Today we have with us, Dr Manjiri Nadkarni, who is a Doctor of Ayurvedic Medicine, Registered Holistic Nutritionist & Certified Base Allergy Consultant. She is the President of Ayurveda Association of Canada and has an M.D (Ayurveda) from Gujarat Ayurved University. She was awarded the Charaka Award 2016 for Excellence in Ayurvedic Teaching from Association of Ayurvedic Professionals of North America (AAPNA) in May 2016.
To know more about Dr. Manjiri Nadkarni, you can visit https://manjirinadkarni.com/
It is really good to meet you Dr.Manjiri. Thanks a lot for spending some time with us.
You’re very welcome.
I understood from you that you’re a specialist in our digestive system, the digestion part of it and the fertility aspects as well. That’s what you’re profile said. Am I right?
Correct. See, my primary training is Bachelor of Ayurvedic Medicine and Surgery. When I went for MD, where I specialized in Rog Nidan evam Vikriti Vigyan better known as Ayurvedic pathology and diagnosis. So in my clinical practice, I deal with a lot with different kinds of disorders. From hormonal balancing, to weightless, though digestion and allergies are two of the main things I specialize in.
Okay. So can you first tell me about GERD so that we can understand about it, what are the symptoms that a person with GERD should look for?
GERD means Gastro Esophageal Reflux Disease. So it occurs when your stomach acid flows back into the oesophagus. There’s a tube that connects your mouth and the stomach known as esophagus. So when the reflux occurs, the contents of the stomach or the stomach acid flows back in to your esophagus. It backs right up to your throat and that can irritate the lining of your esophagus as well. So some people experience acid reflux from time to time, mildly. The other symptoms are burning in your chest. It’s typically known as heartburn. So usually after eating if you’re noticing a lot of burning that’s one symptom. It might get worse at night. Some people have chest pain. Some people experience chest heaviness. Some people experience difficulties swallowing.
Some people feel like food regurgitating in the mouth, especially something sour or rancid. They may feel a knot like sensation in the throat as well. People also seem to have night time symptoms. I had a patient who was coughing at night and couldn’t get rid of the chronic cough no matter what was done. It was actually from the reflux, which was irritating the lining. Sometimes your larynx or the voice box gets inflamed. Sometimes at night if you have asthma, the symptoms could get worse and people don’t sleep well because of this.
How different is this cough from the cough that you get when you have a cold/ flu?
If you have cough due to cold and flu, there would be other symptoms like runny nose, phlegm etc. This specific kind of cough due to GERD can happen in supine position, due to the reflux of stomach contents.
Acid reflux in Ayurveda can be understood as called Amlapitta. Amlapitta means that the Pitta mainly situated in the abdominal area turns rancid. The combination of enzymes, bile and everything else is known as Paachaka Pitta or the Pitta that is responsible for digestion. So if you’re eating something really spicy or lots of pickles or lots of fermented foods like dosas and stuff, if you have a Pitta dominant constitution, then eating all these foods and consuming alcohol provokes provokes your pitta. But the pitta actually turns rancid due to Ama or indigestion. So from a bitter taste it turns sour and from the reflux you get a sour taste in your mouth.
So heartburn is kind of like a symptom of GERD, am I understanding it right?
Yes. Heartburn is the symptom. Acid reflux is what’s causing it,And if acid reflux happens very regularly, as it advances, it is known as GERD. So the lower esophageal sphincter, if it is lax, can cause the food to reflux. Sometimes it is known as hiatal hernia, where the contents come up too.
Got it. So, why do pregnant women feel heartburn so often? Is it because of the pressure that goes up or what exactly is the reason?
Pregnancy heartburn is because of two things – if it’s earlier, in the first or second trimester, the hormone progesterone, which maintains your pregnancy relaxes everything. It relaxes your lower esophageal sphincter. So that’s why the stomach contents can easily go up. The other causes, if it’s later in the pregnancy, when you’re having the baby and the baby gains weight, all the organs are displaced and everything is kind of pushed up. So that’s when the food contents can come up easily and back up in to the esophagus.
