Acid reflux patients often find themselves asking the question - Is anxiety causing my reflux or is reflux causing my anxiety? There is no doubt but there is a connection between the two. In some cases it is obvious which came first, but for other individuals it’s not as clear. Fortunately knowing which comes first is not a prerequisite for successful homeopathic treatment. Accurately describing your unique symptoms of acid reflux and anxiety is.

Homeopathy is a system of medicine whereby a remedy is chosen to match your full symptom picture i.e. all physical, mental and emotional symptoms. A holistic approach is imperative in treating individuals who suffer from acid reflux and anxiety as the two are inextricably linked, and are not likely to be fully resolved if they are treated separately. Homeopathic treatment addresses the root causes of why you became unwell in the first place, and has the potential to restore balance to the gut-brain axis, reverse symptoms and prevent recurrence of acid reflux in the future.

The Gut-Brain axis

The gut and brain are intimately connected. This connection has been recognized for centuries. Hippocrates, the father of Medicine, is said to have stated that ‘all disease begins in the gut’ (1). Modern medicine is finally catching up. Recent advances and new technologies are revealing the exact nature of this physiological connection between our brains and gut.

The gut, also known as the second brain, is made up of millions of neurons arranged in the intricately folded tissue that lines the gastrointestinal tract. It plays a critical role in mental and emotional functioning by sending information to the brain and directly influencing things like feelings of stress, anxiety and sadness, as well as memory, decision-making and learning (2). The largest nerve exiting the brain is the vagus and it runs from the brainstem to the belly.

Another huge physiological factor in the gut-brain connection is the billions of gut bacteria that reside there, which also have a profound effect on our mood, temperament and behaviour. Apparently 95% of our serotonin is stored in the gut.

The Acid reflux - Anxiety connection

The connection between acid reflux and anxiety appears to be a psychosomatic one. Stress and anxiety can increase acid reflux symptoms, and acid reflux symptoms can cause anxiety to increase (3). This connection has been the focus of numerous recent studies.

One study looked into the connection between anxiety and depression in patients with gastroesophageal reflux disease (GERD) and the impact on quality of life (4). Yang et al found that the incidence of GERD was correlated with anxiety and depression and that quality of life of patients was reduced significantly. The authors of this study proposed two theories: 1) That anxiety and depression develop secondary to the reflux and then cause increased sensitivity to the reflux symptoms. 2) The second explanation is that the severity of reflux is greater in patients with psychiatric diseases. Based on this finding researchers suggest treatment with anti-depressants and anti-anxiety medication for patients who don’t benefit from taking proton pump inhibitors (PPIs).

A recent study took this further and studied the efficacy and safety of using a combination of antidepressants (Amitriptyline) and PPIs (Pantoprazole) for GERD with coexisting anxiety symptoms (5). Based on the favourable evidence that both GERD symptoms and anxiety disorder reduced simultaneously, the authors of this study suggest this combination of amitriptyline and pantoprazole in the management of GERD with coexisting anxiety, especially since 47% of GERD patients suffer with anxiety and are not responsive to PPIs.

One of the cited limitations of this study was it’s short duration. They rightly highlight that ‘the short duration of most studies and the lack of follow-up after treatment cessation leave the question unanswered whether amitriptyline has long-term beneficial effects in GERD patients with anxiety symptoms’. 4 weeks is clearly not sufficient time to assess long term side-effects of combining these medications.

The majority of patients with GERD currently use antacid drugs to control their symptoms. However, the symptoms of GERD are sometimes impossible to control, and these patients tend to have a lower response rate, even to the most potent PPIs. Apparently 40% of heartburn patients experience partial or no improvement taking PPIs daily (6). The treatment option of combining antidepressants* and PPIs** will not appeal to some due to the potential of long term side effects. Sounds like we need an alternative treatment approach, right?!.

Could homeopathy be the answer?

We have some excellent Gut-brain remedies, and homeopathy does offer the holistic approach required to treat mental, emotional and physical levels simultaneously. A homeopathic approach offers long acting results by resolving the root causes of ones condition.

A recent pilot study to explore the usefulness of homoeopathic treatment in Nonerosive gastroesophageal Reflux Disease (NERD) showed a significant decrease in the symptom score for all patients from the first follow-up assessment (7). The researchers found that the medicines prescribed on the basis of totality (i.e. full symptom picture) were associated with improvement in the patients. Quality of life assessment showed statistically significant improvement post treatment. Improvements were seen across the board - psychological, social, and environmental levels. Patients reported being more socially active, feeling better emotionally, improved sleep and increased capacity to work.

