In this article, we are going to talk about the different causes of acid reflux, how to identify the cause of your acid reflux, and natural solutions for stopping acid reflux. We will also look at the dangers of prescription medication, and why they are not a good long term option.
Gastro-esophageal reflux disorder, commonly known as GERD, acid reflux, reflux, or simply heartburn is a problem that affects millions of people worldwide. While the fancy title might be GERD, let’s just call it reflux or heartburn.
Reflux is when the acid from the stomach travels up into the esophagus causing the familiar “burning” sensation in the chest and sometimes throat, this is why it is also called heartburn, even though it has nothing to do with the heart. There is also “silent reflux” which does not cause the burning sensation, it can be hard to identify but it often causes a build up of mucous in the throat, this can lead to a chronic dry cough or a frequent need to clear the throat.
While reflux and silent reflux can be seen as an annoyance for many people, it can also cause serious health problems like ulceration, esophageal cancer, hormone imbalance and malabsorption of nutrients. To combat the annoying symptoms of reflux many people take an over the counter medication like Mylanta, or are given a proton pump inhibitor (PPI) prescription from their doctor for Pariet, Losec or Nexium.
These PPI medications often work in treating the symptoms of reflux but they are not addressing the underlying cause, in fact they can make the situation worse as you become reliant on these medications, when you stop the medications the symptoms become worse.
If you ask the average person on the street, or even most doctors “what causes acid reflux?” The most common answer will be too much stomach acid. Yet reflux rarely occurs in children and usually does not start occurring in adults until their 30’s and 40’s and becomes more common in the elderly.
While reflux gets worse with age, it is also a well known physiological fact that as people get older, and especially over the age of 60, stomach acid levels decline …. So if reflux was caused by too much stomach acid it would make sense that it would affect more children and teenagers than the elderly!
The scientific research clearly shows that high stomach acid, or an over production of stomach acid is not the cause of reflux. Even low levels of stomach acid can cause reflux, you don’t need much acid in the esophagus to cause that burning sensation.
The idea that too much stomach acid is the cause of reflux is a very profitable one for the pharmaceutical companies as the drugs like Pariet, Losec and Nexium are all amongst the top selling drugs, second only to Lipitor to treat high cholesterol (another over prescribed drug ). Because the PPI drugs don’t treat the cause people are often given life long prescriptions for these medications, even though in the patient handout that comes with the drugs warns that this should only be used short term (but who reads the fine print).
Dr Jonathon Wright M.D who has done many years of research into the drugs that treat reflux had this to say in his book Why Stomach Acid is Good For You
“When we carefully test people over age forty who’re having heartburn, indigestion and gas, over 90 percent of the time we find inadequate acid production by the stomach.
In 24 years of nutritionally oriented practice, I’ve worked with thousands of individuals who’ve found the cause of their heartburn and indigestion to be low stomach acidity. In nearly all these folks, symptoms have been relieved and digestion improved when they’ve taken supplemental hydrochloric acid and pepsin capsules.”
If the acid lowering drugs don’t treat the cause of reflux, but they do take away the symptoms of reflux, and potentially prevent esophageal cancer and ulcers, then what is the problem you may ask.
Decreased Magnesium Absorption: In March 2011, the FDA released a warning regarding low serum magnesium levels associated with long-term use of PPIs – See more at: https://www.uspharmacist.com/article/longterm-consequences-of-chronic-proton-pump-inhibitor-use#sthash.IHvmedop.dpuf
Because magnesium is a key mineral in over 300 different enzyme reactions in the body, a deficiency in magnesium can affect your health in many ways.
Decreased Calcium Absorption: Long-term PPI drug use has been associated with an increased risk of osteoporosis and decreased bone mineral density (BMD), with a 35% increased risk of fractures. Especially for women who have a greater risk of fractures this can be a real problem.
PPI medications like Nexium, Pariet and Losec also affect the absorption of other nutrients like B12, Zinc, Iron and Vitamin C. A deficiency in these nutrients can cause problems with energy, mood, hormones and other aspects of health, because they take some time to appear it is often not associated with medications causing these problems.
Proton pumps aren’t limited to the stomach; they are present in just about every cell in your body. All of your cells, with the exception of red blood cells, have mitochondria that allow your body to metabolize carbohydrates and fat to produce energy. They do this by pumping protons across the membrane to generate a source of electric potential that can be harnessed to form ATP, the body’s main storage form of energy.
