This article is part 1 of a 2-part series that sheds light on the causes of GERD, Acid Reflux, & Heartburn, and provides new evidence-based solutions that can correct the root causes of these symptoms.
Two years ago I laid on a radiologist’s table getting my stomach and esophagus x-rayed after swallowing a rather large dose of nasty-tasting barium. Why? I had pain where my esophagus met my stomach and this allowed them to see what was going on. As expected, he saw erosion in my esophagus from chronic acid reflux or “GERD.” What did I do? What I always do — I questioned everything, and tried my best to find a solution to heal.
I learned that, in some ways, both orthodox medicine and even many “natural” methods were wrong in some important ways. What follows is a window into what I found.
Defining GERD (Acid Reflux) — What is it Really?
18% – 27% of people in North America have GERD, according to a 2014 analysis.1Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. 2014. http://www.ncbi.nlm.nih.gov/pubmed/23853213 That’s around 100 million to 150 million people, and all indications are that rates will continue to climb. The only place in the developed world where GERD prevalence is below 10% is East Asia. So rather than pack your bags, you can read on because I think you can heal from GERD without learning Japanese.
“GERD” is an acronym for “Gastro-Esophageal Reflux Disease,” but it’s often just referred to by its most popular symptoms “acid reflux” and “heartburn.” The Mayo Clinic states that someone has GERD when someone has symptoms of stomach contents are refluxed back up into the esophagus at least 2 times a week.
This condition is often joked about at the dinner table, and it’s so common you might think Acid Reflux is more of a nuisance than a real disease. What is more, drug company commercials convince people it’s normal and encourage them not to think twice about the pain behind their sternum — just pop some acid blockers like TUMS or Prilosec everyday to control it, and go about your life.
As people come to believe that reflux and heartburn are normal, they are more likely to self-treat with powerful acid blocking drugs found on every drugstore shelf, while the underlying problem and unseen damage may continue to get worse.
Since the lining of your throat and esophagus has little protection from stomach acid, any acid that refluxes up into your esophagus can cause damage. Over time, that acid wears away the delicate lining of your esophagus causing irritation, inflammation, erosion (see right), ulcers, bleeding, scarring, and eventually tumor-like growths.
Serious and even life-threatening complications can develop including “Barrett’s Esophagus” which is a well known indicator of a highly increased risk of esophageal cancer.
All of these complications start with the simple symptoms that millions experience everyday: heartburn.
It’s Very Possible You Have GERD and Don’t Know It — The Epidemic of ‘Silent Reflux’
Here’s some of the primary symptoms most people associate with having GERD:
- Aching, pressure, or burning anywhere behind or just below the sternum, in the middle of your chest, or in the center of your stomach.
- Burping up acid or stomach contents. The ubiquitous “sour burp.”
- Bloating, particularly in the upper abdomen
Yet many who have GERD don’t know it and have NO typical symptoms. Here are the “silent” symptoms of acid reflux:
- chronic dry, irritated cough
- chronic sinusitis or nasal congestion
- post-nasal drip
- chronic hoarseness or sore throat, or hoarseness that gets worse through the day
- difficulty swallowing
- feeling of a lump in the throat
- early satiety, feeling full with just small amounts of food
- feeling of tightness in the chest
- Asthma — most asthmatics (between 60%-89%) actually have GERD. In many cases, the treatment of GERD cures symptoms of asthma.2Most asthmatics have gastroesophageal reflux with or without bronchodilator therapy. 1990. http://www.ncbi.nlm.nih.gov/pubmed/2379769
All these symptoms could be caused by several things, but the most common cause is “Silent Acid Reflux.” Silent reflux is still reflux, and can lead to the same dangerous complications.
Problems with Standard Drug Treatments for GERD
The standard medical treatment of GERD and Acid Reflux is to block your natural and normal production of stomach acid typically through the use of one of three drug types: Antacids (Tums), H2 Blockers (i.e. Zantac, Tagamet), and perhaps the most powerful Proton-Pump Inhibitors or PPIs (i.e. Prilosec, Prevacid, Nexium, Dexilant, and many more).
When the PPI drugs first came on the market, they were only approved for short-term use — typically 8 weeks or less. I recently spoke with one physician who remembers pharmaceutical reps back in the early days telling him specifically to avoid prescribing them more for more than a few months at a time. However, today it is not uncommon for me to run into clients who have been on them for 5 years, 10 years, and I’ve even met one client who had been on them for more than 15 years — I’m not saying there’s a connection, but this client also happened to have stomach cancer.
