Episode 71: Sponsored | Cornerstone Interventions for GERD with Victoria Albina

Take a second and think about this: what clinical presentation would prompt you to prescribe cognitive-behavioral coaching, breathwork or meditation?

Did GERD make your list? Along with gentle, but powerful botanicals and nutraceuticals (IT’s Motility Activator, DGL Chewables, Heartburn Advantage), these are cornerstone interventions for GERD in the practice of Victoria Albina, NP, MPH.

Victoria operates from a patient empowerment position, believing that it’s essential for lasting change in a ubiquitous lifestyle condition such as GERD. We also cover epidemiology (30% incidence in the US), root causes, laboratory—and really interesting to me—the variable clinical presentations GERD can take. Finally, are PPIs .. safe?

Victoria discusses a recent study that made the PR rounds. Take a listen, and be sure to like, comment and rate the podcast in iTunes, Spotify, or wherever you’re hearing my voice. Thank you!  ~DrKF

Gastroesophageal reflux disease (GERD) affects 20 percent of the US population, or 1 in 5 people, by causing painful gastrointestinal symptoms.

But GERD can fuel seemingly unrelated symptoms like bilateral ear pain and flu-like symptoms.

In this episode of New Frontiers, Dr. Fitzgerald talks to Victoria Albina, a cognitive-behavioral life coach, breath work and meditation facilitator, herbalist, and licensed and board-certified family nurse practitioner about the epidemic issue of GERD. Host of the Feminist Wellness podcast, Albina is passionate about supporting clients in a holistic way that treats the root causes of GERD.

Victoria Albina, NP, MPH is a cognitive behavioral life coach, breathwork meditation facilitator, herbalist, licensed & board certified Family Nurse Practitioner, and host of the podcast Feminist Wellness.

She is passionate about supporting folks in a truly holistic way – body, mind, heart and spirit, to reclaim their power and ability to heal themselves by learning to manage their minds, heal their bodies.

Dr. Kara Fitzgerald: Hi, everybody. Welcome to New Frontiers in Functional Medicine, where we are interviewing the best minds in functional medicine. Today is no exception.

I am thrilled to be here with Victoria Albina. Victoria is a cognitive behavioral life coach, breathwork, medication facilitator, herbalist, licensed and board certified family nurse practitioner, and host of the podcast Feminist Wellness. She is passionate about supporting folks in a truly holistic way, body, mind, heart and spirit, to reclaim their power and the ability to heal themselves by learning to manage their minds, heal their bodies and engage deeply with their breath.

Today, we’re actually going to be talking about the epidemic issue of GERD, gastroesophageal reflux disease. Victoria comes to us with such a beautifully unique background to take on this ubiquitous problem and she’s going to talk to us about the functional approaches today, but she’s also going to weave in some of this other work she’s doing, this mind, body work, the breathwork. Some of the approaches that in my dialoguing with her really felt exciting and out of the box for my cerebral analytical usual position.

Victoria, I’m really thrilled to have you on New Frontiers. Welcome.

Victoria Albina: Thank you so much. Really, I’m delighted to be here.

Dr. Kara Fitzgerald: First of all, let’s just talk about the breadth of the problem of GERD and just some of the causes, some of the underlying contributors to this ubiquitous issue.

Victoria Albina: Yeah, well there is studies showing that an approximate 30% of North Americans report some experience of GERD symptoms, in Europe, it’s close at around 26%, in Asian it’s over 33%. This is a huge problem that I see constantly in clinic, and my clinic is in New York City, a high stress environment, so I’m really seeing an awful lot of GERD.

Dr. Kara Fitzgerald: It’s pretty extraordinary, you know when you were dialoguing with me early about the epidemiology. We didn’t pull up a dollar, but when you put a dollar amount to it, I’m sure it’s got to be up there in the trillions anyway. We’ll link to her citations and anything else. If we get a dollar amount, we’ll throw that up. But just go ahead, and just talk to me about it and why it’s ubiquitous.

Victoria Albina: Just to define terms, acid reflux is often when there is imbalances in the lower esophageal sphincter, when there’s pressure within the stomach causing gastric distension, bloating, which can push the stomach contents, including acid, through the LES, into the esophagus. Patients can experience this as a sensation with a burning in the heart. I’ve had patients say that they want to rip their chess open and massage the left side of their chest because it hurts so much, a sensation of acid, or an actual experience of acid or a food in the esophagus.

Victoria Albina: Sometimes, it’s more subtle. When I had really bad GERD myself for a very long time, my primary symptom was bilateral ear pain.

Dr. Kara Fitzgerald: Oh, that’s fascinating.

Victoria Albina: Isn’t that bananas? When you just think about the A&P, there’s all the irritation, inflammation acid going up through the esophagus was making its way through these stations, and creating insane amounts of pressure and actual pain in my ear.

Dr. Kara Fitzgerald: Were you treated repeatedly for ear infections? Were you misdiagnosed for a long time?

Victoria Albina: Mm-hmm (affirmative).

Dr. Kara Fitzgerald: Yeah.

Victoria Albina: Yeah, I was misdiagnosed for about the first 30 years of my life.