So is there no cure/alleviation for pregnancy heartburn?
A lot of the dietary things work really well like this one thing made out of Amala berries known as Morawala/Moramla. It is literally amla berries cooked and put in sugar syrup. So this helps with the excess acid. Ginger candies can help with the indigestion related reflux. Earlier on, if you have a little bit of nausea, then ginger candies work well. Gulkand, made with rose, milk and stuff can give a temporary relief. With the baby there, you really cannot do much in the later trimesters. Earlier on, you can try other measures. GERD is mainly caused if you’re eating spicy foods, pickles and all of that. So you have to stop eating that. Try to have smaller meals. If you have a large meal, then it’s going to fill up your stomach and displace it easily. But if you have small meals frequently, then your stomach is not totally full. Even in the last trimester, it will give you some relief. The other thing is try not to sleep for 2 to 3 hours afer eating your main meal. In India, a lot of people eat late. In the West, we have our dinner at 6’o clock. In India, everybody eats at maybe 9:30 PM or 10:30 PM and then you go to sleep at 11:00 PM. If you do this your stomach is still full of food and the chances of having a reflux are high higher.
Actually I don’t know if this is right, but when I had the same problem during my last trimester, I used to drink saffron milk. I don’t know why, but it actually helped me. Did it actually help me or was it something else, I don’t know.
Milk does help. Saffron can help with you with digestion. But, milk doesnt always work for everyone. Sometimes it works really well in some people because, when we look at the rasa of milk, it’s sweet-tasting. So anything that’s sweet is going to kind of neutralise the acidity, right? But if its due to indigestion, there is Ama or digestive toxin where it won’t work.
Also a lot of people react to milk in the western world.So you have to treat each patient on a case to case basis. There’s a product like an Ayurvedic herb called Shatavari or Asparagus racemosus. Shatavari is a fertility promoting, pregnancy promoting, lactation promoting and also helps with the acidity and it’s really safe. So, you can have Shatavari with milk for pregnancy heart burn. It’s going to strengthen you and it’s going to strengthen the baby and it’s also going to prevent acidity. Amla, you know, gooseberries, there are candies made out of that as well by cooking it in sugar syrup and dried. So, it’s very good. Sunthi, which is dried ginger more than the fresh ginger. So, Sunthi is different than the wet ginger. Then there are different formulations. There’s one called Praval Pishti, which is like a coral that you make a pishti out of it. That works really well to cool you down.
There’s amla juice. Amla juice works really well. Pomegranate works really well. So in food you know you can have lots of pomegranate. You can have pomegranate juice. That’s going to help you with it. Fennel seeds, if you chew on fennel seeds after your meal, it’s gonna help with not only digestion, but also acidity. Corriander seeds also work really well.
When people go through our website, they ask us Ayurvedic preparations or home remedies that we generally use or the ones you kind of suggested. When we take these, certain things tend to agree with the Indian population much more than the Western population, probably because of their food habits or things like that. Being there, what do think goes well with the Western dietary system?
Indian or Western?
Western. For Indians, these things tend to agree well. When I suggest ginger, a lot of people say that the minute I try ginger, I immediately throw up. We are used to taking ginger in our everyday food and also it agrees well with us.
Yeah. Fresh ginger has a strong pungent taste that is unfamiliar to the western palette who are used to bland foods. Also once can have a lot of Ama or digestive toxin which results in low secretion of stomach acid and enzymes. So when we talk about hyperacidity, acid reflux, everyone’s like I have lots of acid in my stomach. There are two kinds of people – one of them have actually low acid in the stomach, due to excess Kapha or Ama. If you have heavy, greasy foods or excess dairy that can provoke, Kapha, if these foods are not getting digestion, this causes Ama. Here the digestion is weakened and so is the Pitta.You’re not secreting bile. You’re not secreting enough enzymes. So ginger will work well if you give it as a tea, that can get rid of both Kapha or Ama.
