The Heartburn Return; Acid Reflux
By John Cassone, Ph.D.
If you experience recurrent heartburn, you may have to do more than stop having pizza and beer. Gastroesophageal Reflux Disease, or GERD, is a potentially dangerous medical condition affecting eighteen percent of people worldwide. If left untreated, acid reflux can lead to esophageal stricture, ulceration, hemorrhage, bleeding, Barrett’s esophagus (pre-cancer), dysphasia, choking, and weight loss. This condition occurs when acid from the stomach flows back upward into the esophagus. “Acid” refers to the stomach acid and “reflux” refers to the backward flow. Heartburn is the most common symptom. This condition involves a muscular valve called the lower esophageal sphincter (LES) which prevents stomach acid from reaching upwards. With the chronic disease of acid reflux, that muscle dysfunctions allowing acid back into the esophagus. This can happen when digestion in the stomach is disrupted. Since the esophagus is only a transport organ and not a digestive organ, we must look at the stomach where ingestion is occurring. A physiological understanding of GERD and the impact of diet and lifestyle will lead to long term management and avoidance future health complications.
What is it?
GERD is not really a disease but rather a syndrome consisting of one or more of the following symptoms: damage to the esophageal lining (producing further symptoms), mild to severe inflammation of the lining of the esophagus, heartburn, belching, upset stomach, bloating, gas, sense of fullness, chronic cough, regurgitation of stomach contents, hoarseness, wheezing or asthma, difficulty swallowing, or sore throat. Other symptoms include food coming back into mouth with acid, food sticking in the throat, weight loss, and blood loss. The general misperception regarding this condition is that there is too much stomach acid (gastric hyperacidity) and is therefore treated by antacid products and medicines like Prilosec, Prevacid, Tagament, Zantac, and Pepcid that suppress stomach acid secretion. This idea is perpetuated by a multibillion dollar pharmaceutical industry. The most effective solution to the problem, however, has nothing to do with eliminating excess acid in the stomach. It is lifestyle. The LES is most affected by what we eat and how we eat it. There are other physical conditions and genetic factors that predispose individuals to GERD, but lifestyle still plays the most important role in managing this condition.
What can I do?
It is more accurate to say that even small amounts of stomach acid in the wrong place will harm the LES and lead to GERD. This is where toxic foods and bad habits come in. Cellular productivity in the body usually decreases with age. The same is true with parietal cells (stomach acid producing cells) located in the gastric mucosa. Instead of too much acid, we may actually not have enough. This creates various states of indigestion. When you combine this condition with foods that are difficult in nature to digest, you set the stage for reflux. The condition of diminished secretion of stomach acid is called atrophic gastritis or gastric atrophy. There is no disease known for inducing gastric hyperacidity (too much acid). GERD is more related to lack of stomach acid than excess. Antacids provide only temporary relief from the symptom of heartburn. Suppressing digestive acids when the body is already having trouble producing them can cause other long term health complications such as: poor absorption of vitamins, minerals, amino acids, poor digestion of proteins, allergies, bronchial asthma, bacterial overgrowth in stomach and small intestine, pernicious anemia, depression, stomach cancer, skin diseases (acne, dermatitis, eczema, urticaria), gall bladder disease, lupus, grave’s disease, ulcerative colitis, chronic hepatitis, osteoporosis, diabetes, and arthritic conditions. Stomach acid, or hydrochloric acid (HCI), is crucial for complete digestion of food and absorption of nutrients. Digestion involves a highly complex and well-coordinated interaction of many different acids, enzymes, alkaline substances, hormones, and many other mechanisms. When these are produced in just the right amounts at just the right times, digestion is efficient. Indigestion happens when something upsets the balance, like a stomach acid deficiency. The mechanism within the parietal cell responsible for secreting HCI is called the proton pump. Drugs called proton pump inhibitors work by turning off this pump. Any drug induced suppression of digestive acids will cause a state of malnutrition and disrupt the natural gastrointestinal environment. Powerful acid blocking drugs make the body produce more gastrin, a hormone related to the production of HCI. Chronic over production of gastrin (hypergastrinemia) can lead to gastric adenocarcinoma - a form of stomach cancer. A common prescription of 40 to 60 mg of Prilosec will typically produce gastrin levels to be ten times the normal level. A long term solution to the problem of acid reflux will have to address diet, supplements, and eating habits. This can be accomplished by proper diagnosis, elimination of offending agents, food allergies and sensitivities, toxins (including caffeine, nicotine, and alcohol), and then by taking a variety of natural substances, including supplements of stomach acid itself.
