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Sunday
Mar222015

Healing Heartburn: What You Don’t Know about Acid Reflux

So many of us have been there….

Minutes after slightly over-indulging in our favorite cheat meal, we start to feel that familiar (and dreaded) sense of discomfort. We try to politely disguise belches beneath our napkin while waiting for the right time to loosen our belts or find some other, um, relief.

Dyspepsia, indigestion or GERD symptoms most commonly happen when stomach contents (presumably after a meal) make their way back up into the esophagus, where the acidic stomach juices irritate the delicate tissue that lines the lower esophagus.

Acid reflux (a.k.a. “heartburn”) is one of the most commonly diagnosed health conditions these days. What are the real factors that explain these skyrocketing numbers - and what options genuinely treat its core causes? Let’s take a look.

Bubbly guts aren’t just part of getting older.

It’s just your body’s protective way of rebelling against you, right? You must be producing too much acid in your stomach, right? It’s normal to feel this way after such a big meal, isn’t it?

Indigestion is common but not normal. That’s a critical point to understand as we continue.

So, just how common are we talking?

Sixty percent of adults will experience some type of gastroesophageal reflux disease (GERD) each year and 20-30 percent will have weekly symptoms.[i] From a personal standpoint, it means dealing with discomfort or pain. Yet, there’s also a societal toll. The American College of Gastroenterology estimates loss of productivity costs due to GERD symptoms at almost $2 billion each week of the year.[ii]

So, with the guidance of authoritative commercial spokespeople like Larry-the-Cable-Guy, millions of people take antacids or proton-pump inhibitors (PPI’s) without questioning what’s really behind their problem.

Here’s the catch: PPI’s don’t work to restore normal physiological digestion. They work to control symptoms the same way antacid tablets (e.g. TUMS, Rolaids, etc.) aim to minimize the damage from having acidic stomach juices mingling with the delicate tissues in our lower esophagus.

In some respects, antacid treatments may be necessary at times. Without these reactive treatments, for example, it’s possible we’d see sky-rocketing rates of esophageal cancer.

However, it’s worth noting that most of these FDA approved over-the-counter indigestion drugs (many of which were prescription only just a few years ago) were only approved for eight weeks of use under the guidance of your doctor. Now even teenagers can buy them at any pharmacy. Many are even flavored and colored to resemble candy.

The thing is this: stomach acid is a good, even necessary element of our functioning. For one, it’s our first line of defense against pathogens we might ingest through our food and environment. With ideal stomach acid pH near that of battery acid, there aren’t many living organisms that should make it farther than our stomach.[iii]

Regular, symptom-free digestion – from a biological or physiological perspective – is a normal part of life, but as we age there are inevitable changes.

It’s well documented that stomach acid production normally and naturally decreases significantly as we age.[iv]. (This is an important fact we rarely hear.)

In fact, overproduction of stomach acid is rare, yet most adults would tell you their stomachs produce too much. So, which is it – overly acidic stomach or underproduction of stomach acid? 

As it turns out, there’s more to GERD than simply strength of stomach acid.

There’s got to be a faulty valve in your plumbing.

Northward migration of chewed up food and stomach acid doesn’t normally happen if there’s a properly functioning lower esophageal sphincter (LES) to keep the junction between the top of the stomach and bottom of the esophagus tightly sealed off. 

The LES is supposed to clamp shut and keep our consumables moving southward, but it wont stay shut if theres not enough gastrin in the blood to stimulate LES closure.[v] And, you guessed it! - gastrin isnt stimulated sufficiently when the stomach acid is too weak (more basic, higher on the pH scale).

This critical message is basically lost in the discussion and treatment of GERD.

Common heartburn treatments are the antithesis of drain cleaner.

You might be getting the sense by now that the stomach’s process as well as conventional GERD medications don’t work the way you’ve perhaps been told. There’s more.