Acid Blockers Do Have a Place in Medicine: To be clear, I don’t have a blanket dogmatic position against these drugs or most drugs for that matter. The orthodox medical profession does important work, but it’s important to note most medical providers practice within very narrow scope of healthcare — they treat specific named diseases with specific drugs, and they can save your life, sometimes against all odds, when you are sick and in pain. Their role is vital, and medications can do amazing things.
These drugs have a place in healthcare. For example, when someone has severe ulcers, gastric bleeding, severe gastritis, and they are in deep amounts of pain, they can help heal that damage rapidly with the targeted use of these medicines over a short period of time.
Acid Blockers Probably Don’t Have a Place on Drugstore Shelves or Taken for Long Periods of Time: Slick marketing has helped acid-blockers like Zantac and Prilosec go from being a short-term aid in healing severely damaged digestive tracts into a daily pill for millions of people, making them the most profitable drugs year after year.
Over $6 Billion dollars of Nexium (a “PPI” or proton pump inhibitor) was sold just in the United States by getting them on every drugstore shelf in the world for anyone to buy without a prescription and take for as long as they want.
It’s big business, which is surprising considering that these drugs do little to address the causes of GERD and have limited value in actually curing it.3The Therapeutic and Diagnostic Value of 2-week High Dose Proton Pump Inhibitor Treatment in Overlapping Non-erosive Gastroesophageal Reflux Disease and Functional Dyspepsia Patients. 2012. http://www.ncbi.nlm.nih.gov/pubmed/22523726 Once they are discontinued, symptoms return, often with a vengeance.4Rebound acid hypersecretion after long-term inhibition of gastric acid secretion. http://www.ncbi.nlm.nih.gov/pubmed/15679764 People then become more convinced they “need” the drug, and thus begin an endless cycle of treatment.
How Acid-Blocking “PPI” Drugs Can Make People Sick Over Time
Now that people are routinely taking PPIs for months and years on end, some interesting complications are starting to be seen both in clinical practice and in the research. Here are the known problems with taking acid-blocking PPI drugs long-term:
- They change the pH of your stomach from something close to battery acid (pH 1-2) to the acidity of tomato juice (pH 3.5 – 4.5). Now how in the h-e-double hockey sticks are you going to breakdown, digest, and absorb your food properly by soaking your food in tomato juice? I believe this is one of the biggest long-term problems with taking these drugs. We evolved to have a stomach with strong acid, and we still need it today. Your entire digestive process and even your immune system relies on stomach acid to function properly. It cannot function well on tomato juice.
- They weaken resistance to serious GI infections5Dial S, Delaney JA, Barkun AN, Suissa S. “Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease.” JAMA 2005 Dec 21;294(23):2989-95. As mentioned, your immune system relies on a stomach that’s acidic enough to quickly kill most invaders that come through it. A study in Canada showed an increase in the likelihood of getting Salmonella, Campylobacter, Cholera, Lysteria, Giardia, and C. Difficile.6Systematic Review of the Risk of Enteric Infection in Patients Taking Acid Suppression. 2007. http://www.ncbi.nlm.nih.gov/pubmed/17509031 Full text here: http://farncombe.mcmaster.ca/documents/Leonardetal.AmJGastroenterol200710292047-2056.pdf This is particularly dangerous for older adults, who are most commonly taking these drugs, and who are at increased risk of death from infections like this.
- They increase susceptibility to pneumonia.7Laheij RJ, et al. “Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs.” JAMA 2004 Oct 27;292(16):1955-60. . Even short-term use increased the incidence of pneumonia by 27-39%.8Perils and pitfalls of long-term effects of proton pump inhibitors. 2013. http://www.ncbi.nlm.nih.gov/pubmed/23927671 Again, this is dangerous for anyone with compromised lung function, immunity, or who is advanced in age.
