Understanding GERD and Acid Reflux: Getting to the Root Cause
Gastroesophageal reflux disease (GERD) and acid reflux are common digestive disorders that can significantly impact an individual's quality of life. This happens when stomach acid repeatedly flows back into your esophagus which is the tube connecting your mouth and stomach. This back flow, also known as acid reflux, can irritate the lining of your esophagus. The stomach is designed for a high acidity environment. It has a thick mucus lining to protect it and bicarbonate to neutralize the acid. The esophagus does not have these protective features, so when acid splashes back up it can damage the cells lining this important tube in our digestive tract. Symptoms of GERD include a burning sensation in your chest (heartburn) usually after eating which might be worse at night or while lying down, backwash (regurgitation) of food or sour liquid, upper abdominal or chest pain, trouble swallowing (dysphagia), and a sensation of a lump in your throat. While conventional treatment options are available, exploring functional medicine approaches can provide holistic and sustainable solutions. In this blog, we will delve into the pathophysiology of GERD, its risk factors and causes, and the role of stomach acid.
Natural treatment tips: In our second blog post on GERD, you’ll learn about at home assessments like the baking soda test and apple cider vinegar challenge, dietary and lifestyle recommendations, and natural supplements to manage GERD.
Pathophysiology, Risk Factors, and Causes of GERD:
GERD occurs when stomach acid frequently flows back into the esophagus, leading to irritation and inflammation of its lining. This can result from a weakened lower esophageal sphincter (LES), the ring of muscle responsible for preventing stomach contents from flowing into the esophagus.
GERD is a complex condition that often arises from a combination of factors involving the lower esophageal sphincter (LES), the diaphragm, and the overall digestive process. While the exact cause can vary from person to person, the following are some common contributors to the development of GERD:
Weak Lower Esophageal Sphincter (LES): The LES is a ring of muscle that separates the stomach from the esophagus. It's supposed to close tightly after food passes into the stomach. If the LES is weakened or relaxed, stomach acid can flow back into the esophagus, leading to reflux.
Hiatal Hernia: A hiatal hernia occurs when a part of the stomach pushes up through the diaphragm into the chest cavity. This can weaken the LES and increase the risk of reflux.
Dietary Factors: Certain foods and beverages can trigger or worsen GERD symptoms by relaxing the LES or increasing stomach acid production. Examples include spicy foods, fatty foods, citrus fruits, tomatoes, chocolate, caffeine, and alcohol.
Obesity: Excess weight, especially around the abdomen, can increase pressure on the stomach and push stomach contents up into the esophagus.
Pregnancy: Hormonal changes and increased abdominal pressure during pregnancy can lead to relaxation of the LES and contribute to reflux symptoms.
Smoking: Smoking weakens the LES and can reduce saliva production, which normally helps neutralize acid.
Certain Medications: Some medications can relax the LES or irritate the esophagus, including NSAIDs such as Advil/Ibuprofen, aspirin, certain muscle relaxers, and blood pressure medications.
Delayed Stomach Emptying: Conditions that delay the emptying of the stomach, such as gastroparesis, can increase the risk of reflux as the stomach contents linger and can more easily flow back into the esophagus. Medications that slow gastric emptying can also make GERD more likely.
Connective Tissue Disorders: Although a rarer cause of GERD, certain connective tissue disorders, like scleroderma, can affect the functioning of the LES and contribute to reflux.
Genetics: Family history may play a role in the development of GERD, suggesting a genetic predisposition.
Lifestyle Factors: Eating large meals, lying down immediately after eating, and tight clothing around the abdomen can contribute to reflux symptoms.
Age: GERD is more common in older adults, as the LES may naturally weaken over time.
It's important to note that while these factors can increase the likelihood of developing GERD, individual experiences can vary. Some people may experience symptoms despite having only one or a few of these contributing factors, while others may have multiple factors at play. It's often a combination of these factors that leads to the development of GERD in any given individual. If you're experiencing symptoms of GERD, it's advisable to consult a healthcare professional for accurate diagnosis and appropriate management.
Low vs. High Stomach Acid and GERD
Contrary to common belief, both low and high stomach acid can contribute to GERD. The conventional medical system always treats GERD as an excess of stomach acid (hyperchlorhydria), rarely exploring the possibility of low stomach acid (hypochlorhydria) being the cause. Low stomach acid impairs digestion, causing food to linger in the stomach and potentially push acid into the esophagus. On the other hand, excessive stomach acid production can overwhelm the LES, leading to reflux. Therefore, personalized assessment is crucial!
Let's explore how each scenario contributes to GERD:
1. GERD and High Stomach Acid:
In some individuals, excessive stomach acid production can lead to GERD. When there's an abundance of stomach acid, it can overpower the lower esophageal sphincter (LES), the muscular ring that separates the stomach from the esophagus. The LES is meant to prevent stomach contents from flowing back into the esophagus. However, when there's too much acid, it can contribute to the weakening of the LES, allowing acid and stomach contents to reflux into the esophagus.
