One of the most common health complaints I see in my practice, is GERD, or Gastroesophageal Reflux Disease. GERD, also referred to as acid reflux (back flow from stomach), has several symptoms associated with it, including heartburn, the most common complaint. Along with heartburn or chest pain, belching, regurgitating food, a sour taste, pain or difficulty swallowing or a burning sensation in your stomach are all symptoms that may be experienced in GERD, although, I have seen cases that did not present with any of the more common or obvious symptoms. Other less common symptoms I have observed are, sore or irritated throats and chronic coughs. The problem with focusing too much on the more obvious symptoms of GERD, is that the underlying causes are often not addressed which leads to the perpetuation, and in many cases a worsening of the symptoms. Relief of the discomfort of the common symptoms is at times important, however over the counter (OTCs) or prescription “antacids” and stomach acid inhibitors, are short term answers that will actually lead to bigger health issues down the line. GERD on the surface may appear as a relatively benign complaint, but left untreated, it can lead to serious complications including cancer of the esophagus. The good news is that GERD can be effectively relieved with, and the underlying causes treated and cured, with natural solutions. Read more…
The lower esophageal sphincter (LES) normally acts, in conjunction with the diaphragm, as a functional mecahnism to prevent reflux of stomach contents into the esophagus. If that barrier is relaxed or dysfunctional, it allows stomach contents to back up into the esophagus. If the reflux is a repeated and untreated condition, damage from stomach acid to the esophagus can result in “esophagitis”, or inflammation of the esophagus. In some cases, a hiatal hernia can be one of the contributing factors to chronic reflux problems. A hiatal hernia occurs when part of the stomach protrudes through the LES in the diaphragm, protruding into the chest cavity. This causes the esophageal sphincter, which would normally closes off and prevents stomach acid from entering the lower esophagus, to malfunction. A useful technique for hiatal hernias, is a chiropractic method, the Hiatal Hernia Procedure, where the doctor pulls the stomach lining down out of the esophagus. However, this is usually a temporary fix, that has to be repeated often for relief.
While LES poblems present in a few individuals, the overriding issue underlying reflux problems is inflammation in the stomach, or gastritis, and low stomach acid, or hypochlorhyria. This is in direct opposition to mainstream approaches that traditionally expouse and promote the reflux problem as being related to high stomach acid production. Nothing could be further from the truth. The function of the LES is dependent on the acid/alkaline state of the stomach. A more alkaline stomach, or one that has a deficiency in hydrochloric acid production, contributes to a more relaxed LES that allows stomach contents to reflux through it. This is especially noticeable, after one has eaten. The stomach is full with insufficient stomach acid for digestion, which in turn, causes the LES to malfunction and allows the reflux of food and stomach acid. A sufficiency of stomach acid, on the other hand, keeps the LES nice and tight, not allowing any reflux. A significant problem associated GERD is that traditional treatments over time, has a negative effect on important nutrient levels in the body. Treatment with antacids, H2 receptor antagonists such as famotidine (Pepcid) or nizatidine (Axid), or prescription proton pump inhibitors (PPIs) such as omeprazole (Prilosec) or esomeprazole (Nexium), suppresses stomach acid (hydrochloric acid), which worsens the low stomach acid problem, and which over time leads to deficiencies of B12, minerals and to protein maldigestion.
Stomach acid is critical to the digestion of proteins and the proper breakdown of and absorption of important minerals like calcium and vitamin B12. The link of low stomach acid and B12 anemia is well established health issue in individuals as they age.(1) Prolonged use of stomach acid inhibitors like PPIs is now associated increased hip fractures.(2) It is my observation in practice that women that have a history of digestive problems that are linked to low stomach acid, often are diagnosed with osteopenia (mild thinning of the bone mass), or osteoporosis. Antacids like TUMS, that are popular for relieving acid regurgitation are also hyped for their calcium benefits. It is actually a very poorly absorbed calcium (carbonate) that is even more dependent on sufficient levels of stomach acid for absorption. Whether it is antacids, H2 antagonists or PPIs, the suppression of stomach acid over time carries with it significant health risks associated with impaired food and nutrient digestion and absorption.