Dr. Kara Fitzgerald: Wow.

Victoria Albina: Until I found a really good naturopath because you all are magic.

Victoria Albina: I went to 1,000 different hearing ear doctors, and took allergy pills, and used nasal sprays and Neti Pots. It was not the issue

Dr. Kara Fitzgerald: Interesting.

Victoria Albina: Yeah, I also experienced … I thought that I had a run-down immune system because I was “constantly sick.” I felt like I had the flu nonstop. I had 1,000 TB, and HIV, and cancer work-ups. Zantac, and we’ll talk all about that, and later DGL, etc. made this flu experience go away.

Dr. Kara Fitzgerald: Geez, that’s fascinating.

Victoria Albina: Right.

Dr. Kara Fitzgerald: Yeah. Just out of curiosity, did you get scoped? Is that how you determined it and did you have some damage? How did you determine that this was just run … Or was it because of just your trial of Zantac. How did you end up figuring it out?

Victoria Albina: Yeah, it was actually I also had IBS my entire life. Blastocystis hominis and SIBO were two of the root causes of that situation, which led to this full digestive system irritation, inflammation and general upset. A friend, who was in naturopath school was like, “You know, I don’t buy it. You’re a very robust athletic active person.” I was going to the gym for an hour every morning going CrossFit, playing rugby, but constantly had the flu? It didn’t add up. But the way it didn’t add up to my conventional clinicians, and I saw 1,000 GI docs, PCPs, was to just tell me it was the flu and go rest.

Victoria Albina: It was the naturopath friend who was able to think outside of that box and say, “This doesn’t add up. Let’s do a trial of Zantac,” on our way to DGL, and zinc, carnosine and things that would actually help heal this as an experiment towards the hypothesis. I later got scoped, did the right stool test, did a SIBO test, figured all of that physiologic organic root-cause portion out. But yeah, there was a lot of trial and error, and a lot of feeling really sick for a long time until we figured it out.

Dr. Kara Fitzgerald: Well I can see why you’re really interested and passionate about speaking on the topic. Talk to me again, as you moved through your own healing journey and now as a clinician, what were your underlying factors? What are you seeing in your practice?

Victoria Albina: A lot of the things that I see are things that affect the lower esophageal sphincter, over eating, metabolic concerns, bending or lying down after eating, spicy foods, fatty foods, when there’s not a digestive capacity to manage those things, and understanding that imbalances in stomach acid can lead to bacterial overgrowth, maldigested carbohydrates, gas within the system.

Victoria Albina: A big issue for me, and something I see clinically a lot are things like motility issues, and I think that we are not thinking about and talking about this enough, in terms of the upper digestive system. When we think about the small intestine, large intestine, we talk about motility, but I’d say that when there’s an upper digestive issue, we still need to think about is this bolus of food actually moving through in an appropriate manner, and getting into the small intestine and then the large?

Victoria Albina: One of the things I think about a lot and see is issues with tissue health. We can broaden that and talk about the terrain at large, which can then conveniently shift us into talking about lifestyle modalities. The underlying tissue health of the human in front of us is so key, if there is inflammation, if there is inflammatory response, really turned on. Looking at nutrition, looking at stress management, and using soothing mucilaginous herbs to support heal, sooth, preserve and restore balance to that tissue from the entire GI tract, mouth to anus is vital.

Dr. Kara Fitzgerald: Any standout foods for you, or food reactions, intolerances of that nature?

Victoria Albina: Yeah, so I do the standard elimination diet that most of us do, gluten, dairy, corn, soy, peanuts, alcohol, caffeine, sugar. New Yorkers love those last three. That’s where we have a lot of spirited conversations. Then I’d pull the GERD specific things, so spicy foods, large boluses of fatty foods, so like your gal who’s having three tablespoons of coconut oil at one go to try to lose weight. A lot of bulletproof thinking.

Victoria Albina: It may be great in a human who’s not dealing with a reflux, lower esophageal motility issue, but may be really problematic for those whose stomach acid isn’t keeping up with the game. Obviously spicy foods, citrus. You may be shocked or you probably aren’t. New Yorkers really fight me on seltzer. They really want their carbonated beverages.

Dr. Kara Fitzgerald: Yeah, right. That’s interesting.

Victoria Albina: The math is pretty simple. If you put bubbles in and the bubbles aren’t moving down, the bubbles are going to go upward, and thus poom, fly open that LES and acid’s going to go with it.

Victoria Albina: The other one that gets really complicated is grains. I do invite people to lovingly step away from. To be clear, that’s always the language I use when talking about nutrition. I don’t make rules for other adults. I advise them about what I think is the best course of action, and invite them to make their own decisions, respecting their autonomy.

Victoria Albina: I would invite an adult with GRED to step away from grains, all grains, for 30 days, to see if it helps. It really often does, but there’s a lot of complexity, particular in this day in age to putting people on really restricted diets. I think it can become really problematic really fast, not just in terms of macro and micro nutrients, but psychologically. It’s just driving up the eating disorder bus and saying, “Let’s hop onboard.” I don’t want to be part in parcel of that, while also understanding that directed nutrition, therapeutic nutrition is vital in healing things like tissue health and inflammation.