Acid stopping drugs (PPI’s) tend to significantly raise stomach pH (lower the acidity) in as little as one dose, opening up the opportunity for bacteria to thrive in the stomach or elsewhere in the intestines.[vi]

In fact, in some trials, up to 50% of patients on PPI therapy end up developing bacterial overgrowth in the small intestines (known as SIBO or small-intestine bacterial overgrowth).[vii]

One particularly resilient bacteria, H. pylori, was identified decades ago with a causative role in GERD and gastric ulcer formation.[viii] About half the world’s population is infected with it, too.[ix]

Now we understand that this has different effects in different people. Some people see increases in stomach acid production while others see decreases. It seems those with decreased acidity end up with higher risk for gastric cancers.[x] Suppression of stomach acid production if you already have GERD may just continue to increase the risk of bacterial overgrowth in many cases.[xi]

Again, if you have a faulty valve (LES), PPI’s or antacids may alleviate symptoms in the short-term, but they most likely won’t eliminate the underlying cause of the reflux that’s happening.

Additionally, weaker stomach acid (increased pH) will likely result in decreased ability to absorb several important nutrients especially minerals and vitamins.[xii] [xiii]

Weak pipes give way under increased pressure.

A tell-tale sign that SIBO has started in one’s system is the sensation of increased gas, bloating, and abdominal pressure within about 30 to 60 minutes of eating followed by fatigue or malaise. Its an indicator that some of the food recently eaten is being gobbled up and fermented by bacteria soon after entering the small intestine, rather than being absorbed and taken to working cells to produce energy youd feel. Sugar and other refined carbohydrates tend to be the favorite entrees for these bothersome bugs, but it can be uncomfortable for those with SIBO to eat many different foods.

That uncomfortable, upper-abdominal gas and pressure puts quite a strain on the stomach itself, and the extra pressure can, yes, increase the likelihood for LES dysfunction.

While they can happen to anyone, heartburn symptoms are more common in obese patients, but it can’t be attributed entirely to the fact that many overweight people eat “heartburn-inducing” foods. Those who are overweight also contend with increased intra-abdominal pressure,[xiv] which may be a major driver of the valve dysfunction discussed above.[xv] It’s simple physics resulting from complex changes to our physiology.

Many people suffering from upper GI woes also suffer from the elusive and ambiguously-defined irritable bowel syndrome or IBS, which suggests a common underlying mechanism[xvi] – imagine that! Two disorders affecting the same organ system somehow related? It’s not a correlation we hear talked about enough.

Moving things along…

I’ve probably given you more than enough science to chew on, so here’s what you should do if you’re serious about addressing the root cause of your GERD and improving your basic quality of health for the long-term rather than simply alleviating symptoms in the short-term.

Avoid overstuffing your clogged pipes.

Since increased intra-abdominal pressure is a major driver of heartburn symptoms, it only makes sense to first try eating smaller portions or more frequent meals. Since eating quickly makes it really easy to over-stuff, maybe you should set your fork down between bites and consider eating somewhere other than over your keyboard or behind a steering wheel.

Dont pour gas on the fire.

If there happens to be a raging war between beneficial and bothersome bacteria in your gut, stop feeding the bad guys and start fueling the good guys. Small studies show promise for the effectiveness of lower carbohydrate approaches, which appear to work well to alleviate GERD symptoms quickly - and maybe even permanently.[xvii]

Alcohol, caffeine, and phosphoric acid (present in many sodas – both regular and diet alike) can potentially irritate sensitive gut mucosal cells, so it’s best to limit your exposure to these. Likewise, avoid consuming highly processed, edible food products that might contain gut-irritating artificial colorings (like caramel coloring or any color with a number next to it), flavorings (MSG), emulsifiers (like carrageenan), or preservatives.

In other words, if your food would spoil in a few days, eat it. If it won’t spoil easily, don’t eat it - for guts’ sake.

Drink your food and chew your water - separately.