- They impair the stomach from emptying food into your small intestine, which itself can worsen GERD symptoms. This has been investigated in a 2010 analysis in Japan9Effects of proton pump inhibitors on gastric emptying: a systematic review. 2010. http://www.ncbi.nlm.nih.gov/pubmed/20012198. When food and bacteria spend more time in the stomach in a higher-pH (low acid) environment, it promotes the overgrowth of bacteria in the stomach and fermentation of carbohydrates, which subsequently causes more bloating that increases acid reflux — however, people taking these drugs will feel fewer symptoms of reflux because the acid coming back up is slightly less acidic. However, it can be damaging nonetheless.10http://www.medscape.com/viewarticle/730747_6
- They severely reduce absorption of essential vitamins and minerals such as Vitamin C11Henry EB, Carswell A, Wirz A, Fyffe V, McColl KE. “Proton pump inhibitors reduce the bioavailability of dietary vitamin C.” Aliment Pharmacol Ther. 2005 Sep 15;22(6):539-45. , B12, Folate, Zinc, Calcium, Magnesium, Iron and more.12Association of Long-term Proton Pump Inhibitor Therapy with Bone Fractures and effects on Absorption of Calcium, Vitamin B12, Iron, and Magnesium. 2010. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2974811/ It is such a huge problem the FDA has released warnings about some of these nutrients being blocked by PPIs. These nutrient insufficiencies could potentially affect every single system in the brain and body.
- They increase the risk of hip fractures by blocking the absorption of some minerals.13Yang YX, Lewis JD, Epstein S, Metz DC. “Long-term proton pump inhibitor therapy and risk of hip fracture.” JAMA 2006 Dec 27;296(24):2947-53. As above, this is just one of the possible effect of blocking vital nutrients. Hip fractures are one of the leading causes of death among the elderly. Hip fracture alone increases their relative risk of death by 20%.
- They increase the risk of Age-Related Macular (Eye) Degeneration.14Clemons TE, Milton RC, Klein R, Seddon JM, Ferris FL 3rd; Age-Related Eye Disease Study Research Group. “Risk factors for the incidence of Advanced Age-Related Macular Degeneration in the Age-Related Eye Disease Study (AREDS) AREDS report no. 19.” Ophthalmology 2005 Apr;112(4):533-9. & Age-related Eye Disease Study Group (AREDS). “Risk factors associated with Age-related macular degeneration,” Ophthalmology 2000:107:2224-2232. This is just one more of the likely effects of reduce nutrient absorption on the body.
- They cause cells in the stomach and small intestine to over-grow in at least 7-10% of cases15http://www.medscape.com/viewarticle/730747_6, in both children and adults (a condition known as hyperplasia), but it is unclear if these overgrowths present an increased risk of cancer, though the evidence is much stronger in rodents that it does.16Gastric carcinoids after long-term use of a proton pump inhibitor. 2012. http://www.ncbi.nlm.nih.gov/pubmed/22861200 AND Gastric histology in children treated with proton pump inhibitors long term, with emphasis on enterochromaffin cell-like hyperplasia. 2011. http://www.ncbi.nlm.nih.gov/pubmed/21320136
- Other FDA reports of kidney inflammation (acute nephritis), a form of muscle wasting (rhabdomyolysis), chronic pelvic pain, low blood platelets (thrombocytopenia), and more, leading the FDA to put out warnings on many of these including on the risk of hip fracture.17Perils and pitfalls of long-term effects of proton pump inhibitors. 2013. http://www.ncbi.nlm.nih.gov/pubmed/23927671
The Myth: “Acid Reflux is Caused From Too Much Stomach Acid and Taking Acid-Blockers Fixes the Problem”
If you listen to television commercials, you might start to believe the claim that GERD and Acid Reflux comes from having an over-production of stomach acid, and that’s why you’re burping up acid and getting heartburn.
If you believe these drug company commercials, which are usually sponsored by a gastrointestinal experts like Larry the Cable Guy, then you would take an acid-blocker to get rid of all this extra stomach acid so you can go on eating just like Larry. Problem solved.
The only problem is that….the beautifully crafted, simple story line is brazenly unscientific. With the FDA cracking down on every child’s bake sale these days, it’s absolutely astonishing they let drug companies peddle this nonsense that lacks a shred of evidence in the scientific literature.
Over-production of stomach acid is very rare.
And the scientific evidence in many cases points to the very opposite conclusion than the commercials: People with GERD often have chronically LOW production of stomach acid, a condition known clinically as “hypochlorhydria” or a more severe form called “atrophic gastritis.”