Dr. Kara Fitzgerald: Yes, that’s right. Yes, I do think we’re just going to be on ICD-11 for orthorexia, isn’t there? I so appreciate you not wanting to feed into that.

Dr. Kara Fitzgerald: I’m assuming that you’re doing … As you said, you’re A) getting their buy-in, and choice around their elimination, but B) you’re not doing it, you’re not prescribing it forever. You’re working on the underlying issues and I’m assuming you guys start challenging things rather early in the journey.

Victoria Albina: We try. Yeah, yeah. For me, it really comes down to consent and autonomy. I think one of the underlying issues of GERD is lack of connection with self, community, autonomy, not feeling in control of your body, your spirit. Just feeling really out of control and seeking control through things that do not serve. If I come in as another paternal or parental figure to wag my finger and say, “No spicy food for you, no coffee, no alcohol,” without bringing in and really taking the time to teach folks how to manage their urges, their urge for wine in the evening, their urge for that coffee pick me up. I’m from South America. Coffee is in my blood.

Victoria Albina: But if people don’t have other ways to support themselves and they’ve just been told what to do, what to do, what to do, and have no autonomy, no agency, it’s not going to work.

Dr. Kara Fitzgerald: What are some of the tools that you’re using in this area?

Victoria Albina: From a cognitive behavioral framework, I deeply believe that our thoughts create our feelings. We can bring some complexity in here with things like Polyvagal theory and bring some somatic theory in, but what I teach my patients is that the thought that you’re having about the situation in your life creates your lived experience of it.

Victoria Albina: If you’re thinking, “Today was really stressful,” you’re going to feel stress in your body, which is going to look like over eating past the point of fullness. If we look, your stomach’s a small thing that fills up rather fast, that overeating puts pressure on the LES and there we go again. Or feeling stressed or telling a story, “I’m so overwhelmed,” leads us to obey urges like eating irritating foods, reliance on alcohol as a buffer against difficult feelings to rely on old stories like, “Why bother going to the gym? It never works anyway.”

Victoria Albina: Again, it’s really putting the patient or the client in the driver seat and helping them recognize that their thoughts about the situations in their life create their feelings. We take action based on those feelings. The way to get to their results or outcomes you want in your life is to step back and look at the self-defeating, self-sabotaging thoughts you may be bringing to the table that are creating that thought, feeling, action cycle.

Dr. Kara Fitzgerald: From that first investigation into what one is telling themselves, then I would imagine the action piece be that maybe doing a little less, perhaps eating a little differently, the knot of resistance that can open up. That’s really lovely to engage with people at that level.

Dr. Kara Fitzgerald: But why not?

Dr. Kara Fitzgerald: Oh, go ahead. Finish that thought.

Victoria Albina: Oh, no. The piece of resistance is really interesting. I’ve had a lot more millennials in my practice lately. One of the themes that I see so much is eating while distracted, so zooming around on their phone, on Instagram, watching Netflix, just not pausing, breathing and getting parasympathetic while eating.

Dr. Kara Fitzgerald: That’s right. We can, and I know that the incidents of GERD is rising, and that’s why we’re at 30% basically globally. The millennials are probably going to continue to nudge that upward because yeah, you’re right, that’s one of the fundamental recipes for GERD, is not moving into parasympathetic.

Victoria Albina: Absolutely. That’s where inner child work comes in, like understanding that so many of us are just emotional children in adult bodies, and that we act on our impulses and urges from that child place, and we act on our fears of change, which is so beautifully mammalian, fight, flight, freeze, vagus nerve. We aren’t teaching our patients to pull back, and to give love to our triggered self, and to recognize the child within us, and to attend to that little human.

Victoria Albina: To meet our own minds, our own habits, our old stories with love, and to say, “No, my darling. You don’t need a glass of wine to unwind or not be anxious at this party.” You get to manage your mind, you get to get present, you get to be your own watcher, and to understand that these other choices will lead to symptoms. These choices that are on auto-repeat in the way back of your mind will lead you to have more GERD. These stories also keep people from taking their supplements.

Dr. Kara Fitzgerald: Well and living their best life. Geez, we’re talking about GERD, which is a real tippy tippy top of the iceberg, in the conversation that you’re embarking on here.

Victoria Albina: Absolutely.

Dr. Kara Fitzgerald: It’s pretty revolutionary.

Dr. Kara Fitzgerald: Okay, well listen, we, again, you and I were talking about his earlier, but why not with this new study that just came out on the safety of PPIs, why not just shut it down so that I can have my wine at the party, I don’t have to introspect? Just talk to us about his recent paper that came out, suggesting that long-term PPIs were fine.

Victoria Albina: Right. I will start by saying I do offer my patients to keep their wine, their tobacco, their coffee, take a PPI. I explain that this will never get to the root and potentially has some really frightening long-term side effects. I do believe that it’s important for each of us to be doing this particularly in a holistic practice, to holistically say, “Babe, you have options. If you want to shut your physiology down and not heal at this root place, girl I have no judgment. You do you. Keep drinking wine.”