2. GERD and Low Stomach Acid:
Conversely, low stomach acid can also contribute to GERD. Stomach acid plays a crucial role in the digestive process by breaking down food and killing pathogens. When stomach acid is insufficient, the stomach might not adequately break down food, causing it to remain in the stomach longer than it should. This can lead to increased pressure in the stomach, which in turn can force stomach contents—including stomach acid—up into the esophagus. Moreover, low stomach acid can affect the proper closure of the LES. Inadequate acid can lead to the LES not receiving the necessary signal to close tightly after food enters the stomach. As a result, acid can flow back into the esophagus.
In a functional medicine perspective, it's important to consider individual variations in stomach acid levels. A personalized assessment can determine whether a person's GERD symptoms are more likely due to high or low stomach acid.
Conventional Treatment of GERD (and why we need natural approaches!)
Before we dive into the natural and root cause treatments for GERD, let’s review the standard treatments for GERD. Lifestyle Modifications are the first-line approaches for managing GERD. They include:
Dietary Changes: Avoiding trigger foods (spicy, fatty, acidic), eating smaller meals, and avoiding lying down after eating. More on nutritional approaches later!
Weight Management: Losing excess weight can reduce pressure on the stomach and improve symptoms.
Elevating the Head: Raising the head of the bed or using pillows can help prevent nighttime reflux.
Smoking Cessation: Quitting smoking can improve LES function and reduce reflux.
Medical treatments include:
Antacids: Over-the-counter antacids like Tums, Rolaids, and Maalox can provide temporary relief by neutralizing stomach acid. They are best used for mild and occasional symptoms.
H2 Blockers: Histamine-2 receptor blockers (H2 blockers) like ranitidine (Zantac) and famotidine (Pepcid) reduce acid production in the stomach. They are available both over the counter and by prescription.
Proton Pump Inhibitors (PPIs): PPIs like omeprazole (Prilosec), esomeprazole (Nexium), and pantoprazole (Protonix) are potent acid-suppressing medications. They block the proton pump in the stomach lining, reducing acid production. PPIs are often prescribed for severe or chronic GERD.
Surgery: In cases where lifestyle changes and medications fail to provide relief, surgical options like fundoplication may be considered. Fundoplication involves wrapping the top of the stomach around the lower esophagus to strengthen the LES.
Risks of Proton Pump Inhibitors
The most common conventional approach to treatment of GERD is the use of PPIs. Although they sound like a simple solution for reducing stomach acid, there are potential dangers and side effects of long-term PPI use. Unfortunately, many people are also unaware that PPIs are designed for short-term use (i.e., 14 days, not years that people are often on them for).
Rebound Acid Hypersecretion: Prolonged use of PPIs can lead to increased acid production once the medication is stopped, resulting in worsening symptoms. PPIs can create dependency and can give you heartburn once you come off them, even if you didn’t have it before!
Nutrient Absorption: PPIs can hinder the absorption of certain nutrients like calcium, magnesium, iron, and vitamin B12, potentially leading to deficiencies over time.
Gastrointestinal Infections: Reduced stomach acid can increase susceptibility to certain infections, including bacterial overgrowth and Clostridium difficile infections. Acid in the stomach is a natural infection fighting tactic. Without enough acid to kill off microbes coming in from what we eat, bacterial overgrowth is more likely.
Bone Health: Prolonged PPI use has been associated with an increased risk of bone fractures, possibly due to reduced calcium absorption.
Kidney Disease: Some studies have suggested a potential link between long-term PPI use and kidney disease.
Gastric Cancer: While the risk is relatively low, some research has suggested a potential association between chronic PPI use and an increased risk of gastric cancer.
Reflux-Related Disorders: Ironically, long-term PPI use can lead to reflux-related disorders like Barrett's esophagus, a condition where the esophagus lining changes, increasing the risk of esophageal cancer.
What to do about GERD
Proton pump inhibitors (PPIs) are powerful medications that can effectively manage GERD symptoms, especially when other treatments have proven insufficient. However, it's important to be aware of the potential dangers and side effects associated with their long-term use. Whenever considering or using PPIs, it's recommended to consult a healthcare professional who can provide guidance based on individual health needs and the risk-benefit assessment. Lifestyle modifications and less aggressive treatment options should also be explored, aiming for a balanced approach that considers both symptom relief and long-term well-being. Stay tuned for part two of our GERD blog to learn all about simple assessment tricks, botanical and supplements supports, nutritional therapies, and lifestyle modifications for managing GERD.
*This is not medical advice and is only intended for educational purposes only. Please always consult your medical doctor, naturopathic doctor, chiropractor, or preferred health care practitioner prior to beginning any treatment*
References
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