Gastro-oesophageal reflux disease (GERD), associated by the unpleasant feeling of acid in your throat and a burning sensation, is a very common problem. The prevalence of acid reflux is on the rise and most of us have experienced it at some point in our life. Whether it is triggered by a glass of red wine or spicy food, it causes a great deal of discomfort to sufferers. Unfortunately, most people don’t take it seriously and put it down to having too much food or the wrong types. Popping a pill available over the counter, is easy, and can alleviate symptoms quite effectively. However, in reality chronic reflux is often more complex and can lead to ulceration and increases the risk of oesophageal cancer.[i]
The common misconception about reflux is that it is caused by excessive production of stomach acid. While the symptoms of reflux certainly involve acid and the stomach contents regurgitating into the oesophagus, this theory doesn’t explain why it happens. Let’s explore the most current research on the causes of GERD, why suppressing stomach acid production isn’t ideal and what you can do to relieve your symptoms.
The Crucial Role of Stomach Acid
Stomach acid is responsible for:
- Breakdown of food in general, especially proteins found in meat, legumes, nuts and seeds etc.
- Forming an acidic barrier to pathogenic bacteria, regulating the population and composition of bacteria in the small intestine.[ii]
- Absorption of minerals and vitamin B12
- Deactivation of environmental antigens (proteins that can cause allergic reactions, if exposed to our immune system).
In about 30% of GERD patients, stomach acidity is actually normal, suggesting other mechanisms.[iii][iv] Insufficient stomach acid production can be caused by certain medications (e.g. anti-histamines, Proton Pump Inhibitors - PPIs), excessive snacking, eating in a rush or mindless eating and deficiencies in nutrients needed for stomach acid production – zinc and B6. Stomach acid production also significantly reduces with age and therefore digestive complaints and indigestion are much more common in the elderly.
Long term, insufficient stomach acid can lead to different complications and further digestive symptoms. These include small intestinal bacterial overgrowth (SIBO),[v] IBS[vi], Clostridium difficile-associated diarrhoea[vii] or higher risk of H.pylori infection – the bacteria that is associated with ulcers and gastric cancer. Long term use of acid blocking medication (e.g. omeprazole) can lead to reduced nutrient absorption, in particular iron, [viii] B12[ix] [x] and vitamin C[xi], consequently contributing to the risk of developing anaemia, cardiovascular disease[xii],[xiii] dementia[xiv],[xv] or osteoporosis.[xvi],[xvii]
Another cause of reflux may be the weakening of the lower esophageal sphincter (LES), which separates the stomach from the oesophagus. In between meals, it is supposed to be closed to prevent the backflow of food into the oesophagus. However, when there isn’t enough stomach acid, the food isn’t digested properly, often leading to an overgrowth of bacteria in the small intestine (SIBO). These bacteria feed on and ferment undigested carbohydrates resulting in the feeling of fullness, discomfort, bloating and distension. This causes an increase in intra-abdominal pressure (IAP), which relaxes the LES and pushes the stomach contents and acid into the oesophagus. Other factors such as obesity, inflammation (poor diet, smoking, high alcohol intake), high intake of caffeinated drinks, spices, mint and chocolate can all relax LES and make symptoms worse.[xviii],[xix]
Key Strategies to Eliminate Reflux
- Weight loss – It may be best to see a registered Nutritional Therapist and/or a Personal Trainer to help you with a personalised weight loss programme.
- Low-carbohydrate diet has been show to significantly reduce GERD symptoms.[xx] Avoid all refined sugars and carbohydrates (e.g. pasta, bread). Simple meals based around a source of protein (meat, fish, eggs, legumes) and vegetables work well. Avoid snacking and eating late in the evening.
- Use healing and soothing herbs that help by coating the stomach lining and regulating acidity:
-Slippery elm mucilage soothes the throat and lining of the stomach and stimulates mucus secretion.[xxi]
-Gamma oryzanol from rice bran oil normalises stomach secretions,[xxii] has potent antioxidant activity and has an anti-ulcer properties.[xxiii]
-Marshmallow soothes irritated mucous membranes and has been used as a remedy for ulcers.[xxiv]
-Deglycyrrhizinated licorice increases production of protective mucus[xxv] and exhibits activity against H. pylori.[xxvi],[xxvii]
-Aloe vera has a long tradition of use for its wound healing and anti-inflammatory properties.[xxviii]
- Strengthen connective tissue with glucosamine, chondroitin, MSM and vitamin C.
- Support bacterial balance with probiotics[xxix] and antimicrobial herbs such as garlic[xxx] or cinnamon[xxxi], for their activity against H.pylori.
- Promote effective digestion with hydrochloric acid (HCL) and digestive enzymes to reduce carbohydrate fermentation, gas production and bloating. If you have ulcers, gastritis or any other tissue damage in the GI tract, use the soothing herbs above before trying HCL or digestive enzymes.
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[i] Zhang Y. Epidemiology of esophageal cancer. World Journal of Gastroenterology : WJG. 2013;19(34):5598-5606.
[ii] Scott Merrell et al. pH-Regulated Gene Expression of the Gastric Pathogen Helicobacter pylori. Infect Immun. 2003; 71 (6): 3529-39.