Victoria Albina: Do you see what I’m saying, that it comes back to autonomy?

Dr. Kara Fitzgerald: Yes.

Victoria Albina: I actually do start there. Then, I have a master’s in public health and studied epidemiology, and then I get real nerdy on them and say things like, “I think this study is really interesting, but it doesn’t, in my opinion give a green light to safety.”

Victoria Albina: Things like cognitive decline issues that previous research has associated with long-term PPI use aren’t addressed here. I would gravitate towards and have a bias towards thinking that PPI use is in most cases unnecessary, meaning yes, when there’s evident of Barrett’s esophagus, that’s a different ballgame. Maybe we’ll just put that aside.

Victoria Albina: B ut for the average bearer with heart burn, most of our patients, short of Barrett’s, have the opportunity to shift lifestyle, shift thinking, and to engage with lower risk alternatives, remembering that our primary directive as clinicians is first do no harm and I don’t believe that proton pump inhibitors, with this new study in mind, have met that qualification for me. It doesn’t meet an understanding of … There is not significant enough evidence of true long-term safety.

Dr. Kara Fitzgerald: Yeah, that’s right. I don’t think that they actually answered … But they did …

Victoria Albina: That didn’t.

Dr. Kara Fitzgerald: They looked at … Basically they said compared to their control group, there wasn’t increased incidents of fracture, but they didn’t, for instance, look at bone density.

Victoria Albina: Right.

Dr. Kara Fitzgerald: I think the only significant thing they found was enteric infection, which is actually quite significant.

Victoria Albina: Quite significant.

Dr. Kara Fitzgerald: But cerebral vascular events, and they looked at dementia, chronic renal failure and so forth. They looked at some clinical end points and said that they didn’t find significant differences.

Dr. Kara Fitzgerald: I’m certain if they did a little bit more of a drill down, they would’ve found those pieces of evidence.

Victoria Albina: Right. Right.

Dr. Kara Fitzgerald: Okay, so this hasn’t been a practice changer for you?

Victoria Albina: No. Not at all. No. It really hasn’t. Both as someone trained with an epidemiologic study background and just on an intuitive gut level, I don’t think these drugs are the answer.

Dr. Kara Fitzgerald: Let’s go back to thinking through about … You were talking about self-empowerment, you were talking about some shifts around diet. Thinking about your story, thinking about your patients, what’s next around treatment?

Victoria Albina: Right on. Yeah, the lifestyle things that patients often don’t think about, not wearing clothing that constricts. So how many people in New York are wondering around, and the world, over in Spanx all day long. Or wearing a too tight bra, or high-waisted very tight jeans, recommending a head of bed elevation of 30 degrees while sleeping. Patients really don’t want to do that and it’s often so helpful. Not lying down for 30 to 60 minutes after eating, eating while in a parasympathetic relaxed state.

Victoria Albina: Again, I can never oversell how important breathing before eating is and putting your fork down. So many of my patients eat at the speed of wolf. This is their catch for the week, and so they need to wolf it down and get to the next meeting. Not drinking a lot of liquid while eating, using things like bitter foods, even arugula, lemon water for the people who tolerate that, bitters to stimulate digestion. Those sorts of simple things are really interesting, and simple and useful.

Victoria Albina: Then pulling back again and looking for the root causes. Yeah, shall we dive into that?

Dr. Kara Fitzgerald: Yes, absolutely.

Victoria Albina: I think one of the missing pieces is gastric emptying and motility. So really thinking about that and really making sure to address that, so we start to address that with parasympathetic focus. But if remembering that if we can empty the stomach, we can relieve a lot of pressure, and therefore reflux and pain.

Victoria Albina: I really love Motility Activator. I love ginger and artichoke. I think those two herbs, and particularly in the formula in which someone finds in Motility Activator really beautiful for supporting motility. I’ll share that my mom’s mom, back home in Argentina, was a kitchen witch, and used a lot of herbs in food as medicine in her parenting. My mom loves to tell the story of when they didn’t have a lot of money. Even though they didn’t have a lot of money, she would save up and buy artichokes, and then was eventually growing them, and would always, if the kids had a belly ache, would cook the artichokes but would feed them the artichoke water.

Dr. Kara Fitzgerald: How smart is that? Yeah, that’s really cool.

Victoria Albina: These are some really ancient well-known ways of soothing the gut. Zinc carnosine …

Dr. Kara Fitzgerald: Before we jump on, and just moving forward with this, how are you using that? When are you prescribing it and how many capsules? What’s the range and the frequency?

Victoria Albina: Yeah, yeah, yeah. Right on. I either do Motility Activator, I usually do one pill with lunch, one with dinner. I have found that lot of people have really hard time remembering to do something midday, so I tell them to put a little Google reminder on their phones so it pops up. If they forget, to just do two in the evening. I also really love the product Heartburn Advantage, and that’s one capsule, BID, and that product both supports the GI tract, the protective mechanisms, and supports motility.

Dr. Kara Fitzgerald: What’s in that?