Older people with lower stomach acid are at a higher risk for GERD: As we age, our stomach acid production naturally and predictably declines. It declines so much that in one study 30% of people over the age of 60 produced little to no stomach acid (a condition known as atrophic gastritis)18Gastric Hypochlorhydria and Achlorhydria in Older Adults. 1997.
http://jama.jamanetwork.com/article.aspx?articleid=419006. This has been
verified to be caused from the death of the cells in the stomach that actually produce the chemicals that are turned into gastric secretions.
Even though people over 60 produce very little stomach acid, they have the highest risk of having GERD.19Aging, the gastrointestinal tract, and risk of acid-related disease. 2004. http://www.ncbi.nlm.nih.gov/pubmed/15478847 Why didn’t they get GERD when they were kids and had 4x the amount of acid in their stomach?
Increasing Stomach Acidity Reduces Symptoms of Acid Reflux in Clinical Practice: Dr. Jonathan Wright, MD, may be one of the more clinically experienced physicians in the U.S. who regularly tests stomach pH in patients with GERD. He has found that over 90% of his patients with GERD have inadequate stomach acid, and he has many patients taking supplemental stomach acid with every meal (my thoughts on taking stomach acid supplements in Part 2).
Dr. Wright has found that increasing stomach acid production in patients with GERD relieves symptoms, digestion improves, and their condition is reversed. This has been my own experience, as well as the experience of clients and even friends and family.
However, Making the Stomach More Acidic Is Only a Part of the Solution
Just like orthodox medical practices believe in blocking stomach acid to treat GERD, a lot of naturopathic clinicians believe that simply increasing stomach acid will fix the problem. This is where both the mainstream and the natural health practitioners have it wrong and have over-simplified the problem and the solution.
I have personally seen people taking way too many stomach acid supplements (usually powdered Betaine HCl, which is stomach acid) and causing more problems than they started with. Besides that, whenever we take something in, our body tends to respond by making less of that thing — so simply taking supplemental stomach acid can result in the body decreasing production of its own stomach acid.
This is a biological process called “Negative Feedback,” and it’s exactly what happens when people take too many anti-depressants that artificially raise serotonin levels. The body responds by making less serotonin and serotonin receptors literally begin to die leading to the possible permanent loss of serotonin production.20Breggin, P. (2001) The Antidepressant Fact Book.
If we are to truly correct this condition, it will take more than either blocking the normal production of stomach acid or only artificially raising it.
The Missing Link Behind stopping GERD: The Lower Esophageal Sphincter (LES).
Most people haven’t heard of this little muscle between their esophagus and stomach, but in GERD, it is the opening and closing of this valve that is directly related to all episodes of reflux.
It is so important that the fact is you cannot have GERD if you have a properly functioning Lower Esophageal Sphincter or “LES” (a normal LES is pictured left).
It turns out that when you address the natural opening and closing of this sphincter muscle, not simply raising or lowering stomach acid, you really start to get at the true causes of most GERD very quickly.
You might think that there is something wrong with the LES in people with GERD, but in most cases (with the exception of a hiatal hernia), the LES itself appears to be normal.21Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N Engl J Med 1982. & Review article: the pathophysiology of gastro-oesophageal reflux disease. 2007. http://www.ncbi.nlm.nih.gov/pubmed/17593062
So, that leads us to the most critical question of all: what causes the LES to open too frequently or for too long allowing stomach contents to reflux back into the esophagus? If we answer this question, I believe we correct the imbalances that cause most cases of GERD.
It appears the LES is actually not malfunctioning in most cases of GERD, but that it is opening longer and more often in response to excess gas pressure. Here’s what the research I have read suggests is causing it to do so:
Increased abdominal pressure (gas) from carbohydrate mal-absorption causes the LES to open too much and for too long.22Review article: the pathophysiology of gastro-oesophageal reflux disease. 2007. http://www.ncbi.nlm.nih.gov/pubmed/17593062
It turns out the LES muscle that normally stays closed has a wonderful fail-safe mechanism that will cause it to open when the pressure in the stomach is too high or the stomach is too stretched to allow the pressure to be released.
That’s generally a good thing or I guess some people just might explode. Think about it — if you can’t pass the gas on the other end, how bad that feels, and how good it feels when you finally do. This same thing appears to be happening in the stomach of most people with GERD.
There are many reasons that gas builds up in people with GERD, but the biggest reason is poor digestion of certain carbohydrates.