For people having excess Pitta, when they get angry or agitated start secreting excess Pitta. Eating lots of sour foods, stale and fermented foods can provoke Pitta as well. This is going to cause increased acidity in the system which can be seen as nausea, sour taste in the mouth. If you give them ginger, the sharpness and pungency of ginger will increase the stomach acid they’re going to throw up because of ginger. So ginger will work for people who have indigestion due to excess Kapha or Ama.
For poor digestive secretions, people take digestive enzymes in the western world. You can give Triphala or Trikatu. Those are simple Ayurvedic formulas to try made of three herbs each. Trikatu actually helps for digestion by kind of increasing your stomach enzymal secretions. A lot of my patients ask me ‘as people grow old, why do they have acid reflux?’ What happens is as you age, your vata increases. The vata dosha increases in the body. The increased Vata in the body accompanied by dryness ensues you’re not secreting enough digestive enzymes. So lots of seniors have poor digestion. They don’t digest food well and it sits there for a long time and that’s when they start getting the acid reflux. If your digestion is really slow, you have to control your intake like smaller portions and add more spices in cooking like cinnammon, cloves, cumin. Hing or Asafoetida is really good. Adding more spices in your cooking always works.
So I think you’ve kind of answered the milk part of it and kind of covered it in the previous question. So again with adults, by adults I mean to say the geriatric set of people. So, when they have a problem of digestion during nights, what can we actually do to increase their digestion a bit? A lot of I’m saying 70+ age category are finding it really difficult to take even small portions of say rice or chapati. Our kind of foods.
Yes. So, with them the problem is digestion. You’re not digesting things enough. There are some great Ayurvedic remedies. There’s an ayurvedic powder called hingwashtak churna. So this helps with digestion. You mix it with your rice and dal. You eat this as your first two or three morsels of your food. And this actually helps you to digest your food and so the food is not gonna sit here. But this is not like if you have a lot of acid, the hing is actually gonna provoke the acid. So you have to be aware about what exactly is going on with you. But this helps your digestion.
For some people, if you can have more liquid foods or easier to digest foods like cooked foods and not go for really spicy foods at night-time, avoiding the pickles and all that, adding spices to your cooking and try not to eat stale food. Try to eat early. So, eat at maybe 6 PM or 7 PM, if you go to bed at 10 PM. In Marathi, we say like walk a 100 steps. So if you’ve eaten at 6 PM, before you go to bed, maybe at 8 PM, walk a 100 steps in your home. We call it Shatapawali. That helps you with digestion. These are all like grandma remedies, but they do stem from the wisdom of Ayurveda.
So in Ayurveda, everything is connected. Stress is another big factor with the senior population. They retire and then they are not sure what to do with their life. Especially where I live, there’s a lot of senior population. So once they retire, they ask themselves what am I doing? I used to go to work. They have to find things to keep themselves busy. Volunteering in the community, making sure that they feel productive, because once you stop working, so many people attach their work to their self worth. So they feel worthy only when they’re working. So that’s not true. So you are worthy no matter what. They can always enjoy with different things, there are different clubs for seniors where you can go and volunteer at different communities and all that. So that’s really going to help you in terms of your physical and mental health.
Stress is not always physical. Emotions play a huge part in it too. If you’re a person who gets really angry easily when stressed, and if you’re getting frequently angry for no reason, it’s going to provoke the stomach acid. If you get more depressed, your system just shuts down. Then your secretions will actually slow down.
Something that I tell my clients is that when you’re eating, make sure that you focus on the food. If you’re watching TV and eating, your brain doesn’t register that you are eating. Then how is it going to secrete any enzymes?
So you have to make sure that when you eat, you eat in a quiet environment, you can eat with family members so that you’re happy and ideally you shouldn’t be talking, completely TV and other distractions.