Victoria Albina: That’s zinc carnosine, and also has artichoke, cynara, ginger and then DGL. I love DGL. Gosh, my patients end up using it like candy. That’s deglycyrrhizinated licorice. We know that licorice as an herb … You all right over there?

Dr. Kara Fitzgerald: I’m sorry. Yeah.

Victoria Albina: Oh, no. It’s okay. Just wanted to pause for your editor.

Victoria Albina: Licorice can lead to some blood pressure dysregulation, and so the DGL form removes the chemical that would do that. I will use it either in a blend, like Heartburn Advantage which I absolutely love, there is also DGL chewables in a powder, and so people can use the chewables or the powder before a meal. I usually say two chewables or a teaspoon of powder right in your mouth, which is super gross. It’s so gross. Like when you give a dog peanut butter and they’re, “What did you do to me?” It’s like that. People whine for the first week and then they’re like, “Oh my gosh, I feel so much better. Thank you.”

Victoria Albina: Heartburn Advantage is great, that or Motility Activator to address those motility issue while also healing and soothing the stomach lining, the esophageal lining, and then carrying all that goodness right on down.

Dr. Kara Fitzgerald: Good, good. That’s lovely. Okay, anything else that you’re doing with regard to your interventions. I like it, I do agree that middle day dosage is often missed, but you’re keeping it really pretty simple. These aren’t overwhelming, these recommendations. But is there anything else that you wanted to add you might work with?

Victoria Albina: Absolutely. I am a woman obsessed with zinc carnosine. It’s really deeply healing, to the gut lining, and it also helps with pylori. We can’t forget the role of Helicobacter pylori when we’re talking about GERD. I think it’s really important to work our patients up for pylori when we present with GERD or what we think is GERD.

Dr. Kara Fitzgerald: I want to hear your H. pylori intervention, what additional things you might be doing, but before we do that, let’s talk about your work-up.

Victoria Albina: Oh yeah. I’m not doing endoscopy in office, and so many of my patients want to avoid things like endoscopy. So when the symptoms are compelling, I’ll just start treatment often as a first line to see what the what is. I will start with basics like zinc carnosine, the heartburn soother, DGL chewables, in addition sort of as a PRN often. I’ll often say to them, “If you’re tempted to take Tums, give the DGL a try first,” so they’re not taking Tums.

Dr. Kara Fitzgerald: Yeah.

Victoria Albina: Sorry, editing side note. I just dissed a brand name. Should I re-do? You were like, “Girl, don’t do that.”

Dr. Kara Fitzgerald: No, no, no, no, no. That’s fine. No, you’re fine.

Victoria Albina: You sure you don’t want me to say an over the counter chewable antacid?

Dr. Kara Fitzgerald: No worries. No worries.

Victoria Albina: All right, you’re the boss.

Victoria Albina: Yeah, so I’ll have them use DGL, PRN. Where was I going? We’ll add to that all of the lifestyle factors. Often, people can begin to start to see improvement relatively quickly, two weeks, three weeks. Sometimes even faster when they have wolf eater syndrome, and eating really quickly, really distracted. Or maybe it’s something just as simple as using the heartburn soother to bring some gentleness into the stomach lining while taking the citrus, the coffee, the alcohol, the tobacco away.

Victoria Albina: The next level of diagnostic intervention would be to start to see what else is going on in the system that may be causing an increase in distension gas and bloating throughout the system. Obviously, if those symptoms are co-concurrent or concurrent rather, then of course I’ll start with those work-ups day one.

Victoria Albina: Of course, I’ll get bloodwork, just to see what’s going on. When I think motility, I think thyroid needs to be there, in the work-up. I’ll also think about SIBO, and I’ll think about the large intestine, and so I’ll get a stool test. I currently am using GI-MAPs, which is a DNA PCR. I’m liking it. I’m liking the results I’m getting. It’s affordable, it’s one test, it’s one sample, which we could critique that. My patients do it. When I give them the kit and I’m like, “It’s just one poop. Get it done.”

Victoria Albina: Previously, I was using a three-day test, which one could make an argument that you’re more likely to catch things like blasto that are sneaky and hidey when you’re doing three days. But doing one day and it being DNA PCR, people actually do it, whereas the three-day kits, three weeks, a month, two month, later.

Dr. Kara Fitzgerald: It is. It’s true. Yeah, it’s true.

Victoria Albina: They don’t want to do it. They don’t want to collect stool from three days. It’s gross. Let’s be honest with ourselves, I don’t want to do it either.

Dr. Kara Fitzgerald: There’s actually a pretty nice panel of virulence factors for H. pylori, so you’re doing a bit of a drill down there as well.

Victoria Albina: Yeah, which is really, really great and super useful. Yeah, so I’ll do a stool test. I’m in constant flux around SIBO testing versus looking at the phyla that’s on Page 2 of GI-MAPs and looking at what we’re seeing there as an indicator of likelier possible SIBO, and of course looking at symptomology as our guide. I’m in process with my thinking around doing SIBO testing.