Homeopathic remedies for Acid reflux & anxiety

With chronic conditions such as anxiety and GERD it is advisable to undergo treatment with a professionally trained homeopath. Self prescribing is generally not recommended as results can be mixed. We have 3,000 remedies to choose from so it takes experience to pick the right one to match your full symptom picture. Chronic GERD and anxiety is likely to require a series of remedies to fully resolve your condition.

Following is a sample of homeopathic medicines I regularly employ to treat patients who suffer from both anxiety and acid reflux. The remedy descriptions are brief. Each remedy picture also has a defined throat, chest, and sleep picture etc. For more information about each remedy please refer to a homeopathic materia medica. An online version of Boericke’s materia medica is available - http://www.homeoint.org/books/boericmm/a.htm

Nux Vomica

Mind/ Temperament: Nervous. Oversensitive to all external impressions. Very irritable. Zealous fiery temperament. Overactive mind. Angry and impatient.

Anxiety: about business, felt in chest and stomach, worse in evening, about health.

Cause: Dyspepsia from drinking strong coffee. High living, alcohol, highly spiced seasoned food, irregular diet, long continued mental or physical stress, excessive intake of medicines.

Physical symptoms relating to GIT and Acid reflux: Nausea in the morning, after eating.

Weight and pain in stomach; worse eating, some time after. Nausea and vomiting, with much retching. Epigastrium bloated, with pressure as of a stone, several hours after eating

Sour, bitter eructations. Sour taste in the morning. Flatulence and heartburn. Epigastrium bloated with pressure as of a stone, several hours after eating.

Concomitant symptoms: Throat: rough, scraped feeling. Tickling after waking in morning. Stitches into ear. Region of stomach very sensitive to touch. Desire for stimulants

Loves fat and tolerates them well. Constipation, with frequent ineffectual urging; passing small quantity at each attempt; feeling as if part remained unexpelled.

Modalities (< feels worse, > feels better) < morning, mental exertion, after eating, stimulants, spices, cold, dry weather, disappointments of ambition.

> in evening, damp-wet weather, strong pressure of clothes at waist.

Lycopodium

Mind/ Temperament: Indecision. Timidity. Loss of self-confidence. Poor self-esteem. Constant fear of breaking down under stress. Anticipation. Stage fright. Fear of public speaking. Averse to undertaking new things, yet goes through it with ease. Apprehensive. Melancholy, afraid to be alone. Awakes, irritable, angry, sad and anxious. Headstrong and haughty. Domineering, fault-finding. Love for power. Hateful, Cranky. Weak memory, confused thought. Dyslexia. Anxiety: in bed, felt in the chest, in company, in a crowd, difficult breathing, < evening, > feels better in open air, anxiety exaggerated, when anything is expected of him, about health, anxiety felt in region of heart -palpitations, with nausea with anxiety, as if about to die, during vertigo.

Cause: due to farinaceous and fermentable food, cabbage, beans, etc.

Physical symptoms relating to GIT and acid reflux: After eating, pressure in stomach, with bitter taste in mouth. Eating ever so little causes fullness. Food and drink regurgitates through nose. Immediately after a light meal stomach is bloated full. Incomplete burning eructations rise only to pharynx, there burn for hours. Sour eructations. Vomits food and bile. Food and drink regurgitates through nose. Wakes at night feeling hungry. Great weakness of digestion with bloating. Gastroenteritis from fright. Flatulence

Concomitants: Aversion to bread. Desire for sweets. Likes to take food and drink hot. Excessive hunger. Stool hard, difficult, small, incomplete.

Modalities: (< feels worse, > feels better) < 4 to 8 p.m., right side, heat except throat and stomach > belching, warm food and drink, loosening the garments, open air.

Pulsatilla

Mind/ Temperament: Mild, gentle, timid, yielding disposition. Emotional, sad, crying readily, weep when talking. Moody, contradictory. Changeable nature. Child wants to be carried slowly. Easily offended. Whining. Craves sympathy. Desires company. Fear of abandonment or history of, grief. Irritable, touchy. Fixed ideas about food. Sadness from disagreeable news.

Anxiety: felt in the chest, felt in stomach, must loosen clothing and open window, in the dark, in bed, < evening, exaggerated anxiety, about the future, about health, palpitations in heart region, with perspiration with, suicidal with anxiety, weariness of life with anxiety.

Cause: eating rich foods, ice cream, pork, fats, pastry, desserts. Abandonment, grief.

Physical symptoms relating to GIT and acid reflux: Belchings, taste of food remains for a long time especially after ices, fruits, pastry. Bitter taste, diminishes taste of all food.