There is another factor in GERD problems that often are overlooked and untreated-H. pylori. H. pylori is a bacteria that is a primary cause of many gastritis cases in this country. Helicobacter pylori (H. pylori) is an important risk factor for inflammation and the development of peptic ulcer disease, and cancers of the stomach.(3) The role for H. pylori in the pathogenesis of GERD, has been suggested in a growing number of studies. However, the link between GERD and H. pylori is complex and there is conflicting evidence to whether it is a factor or not. It is my experience in looking at the correlation of H. Pylori and GERD, that a number of patients with GERD, are positive for Helicobacter pylori infection. I believe it is an important factor to rule out, due to the long term consequences of H. pylori infections. Chronic H pylori infections are associated with lower levels of stomach acid(4) which I believe is part of the mechanism that contributes to GERD in some individuals. This is how it works. The bacterium H. Pylori secretes urease, an enzyme that plays a role in the bacterium’s ability to colonize the acidic gastric environment. Urease helps digest urea to produce ammonia and bicarbonate. The ammonia generated neutralizes gastric acid, which provides a more hospitable environment for the bacterium. While H. Pylori benefits from a more alkaline home, the ammonia produced, is toxic to gastric epithelial cells that produce stomach acid. The result is diminished gastric acid production and a more favorable environment for H.Pylori-a very clever mechanism that H.pylori operates to promote it’s survival. Another good reason to define the role of H.pylori in GERD, is the use of PPIs in cases where there may be a H. pylori infection. In the presence of H. pylori, proton pump inhibitor therapy (PPI) appears to accelerate the development of atrophic corpus gastritis, a potentially precancerous condition.(5) Healthy levels of stomach acid is needed for proper protein digestion. Chronic low levels of stomach acid and the subsequent maldigestion of proteins promotes bacterial overgrowth in the digestive tract-a condition referred to as dysbiosis.(see dysbiosis category). Hydrochloric acid is one of my primary prescriptions when treating digestive problems. A majority of individuals with chronic gas, bloating or constipation will invariably have a food digestion weakness, with low stomach acid, and/or a weak pancreas that does not secrete sufficient enzymes for the optimum digestion of protein and fats. Sub-optimal blood total protein levels are common in these cases.
Recent research indicates that overweight individuals (increased BMI)* are at greater risk for GERD.(6) Other research found that obesity and eating a carb-heavy diet, predisposed individuals to the development of GERD. Participants eating less than 20 grams of carbohydrates/day, significantly reduced GERD symptoms in that study.(7)
The upside to the GERD problem is that one does not have to rely on any of the traditional antacids or stomach acid inhibitor prescriptions for relief. Natural herb extracts such as slippery elm, deglycerinated licorice and quercetin, and supplementing with glutamine, are very effective at calming the overt symptoms of GERD as well providing important substrates for healing the irritated and inflamed mucosal tissue of the stomach. Eliminating food allergies and eradicating H.pylori if needed, will also provide not only palliative relief of adverse symptoms, but more importantly, a real cure for long lasting health benefits.
*Body Mass Index (BMI) is a relationship between weight and height that is associated with body fat and health risk.
1. Vitamin B12 (cobalamin) deficiency in elderly patients.
Andres E, Loukili NH, Noel E, Kaltenbach G, Abdelgheni MB, Perrin AE, Noblet-Dick M, Maloisel F, Schlienger JL, Blickle JF.
CMAJ. 2004 Aug 3;171(3):251-9.
2. Long-Term Proton Pump Inhibitor Therapy and risk of Hip Fracture Journal of the American Medical Association, Vol. 296, No. 24, 12/27/06,
3. Inflammation, atrophy, and gastric cancer James G. Fox and Timothy C. Wang.
Clin Invest. 2007 January 2; 117(1): 60–69.
4. Helicobacter pylori infection and chronic gastric acid hyposecretion. El-Omar EM, Oien K, El-Nujumi A, Gillen D, Wirz A, Dahill S, Williams C, Ardill JE, McColl KE.
Gastroenterology. 1997 Jul;113(1):15-24.
5. Helicobacter pylori and gastro-oesophageal reflux disease-clinical implications and management. O’Connor HJ.
Aliment Pharmacol Ther. 1999 Feb;13(2):117-27.
6. Body Mass Index and Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis Douglas A. Corley, M.D., Ph.D.; Ai Kubo, M.P.H.
The American Journal of Gastroenterology. 01/12/2007
7.A very low-carbohydrate diet improves gastroesophageal reflux and its symptoms. Austin GL, Thiny MT, Westman EC, Yancy WS Jr, Shaheen NJ.