Victoria Albina: The other reason I really pause with it is again lifestyle, and feasibility, and having folks do a day of eating just chicken or fish as prep is really quite challenging in my patient setting, as well as them finding a minimum three-hour window where they can pretty much sit still and not do much. But test, is again, that’s one of the kits that people have for a month or two or three before they get around to it. If I can do the one stool, and be one and done, and begin treatment, everyone’s happier much faster.

Dr. Kara Fitzgerald: Yeah, I agree with you. I know there’s some challenges to the reliability of them.

Dr. Kara Fitzgerald: The clinical picture, it’s pretty straightforward I think with SIBO. I think with GERD, especially with your presentation, that can be a little bit trickier. But if you can buy a little time, I think like you said, it sounds like you do a couple of therapeutic probes as David Jones from IFM used to call them, you trial some interventions and see if they respond as part of your diagnostic work op, which I think it makes a lot of sense. As you are treating GERD, you are addressing the presence of SIBO, I think. I understand having some challenge around that one.

Dr. Kara Fitzgerald: What about nutrients? Are you thinking about nutrients? Are you measuring nutrients with folks who might have had the GERD complaint for a long time? What are you thinking about there?

Victoria Albina: I used to do it all, and I have stepped away from that in part because I think most of us can assume what we’re going to find, that with chronic GERD, particularly if there’s an underlying SIBO or an underlying large intestine bacterial parasitic helminth overgrowth. Well, helminth is not overgrowth, you got the worm or you don’t. But there is going to be a nutrient imbalance, so I do everything I can to really preach the gospel of whole foods of nutrient density, of attempting to bring in organ meats and bone broth if I’m not highly suspicious of SIBO fermented foods, and to vary the diet as much as possible within the framework of the elimination protocol. It gets a little tricky.

Victoria Albina: Then I put them on a really good quality multivitamin, minerals, and introduce things from my herbalist training like nettles, oatstraw tea, hibiscus tea, rose hips. I know that they’re getting antioxidants, they’re getting minerals, and they’re getting something delicious that may help emotionally to take the place of the coffee, alcohol and seltzer that I just invited them to step away from.

Victoria Albina: I test D, and B, MMA and folate. I do those things for bloodwork, but I am no longer doing the above and beyond nutrient testing just because I think it’s a fair assumption, wouldn’t you say, that their nutrients are probably pretty tanked.

Dr. Kara Fitzgerald: Yeah, absolutely. Yup, I think it’s reasonable to conclude that and to just treat towards that, especially with your food forward approach.

Dr. Kara Fitzgerald: When are you going to pharma?

Victoria Albina: Yeah, so again, definitely we have endoscopy with evidence to Barrett’s esophagus, not a question.

Victoria Albina: I am not personally afraid to do an H2 bridge. I’m not scared of it in the setting of really smart thoughtful evidence-based supplement support. Just an H2 blocker on its own, again, I don’t believe going to do much towards our goal of managing the root-cause, but doing a short bridge of that with the zinc carnosine, with the DGL, with motility support, all the lifestyle issues is a really beautiful bridge for folks to be able to do the rest of the work, to be able to … There is studies looking at pranayama yoga, breathing modalities to help reduce GERD symptoms and experience.

Victoria Albina: I’ll just speak from personal experience that when I was exercising, I had less GERD. But I’m sorry, I’m not going to do a downward dog if my mouth is going to fill with acid. What are you talking about? That’s bananas. I’m not going to do that.

Victoria Albina: We can use an H2 blocker plus supplements, while the stool test is running, or the SIBO test is running, the blood is running, the adrenals are running, the hormones are running in the background while the elimination diet is taking the time it takes to begin to reduce, to allow for inflammation to reduce. It gives that patient some hope.

Dr. Kara Fitzgerald: Absolutely. Yeah, they’re going to appreciate having a reduction in symptoms pretty quickly.

Dr. Kara Fitzgerald: What if you’re seeing H. pylori, what if you’re seeing blasto, what if you’re seeing some of the more angry microbial findings? How might you approach some of those? You have blasto, so maybe use your case as an example and H. pylori is relatively common.

Victoria Albina: To start with pylori, pylori needs to be managed, it needs to be addressed, absolutely. Tissue health is a vital part of this, ulceration, pre-ulceration, irritation and paying attention to the stomach lining. We’d know that pylori worsens that situation. If we are being thoughtful, of being a mindful good steward, of antibiotics, I would rather use herbs and supplements than triple therapy, and triple antibiotics, therapy with antibiotics for pylori.

Victoria Albina: As always, we’ll just have it as the baseline, all the lifestyle support which I actually see that making a difference. This is empirical, not, I can’t point to a study that says lifestyle factors reduce pylori, but what the issue is with pylori is the virulence. Pylori secretes irritants at a higher rate and that’s the issue. Reducing virulence helps reduce erosion, and that’s where bringing things in like a really high quality zinc carnosine. It may not affect the counts of pylori, the colony counts, but you will generally, if you’re checking virulence, you’ll see that carnosine will reduce virulence and thus will help with erosion.

Victoria Albina: For anyone out there who is feeling frustrated or confused, maybe because their patient is reporting improvement in symptoms but you’re not seeing the colony counts go down, that may not be a problem.

