The 4th of July. The day to celebrate the birth of the United States, watch amazing fireworks, and eat a lot of barbecue. In anticipation of this eating extravaganza, here’s a post on acid reflux, more affectionately referred to as GERD.
Nexium, a GERD medication is currently the 3rd most prescribed medication in the US today, so we know there are a lot of people who are dealing with GERD.
What is GERD?
GERD stands for Gastroesophageal Reflux Disease.
When you eat, food normally goes in through your mouth, down the esophagus (aka food tube), through the lower esophageal sphincter (LES), and enters the stomach.
Once in the stomach, food is massaged and broken down further before entering the small intestines to be absorbed by your body before passing through the large intestine and being excreted as feces.
The stomach is a muscular sack filled with acid. This acid activates the enzymes and juices that break down food into smaller bits, and also acts to kill potential pathogens (microorganisms that could get you sick).
So where’s the issue?
The problem occurs when the acidic contents of the stomach back track up into the esophagus. In many cases the LES, a muscular ring of tissue between the esophagus and stomach, is relaxing inappropriately and not doing its job well, allowing for the acidic contents to get into the esophagus. While the tissues of the stomach are meant to handle acidic contents, the esophagus is easily irritated by this acidic back flow.
This acid back flow often makes itself known with symptoms of heartburn, acid regurgitation, and having difficulty swallowing.
Occasional reflux is completely benign and mostly just uncomfortable. The problem is when the reflux happens more and more often, destroying the lining of the esophagus and even as far up as the throat.
What many people do not know is that the damage from chronic reflux can lead to Barrett’s Esophagus, a major risk factor for esophageal cancer.
How do you treat this?
So you tell your doctor that you’ve been having this reflux. Depending on the severity, he may do one or more of the following:
- Prescribe an antacid of some sort, which is often not very effective if the GERD is severe enough.
- Prescribe and H2 receptor blocker. H2 receptors regulate the secretion of acid in the stomach, so the idea is to decrease acid secretion. (e.g. Tagamet, Pepcid, Zantac)
- Prescribe a proton-pump inhibitor (PPI) to decrease the acid production of the stomach, like Nexium (esomeprazole magnesium) or Prilosec (omeprazole).
In severe cases of GERD, the other conventional option is surgery:
- They may stick a tube into your abdomen and try to “fix” the LES (laparoscopic surgery).
- If things get really serious, surgeons may attempt to wrap part of the stomach around the esophagus to create another sphincter (fundoplication).
Additionally, your doctor might recommend certain lifestyle changes:
- Avoiding triggers (chocolate, coffee, mint, spicy food, acidic foods, fried foods, alcohol, smoking)
- Sleeping in an elevated position using a wedge
- Not eating too close to bed time
- Losing some abdominal fat if necessary (Your stomach is essentially a sack, and what happens when you put pressure on a full sack? The contents get squeezed out.)
Are there issues with conventional treatment?
The acid blocking medications can help relieve the symptoms of GERD, but patients are often prescribed acid blockers even if they have normal levels of acid production. What this means is that excess acid production is not usually what needs to be treated. It is often LES integrity that is compromised, which means that acid blockers are not actually treating the true underlying cause of GERD but rather a secondary effect.
Not only that, there is a well known acid-rebound effect when discontinuing PPI’s and H2 receptor blockers. This means that an abrupt discontinuation of the medication results in MORE acid production, and if the LES is still compromised, reflux can return with even greater severity.
Additionally, remember that the stomach is supposed to be an acidic environment?
Staying on a acid blocker for extended periods of time prevents you from properly digesting your food, allowing potential pathogens to make its way farther down the GI tract, and can contribute to nutrient deficiencies, like Vitamin B12, calcium, magnesium, zinc, and iron.
And if medications do not seem to be helping, treating a structural issue with surgery can be expensive and not without its risks.
What else can you do about it?
GERD does not just happen. As one of my mentors says, disease is not random. There are things you can try to stop GERD once and for all.
Optimize the Digestion
You need acid to digest food, absorb certain nutrients, and prevent overgrowth of the certain bacteria and fungus. Often reflux is a result of INSUFFICIENT stomach acid that can increase susceptibility to small intestinal bacterial overgrowth (SIBO) and fungal overgrowth that can disrupt proper digestive function and throw off the balance of the GI tract.
Digestive health and optimal function can ensure that the food you eat moves through the digestive tract uneventfully (e.g. less gas and bloating, well-formed bowel movements, and maximum absorption of essential nutrients).
Another hypothesis is that food that is improperly/incompletely digested in the intestines tends to ferment and cause gas in the tube that is your GI tract that can prevent food from going the right way, which is down and out.
One simple way to start optimizing gut health on your own is eating mostly whole foods and high quality meats and less processed foods.
Work with a doctor and/or a nutrition expert to restore proper gut function. Treatment might include diet consultation, probiotics, antimicrobial treatment, digestive enzymes, and glutamine to name a few.
Many times, people who experience GERD may have an underlying hiatal hernia, which means that part of the stomach that is usually below the diaphragm is sliding up through he opening where the esophagus passes through diaphragm.
This gentle body work can improve the integrity of and function of the structures that could be contributing to reflux, such as the LES, stomach, pancreas, and gall bladder. If something like a hiatal hernia is indeed causing the reflux, this is one way to treat the underlying cause.
There are a number of herbs that can be used to both relieve the symptoms of reflux that also protect and help heal the tissues of the esophagus. These include DGL (de-glycerinated licorice, Althea officials (marshmallow root), and Ulmus rubra (slippery elm).
I won’t give specific recommendations here, but any naturopathic physician or herbalist would be able to help you with your individual situation.
Take Pressure Off the Poor LES
Their is data that supports that the abdomen and thorax are sensitive to changes in pressure, and extra pressure in the gut caused by obesity disrupts this pressure balance, creating the perfect conditions for a hiatal hernia and GERD.
This means that if you are carrying some extra weight around your midsection, small steps towards a healthy weight will go a long way in decreasing GERD symptoms!
GERD is a common, and sometimes seemingly harmless condition, but over time, GERD can cause serious, lasting damage and increase the risk of esophageal cancer. Don’t sleep on this!
GERD is reversible, and there is more you can do besides mask the symptoms. I recommend seeking the help of a doctor to help guide you through this process, especially a doctor open to and with some knowledge of these other treatment options.
- Top 100 Most Prescribed Drugs – http://www.medscape.com/viewarticle/825053#2
- Lee, YY, McColl. “Disruption of the gastroesophageal junction by central obesity and waist belt: role of raised intra-abdominal pressure.” Diseases of the Esophagus. 28 Feb. 2014. Web. 3 July 2014. [http://www.ncbi.nlm.nih.gov/pubmed/24575877]