What do I do first?
Before beginning a program of restorative supplements, it is essential to remove irritants that disrupt the gastrointestinal (GI) tract, or weaken the LES. Through the help of a qualified physician, food allergies can be recognized and eliminated in the diet. Allergens in food cause an immunological response in the body. This creates indigestion as well as cravings for more such foods. The stomach should also be checked for dangerous bacterial infections such as Helicobacter Pylori. This dangerous bacteria will flourish when natural acid production is low or when acid suppressing drugs are taken. H. Pylori is the leading cause of atrophic gastritis. Your physician can tell you if any other drugs you are taking are irritants. Common ones include aspirin, NSAIDs (ibuprofen, naproxen, and others), and certain antibiotics. Foods that aggravate and weaken the lower esophageal sphincter and should be limited are: fried or fatty foods, coffee, caffeinated drinks, alcoholic beverages, chocolate, peppermint and spearmint, garlic, onions, citrus fruits, tomato products, chili peppers, pepper, and all carbonated beverages. Other factors that affect this condition are how and when we eat. It is important to eat small amounts of food and chew it carefully. This ensures complete breakdown of food before passing to the stomach and limits the amount of acid secreted and the amount of time it is in the stomach. Late night meals should be avoided altogether. Lying down after we eat creates pressure from gravity that pushes acid back towards the esophagus. Emotional stress will also limit the body’s ability to fully digest food. Some people eat on the run or under emotional pressures which disrupt the digestive process. If changes can not be made for these people, then stress and time management will have to be considered. Once the offensive aspects of our diet and lifestyle are eliminated, a program of restoration and healing can be considered.
What supplements can I take?
The body needs nutrients to repair and maintain its functions. A whole foods diet based on a variety of organic whole grains, fruits, vegetables, legumes, and small amounts of lean meats is the basis for health. It is important to take a high quality multi-vitamin and mineral supplement to ensure that basic deficiencies are addressed and that optimal nutrition is available to our bodies to be in optimal health. But even if we are consuming all the right ingredients, we may not be able to absorb them if we are lacking crucial digestive enzymes and acids. Nutrients such as peptide and amino acid components of proteins, minerals, B vitamins, and other nutrients all depend on adequate amounts of stomach acid to be digested and absorbed. The stomach achieves this by regulating the gastric pH (acidity level) and by producing a digestive enzyme called pepsin when acid is increased. Pepsin is essential for the initial digestion of protein. If acid levels are depressed then so are pepsin levels and proteins will not be broken down into amino acid components and peptides. A treatment of HCI and pepsin supplements can be very effective on problems of indigestion but has some risks. It should only be given by a trained physician once stomach acid has been proven low by clinical testing such as gastric analysis. Stool samples are then checked for protein digestion to measure success and dosage of further treatment. Enzyme therapy is also used when our own levels are found to be deficient. Enzymes are protein catalysts that are needed for digestion and absorption of fats, proteins, and carbohydrates. The most common supplements are bromelain (from pineapple), papain (from papaya), and pancreatin (from animal tissue). They are fairly safe and inexpensive. Other herbs and agents that stimulate production of digestive juices include: yellow dock, wormwood, milk thistle, hops flowers, goldenseal root, globe artichoke, ginger, gentian root, fennel, dandelion, caraway, and barberry bark. It is best to stay with recommended doses and receive guidance from someone trained in herbs. 1 to 3 grams of vitamin C taken two or three times a day with meals has been reported to increase the health of the stomach lining and decreases risk of gastric cancer. Ascorbic acid forms of vitamin C should be avoided. Instead, ascorbate forms such as sodium or magnesium/calcium ascorbate are better tolerated.
In Summary
By understanding the relationships between what we eat, how we eat, the drugs and supplements we take with how our bodies respond we can make choices for a long term solution to the problem of acid reflux instead of short term relief of symptoms. By making changes in our lifestyle to eliminate harmful foods and eating practices we can stop taxing our digestive organs. With help from our physician we can then restore imbalances and increase absorption of all nutrients. This awareness of toxicity and deficiency is a master key to improving the quality of our lives. This is functional medicine and it is effective. However, when a disorder becomes chronic or nonresponsive then it is necessary to pursue a holistic approach, such as Homeopathic Medicine, which can address the totality of symptoms for a complete restoration of the entire constitution.
