Acid reflux, gastroesophageal reflux disease (GERD) and heartburn are terms that describe stomach acid backing up into the lower esophagus from the stomach. Acid reflux can be quite common, in fact, the vast majority of adults will experience reflux at some point in our lives. Typically, reflux is transient and self-limiting, which means that it goes away on its own.
It?s been estimated, however, that 20% of Americans have reflux on a weekly basis, and another 10% have it daily. So that is about a third of us.
Risk factors for reflux include obesity, presence of a hiatal hernia, pregnancy, smoking and the use of certain medications, including those used to treat reflux, but also NSAIDs, birth control pills, progestin?s, diazepam, aspirin and theophylline.
We think that because reflux is caused by acid backing up into the esophagus, that the problem must be too much acid. This is not the case. More accurate to say that the acid is in the wrong space, but let?s take a closer look.
When you swallow food, it travels down a tube called the esophagus. At the bottom of the esophagus, where it meets the stomach, is a muscular ring called the lower esophageal sphincter (LES).
The LES is where it is at in terms of reflux. The LES is interesting and unique because it is both a pressure/mechanical sphincter and a physiological one.
The LES stays closed until there is pressure from above ? the food you just swallowed ? and it opens and makes way for the food to enter the stomach. If you overeat, and your stomach is very full, the LES will also open from the pressure from below. Surely we can all remember a meal or two where we ate way more than we should have and had reflux later. Pregnancy can also trigger reflux in the same way. These causes of reflux are pressure induced.
Much more, common, however, is reflux created from physiology. I mentioned that the LES is also a physiological sphincter. What this means is that when pressure is not a factor, the LES is held closed by adequate stomach acid. It is held closed by a low enough pH.
If there is not adequate stomach acid, the LES creeps open. Then, whatever acid is present in the stomach splashes upward and that burning sensation manifests. Other symptoms of reflux can include coughing, burping, chest pain, a sour taste in the mouth, wheezing and heart palpitations.
Conventionally, what do we do next? Typically given acid-blocking drugs, which drive down acid production even further. These may bring temporary relief, but unfortunately they exacerbate the causative issue and introduce a variety of side effects if taken long-term (greater than 6 months) including anemia ? both iron deficiency and B vitamin deficiency ? low calcium, low B12, and vulnerability to diarrhea, including C. difficile and antibiotic-associated diarrhea. Interestingly, acid blocking drugs were only approved for short-term use, with a max time of 4-6 months. Oh, how things have changed, as we can pick them up over the counter now and take them indefinitely.
How does stomach acid become low? Hydrochloric acid is made from special cells in the lining of the stomach. It takes an enormous amount of energy to generate these acidic compounds. Consider this: the pH of our bodies is around 7, yet the pH of our stomach ideally is between 1-2 for optimal digestion and digestive function. Imagine the energy these cells must expend to achieve this goal!
As we get older, we have decreased acid output simply because these cells are not as efficient as they were. We don?t have the energetic currency to produce enough acid to keep the LES closed. If we throw in food sensitivities, bacterial overgrowth, H. pylori, stress, and a damaged gut, we have the perfect storm for reflux to develop.
In this way, reflux is not the cause but the symptom of a larger functional digestive issue. The issue becomes further complicated if there are ulcers of gastritis present. This speaks to the fact that the cells that produce the thick mucosal barrier that protects our stomach from the acid are also getting tired.
Luckily, the approach to reflux is straightforward and fairly simple. There are a variety of dietary and lifestyle changes that can be made to ensure that reflux becomes a minor or nonexistent issue.
Like so many other functional digestive issues, a broader look and multi-factorial approach is warranted to address the many facets of the issues. First is to look for and eliminate any food sensitivities and also to look for and. eliminate bacterial overgrowth and H. pylori. H. pylori is the bacteria that is often present in ulcers, and can contribute to more serious GI complaints down the line.
Common foods and substances that exacerbate reflux that should be minimized at least initially for 30 days are: coffee, black tea, milk, orange juice, tomato juice, alcohol, chocolate, spicy foods, onion, mint tea/toothpaste/gum, gluten and potentially eggs. Foods to emphasize are green leafy vegetables, healthy fats, adequate protein and complex carbohydrates from fruits, tubers and other starchy veggies. For ideas about what foods are great for GI health, click here.
Next, we need to begin to boost digestive fire. The stomach, if given the right stimulus, will begin producing adequate stomach acid on its own. Sometimes it just needs a little kick in the pants. To accomplish this, we can supplement with stomach acid at meal times. Typically I recommend 1-2 500mg Betaine HCl caps with or without enzymes, taken with each meal. If you take these and feel warmth in the stomach, palpitations, etc, you have enough stomach acid and should discontinue. Over time, as your stomach wakes up, it will begin to produce its own acid, and eventually you will feel these sensations of warmth.
If you have been diagnosed with ulcer or gastritis, do NOT take supplemental HCl until the ulcer and gastritis have been healed. Ulcers and gastritis are like open wounds in your stomach, and supplemental acid is like pouring salt on them. Until they are healed, utilize the other strategies I will detail for building digestive fire.
In addition to supplementing with acid and enzymes, you can also use foods to increase digestive fire. Taking a shot of apple cider vinegar before meals is the classic complementary approach to stimulating adequate gastric juices. Incorporating bitter foods, like lemon, dandelion greens, artichokes, broccoli rabe and other greens will also help boost digestive fire. Drinking cabbage juice ? extremely rich in glutamine, and bitter ? also helps fire up digestion and helps soothe the belly.
If you are overweight, consider that it may be time to start to optimize body composition. People who are overweight have the double whammy of increased pressure plus likely lowered acid status.
Smoking and drinking also exacerbate reflux. These vices are best minimized until symptoms are well under control.
You my want to consider elevating the head of your bed about 6 inches, while you are working on your diet, until symptoms resolve.
Coming off acid blocking drugs can lead to rebound reflux as the heavily suppressed acid hits your still-open LES. There are many compounds that can help transition you off acid-blocking drugs.
Slippery elm and DGL (deglycyrrhizinated licorice) are herbs that are classically used in reflux and ulcer. These herbs are demulcent, meaning they are slippery and soothing, helping to coat and protect tissues. These can be taken immediately following meals. Chamomile tea can also help with symptom relief without adverse effects, and also has a relaxing effect on the mind.
Another major component of reflux is stress management. Reflux seems to worsen in times of stress. Changing perspective, using tools like gratitude, finding silver linings, giving others the benefit of the doubt, staying in our own business and going on meditative walks can help us begin to get a handle on stress.
Good bacterial flora is also key in reflux resolution, and I typically recommend my clients take probiotics daily for at least a month while they implement the other strategies we have discussed.
Lastly, repairing the lining of the gut is the finishing touch of this entire process. Using nutrients like glutamine, zinc carnosine, magnesium, mucin, IgA, fish oil and other gut healing nutrients help close the door on reflux once and for all.
That is, until that next holiday meal we way overeat?.
Are you interested in learning more about healing digestive issues for good? Check out Restoring Gut Function
Do you suspect you may have leaky gut? What is leaky gut, anyway?