[iii] Schlesinger PK et al. Limitations of 24-hour intraesophageal pH monitoring in the hospital setting. Gastroenterology. 1985; 89(4): 797-804.
[iv] Barlow WJ, Orlando RC. The pathogenesis of heartburn in nonerosive reflux disease: a unifying hypothesis. Gastroenterology. 2005; 128(3):771-8.
[v] Ardatskaia MD, Loginov VA, Minushkin ON. [Syndrome of bacterial overgrowth in
patients with the reduced stomach acid secretion: some aspects of the diagnosis].
Eksp Klin Gastroenterol. 2014;(12):30-6.
[vi] Choung RS et al. Associations between medication use and functional gastrointestinal disorders: a population-based study. Neurogastroenterol Motil. 2013;25(5):413-9
[vii] Aseeri M et al. Gastric acid suppression by proton pump inhibitors as a risk factor for clostridium difficile-associated diarrhea in hospitalized patients. Am J Gastroenterol. 2008;103(9):2308-13
[viii] Shikata T et al. Use of proton pump inhibitors is associated with anaemia in cardiovascular outpatients. Circ J. 2015;79(1):193-200
[ix] Lam JR et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA. 2013; 310(22):2435-42
[x] Hirschowitz BI, Worthington J and Mohnen J. Vitamin B12 deficiency in hypersecretors during long-term acid suppression with proton pump inhibitors. Aliment Pharmacol Ther. 2008;27(11):1110-21
[xi] Henry EB et al. Proton pump inhibitors reduce the bioavailability of dietary vitamin C. Aliment Pharmacol Ther. 2005;22(6):539-45
[xii] Ghebremariam YT et al. Unexpected effect of proton pump inhibitors: elevation of the cardiovascular risk factor asymmetric dimethylarginine. Circulation. 2013;128(8):845-53
[xiii] Charlot M et al. Proton-pump inhibitors are associated with increased cardiovascular risk independent of clopidogrel use: a nationwide cohort study. Ann Intern Med. 2010;153(6):378-86
[xiv] Haenisch B et al. Risk of dementia in elderly patients with the use of proton pump inhibitors. Eur Arch Psychiatry Clin Neurosci. 205; 265(5):419-28
[xv] Wijarnpreecha K et al. Proton pump inhibitors and risk of dementia. Ann Transl Med. 2016;4(12):240
[xvi] Jacob L, Hadji P and Kostev K. The use of proton pump inhibitors is positively associated with osteoporosis in postmenopausal women in Germany. Cimacteric. 2016;19(5):478-81
[xvii] Anderson BN, Johansen PB and Abrahamsen B. Proton pump inhibitors and osteoporosis. Curr Opin Rheumatol. 2016;28(4):420-5
[xviii] Richter JE. Advances in GERD. Current developments in the management of acid-related GI disorders. Gastroenterol Hepatol (NY). 2009; 5(9): 613-615.
[xix] Kahrilas PJ, Gupta RR. Gut. 1990; 31 (1): 4-10
[xx] Austin GL, et al. A very low-carbohydrate diet improves gastroesophageal reflux and its symptoms. Dig Dis
Sci. 2006;51(8):1307-12.
[xxi] The Review of Natural Products by Facts and Comparisons. 1999. St Louis: Wolters Kluwer Co.
[xxii] Mizuta et al. Effects of gamma oryzanol on gastric secretions in rats. Folia Farmacol Japon. 1978; 74: 285-95.
[xxiii] Ichimaru et al. Effects of gamma-oryzanol on gastric lesions and small intestinal propulsive activity. Nihon Yakurigaku Zasshi. 1984; 84 (6): 537-42.
[xxiv] The Review of Natural Products by Facts and Comparisons. 1999. St Louis: Wolters Kluwer Co.
[xxv] Khayyal. Antiulcerogenic effect of some gastrointestinally acting plant extracts and their combination. Arzneimittelforschung. 2001; 51 (7): 545-53.
[xxvi] Fukai et al. Anti-Helicobacter pylori flavonoids from licorice extract. Life Sci.2002; 71 (12): 1449-63.
[xxvii] Wittschier et al. Aqueous extracts and polysaccharides from liquorice roots (Glycyrrhiza glabra L.) inhibit adhesion of Helicobacter pylori to human gastric mucosa. J Ethnopharmacol. 2009; 125 (2): 218-23.
[xxviii] Langmead et al. Randomized, double-blind, placebo-controlled trial of oral aloe vera gel for active ulcerative colitis. Aliment Pharmacol Ther.2004; 19 (7): 739-47.
[xxix] Chen et al. Antagonistic activities of lactobacilli against Helicobacter pylori growth and infection in human gastric epithelial cells. J Food Sci. 2012; 77 (1): M9-14.
[xxx] Cellini , et al Inhibition of Helicobacter pylori by garlic extract (Allium sativum). FEMS Immunol Med Microbiol. 1996; 13: 273-77.
[xxxi] Tabak M et al. Cinnamon extracts' inhibitory effect on Helicobacter pylori. J Ethnopharmacol. 1999; 67 (3): 269-77.
December 27, 2017
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