Gastroesophageal Reflux Disease (GERD)
What Is It?
Gastroesophageal reflux disease (GERD) is a condition known by a variety of names, often referred to as acid reflux, chronic heartburn or acid indigestion. These terms are frequently used in advertisements to get you to buy the latest pill or tablet guaranteed to ease your pain. But if you are experiencing discomfort on a regular basis, the recurring sensation of heartburn is likely the symptom of a larger problem.
GERD is a digestive disorder in which partially digested food from the stomach, along with hydrochloric acid (HCl) and enzymes, backs up into the esophagus. This process is known as reflux.
HCl has a low pH, meaning that it is very acidic. Even if present in low amounts, HCl can cause damage when it comes into contact with the delicate lining of the esophagus. This mucous lining, or mucosa, of the esophagus, unlike the lining of the stomach, is not designed to withstand the caustic effects of acid and stomach contents.
Definitions of some conditions that involve reflux are listed below. Some of these terms are used interchangeably.
• Heartburn – painful burning sensation in the esophagus usually associated with regurgitation of stomach contents
• Acid indigestion – another name for heartburn
• GERD – chronic heartburn, usually defined as two or more times per week
• Reflux esophagitis – inflammation of the lining of the esophagus that has been caused by the backflow of stomach acid or contents into the esophagus
What Causes It?
• Eating too rapidly
• Inadequate chewing
• Swallowing large amounts of air when eating
• Lying down after eating
• Intra-abdominal pressure
• Tight-fitting clothing that constricts the abdomen
• Stress (and eating when upset)
• Alcoholic beverages
• Chocolate, peppermint
• Spicy foods, including yellow onions and garlic
• Tomato-based foods and citrus, black pepper and vinegar
• Fatty foods and fried foods
• Insufficient water intake causing dehydration
• Coffee, tea and other caffeine-containing beverages
• Carbonated beverages
• Drugs that irritate the GI lining – non-steroidal anti-inflammatory drugs (NSAIDs), the antibiotic tetracycline, the antiarrhythmic drug quinidine, potassium chloride tablets and iron salts
• Pregnancy/birth control pills/estrogen replacement therapy
When food is eaten too quickly, the stomach becomes distended, and the food is pushed against the top of the stomach.
Swallowing air while eating—common when eating quickly or in an anxious state.
Smoking inhibits production of saliva, and certain antibodies in saliva protect against damage to the esophageal lining.
NSAIDs (like aspirin, ibuprofen and naproxen), bronchodilating drugs used to treat asthma (like theophylline, albuterol, ephedrine), some blood pressure medications (calcium channel blockers, beta blockers), diazepam and nitroglycerine relax all muscles in the body, including the esophagus and contribute to different forms of heartburn.
Because estrogens can contribute to GERD, women who are pregnant, taking birth control pills or estrogen replacement therapy are more likely to suffer from heartburn than those who are not. More than 25 percent of pregnant women experience daily heartburn, and more than 50 percent have occasional distress.
Other factors that can contribute to GERD are:
• Food allergies and sensitivities, especially to wheat and dairy
• Gallbladder problems
• Enzyme deficiencies
It has been commonly accepted by the medical profession that heartburn and GERD are caused, solely, by excess stomach acid (hyperchlorhydria). Virtually all drugs used to treat GERD neutralize, reduce, suppress or inhibit HCl production.
This is very interesting in view of the fact that the 11th edition of the “Merck Manual,” published in 1966, states quite clearly that “[heartburn] is not due, as formerly believed, to excessive gastric acidity per se, as the same symptom often occurs in achlorhydria [absence of stomach acid].” The bottom line is that heartburn and GERD are more often caused by deficiency or lack of HCl than by too much of it. Interestingly, both hypochlorhydria and hyperchlorhydria produce the same symptoms—a heartburn-like sensation that is sometimes accompanied by bloating and stomach pain.
Hypochlorhydria, or low HCl production, is more common than most people realize. With age, the production of stomach acid decreases. It has been estimated that between 30 and 50 percent of people over 60 do not produce enough stomach acid. To support healthy digestion, the stomach needs enough HCl to begin the breakdown of protein and activate pepsin, a protein-digesting enzyme found in the stomach.
Although it is difficult to comprehend taking acid to relieve heartburn, additional HCl helps the stomach to properly digest food, which ultimately helps to prevent putrefaction (the decomposition of animal proteins), a cause of gas production, reflux and heartburn.
So what causes low HCl production? Low HCl production can result from a deficiency of vitamin A and B complex, as well as from a low intake of protein. Chronic stress and zinc deficiency are other factors that may result in suppression of stomach acid. Low-salt diets may also contribute to HCl deficiency, as sodium and chloride are needed for HCl production.
HCl deficiency has some far-reaching consequences as far as overall health is concerned. HCl deficiency causes electrolyte deficiency, which in turn inhibits enzyme production. The net result is poor metabolism of nutrients, disruption of homeostasis and development of degenerative disease conditions.
The most important step for people with GERD is to determine whether they have hypochlorhydria, or hyperchlorhydria. From there, the treatments are very different. In fact, more health problems are created if treated improperly.
While chronic heartburn can strike anyone at any age, it is more common in older people than in younger people. It is interesting that low HCl production also occurs more often in older people, suggesting a connection between low HCl and chronic heartburn.
What Are the Signs and Symptoms?