In India, we usually make delicious food because food should be enjoyed with all oursenses. It should be fragrant, it has to look visually appetizing , the texture of the food should be pleasing to you. The crunch or sizzle of the food should delight you. So it also satisfies all 5 of your senses. This will make your mind and body calm and engage with food. Thus you eat not only for your body, but also for your mind and soul.
So not paying attention to food, actually has an impact on our enzyme secretion is what you’re saying?
Totally. So for example, if I’m doing my work on the computer and if I just grab something to eat, my brain is still focussing on the computer, so my brain is already occupied with some work and will not be able to focus on secreting enzymes for digestion.
In the body, there are two different systems operating. One is the rest and digest system. The other is the adrenalin system. The sympathetic and para-sympathetic systems. So when you’re like worked-up and stressed, when you have files to submit, you’re like stressed. So at that time, if you have a lot of anxiety, if your adrenalin is high, you’re not gonna digest anything. So the food is just going to sit in your belly.
But if you’re in the rest-digest mode, you’re more relaxed, you can digest really well. So that’s important to understand. Today people are mimicking the West, in a lot of not so great ways. So, there are some really good things about the Western culture and there are some really great things about Indian culture.
But your diet is something that is connected to your roots where you come from, which makes the traditional or native foods easier for you digest. So for me I can digest dals made of lentils as well as beans very easily but an hardly digest any red meat, but the Western people cannot digest lentils so easily. They can handle lots of beef and pork and meat as they are used to it this diet for generations. So you also have to take into account your ancestry, your roots, where you come from, because you have certain genetic code that determines what you can digest and what you cannot digest. So with more and more teenagers who go to KFC, you’re seeing heartburn in kids too now.
So will Pranayama help to completely reduce the stress levels and anxiety? But when you do Pranayama, you inhale a lot of oxygen. Will that have an impact on your digestion?
See, Pranayama unlike what a lot of people think, is not just about oxygenating your body. But Pranayama is more a spiritual practice. Pranayama is more about energizing with your Prana. During bahir kumbhak or pause after exhaling,when you don’t have enough oxygen, that secretes certain chemicals in your body that assist in facilitating spiritual experiences. That’s a completely different science. But most people do Pranayama for relaxation, which will definitely help the stress levels.
The best way is Nadi Shodhan Pranayama, balancing both channels- the solar and the lunar. There are 2 channels in the body- the right nostril which is the solar channel- your masculine/reactive side or the left side which is the lunar channel/receptive side. In nadi shodhan where you are practicing alternate nostril breathing, you tend to balance both sides to your being, both hemispheres of your brain, your active as well as passive side.
There’s also one Yogic kriya called kapalabhati. While performing Kapalbhati, you are forcefully exhaling and inhalation. If you have a weak sphincter, this can help you strengthen the sphincter. In the old age, sometimes this can also help you boost your digestion. It can really help you strengthen the sphincter. Here the forceful exhalations make you pump your abdomen. So your muscles are getting strengthened. So your entire GIT (gastro-intestinal tract?) is also getting strengthened. The Kapalabhati is one yogic kriya that I really like.
Any kind of pranayama which brings you back to the centre of your being, which relaxes you, is really good. There are some specific ones which cool your body so you aren’t that angry person with excessive Pitta like Seetakari.
Avoid drinking alcohol, cigarettes or overly spicy food. In India, we eat a lot of spicier things. So, for that too you can do like sitali or seetakari pranayama. Sitali is going to cool your entire body down. It’s really good in the summer time. So in India, when temperatures are like 40° or so, you kind of try to cool down.
So is there a link between heartburn and peptic ulcer? Does prolonged heartburn cause peptic ulcer or the other way round?