For many people without severe complications, managing this excess gas and pressure is the single most important aspect of this disorder to treat, and in part 2, I’ll show you how to do it.
In part 2 of this article, we will go into the real cause of GERD: excess abdominal pressure and the 7-step process that shows you exactly how to normalize that abdominal pressure and heal the damage caused from chronic acid reflux.
Click here to go on directly to part 2!
References [ + ]
|1.||↑||Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. 2014. http://www.ncbi.nlm.nih.gov/pubmed/23853213|
|2.||↑||Most asthmatics have gastroesophageal reflux with or without bronchodilator therapy. 1990. http://www.ncbi.nlm.nih.gov/pubmed/2379769|
|3.||↑||The Therapeutic and Diagnostic Value of 2-week High Dose Proton Pump Inhibitor Treatment in Overlapping Non-erosive Gastroesophageal Reflux Disease and Functional Dyspepsia Patients. 2012. http://www.ncbi.nlm.nih.gov/pubmed/22523726|
|4.||↑||Rebound acid hypersecretion after long-term inhibition of gastric acid secretion. http://www.ncbi.nlm.nih.gov/pubmed/15679764|
|5.||↑||Dial S, Delaney JA, Barkun AN, Suissa S. “Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease.” JAMA 2005 Dec 21;294(23):2989-95.|
|6.||↑||Systematic Review of the Risk of Enteric Infection in Patients Taking Acid Suppression. 2007. http://www.ncbi.nlm.nih.gov/pubmed/17509031 Full text here: http://farncombe.mcmaster.ca/documents/Leonardetal.AmJGastroenterol200710292047-2056.pdf|
|7.||↑||Laheij RJ, et al. “Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs.” JAMA 2004 Oct 27;292(16):1955-60.|
|8, 17.||↑||Perils and pitfalls of long-term effects of proton pump inhibitors. 2013. http://www.ncbi.nlm.nih.gov/pubmed/23927671|
|9.||↑||Effects of proton pump inhibitors on gastric emptying: a systematic review. 2010. http://www.ncbi.nlm.nih.gov/pubmed/20012198|
|11.||↑||Henry EB, Carswell A, Wirz A, Fyffe V, McColl KE. “Proton pump inhibitors reduce the bioavailability of dietary vitamin C.” Aliment Pharmacol Ther. 2005 Sep 15;22(6):539-45.|
|12.||↑||Association of Long-term Proton Pump Inhibitor Therapy with Bone Fractures and effects on Absorption of Calcium, Vitamin B12, Iron, and Magnesium. 2010. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2974811/|
|13.||↑||Yang YX, Lewis JD, Epstein S, Metz DC. “Long-term proton pump inhibitor therapy and risk of hip fracture.” JAMA 2006 Dec 27;296(24):2947-53.|
|14.||↑||Clemons TE, Milton RC, Klein R, Seddon JM, Ferris FL 3rd; Age-Related Eye Disease Study Research Group. “Risk factors for the incidence of Advanced Age-Related Macular Degeneration in the Age-Related Eye Disease Study (AREDS) AREDS report no. 19.” Ophthalmology 2005 Apr;112(4):533-9. & Age-related Eye Disease Study Group (AREDS). “Risk factors associated with Age-related macular degeneration,” Ophthalmology 2000:107:2224-2232.|
|16.||↑||Gastric carcinoids after long-term use of a proton pump inhibitor. 2012. http://www.ncbi.nlm.nih.gov/pubmed/22861200 AND Gastric histology in children treated with proton pump inhibitors long term, with emphasis on enterochromaffin cell-like hyperplasia. 2011. http://www.ncbi.nlm.nih.gov/pubmed/21320136|
|18.||↑||Gastric Hypochlorhydria and Achlorhydria in Older Adults. 1997.
|19.||↑||Aging, the gastrointestinal tract, and risk of acid-related disease. 2004. http://www.ncbi.nlm.nih.gov/pubmed/15478847|
|20.||↑||Breggin, P. (2001) The Antidepressant Fact Book.|
|21.||↑||Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N Engl J Med 1982. & Review article: the pathophysiology of gastro-oesophageal reflux disease. 2007. http://www.ncbi.nlm.nih.gov/pubmed/17593062|
|22.||↑||Review article: the pathophysiology of gastro-oesophageal reflux disease. 2007. http://www.ncbi.nlm.nih.gov/pubmed/17593062|