|
Nutrients for the Treatment of Heartburn
By Maureen Williams, ND
Heartburn—a symptom experienced regularly by over 60 million Americans—is associated with upper digestive problems including gastritis, peptic ulcer disease, gastroesophageal reflux disease, and reflux esophagitis. Chronic acid suppression therapies such as H2-blockers and proton pump inhibitors comprise the standard approach to heartburn and its underlying causes, and sales are brisk with two anti-ulcer agents making the list of the top 10 best-selling drugs.
The problem is that the stomach is supposed to be acidic, and long-term suppression of acid production compromises digestion and increases the risk of small bowel bacterial overgrowth. [i] [ii] A better approach, focused on soothing, healing, and strengthening the protective mucosal membranes of the upper gastrointestinal tract, could lead to better digestion and overall health.
Combining herbs and nutrients works synergistically to provide relief of occasional heartburn and indigestion. The combination also functions to soothe the gastrointestinal tract and promote and maintain the integrity of its mucosal linings.
L–Glutamine
L–Glutamine is the most abundant amino acid in the body. It is a precursor of the potent antioxidant glutathione, is needed for proper immune function, and is a critical fuel source for the epithelial cells of the small intestine. Its beneficial effect on intestinal mucosal integrity and inflammation in post-operative patients has been well established, [iii] [iv] [v] [vi] [vii] and a preliminary study found that L-glutamine supplementation prevented esophagitis during chemotherapy. [viii] It has also been shown to stimulate collagen repair and wound healing. [ix] Its protective and healing properties can benefit the lower esophagus, stomach, and upper small intestine, which are vulnerable to erosive damage in people who experience heartburn.
Glycine
Glycine is an amino acid, a precursor to glutathione, and an inhibitory neurotransmitter. Several animal studies have demonstrated an anti-ulcer effect of glycine, [x] [xi] [xii] and it is sometimes included in over-the-counter antacids because of its apparent neutralizing effect on stomach pH. Glycine also appears to prevent infection by Helicobacter pylori, the bacterium that has been implicated as a major contributing factor in many cases of peptic ulcer disease and gastritis.[xiii]
N-Acetyl Glucosamine
N-Acetyl Glucosamine (NAG) is an amino-sugar that is incorporated into glycosaminoglycans and glycoproteins, the substrates for tissue repair.
Nutrients for the Treatment of Heartburn
The prognosis for people with inflammatory bowel disease (IBD) is related to their ability to synthesize NAG and these foundational molecules, [xiv] [xv] and there is preliminary evidence that NAG supplements promote healing in IBD-affected bowel mucosa and improve the course of the disease. [xvi] NAG is included in this formula because it is involved in the protection and repair of mucous membranes throughout the body, including the upper small intestine, stomach, and esophagus.
Deglycyrrhized Licorice
Deglycyrrhized Licorice (DGL) is a licorice extract in which glycyrrhizin, the constituent that stimulates the adrenal glands and can cause a rise in blood pressure, has been removed. DGL is widely used to treat gastritis and peptic ulcer disease, and studies have shown that it stimulates healing and improves the thickness and integrity of the protective mucosal lining of the stomach and upper small intestine. [xvii] [xviii] [xix] Additionally, mouth rinses with DGL have been found to be helpful in treating aphthous ulcers. [xx] [xxi] [xxii] Because of its beneficial effects on the mucous membranes of the digestive tract, DGL is also thought to be helpful in treating reflux esophagitis.
Aloe vera
Aloe vera is a succulent plant and the juice from the inside of its leaves is a popular remedy for burns and skin wounds. [xxiii] [xxiv] [xxv] Results from animal studies suggest that aloe extract can promote healing of gastric ulcers. [xxvi] [xxvii] [xxviii] Because of its soothing and healing properties, extracts from the inside of the aloe vera leaf have been used historically to treat gastritis, peptic ulcer disease, and reflux esophagitis.
