Gastroesophageal Reflux Disease, also known as GERD, is one of our society’s most common health complaints with one in ten Americans having daily episodes of heartburn. Researchers estimate that GERD is experienced by 25%-35% of the population, which makes Proton Pump Inhibitors, a popular medication used to treat GERD, the third best-selling class of drug in the United States.
There is mounting evidence that drug treatment for GERD does not come without potentially serious risk. Such studies suggest that these drugs increase the risk of osteoporosis, depression, serious digestive tract infection, flu, irritable bowel disease and nutrient deficiencies such as vitamin B12 as well as important minerals. Although research has demonstrated these potential consequences, it does not take a multi-million dollar study to be able to reason that medications that interfere with acid secretion in the stomach will also interrupt nutrient absorption while making it easier for harmful organisms such as C. difficile to grow and cause havoc in our digestive tracts.
GERD occurs when the digestive juices back up into the esophagus, which results in an irritation to the fragile lining of the esophagus. The chronic irritation to the esophagus potentially results in a pre-cancerous condition called Barrett’s esophagus and then, left unchecked, to esophageal cancer. This process of progression sounds horrible and, drug companies would have you believe, imminent if left untreated. Research, however, does not support this seemingly rational and unquestionable connection. In fact, a recent review of the data suggests that the connection between GERD and Barrett’s esophagus is so weak that the reviewing scientists felt that the widespread practice of screening patients with GERD, using endoscopy, was not warranted. Other researchers found that patients who were suffering with nighttime symptoms, as well as obese patients, were at a higher likelihood of having GERD progress to Barrett’s and ultimately to cancer. These patients may be the ones who require endoscopy as a screening tool.
What causes GERD?
A common characteristic of GERD is what is known as a relaxed lower esophageal sphincter (LES Valve). This sphincter acts as a door between the esophagus and the stomach. In a healthy person, the door slams tightly shut after food enters the stomach; however, in someone with GERD, this door may not shut snuggly, which can lead to reflux of stomach contents and ultimately irritation of the esophagus. The better question is, “what causes this doorway to remain slightly ajar?” There are number of reasons for this:
- Portion size – People who eat large quantities of food can cause the stomach to expand well beyond the normal stretched size. Regular exposure to this degree of stretch can cause a deformity in the doorframe so that a gap remains, even when the door is shut. Portion size of food can have an immediate and a more long-term effect. If you eat a large meal right now, the stretching of the stomach can immediately cause symptoms; long-term exposure to such large portion sizes can result in a deformity in the doorframe even when the stomach is empty. Both of these situations can be remedied by eating smaller quantities.
- Mint – Mint has a relaxing effect on the esophageal sphincter, you may want to avoid using mint candies and gum if you suffer with GERD.
- Deep fried food – These foods slow the movement of food from the stomach to the intestines, this increases the likelihood of contents moving into the esophagus.
- Late night eating – This increases the likelihood that food will be in the stomach while your body is in a horizontal position.
- Medications – There are many medications that can cause problems with GERD: Calcium channel blockers, beta blockers (metoprolol, Toprol XL, etc.), NSAIDs (Ibuprophen, Naproxen, Advil, Aleve) , aspirin, nitrates, anti-depressant medications, bisphophonates (Fosamax, Actonel, Boniva, etc.) and progesterone.
- Excess weight, especially central obesity.
- Food allergies and sensitivities. Although this is an underappreciated cause of reflux disease, it is important to note and it may be worthwhile to look for offending foods and precede with eliminating these foods from the diet. These food sensitivities can be worsened by acid suppression through the use of medications like Nexium, Prevacid, Tums, etc.
- Stress is a major cause of GERD. When you are stressed, the digestive tract does not function properly. This can result in a poorly functioning LES valve and more reflux.
- Other factors – There are other factors that have been linked to GERD such as: Smoking, spicy food, citrus, tomato products, caffeine, alcohol and chocolate.
Isn’t GERD Caused by Too Much Acid in the Stomach?
Although there is a condition, called Zollinger-Ellison Syndrome, where the stomach produces excess acid, this condition is quite rare. In fact, many doctors have discovered that 9 out of 10 people, who suffer with reflux, actually do not produce enough acid to trigger the closure of the LES valve. In addition, when stomach juices do not reach a particular acid level, the food contents sit stagnant and the food begins to putrefy and rot. As the food sits, it ferments and causes excess gas to form. This bubbling action can further worsen reflux by pushing the contents of the stomach into the esophagus.
So what do we do about it?
- Have a careful assessment of medications and request your doctor remove or alter any medication listed above that may be linked to reflux. Please note, most doctors and pharmacists do not know about the link between these medications and reflux.
- Learn about and implement a food elimination diet to try and pinpoint certain food triggers. Wheat, gluten and dairy are common culprits.
- Replace acid in the stomach. It is a little known fact that a lack of acid in the stomach may be responsible for the reflux. This goes contrary to the conventional belief about what causes GERD; excess acid and poor sphincter tone. See our article about Betaine HCl Therapy for GERD. Taking an enzyme along with the Betaine HCl could result in further improvements.
- Take an Enzyme – Plant enzymes work throughout the entire digestive tract to break down the food that we consume. Through the use of enzymes, we can decrease the time it takes to move the contents of the stomach from the stomach to the intestines. A potent enzyme that we commonly recommend is OrthoDigestzyme V. What makes these enzymes so powerful is the fact that they work through a broad range of acid levels. If the pH within your digestive tract is off, these enzymes will still work. This will often improve transit times and decrease gas and bloating.
- DGL Ultra – This is a chewable form of licorice that helps to coat, soothe and stimulate healing in the esophagus and stomach. Chew 1 tablet before each meal and at bedtime.
- Acid Assist – For symptomatic relief and/or in serious cases of GERD, Acid Assist is a chewable tablet that forms buffered foam on top of the stomach acid. This allows normal digestion to occur beneath the foam while preventing acid from jumping into the esophagus. This is to be used as needed to control symptoms while you are working to rebalance the body.