuming these fruits on an empty stomach is found to be more beneficial.

2.       Drinking at least two glasses of warm water every morning on an empty stomach can reduce acidity and heartburn.

3.       Consuming smaller meals throughout the day for at least 5 times can help maintain normal body weight.

4.       Buttermilk with one tablespoon of coriander juice is beneficial in cases of indigestion and acidity.

5.       Other remedies include chewing few tulsi leaves, amla, haritaki and mint juice can help in regulating acidity.

See: Sample Meal Plan for GERD- Gastrointestinal reflux disease

Scientific studies for Ayurveda healing GERD

There are many studies demonstrating the efficacy of Ayurveda to cure GERD naturally.

a) In a scientific study named Clinical evaluation of the efficacy of Dashanga Kwatha Ghana Vati in the management of Urdhwaga Amlapitta (Non-ulcer dyspepsia).1. A total of 138 patients with signs and symptoms of Urdhwaga Amlapitta like Tiktamlodgara, Avipaka, Hritdaha, Vidaha, Klama, Kanthadaha etc were included. Out of 138 patients, only 110 completed the whole treatment. These patients were divided into two groups; 67 patients in group A received Dashanga Kwatha Ghana Vati with 250 mg twice a day dose after food with water as Anupana. Patients in Group B (n=43) were administered with Placebo tablet 250 mg twice a day prepared with gram flour. Treatment continued for 8 weeks with the dietary restriction that restricted from eating spicy foods.

Results showed significant relief in patients suffering from Urdhwaga Amlapitta who received Dashanga Kwatha Ghana Vati in comparison to the placebo group. Encouraging results were also observed in the placebo group, which may be because of certain dietary restrictions advised to the enrolled patients during the trial period.

b) In another study entitled A comparative clinical trial of Chincha kshara and Kadali kshara on Amlapitta,2. Thirty patients with complaints of Avipaka, hrit-kanthadaha, tikta-amlodgara, utklesa, udarasula, adhmana and aruchi were registered. These patients were grouped into three groups named C, K, and P and each group consisted of 10 patients.

Group C – The patients in this group were prescribed with Chincha kshara thrice daily with water after food for 30 days

Group K – The patients received Kadali kshara thrice daily with water after food for 30 days

Group P – In this group, the patients received fried wheat powder as a placebo in a dose of 500 mg thrice daily with water after food for 30 days

In addition, patients were advised to take a normal diet that is devoid of excess amla, lavana, and katu rasa. At the end of the 30th-day clinical assessment was carried out and it was inferred that both Chincha kshara and Kadali kshara were effective and reduced the symptoms of amlapitta. However, Chincha kshara was found to be more effective than Kadali kshara in patients affected by amlapitta disease.  No adverse effect was noticed during the clinical trial period.

See: Acid Reflux Diet for GERD

Real world outcomes from GERD patients

The success story of Ayurveda for GERD

A 35-year-old male who was suffering from constant pain in the stomach, sour belching, and lack of appetite came to Ayurveda clinic to seek ayurvedic treatment for acidity. He has previously tried all kinds of medications but couldn’t find any relief. However, upon consulting an ayurvedic specialist he was advised to follow a strict diet and lifestyle modification that included avoiding spicy food, chewing the food properly, and having food in a disciplined manner. He was also administered with some ayurvedic herbs for a period of 4 weeks that included herbs like Amla, Guduchi, Yashtimadu, Licorice, Chitraka, Triphala, Avibathikara choornam, Indukantam ghritam, Dadimadi ghritam, drakshadi kashyam, sukumara kashyam, Guduchyadi Kashayam, and Shankha Bhasmam. 

Within 4 weeks of treatment, he observed a better appetite, regular bowels, less/negligible pain, no belching, and a bloated stomach. Almost all the symptoms were relieved and the patient was very happy to see the results.

See: Ayurvedic herbs for detoxification

Summary

Ayurvedic medicine of plant origin has been used in the treatment of many diseases for a very long time. Similarly, Urdhwaga Amlapitta (GERD) can be effectively managed with negligible side effects by Ayurvedic treatment. More research needs to be carried out on a large scale to evaluate the comparative efficacy and safety of ayurvedic formulations in the management of Urdhwaga Amlapitta. Many clinical trials have also proved that dietic and lifestyle habits play a considerable role in managing acid reflux, as most of the etiological factors of Urdhwaga Amlapitta are related to lifestyle and dietary habits.

See: Amla Berry Health Benefits & Side Effects

References

1. Umapati C. Baragi and Mahesh K. Vyas. (2012) Clinical evaluation of the efficacy of Dashanga Kwatha Ghana Vati in the management of Urdhwaga Amlapitta (Non-ulcer dyspepsia).1   Ayu Journal.33(2): 219–223.           

2. S. Acharya,1 P. K. Panda,2 G. Acharya,3 N. Mohanty,4 P. K. Nathsharma,5 and S. C. Dash. (2011). A comparative clinical trial of Chincha kshara and Kadali kshara on Amlapitta,2. 32(4): 494–499.

3. https://www.omvedicheritage.com.sg/doctor.php?llink=54&info=Gastritis%2FGERD-Gastroesophageal+reflux+disease 

4. https://www.pureherbalayurved.com.au/acid-reflux.htm

5.  Saroch Vikas1, Singh Jajbir. (2015).A review on ayurvedic medicine for Amlapitta (Hyperacidity).3. Anvesha Ayurveda medical journal.

6. http://www.rasamruta.com/pdf/1469719273_8_13%20(2).PDF

See: Buttermilk as Ayurvedic medicine

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