Zinc Carnosine
Zinc carnosine is an amino acid chelate that has recently been recognized for its antiulcer effects. It appears to work by readily adhering to ulcer sites, [xxix] reducing the inflammatory response to H. pylori in gastric epithelial cells, [xxx] [xxxi] and preventing inflammation-induced DNA damage in those cells. [xxxii] Studies have found it able to prevent gastric ulcers in H. pylori-infected [xxxiii] and NSAID-damaged animals. [xxxiv] Findings from a controlled trial in humans suggest that the effectiveness of the conventional triple antibiotic therapy for H. pylori might be improved by adding zinc carnosine. [xxxv] Zinc carnosine has also been found to prevent drug-related gastrointestinal side effects in healthy people after taking a moderate dose of indomethacin (a non-steroidal anti-inflammatory drug) for five days, [xxxvi] and in people with hepatitis C being treated with an antiviral cocktail. [xxxvii]
D-Limonene
D-limonene is found in the essential oils of citrus fruits and many other plants. Because of its pleasant citrus flavor and fragrance, d-limonene is widely used as an additive to foods, beverages, soaps, and cosmetics. Studies have shown that d-limonene can promote detoxification of carcinogens in the liver and displays anticancer effects. [xxxviii] [xxxix] [xl] It is sometimes used in the treatment of heartburn and GERD because of its acid-neutralizing effect and ability to stimulate normal peristalsis. [xli]
References
[i] J Thorens, F Froehlich, W Schwizer, et al. Bacterial overgrowth during treatment with omeprazole compared with cimetidine: a prospective randomised double blind study. Gut 1996;39:54-9.
[ii] Theisen J, Nehra D, Citron D, et al. Suppression of gastric acid secretion in patients with gastroesophageal reflux disease results in gastric bacterial overgrowth and deconjugation of bile acids. J Gastrointest Surg 2000;4:50-4.
[iii] Wernerman J, Hammarqvist F, Clinical Experiences With Glutamine Supplementation. Nutrition 1994;10:176-7.
[iv] Morlion BJ, Stehle P, Wachtler P, et al. Total parenteral nutrition with glutamine dipeptide after major abdominal surgery: a randomized, double-blind, controlled study. Ann Surg 1998;227:302–8.
[v] O’Riordain MG, De Beaux A, Fearon KC. Effect of glutamine on immune function in the surgical patient. Nutrition 1996;12:S82–4.
[vi] Jian ZM, Cao JD, Zhu XG, et al. The impact of alanyl-glutamine on clinical safety, nitrogen balance, intestinal permeability, and clinical outcome in postoperative patients: a randomized, double-blind, controlled study of 120 patients. J Parenter Enteral Nutr 1999;23:S62–6.
[vii] Quan ZF, Yang C, Li N, et al. Effect of glutamine on change in early postoperative intestinal permeability and its relation to systemic inflammatory response. World J Gastroenterol 2004;10:1992-4.
[viii] Algara M, Rodríguez N, Viñals P, et al. Prevention of radiochemotherapy-induced esophagitis with glutamine: results of a pilot study. Int J Radiat Biol Phys 2007;69:342-9.
Lacruz M, Foro P, Reig A, Quera J, Lozano J, Fernández-Velilla E, Membrive I, Dengra J, Sanz X.
[xiii] Minami M, Ando T, Hashikawa SN, et al. Effect of Glycine on Helicobacter pylori In Vitro. Antimicrob Agents Chemother 2004; 48:3782-8.
[xvii] Bardhan KD, Cumberland DC, Dixon RA, et al. Clinical trial of deglycyrrhizinised liquorice in gastric ulcer. Gut 1978;19:779–82.
[xviii] Kassir ZA. Endoscopic controlled trial of four drug regimens in the treatment of chronic duodenal ulceration. Irish Med J 1985;78:153–6.
[xix] Morgan AG, McAdam WAF, Pacsoo C, et al. Comparison between cimetidine and Caved-S in the treatment of gastric ulceration, and subsequent maintenance therapy. Gut 1982;23:545–51.