Water Brash with foul taste in the morning. Stomach disordered, feels heavy. Heartburn.

Dyspepsia with great tightness after a meal, must loosen clothing. Vomiting of food eaten long before. Pain in stomach an hour after eating. Weight as from a stone , especially in the morning on awakening. Flatulence. Great soreness of epigastrium. Cutting, pulsation in epigastrium. Painful, distended, loud rumbling. Pressure as from a stone. Shortness of breath with digestive complaints

General symptoms: Changing, shifting symptoms. Feel better in open air. Discharges thick, bland and yellowish/ green. Great sensitiveness. Thirstlessness. Chilliness.

Modalities (< feels worse, > feels better) < warmth of air, stuffy rooms, clothes, bed. Worse evening and night. Rest, beginning motion. From eating, long after, rich foods, fats, ice cream, eggs. Puberty/ pregnancy. Hot food is vomited immediately. > cold, fresh open air, cold applications. Continued motion, pressure, rubbing, massage.

* Amitriptyline can cause nervousness, insomnia, and anxiety in some patients because it can stimulate the nervous system. In addition, amitriptyline can also block the effects of a chemical known as acetylcholine, which is used by nerves to control muscles. This can result in constipation, urinary retention and increased eye pressure. Other side effects include confusion, numbness and tingling in your arms and legs, headache, constipation or diarrhea, blurred vision, skin rash, swelling of your face and tongue, nausea, unexpected weight gain or loss, swelling and tenderness of the breast tissue. Some of the more severe side-effects include Heart attack (symptoms can include: chest pain, shortness of breath, pain or pressure in your chest or upper body) and stroke (weakness in one part or side of your body, slurred speech) (8).

**The most common side effects of proton pump inhibitors: headache, diarrhea, constipation, abdominal pain, flatulance, fever, vomiting, nausea. As a result of reduced stomach acid production PPIs may increase the risk of Clostridium difficile infection of the colon. High doses and long-term use (1 year or longer) may increase the risk of osteoporosis related fractures of the hip, wrist, or spine. Prolonged use may also interfere with the body’s natural digestive process, important nutrients such as Calcium, Vitamin B12, Phosphorus, Vitamin D, Folic acid, Iron, Zinc, Vitamin B1 are not absorbed well. Analysis of patients taking PPIs for long periods of time showed an increased risk of heart attacks. Therefore, it is important to use the lowest doses and shortest duration of treatment necessary for the condition being treated (9, 10).

Sources

1. https://www.huffingtonpost.com/entry/all-disease-begins-in-the-gut-hippocrates_us_58f9ed4ee4b086ce58980fc3

2. https://www.heysigmund.com/our-second-brain-and-stress-anxiety-depression-mood/

3. https://howtotreatheartburn.com/acid-reflux-and-anxiety/

4. Yang X-J, Jiang H-M, Hou X-H, Song J. Anxiety and depression in patients with gastroesophageal reflux disease and their effect on quality of life. World J Gastroenterol. 2015 Apr 14;21(14):4302-09.

5. Faruqui A - A. Gastroesophageal Reflux Disease Associated With Anxiety: Efficacy and Safety of Fixed Dose Combination of Amitriptyline and Pantoprazole. Gastroenterology Res. 2017 Oct; 10(5): 301–304.

6. Dean BB1, Gano AD Jr, Knight KAUfman JJ, Fass R. Effectiveness of proton pump inhibitors in nonerosive reflux disease. Clin Gastroenterol Hepatol. 2004 Aug;2(8):656-64.

7. Mittal R, Khurana A, Ghosh MS, Bawaskar R, Taneja D, Kashyap S, Manchanda RK. An open-label pilot study to explore usefulness of Homoeopathic treatment in non erosive gastroesophageal reflux disease. Indian journal of research in Homeopathy. 2016. Aug; 10 (3): 188-198.

8. https://www.healthline.com/health/amitriptyline-oral-tablet#side-effect

9. https://www.medicinenet.com/proton-pump_inhibitors/article.htm#what_are_the_side_effects_of_proton_pump_inhibitors_ppis

10. https://www.drugs.com/amitriptyline.html

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Disclaimer: This article is for educational purposes only and not intended to replace the advice of your physician or health care provider. First aid situations may require medical or hospital care. Do not use this article as a means to diagnose a health condition. Speak to your doctor if you think that your condition may be serious, before discontinuing any medication that has been prescribed for you, or before starting any new treatment.

If you suffer from GERD and anxiety and want to explore how homeopathic treatment could help you get in touch. Free 15 minute consultations available by appointment.