Acid Reflux and Gastric Esophageal Reflux Disease (GERD)
This condition is characterized by a burning sensation in the chest, throat or upper abdomen that includes the common term “heartburn.”
What is GERD?
One of the most common conditions affecting many people today is termed ‘GERD’ or gastroesophageal reflux disorder. This condition is characterized by a burning sensation in the chest, throat or upper abdomen that includes the common term “heartburn.” Many prescription drugs have been created by the pharmaceutical industry that suppress acid secretion as an answer to what is truly a systemic problem. This results in raising factors that add to inflammatory events in the whole body, - thereby contributing to further diseases such as diabetes, arthritis, and autoimmune disorders.
An anti-inflammatory lifestyle has been shown to reduce acid reflux and it is important we make attempts to change our diet toward foods that are less reactive with the immune system.
Upon eating, food naturally passes from the throat to the stomach through the esophagus. The esophagus contains a group of muscle fibers in the shape of a ring that aids to prevent food from moving back upwards from the stomach. These muscle fibers make up what is called the lower esophageal sphincter (LES).
If the LES is not functioning properly it allows for food, fluids and hydrochloric acid to leak back into the esophagus. Hydrochloric acid is produced in the stomach when food stimulates certain cells called ‘amacrine’ cells to secrete it. The inner esophageal tissue is not designed to handle the strong acidity which inflames the region. This causes the characteristic ‘heartburn’ sensation. Chronically damaging the esophageal tissue can even eventually, combined with a poor microflora ecology, cause esophageal cancer and other serious conditions or necessary palliative procedures.
Risk Factors for GERD
The most common risk factors for GERD include anything that aggravates or distorts the esophagus or upper stomach region such as hiatal hernia, pregnancy, and in rare cases scleroderma. Other proven risk factors include obesity, smoking, and alcohol usage. Many prescription medications list GERD as a common side effect so this should always be considered.
The popular belief is that acid reflux is due to an excessive amounts of hydrochloric acid in the stomach. New research has revealed that this is not the case and that GERD is most often caused by a deficiency of hydrochloric acid (HCl) secreted by the stomach.
During digestion, the stomach lining secretes HCl to lower the pH to around 1.5-2.5. Hydrochloric acid is necessary for creating an acidic environment in the stomach to digest protein and ionize minerals. More protein in the meal results in a greater needs for stomach acid. Individuals with non-obstructive acid reflux are often not able to get their pH low enough.
The LES is known to be a pH sensitive valve that initiates closure when pH drops under 3.0. When the stomach does not have enough acid, the LES remains open and acid can spill into the esophageal region and damage the tissue. Additionally, when the diaphragm herniates through the stomach sphincter it is called a hiatal hernia and can lead to the symptoms of acid reflux. Hiatal hernia is a common disorder but is usually mild and does not cause major GERD.
When food is being digested in the stomach, bile is also stimulated to be produced by the liver and travels down the bile duct into the first part of the small intestine, called the duodenum. Bile functions to breatk down fats. Without these key functions working optimally we become at risk for anaemia, thyroid problems, osteoporosis and auto-immune disorders.
Low stomach acid in a very common problem especially in older individuals or those who have suffered from various infections like H. Pylori, patients with histories of repeated antibiotics and other medications such as non-steroidal anti-inflammatories (NSAIDs). Low stomach acid sets the stage for damage to the delicate lining of the digestive tract and the contributes to the malady called leaky-gut syndrome. Further complications such as problems in the nervous system such as depression can follow due to lack of normal precursers to neurotransmitters normally produced by the gut.
Causes for low stomach acids (Hypochlorhydria)
Causes for lowered HCl secretion are as follows:
1) Overuse of Antibiotics: Antibiotics will transform the microbiome (bacterial ecology) and cause an increase in intestinally-related inflammation. This inflammation causes a rise in stress hormones which in turn reduce the body’s ability to produce HCl, thus producing a never-ending cycle of disease progression.
2) H. Pylori Infection: H Pylori is a common part of our microbiome, however, with the overuse of anti-biotics, chronic stress, poor diet, etc. we can cause a shift in the microbiome, a lowering of stomach acid and the overgrowth of H. Pylori.
As H. Pylori overgrowth occurs, an enzyme called ‘urease’ is produced which breaks down the urea in the stomach into carbon dioxide and ammonia. This causes belching and halitosis (bad breath) and it neutralizes HCl, allowing for further growth of H. Pylori and more stress on the gastrointestinal system.
3) Chronic Stress: Chronic stress impairs the digestive systems ability to produce HCl and other digestive juices. Key to the management of stress is the state of the involuntary nervous system, called the Autonomic Nervous System (ANS) The autonomic nervous system is composed of 2 main branches; the sympathetic and parasympathetic branches;
Sympathetic System: Fight or flight, - activating the body, and the
Parasympathetic System: Active to Rest, Digest, Repair and Reproduce.
Proper digestion depends upon us being in a parasympathetic dominant state. Chronic stress puts us in a sympathetic dominant state which restricts activity in the digestive tract and causes poor digestive function. In other words, if we can truly relax, we can be balanced and healthy.