[xx] Das SK, Das V, Gulati AK, et al. Deglycyrrhizinated liquorice in aphthous ulcers. J Assoc Physicians India 1989;37:647.
[xxi] Martin MD, Sherman J, van der Ven P, et al. A controlled trial of a dissolving oral patch concerning glycyrrhiza (licorice) herbal extract for the treatment of aphthous ulcers. Gen Dent 2008;56:206-10.
[xxiv] Avijgan M. Phytotherapy: an alternative treatment for non-healing ulcers. J Wound Care 2004;13:157-8.
[xxv] Visuthikosol V, Chowchuen B, Sukwanarat Y, et al. Effect of Aloe vera to healing of burn wound: A clinical and histologic study. J Med Assoc Thai 1995;78:403–9.
[xxvi] Eamlamnam K, Patumraj S, Visedopas N, et al. Effects of Aloe vera and sucralfate on gastric microcirculatory changes, cytokine levels and gastric ulcer healing in rats.World J Gastroenterol 2006;12:2034-9.
[xxvii] Prabjone R, Thong-Ngam D, Wisedopas N, et al. Anti-inflammatory effects of Aloe vera on leukocyte-endothelium interaction in the gastric microcirculation of Helicobacter pylori-infected rats. Clin Hemorheol Microcirc 2006;35:359-66.
[xxix] Furuta S, Toyama S, Miwa M, et al. Residence time of polaprezinc (zinc L-carnosine complex) in the rat stomach and adhesiveness to ulcerous sites. Jpn J Pharmacol 1995;67:271-8.
[xxx] Shimada T, Watanabe N, Ohtsuka Y, et al. Polaprezinc down-regulates proinflammatory cytokine-induced nuclear factor-kappaB activiation and interleukin-8 expression in gastric epithelial cells. J Pharmacol Exp Ther 1999;291:345-52.
[xxxi] Handa O, Yoshida N, Tanaka Y, et al. Inhibitory effect of polaprezinc on the inflammatory response to Helicobacter pylori. Can J Gastroenterol 2002;16:785-9.
[xxxii] Suzuki H, Mori M, Seto K, et al. Polaprezinc, a gastroprotective agent: attenuation of monochloramine-evoked gastric DNA fragmentation. J Gastroenterol 1999;34 Suppl 11:43-6.
[xxxiii] Ishihara R, Iishi H, Sakai N, et al. Polaprezinc attenuates Helicobacter pylori-associated gastritis in Mongolian gerbils. Helicobacter 2002;7:384-9.
[xxxiv] Mahmood A, FitzGerald AJ, Marchbank T, et al. Zinc carnosine, a health food supplement that stabilises small bowel integrity and stimulates gut repair processes. Gut 2007;56:168-75.
[xxxv] Kashimura H, Suzuki K, Hassan M, et al. Polaprezinc, a mucosal protective agent, in combination with lansoprazole, amoxycillin and clarithromycin increases the cure rate of Helicobacter pylori infection. Aliment Pharmacol Ther 1999;13:483-7.
[xxxvii] Suzuki H, Takagi H, Sohara N, et al. Triple therapy of interferon and ribavirin with zinc supplementation for patients with chronic hepatitis C: a randomized controlled clinical trial. World J Gastroenterol 2006;12:1265-9.
[xxxviii] Grassmann J. Terpenoids as plant antioxidants. Vitam Horm 2005;72:505-35. [review]
[xxxix] Wagner KH, Elmadfa I. Biological relevance of terpenoids. Overview focusing on mono-, di- and tetraterpenes. Ann Nutr Metab 2003;47:95-106. [review]
[xl] Crowell PL. Prevention and therapy of cancer by dietary monoterpenes. J Nutr 1999;129:775S-778S. [review]
[xli] Sun J. D-Limonene: safety and clinical applications. Altern Med Rev 2007;12:259-64. [review]
|