Dr. Kara Fitzgerald: Then in those cases, if they’re clinically better, you’re not super concerned about the presence of H pylori. But if you see the virulence factors, then you’re addressing that. How do you figure that out in your practice?

Victoria Albina: Yeah absolutely. Virulence factor equals treatment, basto. End of story. The single presence of pylori, and we can get really complicated in the conversation about is pylori a commensal before age 25, 28, 30? Or is it problematic in someone younger who is asymptomatic?

Victoria Albina: But let’s say we have a fully-fledged grownup, someone in their 30s, 40s, 50s and above with the simple presence of pylori, with absolutely zero symptomology, I may do something again like zinc carnosine which what’s the risk there? Like 20 bucks is the risk. That is do no harm medicine as a way to begin to invite that pylori out of the system, and while healing the gut, but I wouldn’t go hardcore on it.

Victoria Albina: With things like blasto, blasto with blasto’s concurrent symptoms, generally an IBS picture depression, anxiety, big skin concerns, like that full blown this beast is taking over my life picture, like what I live through. That’s when I go to pharmaceuticals, plus products like Paragard, plus particularly in the present of heartburn or reflux Heartburn Advantage, something like Similase, some enzymes to help with digestion. I like Similase because it’s for a sensitive tummy. Yeah, those would be my go-to, but Paragard to kill off the bugs, and then some good probiotics like Probiotic Pearls to begin to support colony counts and of course a prebiotic where tolerated.

Victoria Albina: Again, SIBO complicates everything because if we’re having gas issues, malabsorption issues, so many of the mucilaginous herbs plus prebiotics, even probiotics are going to trigger more gas creation, more distension, more opening of that lower esophageal sphincter, more reflux, more pain as hope and less trusting you as a clinician. We know therapeutic relationship is everything.

Dr. Kara Fitzgerald: Talk to me just how did you get through to the other side of your horrible case of GERD.

Victoria Albina: It took a very long time. I now believe that it is our job, it is our ethical duty as clinicians to say that clearly to our patients. It’s not going to make us popular, it’s not going to get us good Yelp reviews, but I think it is our ethical duty to say, “Babe, this could take years.”

Dr. Kara Fitzgerald: Really?

Victoria Albina: Well there’s the old standby of one month of treatment for every year of symptoms, but if someone shows up like me with 30 years of wildly unmanaged GI symptoms, that’s years, if we think of the extent of tissue damage.

Victoria Albina: So you think, I’ll be New York here, eating a hot slice of pizza, and it burns the roof of your mouth, that could hurt for days, or a week or longer, or even biting your lip, it’ll hurt for a week. If we think of the pH of stomach acid. Every time you go to bed, that’s washing up into your esophagus, and it’s coating your stomach. It’s going to take a while to heal that and that’s why I start supplements really quickly to begin to sooth and comfort the stomach, getting that ginger, the DGL, the artichoke in there, and the zinc carnosine to do healing work so that the patient could suffer less while all that delicate tender tissue can find its way to get knit back together.

Dr. Kara Fitzgerald: In your case, do you think it was the blasto, just decades of blasto that really drove it? Then layer onto that I’m sure you walked through your share of stress. You’re in New York, you were in school, and doing a lot of the usual stuff that we find ourselves doing. Was it that original infection or collection of infections? What was your Mrs. O’Leary’s cow?

Victoria Albina: The thing that was mooing for me … Yeah, blasto is an easy thing to point to.

Dr. Kara Fitzgerald: To suggest, yeah.

Victoria Albina: Yeah, and I think the blasto happened and then we moved to a foreign country. We can’t forget to layer in lack of connection, social isolation, being that weird kid at MLK Elementary in Providence, Rhode Island with an Argentine accent who brings milanesas for lunch, and people are like, “Who are you?” All the psychological stressors that people aren’t thinking of that are keeping them in that low grade fight or flight, that low grade sympathetic, that’s keeping the mucosa thinned and not healing. The blasto does its damage to the enteric lining and then there’s not that.

Victoria Albina: When we were back home, we’d lived our whole family in the apartment building. Everyone had their floor, and there was connection. There was the food that my body was built for. It doesn’t have to be immigration, it can be a divorce, it can be a sibling being born, it can be grad school, all the stressors that you alluded to keeping the system in dis-ease out of balance so that the blasto becomes a problem.

Dr. Kara Fitzgerald: Right. Yeah, that’s right. It can become a really refractory challenging issue, for sure.

Victoria Albina: Geez, that was gnarly.

Dr. Kara Fitzgerald: But you sound great now, you’re doing great, and now you’re knocking it out of the park with this epidemic of many faces.

Dr. Kara Fitzgerald: Listen, so I just wanted to ask you one more question going back to your own story with a variant presentation that’s probably not that outside of the box. What are some of the more unusual clinical presentations of GERD that you’ve seen? Yours is a big outlier. Anything else that we might be thinking about other than the typical picture, which incidentally it could be heart, so we’re thinking about that as well? What are you thinking about clinically or seeing?