Gross huh? Well, it makes simple sense to me that if you chew your food so thoroughly you swallow it as a thick liquid, there’s less work for your stomach to do before passing your nutrients through to your intestines. Giving your food more time in your mouth also allows your saliva to fulfill its purpose and truly begin the digestive process - especially for carbohydrates.

Similarly, chewing your water forces you to sip and savor your main source of hydration and allows it to mix more thoroughly with saliva. Sipping water separately from solid-food meals is also a way to slow yourself from filling your stomach’s limited space with liquid that would essentially dilute your stomach acid, making it weaker when it has a whole meal to digest.

Remember, strong stomach acid = better nutrient absorption. Weaker stomach acid = poorer nutrient absorption, weaker lower esophageal sphincter and more reflux probability.

Replenish anything that might be missing.

What’s missing? Most likely, sufficient hydrochloric acid (major component of stomach acid) and pepsin, which can be taken as a supplement with meals. Generally, when supplemental digestive enzymes are given in studies, the results are very positive,[xviii] and such support may have a significant role in the future management of such common digestive disorders.[xix]

However, digestive enzyme supplements like HCl Enzyme Complex are not recommended for those with ulcers or for those who take medication that may irritate the lining of the stomach, such as NSAIDs.

Digesting it all...

Treating heartburn is likely more complicated than popping a pill, but it is unfortunately seen that simply in the eyes of many in the health community. We can think beyond the scope of managing symptoms and envision a greater solution to the core cause. Breaking free from GERD’s chokehold involves overlapping strategies that also happen to support weight loss efforts and health pursuits alike.

If you don’t yet feel you have a strong, comprehensive treatment plan for GERD, be sure to schedule a consultation with a knowledgeable health and nutrition professional. Also, for more information on healthy eating, download your free copy of Eat Well. Live Well. Thanks for reading.

Written by Paul Kriegler - Corporate Registered Dietitian

This article is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations in this and other articles is at the choice and risk of the reader.


[i]http://www.hcup-us.ahrq.gov/reports/statbriefs/sb44.jspvia http://www.healthline.com/health/gerd/statistics#2

[ii]http://www.iffgd.org/site/news-events/press-releases/2005-1125-gerd-costsvia http://www.healthline.com/health/gerd/statistics#2

[iii] http://www.anaturalhealingcenter.com/documents/Thorne/monos/HCLmono.pdf

[iv] from Wright, 2001 p.20

[v] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC436653/

[vi] http://www.ncbi.nlm.nih.gov/pubmed/2902178

[vii] http://www.ncbi.nlm.nih.gov/pubmed/20060064

[viii] http://www.ncbi.nlm.nih.gov/pubmed/3982346?dopt=Abstract&holding=f1000,f1000m,isrctn

[ix] http://www.sciencedaily.com/releases/2009/06/090624161624.htm

[x] http://www.ncbi.nlm.nih.gov/pubmed/9394759

[xi] http://link.springer.com/article/10.1016%2FS1091-255X%2800%2980032-3

[xii] Saltzman JR, Kemp JA, Golner BB, et al. Effect of hypochlorhydria due to omeprazole treatment or atrophic gastritis on protein bound vitamin B12 absorption. JAmer Coll Nutr 1994;13:584-591

[xiii] http://annals.org/article.aspx?articleid=707082

[xiv] http://www.gastrojournal.org/article/S0016-5085(07)01843-4/abstract

[xv] http://www.ncbi.nlm.nih.gov/pubmed/10378622

[xvi] http://www.wjgnet.com/1007-9327/pdf/v16/i10/1232.pdf

[xvii] http://www.ncbi.nlm.nih.gov/pubmed/11712463

[xviii] http://www.ncbi.nlm.nih.gov/pubmed/25274610

[xix] Roxas M. The Role of Enzyme Supplementation in Digestive Disorders. Alt Med Rev. 2008;13:307-314

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