Along with reflux usually comes heartburn (in 70 to 85 percent of cases). Other signs and symptoms of GERD may include:
• Angina-like chest pain
• Dsyphagia (difficulty swallowing)
• Bronchial spasms with asthma
• Laryngitis (voice problems or hoarseness)
• Shortness of breath
• A sense of fullness after eating (especially in conjunction with a chronic cough)
• Abdominal distention after eating
• Chronic sore throat
• Vomiting of blood (which may lead to anemia)
In addition, some people experience silent GERD, which does not produce the characteristic heartburn pain, but instead is associated with symptoms such as:
• Chronic cough, worse at night
• Inflammation of the gums
• Erosion of tooth enamel
• Bad breath
• Chronic throat irritation
• Hoarseness in the morning
Not all people with GERD will experience all of these signs and symptoms. All GERD patients have reflux, but not all have burning, bloating and/or nausea.
Bloating and gas, when present, can be the result of swallowing air, undigested food being acted upon by bacteria, overeating or by delayed gastric emptying. The stomach expands from gas, which travels up toward the esophagus, pushing HCl with it.
The resulting heartburn is caused, not by too much HCl, but by stomach contents, including undigested food, pathogens and even very low amounts of stomach acid that is in the wrong place—in the esophagus instead of in the stomach.
It is important to note that many of the symptoms of GERD may be indicators of other problems. For this reason, and because GERD can lead to the more serious Barrett’s esophagus, or, for a small percentage of people, even cancer, physicians will often perform tests to establish a definitive diagnosis.
Brenda's Better Way
The condition of GERD causes distress to many people. Unfortunately, it can be a bit complicated because our traditional doctors do not take the necessary steps to find out why a person has GERD in the first place.
Hydrochloric acid is one of nature’s most essential antibiotics. Imagine a scenario where a patient with virtually no stomach acid production eats a salad and is incapable of destroying the bacteria present on all the raw vegetables.
Acid-blocking medication was originally developed for short-term treatment of gut irritation. If this were the only case in which people were given these drugs, it may not have escalated to the point it is today. If you go to a GI doctor with a symptom of heartburn, gas, bloating or even irritable bowel syndrome (IBS), they hand out these acid-blocking medications like they were candy with no testing to determine whether stomach acid is even the main problem!
People are kept on acid-blocking medication for years, which sets the stage for the development of serious health conditions down the road. Recent studies clearly show that these medications are over prescribed more than 53 percent of the time.
While acid-suppressing drugs may offer temporary relief of the symptoms of heartburn, they create many major problems. By alkalizing the lower stomach (the antrum), the hormone gastrin is released causing a huge rebound output of acid. This rebound requires more acid-supressors to neutralize the increased acid output in response to the gastrin.
Also important to note, acid-supressors create conditions conducive to yeast and fungus growth. They can also mask symptoms of an ulcer, or even cancer of the stomach or esophagus.
Eventually the parietal cell mass that manufactures stomach acid ceases to function normally, resulting in low stomach acid (hypochlorhydria), or worse, no stomach acid (achlorhydria), which elevates the risk of stomach cancer. While there is no outright proof that use of acid-suppressing drugs causes cancer, it is predicted that at least some of these drugs will be found to increase cancer risk, particularly when taken for a long time.
In cases where the patient is persistent about finding the underlying cause, the doctor will test for H. pylori infection. If found, antibiotics are given to treat the bacteria and acid-blocking medication to heal stomach irritation or ulcers. Other than recommending basic dietary and lifestyle changes, in traditional medicine the search for the underlying cause is over. The doctor does not heal the gut afterwards with nutrients like L-glutamine, NAG (N-Acetyl-D-glucosamine) and gamma oryzanol, nor does he know to replace the good bacteria that were destroyed by the powerful antibiotic.
We have watched the pharmaceutical industry wreak havoc on our bodies with the over-prescription of antibiotics. And now we can see another travesty unfold long-term use of acid-blocking medications putting the health of millions of individuals in jeopardy. Instead of pulling out the prescription pad and writing another prescription, the doctor should be looking for the underlying causes. The Heidelberg pH test should be in every GI doctor’s office, and this nonsense could stop.
If you have GERD and are on acid-blocking medication long term, go to your doctor and tell him you are aware of the dangers and want to be taken off the medication. You can be carefully weaned off these drugs. Then follow the protocol that follows.
In my experience, people who have these kinds of digestive problems have an underlying digestive issue in addition to stomach acid levels. If you have been on acid blockers long term, the chances that you have Candida overgrowth and other imbalances throughout the gut are highly probable.
• Stool test for Candida or parasites
• HCl (hydrochloric acid) test - Heidelburg test
• Food sensitivity test if suspected
• Follow the Skinny Gut Diet Eating Plan
• If you suspect Candida overgrowth is an issue, the Get Lean Phase of the Skinny Gut Diet Eating Plan will help you get your carbohydrate intake under control.
• Some research suggests that a gluten-free diet can be useful in reducing GERD symptoms.
• Chew foods well, to mush or liquid, before swallowing.
• Sleep on your left side to avoid heartburn and reflux.
• Do not lie down for at least three to four hours after eating.
• Elevate the head of the bed four to eight inches when sleeping.
• Make sure you have good bowel elimination daily.
Complementary Mind/Body Therapies
• Stress-reduction therapies such as yoga, biofeedback, massage, and meditation will be helpful.
• Acupuncture may be helpful as it targets the meridians associated with the digestive system.
• Chiropractic may be beneficial.
• Colon hydrotherapy should be considered.