Heartburn is a symptom. So it could be that you already have a peptic ulcer and you’re having heartburn as a symptom. But it could also be that if you have just heartburn right now and you absolutely don’t take care of it, then due to the prolonged negligence may develop peptic ulcer. So it could be kind of both ways. There are different reasons that cause peptic ulcer. There’s one most common H. pylori which is an infection. It’s a bacteria that causes you to secrete a lot of acid in the stomach. So that’s one example. A lot of people, especially the seniors also take painkillers. They’re taking aspirin, tylenol etc. If you take some non-steroidal anti-inflammatory drugs, they can cause peptic ulcer too. They can cause heartburn as well as a symptom.
Is there any remedy that can be suggested right away or should it be really be treated on a case-to-case basis?
Ideally, it should be treated on a case-to-case basis. So if you’re trying, sometimes, even aloe vera works really well. Just scoop out the aloe vera gel. It’s going to really soothe and heal. But if this is happening for a long time and you think nothing’s really helping, just go to a doctor. They can diagnose exactly what’s the cause. Everybody’s like home remedies can work fantastic in the initial stages. But if you don’t know exactly what’s the cause, like if you have high acid or low acid, then you don’t know the remedy. So the other thing that I see in my practice is that people have intolerance to foods. Allergies or intolerance such as lactose intolerance are very common here. People with lactose intolerance can have heartburn. Especially, we talked about milk. I forgot to mention that if you have an intolerance to lactose, it could cause heartburn in you along with feeling bloated. Some people react to eggplant, which is very common. Some people react to tomatoes.
Tomatoes are also a very acidic food. So that can also cause heartburn in certain people. Chocolate can cause heartburn in certain people. So you have to know if you’re eating a lot of salty foods, you don’t like spices, but you’re eating a lot of chips. So salt is also going to cause heartburn. If you eat a lot of fried foods it’s also going to cause heartburn. If you’re not sleeping well, for example, if someone sleeps for only 3 hours a night, it provokes your pitta. Everything’s going to be upset. Carbonated drinks like pop, if taken for a long time, that’s going to cause heartburn. Coffee is another cause of heartburn.
Lot of foods can cause heartburn, especially if you have developed sensitivity to it. If you’re not sure, write down everything that you are eating for atlas 5 days. That’s one my advices that I give to every client of mine. For 5 days write everything that you’re eating and write when you have heartburn and connect the dots. And see and try eliminating the food that’s giving you the heartburn. So if you’re having tomatoes and you’re feel acid reflux, then eliminate it. If you’re getting better, that’s good. Otherwise, take the same list to the doctor and check with them. They can guide you better.
Is there a link between heartburn and dizziness or vertigo symptoms? Because I was talking to a few people and they all said that they have severe cases of heatburn, like for years, and now they say that we feel dizzy and we have imbalance issues. So is there a connection between the two?
There can be. Sometimes one of the things is if they also take something for PPIs or proton pump inhibitors. So they’re on medication specifically for acid reflux. That can also cause dizziness. Sometimes the medication side effect is dizziness. Sometimes, if you have severe heartburn or lots of acid coming up, the contents can also go through your inner ear or eustachian tubes. This can cause issues with your balance as well. So it can happen that if you have low blood sugar levels, it could lead to throwing up a lot. This makes the blood sugar go low and you may start feeling like you’re about to faint. Dizziness is when you’re light-headed and a little weak. Vertigo is when everything spins around you. So it can happen too but it could happen mainly because of the acid reflux. It could be happening because of different things as well, so you have to find out.
Okay Dr. Manjiri, great! Actually, I was expecting to get a high level idea about GERD but you gave me a lot of in-depth answers. I was wondering because you’re into digestion and all that, maybe we could do a session on vegan diet. Would that be okay with you.
Okay totally! Anything to do with diet – vegan, paleo, keto. I’m most happy to do another session on.
It was really great to have you here today Dr.Manjiri. This was a really informative session.
You’re very welcome. And thanks for having me, it is always a pleasure to talk about Ayurveda.