Victoria Albina: Maybe it’s that I draw these kind of patients because I see the things, but migraines, chronic neck pain. My sternocleidomastoids were like actual ropes, and I was going to … I had such chronic neck pain when my GERD was a mess and even now. I just don’t drink caffeine, I drink Yerba Mate because I’m Argentine, but coffee. Sometimes I’ll sip a little, like steal a sip of my partner’s coffee, and we’ll get neck pain within 10, 15 minutes.

Dr. Kara Fitzgerald: Isn’t that something?

Victoria Albina: Right. I used to go running, I love a good chiropractor for an adjustment and dude would move stuff, and put my neck back where it was supposed to be, but I came to realize that once the ear pain had passed as a symptom, neck pain, migraines, not just occipital headaches, but frontal headaches, sinus pain and pressure because again, it’s the same physiology as the ear pain, hoarse voice. Here, this is one that I see, well rather I hear it constantly. I had it for my entire life. It was just my tick, but it was no tick, it was heartburn. My mom had it, my sister had it. We killed our collective blasto because blasto is like cucarachas, there’s one in the house, there’s more than one in the house.

Victoria Albina: None of us now has that chronic cough, but I’ll hear it on the subway, I’ll hear it in patients. That’s when I’ll do the DGL, carnosine, Zantac trial to see if my hypothesis is right. More often than not, it’s right on.

Dr. Kara Fitzgerald: Would you say you … Yeah, go ahead.

Victoria Albina: Sorry, there’s just this very specific … Anyone who’s worked in the hospital is like, “Ooh, I can smell C. diff from a million miles away.” There’s this very particular halitosis that is like a heartburn, like if there was metalic composting. It’s weird to describe, but there is this breath that I will smell and I’m like, “That is GERD.” That is your mouth being washed in acid, and there is an imbalance in the microbiome of your mouth that you’re waking up and you can’t brush it away, you can’t tongue scrap it away, you can’t coconut pull it away. It’s there because it’s coming from your esophagus, it’s coming from your stomach.

Dr. Kara Fitzgerald: Do you ever see GERD present without GI symptoms, normal bowel movements, no gas, where you’re just getting a description of ear pain, or sinus pressure, or headaches? Would you ever see that, or are you always going to be pinged to think GI or most of the time?

Victoria Albina: Yeah, sort of a yes, and. I’ll pick up those side presentations in the human who comes to me for PCOS, or a human who comes to me for a thyroid issues, or fatigue. Often folks don’t present saying, “I have these out of the box GERD symptoms.” They’ll present with something that has always, because we are one beautiful perfect machine, is part in parcel of imbalances in the hydrochloric acid levels, in motility. It’s all one and the same in its way, if we science it out. But yes, I will catch that throat clearing in someone who would never thinking that GERD was part of their picture.

Victoria Albina: Then I am often the last stop or one of the last stops on the choo-choo train of health that people have been to lots of GI clinicians, and lots of PCPs. When folks get to me and they have wicked GERD, there is usually something else going on. There’s the SIBO, there’s a bug, there’s an insufficiency dysbiosis or a flagrant overgrowth that needs to be rebalanced.

Dr. Kara Fitzgerald: Yeah, I got it. That makes sense. That’s my experience as well. Yeah, for sure. For sure. But yeah, I just suspect you’re seeing it and probably seeing some more interesting cases because of your own experience.

Dr. Kara Fitzgerald: I think also in many of our GERD cases, you do foundational functional medicine and you get people better. One doesn’t necessarily need to identify somebody’s ear infection or what looks like an ear infection as GERD, because when you treat the whole person, you’re probably going to start to turn it around.

Victoria Albina: True.

Dr. Kara Fitzgerald: That said, having your pearls today, it’s just a really interesting eye-opener for me and I’m sure a lot of other folks out here too are going to value it.

Dr. Kara Fitzgerald: Well listen, Victoria, it was lovely to talk to you today and your just really nice holistic approach …

Victoria Albina: Thank you. Likewise.

Dr. Kara Fitzgerald: Yeah. The supplements that you’ve recommended, the papers you’ve recommended, we’re going to corral them together. In fact, go ahead and give us a shout out to your website and your podcast. We’ll also put all of that, all of that will be corralled onto the show notes, but you’ve got a fabulous podcast.

Victoria Albina: Oh, thank you. Yeah, so the podcast is called Feminist Wellness. It’s for humans of all genders. You can find it on iTunes, Stitcher or wherever you get your podcasts from. Make sure to subscribe so that you get every episode downloaded right to your phone each week, which is a delight.

Victoria Albina: Then my website is my name, victoriaalbina.com. There is a free e-book on there, on the home page where I talk about my holistic mind, body, spirit approach to medicine. There is also some free meditations that you can download and share with our patients at victoriaalbina.com/bodyscan. Those are some quick meditations that you can do any time or place to help yourself get really present. I love to prescribe those for right before eating so people can take literally two minutes to get in touch from their toes up to their nose. Really helps.

Dr. Kara Fitzgerald: That’s great. Okay, everything to be on the show notes, and again, really nice time talking to you today, Victoria. Thanks for joining me.

Victoria Albina: It’s been my pleasure. I love nerding out with you.