The PPI medication that is prescribed to inhibit the stomach from releasing stomach acid can also affect our energy producing systems, it may inhibit stomach acid but can leave us feeling flat in the process.
Several recent studies have also linked PPI reflux medications to heart disease. PPI users have been shown to have a significantly greater risk of heart attack than those on other antacid medication. PPIs also reduce production of nitric oxide, this is naturally produced by the body and promotes the dilation of blood vessels and improves blood flow, this maybe one of the mechanisms behind the increased risk of heart disease.
The kidneys are also affected by PPIs. A study published in 2016 compared patients using PPIs to patients using H2 blockers, another common antacid drug. They showed that over the course of five years, those in the PPI group were 28 percent more likely to develop chronic kidney disease and 96 percent more likely to develop end-stage renal disease.
The commonly prescribed PPI reflux medication also impairs cognitive function. A 2016 study found that regular PPI users had a 44 percent increased risk of dementia compared with those not using the drugs. A different study published in 2015 that assessed cognitive function in PPI users versus controls found significant impairment in visual memory and attention, this is a concern with the every increasing levels of dementia in developed countries.
Lower levels of stomach acid caused by PPI medications also have been shown to increase the risk of many different bacterial infections of the digestion tract, including C.Diificile, Streptococcus and Helicobacter Pylori. Gut infections can cause leaky gut, disrupt the levels of good bacteria producing IBS symptoms and the many other health problems associated with an imbalance in gut bacteria.
The scientific research clearly shows that stomach acid decreases with age, while the incidence of reflux increases, and accept in a few rare cases most people with reflux have a lack of stomach acid, so what is the cause of reflux and heartburn?
The research shows that it is a dysfunction with the Lower Esophageal Sphincter or LES for short that causes reflux. If there is a dysfunction with the LES then even a small amount of stomach acid can travel up into the esophagus causing the symptoms of reflux and silent reflux.
In some cases this maybe a physical problem with the LES that can be identified with a Gastroscopy, but the most common cause of LES dysfunction is bloating and abdominal pressure that causes the LES to relax.
I find that bloating is one of the most common symptoms listed by clients, even clients who say that they do not have any bloating often report back that they are so much less bloated after removing some of the trigger foods that can affect reflux.
Low stomach acid is a major cause behind acid reflux and it helps to explain why reflux increases with age as stomach acid levels decrease. Other causes of low stomach acid include stress, infections and nutrient deficiencies. If you don’t have enough stomach acid the food in your stomach can’t digest properly, this contributes to the bloating that causes reflux.
Helicobacter Pylori or H.Pylori for short is a bacterial infection that infects the stomach, part of it’s mechanism for survival is to lower the secretion of stomach acid. This lower stomach acid leads to Acid Reflux.
SIBO is an overgrowth of bacteria in the small intestine, you should have trillions of bacteria in your large intestine but very few in the small intestine. It is these bacteria in the small intestine that produce the methane and hydrogen gas, it is this gas that produces bloating and other IBS symptoms, and leads to acid reflux.
Simple eating too much can lead to acid reflux, this can happen to many people around Christmas time, but if you find that you eat big meals your stomach will not be able to digest the food properly leading to bloating and pressure from the excess food on the LES.
Being overweight puts more pressure on the stomach and the LES, studies show that even losing 5 – 10 kilograms (10-20 pounds) can make a big difference to reducing acid reflux symptoms.
Bending over or lying down soon after eating can put more pressure on the stomach, this can force the LES to open and allow some of the stomach acid to rise into the esophagus. This will be worse if you have eaten a big meal.
A lot of people are on the run these days, quickly eating meals or eating in front of the TV. Even if you think you do not eat quickly I recommend slowing down and chewing your food really well to see what difference this makes to your acid reflux and digestion. Carbohydrate digestion begins in the mouth, so if you eat quickly the salivary amylase cannot start to digest your food.
In particular wheat and other gluten containing grains can cause acid reflux, another main cause is dairy and in particular if someone is lactose intolerant. While food allergy testing is available, I recommend eliminating grains and dairy for a couple of week to see if this makes a difference to your acid reflux.
While everyone is different and will react to different foods these are some of the common culprits that can cause acid reflux. Coffee, citrus fruits, tomatoes, spicy foods, fried foods, vegetable oils and processed foods in general.