4) Poor Diet: A diet rich in processed foods, sugars, grains, etc change the microbiome and cause chronic inflammation and elevated stress hormone production. Blood sugar stabilization is very important for normalizing stress hormones. Staying on a lower carbohydrate, higher fat, anti-oxidant rich diet allow the improvement of the stomach acid levels.
5) Eating Too Quickly or on the Go: This is one of the most common problems affecting our society today. Foods eaten too quickly or wrong foods eaten often throughout the day can be forces that will develop system-wide problems. It is critically important to be sure to avoid eating when in a sympathetic (fight or flight) mode and to take time to relax, breathe deeply and increase a parasympathetic, relaxed time. Everyone should feel relaxed at least 15 minutes before eating and up until 1-2 hours after concluding a meal.
6) Overuse of NSAIDs: NSAIDs wear down the stomach lining and reduce the ability of the stomach cells to produce HCl. Some are also toxic to either kidney or liver function and should be avoided, especially when we have natural antiinflammatory herbs such as Turmeric (Curcumin) and Bromelain (from Pineapple).
7) Using Proton Pump Inhibitors: These acid blocking medications reduce acid levels in the stomach which does give temporary relief to those with acid reflux. Unfortunately, because acid reflux is typically caused from too little acid, taking these medications further reduces stomach acid, which leads to microbial overgrowth and further stress on the body. In addition, such drugs treat a problem that is in fact not caused by the stomach but is the result of an acid overabundance in the body’s tissues, and inhibiting the acids from being secreted into the stomach, deepen the problem of whole-body acidosis (in the tissues) which is additive to the acid problem causing inflammatory disorders all over again.
8) Small Intestinal Bacterial Overgrowth (SIBO): It is hard to say what comes first, is it the low stomach acid that allows for an elevated level of pathogenic bacteria to enter into the digestive system and proliferate around undigested food particles or SIBO causes chronic stress hormones to circulate, which reduces the body’s ability to produce adequate HCl. Either way, there is a crucial and major connection between SIBO and low stomach acid levels.
9) Aging: Aging will cause the body systems slow down and especially the digestive physiology. This is even more the case if the body is stressed more than it can adapt too. If the body is taken care at an early age and keep the digestion at an optimal level throughout life, it can to produce enough HCl in later years. However, over 50 years of age, it is wise to consider supplemental HCl as may help to feel better and decrease pH-involved imbalances.
10) Food Sensitivities: Some of the most common food sensitivities cause major stress in the body, which puts us into chronic fight or flight. Be sure to stay off of the most common offenders such as gluten, corn, soy, peanuts and pasteurized dairy. If other foods also cause subjective discomfort, chances are the individual is hypersensitive and may have increased inflammatory histamines or reactive chemistries that can contribute to numerous diseases and disorders. The wider the number of food sensitivities, the higher will be the chance of low HCl.
Steps to Beat Acid Reflux Naturally:
1. Change Your Diet: Take out all gluten, pasteurized dairy, soy, peanuts, corn and refined vegetable oils. Consume a diet that is low in carbohydrates and high in good fats.
2. Don’t Eat Late at Night: Finish your last meal at least 2-3 hours before bed.
3. Use Apple Cider Vinegar: Have 1-2 tbsps. of ACV in 4oz. of water about 10 minutes before each large meal.
4. Only Eat 1 Solid Food Meal Daily: Drink green drinks and smoothies during the day. These are easier on the digestive system. One good quality solid food meal daily along with several protein shakes or smoothies and green drinks will help the digestive system to heal.
5. Use Digestive Enzymes with HCl: Taking a digestive enzyme supplement can help the body to digest food more effectively and reduce stress on the entire digestive system.
6. Consume Fermented Foods Everyday: Have a few tablespoons of organic kimchi, sauerkraut, pickles, fermented raw, grass-fed dairy each day. The unique probiotics and enzymes within these foods help to improve your microbiome and enhance HCl production.
7. Consume Fermented Drinks & Tonics (homemade): This includes coconut water kefir, fermented grass-fed whey and kombucha. Drink 2-4oz daily before a meal or meals to improve digestion and HCl production.
8. Use Lemon and Ginger: Make green drinks with a whole lemon or lime and ginger as both of these have key nutrients that enhance HCl production.
9. Reduce Stress on the Digestive System: Be sure not to try to eat solid foods when you are under stress. Stress reduces the secretion of digestive juices and enzyme production. I teach people to only consume raw and liquid foods in small quantities during the stressful periods of the day. Enjoy your larger meal with healthy proteins. good fats and veggies at a more relaxed time of day (for many this is in the evening).
10. Use a Hydrochloric Acid Supplement: Improving stomach acid production is one of the biggest factors in improving someone’s health. HCl (hydrochloric acid) supports nutrient absorption and helps maintain a healthy gastric pH, which, in turn, supports healthy gastric ecology. Often this supplement is called ‘betaine hydrochloride’.
11. Use High-quality sea salt (unprocessed salt), such as Himalayan salt: This salt will not only provide the chloride your body needs to make hydrochloric acid, it also contains over 80 trace minerals your body needs to perform optimally.
12. Vitamin D3: Vitamin D is important for addressing the infectious component. Once the vitamin D level optimized, around 200 antimicrobial peptides can be optimized.
By: Dr Hasveni Chellamuthu - SOL Integrative Doctor