Acid Reflux - is the acid to blame?

Acid Reflux - is the acid to blame? 

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.

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.
• 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 reasons for the discomfort.

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,  Clostridium difficile-associated diarrhoea 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, B12, and vitamin C, consequently contributing to the risk of developing anaemia, cardiovascular disease, dementia or osteoporosis.

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, 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.

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

This has been show to significantly reduce GERD symptoms. 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

These may help by coating the stomach lining and regulating acidity and include:

• Slippery elm mucilage soothes the throat and lining of the stomach and stimulates mucus secretion.
• Gamma oryzanol from rice bran oil normalises stomach secretions has potent antioxidant activity and has an anti-ulcer properties.
• Marshmallow soothes irritated mucous membranes and has been used as a remedy for ulcers. (you can get Slippery Elm, Gamma Oryzanol and marshmallow all in one capsule here.
• Deglycyrrhizinated licorice increases production of protective mucus[xxv] and exhibits activity against H. pylori.
• Aloe vera has a long tradition of use for its wound healing and anti-inflammatory properties.
• Strengthen connective tissue with glucosamine, chondroitin, MSM and vitamin C.
• Support bacterial balance with probiotics and antimicrobial herbs such as garlic or cinnamon, 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.