The FODMAP diet is the most researched diet when it comes to Irritable Bowel Syndrome (IBS) and reducing acid reflux. FODMAP’s are carbohydrates that are hard for some people to break down and digest, they include commonly eaten foods like onion, garlic, apples and watermelon. If you are reacting to these foods it may indicate you have an underlying SIBO infection that should be investigated.
While there are a lot of different causes of bloating which can lead to symptoms like reflux, and other IBS symptoms, the main causes is diet and lifestyle combined with low stomach acid.
While digestion supplements that contain Betaine HCL and pancreatic enzymes help to replace the low stomach acid and can greatly improve the symptoms of reflux, they may actually mask and infection like SIBO or Helicobacter pylori. These digestive enzyme supplements do not have the same side effects as PPI reflux medications but you don’t want to have to take a supplement forever if there is an underlying cause that has not been addressed.
I recommend getting tested for Helicobacter pylori either with a breath test, or even better stool antigen test, this bacterial infection occurs in the stomach and will lower your ability to produce stomach acid. There are many studies associating Helicobacter pylori with reflux and also autoimmune conditions like Hashimoto’s, skin conditions such as Acne Rosacea, hormone imbalances, and the many other health problems associated with low stomach acid.
Also test for Small Intestinal Bacterial Overgrowth (SIBO), this is the number one cause of Irritable Bowel Syndrome (IBS) symptoms, and the methane and hydrogen gas that these bacteria produce creates a lot of bloating. Reflux, diarrhea, constipation are all associated with SIBO.
A breath test that you can do at home can identify SIBO, this can be ordered through Planet Naturopath and if you are positive for SIBO you will be given a treatment plan to eliminate it naturally.
This type of functional medicine approach cuts out the guess work and identifies the underlying cause of reflux and other digestion issues, saving time and money in the long run.
A good place to start with diet changes is cutting out certain carbohydrates known as FODMAP’s, these are difficult to digest and produce an overgrowth of bacteria that create the gas that causes bloating.
A low FODMAP diet cuts out the easily fermentable carbohydrates that “feed” the bacteria in the small intestine that are producing the bloating, but it also cuts out a lot of healthy carbohydrates like onions, garlic, cruciferous vegetables, apples and pears.
I see a low FODMAP diet as a good short term solution while you identify and treat the underlying cause of bloating and reflux. It is not a diet that you want to be following, or need to be following for the long term, as a low FODMAP diet also cuts out a lot of the beneficial foods for the good bacteria in the large intestine.
In today’s world many people are eating on the run, eating out, eating too quickly and generally doing things that are not optimal for good digestive function. If your nodding your head saying yes to any of these then it is time to make some simple changes, the secret to success is to start small. This may include eating smaller meals, but the biggest key to success is to eat mindfully.
Eating mindfully means not eating in front of the television or any other type of screen, or at the desk while you continue to work, but eating in a relaxed environment where you just focus on eating – slowly. I know this is impossible to do all the time, but try and introduce this style of eating most of the time and see what difference it makes to your digestion and reflux.
Addressing the under lying cause of any health problem is always the priority in Functional Medicine, but sometimes supplements are necessary in the short term while you treat the underlying problem.
I think doing a SIBO breath test and a G.I Map Stool Test to identify if you have Helicobacter pylori, or any other digestion imbalances is a good first step in eliminating reflux and improving your health. Once you have done this there are several supplements that can help to increase low stomach acid and help to repair the damage done to the mucous membrane of the esophagus caused by the stomach acid.
Betaine HCL and Pepsin help to replace the low stomach acid. For younger people this maybe a good short term fix while you address the underlying cause, but if you are over 60 years of age it maybe a useful long term supplement to help increase your diminished stomach acid levels.
If your an Australian client the Metagenics Metagest is excellent, this is “prescription only” so contact me for details on how to order.
Deglycyrrhizinated Licorice (DGL) extract is highly effective at treating the damage to the mucosal membrane caused by reflux and ulcers, it also does not have the blood pressure effects that other licorice supplements can have. Other herbs that are beneficial for repairing the mucosal membrane include Marshmellow, Slippery Elm and Aloe Vera.
If you are an Australian client contact me for “prescription only” options in Australia or order from iherb
There is a lot of information to take in from this article so here is the quick summary of the steps you need to take to eliminate reflux
If you need one on one support to help guide you through this process to help you optimize your digestion and health, you can schedule an appointment with Planet Naturopath here
Michael is head consultant at Planet Naturopath - Functional Medicine and Nutrition Solutions.
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