GERD/ Heartburn

Considering millions of Americans suffer daily with gastrointestinal disorders, you may very well be one of them. If so, you are all too familiar with the nagging minutiae that accompanies them: bothersome gas and bloating, maddening constipation or diarrhea (or both), belching, and pain that can sometimes be better described as agony. Some even suffer from diseases such as Celiac, Crohns, and Ulcerative Colitis. But the one disorder that is the most prevalent in the United States is heartburn, otherwise known as GERD. According to the International Foundation for Functional Gastrointestinal Disorders, 44% of Americans have heartburn once a month. Although some may see heartburn symptoms as benign or even comical, heartburn can be a warning sign of serious problems in the body.

Conventional treatment

Proton pump inhibitors, or PPIs, are the first line of defense used by conventional medicine when treating heartburn symptoms. PPIs would be better off labeled PAIs (in my humble opinion), you know, just keeping it as Pump and Inhibitors…a.k.a—Pump out nutrients and  inhibit gastric acid secretion.  PPIs, like Prilosec and Nexium, are the fourth most prescribed drugs in America, as of 2016. That leads to more than $10 billion per year in revenue just from heartburn medication. While these drugs are used commonly, they can lead to dangerous side effects.

One major red flag for PPIs is the fact that those who take them are prone for nutrient deficiencies. Because the stomach acid is decreased, breakdown and absorption of food is hindered. Therefore, vital nutrients like magnesium, calcium, B12, iron, and zinc can be lost. The loss of these nutrients cannot be overstated- deficiencies can lead to depression, fatigue, anemia, immune dysregulation, and even osteoporosis. And that is just the tip of the iceberg. In fact, one study showed that those who took PPIs are at a higher risk of developing osteoporosis, even those who only took for a short period.

That’s not all- another study showed that those on PPIs had a 44% higher risk of developing dementia. That’s huge! That means almost half of EVERYONE who takes them is more likely to develop dementia.

Proton pump inhibitors, while raising the pH in the stomach, lead to increased risk for infections such as clostridium difficile, salmonella, pneumonia, dysentery, and other bacterial overgrowth. One study showed that 50% of those who were on PPIs had SIBO (Small Intestinal Bacterial Overgrowth), while only 6% of the control group did.

As if all of this wasn’t bad enough, another study showed those on PPIs were at an increased risk for heart attacks.

The duration of PPI therapy for heartburn symptoms and other gastrointestinal disorders has been debated, but most guidelines recommend someone be on them for no longer than 1-2 months.

This becomes a problem, as many take these drugs daily for years and years, and now anyone can pick up over-the-counter forms with ease. This is deleterious and dangerous, according to the science. Moreover, PPIs don’t fix the problem. When is the last time you saw someone take PPIs for 1 month and be cured forever?

Digestion

The process of digestion is a harmonious array of hormones, enzymes, food and digestive organs. The symphony has to sing in harmony in order to complete the process of digestion correctly. Any deviation of the digestive process can lead to serious complications. Without proper digestion of food, the body loses vital nutrients, which can show up in such conditions as anemia, depression, autoimmune complications, leaky gut, heart disease and many more.

The digestive process actually starts with our sense of smell. Smelling foods triggers the olfactory centers to stimulate the brain, which will start the digestive juices to start secreting. Once the food is in the mouth, enzymes like amylase start breaking down carbohydrates. It is important here to chew the food thoroughly in order to properly break down the food and take pressure off of the digestive organs. Years of not chewing thoroughly takes its toll on the gut, pancreas, gallbladder, and stomach.

Once food enters the stomach, the chief cells and parietal cells work to stimulate hydrochloric acid and pepsinogen in order to break down the food, especially the protein. Once the food is ready for absorption, the pyloric sphincter will open, allowing the food to enter the duodenum (first part of the small intestine). The small intestine is where the majority of food absorption takes place. In the duodenum, CCK is released, which causes the gallbladder to release bile, and stimulates the pancreas to release enzymes to finish breaking down food.

As you can see, this is a process that takes coordination, energy, and healthy organs to work correctly. Any deviation from normal can cause symptoms such as bloating, gas, fatigue, constipation or diarrhea, brain fog, heartburn, and much more.

The importance of stomach acid

Different parts of the body need different pH levels in order to maintain homeostasis, or order in the body. For example, the pH of blood needs to maintain a narrow range between 7.35 and 7.45. Any deviation from this range can cause serious problems. The digestive organs have varying pH ranges, all in order to perform 2 main duties:

1-fight off infections and bad bacteria, and

2-digest food properly.

Most infections cannot survive an environment of a pH under 3. The pH of a healthy stomach is around 2. This is very acidic, so much so that outside of the body, stomach acid would burn through many objects. But the stomach walls are inherently resilient to the acid, and cells replicate frequently in order to maintain a good border. Healthy amounts of stomach acid act as a first line of defense, and first and most important role in the digestion of food.

