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Functional Nutrition Intervention Protocols

GASTROESOPHAGEAL REFLUX DISEASE

SSESSMENT
Anthropometrics Height, weight, BMI
Waist circumference, hip circumference, waist-
to-hip ratio
% body fat, % lean body mass
Biomarkers/Labs
Conventional CMP, CBC, R/O Helicobacter pylori, parasites;
methylmalonic acid (MMA)

Functional IgG/IgG4 food sensitivity or MRT testing; consider


stool testing to rule out underlying infection

Nutrigenetic None

Clinical Indicators Nutrition-focused physical exam

Diet/Lifestyle Histories Comprehensive intake form


Medical Symptoms Questionnaire

IAGNOSIS Gastroesophageal reflux disease

NTERVENTION
Core Food Plan Balanced core food plan; weight loss, if indicated

Food Plan Modifications Comprehensive Elimination Diet to R/O food


sensitivities
Avoid foods that relax the lower esophageal
sphincter: high
fat foods, chocolate, alcohol (especially white
wine); avoid
foods that may be irritating to the esophagus:
carbonated
beverages, citrus fruit/juice, coffee, onions,
garlic, pepper,
spicy foods, peppermint, tomatoes/products,
very hot or
very cold foods; choose foods that dont relax
the lower
esophageal sphincter: low-fat protein foods,
low-fat
carbohydrate foods; 5-6 small, frequent meals,
drink fluids
30 min before or 60 min after meals
Anti-inflammatory foods: cold water fish; dark
red, black, or
blue fruits/juices; green tea; dark chocolate;

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Functional Nutrition Intervention Protocols
fruits and
vegetables in general

Medical Foods Anti-inflammatory food, if indicated

Dietary Supplements
High quality daily multivitamin with chelated
minerals
If using acid blocker, replenish vitamin B12,
folate, minerals
(replace, as indicated: Ca, Cr, Fe, I, Mg, Mn, Se,
Zn; zinc
carnosine recommended)
Transit time modulators: enteric peppermint oil,
probiotics,
also ginger as a modulator
Omega-3s, ~2g/d for inflammation
Melatonin, 0.5 mg 10 mg 1 hr before bed
Aloe vera juice (aloes-free), 50 ml (~6 oz) tid
DGL (deglycyrrhizinated licorice) may be helpful,
200 mg
tid
Ginger root (Zingiber officinale Roscoe), 1-4 g
fresh
(maximum 4g/d) or supplement standardized
to gingerol
content; root can also be steeped in hot water
and enjoyed
as a tea

Food/Medication/Dietary Aloe vera may cause hypoglycemia


Supplement
Interactions
Lifestyle
Recommendations
Physical Activity Daily activity, as tolerated, preferably outdoors
(sunshine)

Sleep Full complement, as determined for individual


patient
Elevation of head of the bed; wait at least 2-3 hr
after eating before lying down; avoid sleeping in
the left decubitus position

Psycho-social Encourage social connections, activities that are


meaningful
and pleasurable for the individual
Smoking cessation
Potential transit time modulators: acupuncture,
hypnosis, music therapy

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Functional Nutrition Intervention Protocols

ONITORING and VALUATING


Follow-up Plan Periodic contact by functional nutrition
practitioner
Return to clinic in 3 weeks to begin food
reintroduction

Key Resources:
Natural Standard Database or Natural Medicine Comprehensive Database for
supplement information

Kaltenbach T, Crockett S, Gerson LB. Are lifestyle measures effective in patients


with gastroesophageal reflux disease? An evidence-based approach. Arch Intern
Med. 2006;166:965-71.
Li Y, Foundation and clinical research on the effect of traditional Chinese herbs on
gastrointestinal motility. Chin J Integr Med. 2009;15:86-8.
Werbach MR. Melatonin for the treatment of gastroesophageal reflux disease. Altern
Ther Health Med. 2008;14:54-8.

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