Causes

–inflammation

-h Pylori- is a gram negative bacteria that can take root in the stomach. Most can contract the bacteria from undercooked food, or even from other people. H Pylori burrows in the stomach walls, causing inflammation and produces lipopolysaccharide, a highly toxic molecule that stimulates an immune response. H Pylori can shut off stomach acid production and lead to ulcers, in turn leading to GERD or heartburn.

-stress

In times of stress, the body favors certain processes in order to protect itself. When someone is under profound or chronic stress, cortisol raises and stays elevated, which can lead to a chronic state of sympathetic dominance. This is when the’ fight or flight’ part of the nervous system is activated, which favors raising blood pressure and blood sugar, while negating digestion and relaxation. When in sympathetic mode, blood is shunted away from vital organs, the immune system is put on hold, and gastric enzyme production can plummet (why worry about digesting food if the body thinks it is in danger?).

-low stomach acid

When stomach acid is lacking, food is not broken down completely, which then leads to food sitting in the small intestine. The longer food sits in the gut, the higher chance it will rot and ferment. This leads to malabsorption and bacterial overgrowth. When food rots and ferments, gas is produced (a surprisingly high amount!), which can cause those unwanted symptoms of gas and bloating, but it also increases intra-abdominal pressure. This has been hypothesized to be the number 1 cause of heartburn. The highest population of those with GERD is the elderly population, which is interesting because humans lose the ability to produce stomach acid as they age. This goes right in line with the notion of low stomach acid=heartburn.

*One way to see if you have sufficient stomach acid is: take ¼ teaspoon of baking soda in a few ounces of water on an empty stomach after waking. Track how long it takes you to burp. If you burp in under 3 minutes, you most likely have sufficient stomach acid. If it takes longer than 5 minutes, you could have a problem with stomach acid.

-intra-abdominal pressure

One of the main prevailing theories now is that increased intra-abdominal pressure causes heartburn. It does this by causing the lower esophageal sphincter, the gate between your stomach and your esophagus, to open when it shouldn’t. While your stomach lining is protected from gastric acid, your esophagus is not, this leads to the pain and irritation when reflux happens. Things that can cause increased intra-abdominal pressure are: obesity, low stomach acid, and purification of food from bad bacteria.

Naturally treat

The majority of people who suffer with heartburn are actually deficient in stomach acid. One way to stimulate the stomach’s ability to produce gastric acid is to supplement with Hydrochloric Acid and pepsin with meals. (*Caution- I highly recommend working with a trained functional medicine practitioner when using HCL, as it could possibly worsen certain conditions). Another remedy to stimulate stomach acid production is by taking Apple Cider Vinegar with meals. Take 1tsp- 1tbsp right before meals, if this eliminates your digestive problems then you most likely suffer from low stomach acid.

Digestion is a cascade of events, organs, and enzymes that all have to work together in concert in order to properly digest food. When we eat on the go, or are stressed, or are in the wrong position while eating, digestion suffers and can even fail. This leads to problems all over the body, as mentioned above. In order to set yourself up for optimal digestion, don’t eat while stressed- you can do this by taking 5-10 large deep belly breaths prior to eating. This will stimulate the digestive part of your nervous system, setting the stage for enzymes to secrete and break down food. Also- chewing your food takes pressure off of your digestive organs like the stomach, gallbladder, and pancreas. Chew your food at least 20 times before swallowing. Make sure that when you eat you are not hunched over, observe good posture, so as not to put pressure on your stomach.

No water with meals

The stomach needs to operate at around a pH of 2 to work correctly. Drinking water with a pH of anywhere from 6-8 has the ability to dilute stomach acid, making it harder to break down food. Avoid drinking large amount of fluids 15 minutes prior to 1 hour after a meal.

Food allergies

Certain foods like fried foods, chocolate, peppermint, spicy foods, and caffeine are notorious for causing heartburn. Other times, food sensitivities can trigger the same symptoms because they are harder to break down and absorb. Also because they can stimulate an immune response from the body. The common food sensitivities are gluten, dairy, eggs, nightshades (tomatoes, potatoes, eggplant, peppers), soy, and tree nuts. Eliminating these foods for a period of time gives the digestive tract and the immune system a break.

Clear infections

Infections such as H Pylori, SIBO, and other bacterial overgrowth can all cause heartburn symptoms. It is important to find and eradicate these in order to clean the digestive tract so you can absorb food and have a healthy gut! I recommend working with a functional medicine practitioner in a functional medicine institute or a natural health institute to help you test and treat.

Still have heartburn symptoms?

If you have heartburn symptoms, implement the changes listed in this article. If you are still having problems you may have low stomach acid, and I recommend seeing a functional medicine practitioner. If you would like to set up an appointment, call our functional medicine practice in St. Louis at 314-449-1712 .