What Is Known About GERD
Healthy Steps: GERD—First Steps
Healthy Steps: GERD—Full Program
From Dr. Deborah's Desk
Reflux can be a totally silent illness, with symptoms so mild or confusing that you barely think about it. Perhaps you have just a nagging cough, a hoarse voice, or an occasional sharp pain in your chest after eating. It all passes, so you don’t worry about it.
Or, you can be truly miserable. Pain sitting behind the chest bone, or in the upper abdomen, can be stabbing, burning and relentless. The pain can radiate up to the neck or throat, and if it’s bad enough to take your breath away, you’ll be on your way to the hospital to have your heart checked out.
At its worst, the liquid refluxed is highly corrosive and causes permanent damage to the lower esophagus, creating pre-cancerous cellular changes called Barrett’s esophagus. Usually this only occurs (and is identified) when the reflux is very symptomatic.
GERD stands for gastro-esophageal reflux disease, perfectly describing just what is happening. The contents of the stomach, which are normally acidic, spill upwards into the esophagus that lacks the protective lining present and protective in the stomach. Stomach acid flowing into the esophagus causes a variety of symptoms as described above, usually depending on the degree of acidity of the liquid that is refluxed upward. Sometimes the reflux travels all the way up to the throat and larynx, causing a sore throat or hoarse voice. When the reflux contents are actually low in acid, the person experiences less acute pain, but perhaps more voice or throat symptoms.
Reflux is a common complaint, affecting more than 10 percent of US adults on a daily basis, and up to a third of us at some time. Drugs designed to treat the problem are among the top-selling prescription meds, and commercials on television abound for both prescription and over-the-counter medications.
Treatment of reflux is based on the cause of the reflux, but just what causes reflux brings up a point of wide disagreement in the world of medicine. Reflux occurs because the valve at the bottom of the esophagus fails in its sphincter duties, but why?
- In the conventional medical model, the culprit is increased stomach acid and the therapeutic goal includes reducing the acid content so that when and if it refluxes, the refluxed material won’t be as corrosive or irritating. Various categories of acid-blocking drugs block acid to different degrees, but are widely consumed in both prescriptive and over the counter forms.
- Integrative physicians wonder why stomach contents aren’t traveling “downward” as they are supposed to do, and presume that some deficit of usual digestive health is keeping the stomach full, increasing upward pressure and causing the valve to fail. Therapy is aimed at strengthening every aspect of digestion.
Conventional treatment intentionally interrupts one of the central aspects of digestion and not surprisingly carries some serious complications, based on the normal benefits of physiological stomach acid. Without adequate acid, there is reduced absorption of key nutrients including calcium, magnesium, vitamin B12 and others. Calcium deficiencies can lead to osteoporosis and increased fractures. Insufficient acid can also lead to an intestinal bacterial imbalance, manifest as symptoms consistent with irritable bowel syndrome or severe life-threatening infections . Other observed side effects include atrophic gastritis and gastric cancer, increase in gut permeability and food allergies, and possibly increased polyps of the stomach and colon.
People taking such drugs have also been noted to be of increased risk of pneumonia, weight gain, and other risky side effects. The medications have not reduced the rate of esophageal cancer rather they have increased 350% since 1970. Reducing the acid takes away the burn but not the harmful reflux itself.
Conventional and integrative practitioners alike recognize that obesity, a sedentary lifestyle (slows peristalsis), and certain “foods” (fried foods, alcohol, caffeine and carbonated beverages) can trigger reflux in many. Individuals vary, but many are also sensitive to spicy, tomato, or citrus foods. Big meals should not be eaten at bedtime, and it may help to slightly (up to 4 inches) elevate the head of the bed over the foot. Abdominal bloating contributes to pressure on the stomach contents, so excess fiber, excess water, and inadequate salt (needed for stomach acid production) might all be implicated in GERD.
Integrative treatment focuses on physiology, departing from the conventional approach that seems to have missed the G.I. Physiology class in Medical School. Our digestive tracts function smoothly with complex physiology that benefits from being optimized, not suppressed. When function is not normal, it is worth asking the question, “How could normal function be best restored?” Nothing is disabled; efficacy is enhanced.
Following this line of analysis, it appears that many individuals with GERD actually suffer from reduced stomach acid. It has been observed that very low carbohydrate diets reduce GERD symptoms and the converse is inferred: increased carbohydrates can cause bacterial overgrowth, or dysbiosis, which leads to reduced stomach acid. In fact, any poorly tolerated food, whether improperly prepared or individually allergenic, can increase dis-order and bloating in the GI tract. With proper attention to optimal function and digestive requirements, it is possible to relieve symptoms of GERD in most cases without resorting to physiology-thwarting acid suppressive drugs.
The link between stress and reflux is also crucial: we have two physiological nervous systems; one prepares us for fight-or-flight (the sympathetic or SNS) and the other for rest-and-digest (the parasympathetic, PNS). When the SNS prevails, particularly for persistent periods of time, all the hormonal signals that support healthy digestion as part of the PNS are overwhelmed and food can sit like a rock in our stomachs, and sooner or later be refluxed up into the esophagus. Interestingly, the sales of drugs used to treat reflux correlate well with unemployment rates.
Research gastroenterologists have also pioneered some interesting natural treatments, but they are not in widespread use. Melatonin is the most promising agent.
Healthy Steps: GERD—First Steps
In an urgent situation, there are a few steps you can take to alleviate the symptoms of reflux:
- Go for a walk to stimulate peristalsis. Applying a hot water bottle to your upper abdomen may be necessary to reduce cramping to allow you to walk.
- Drink lots of liquids: milk was the old remedy (better in the “old days” when it was raw), but water will work very well to dilute the offending liquid.
- Promote peristalsis with magnesium. Thorne Research Magnesium Citrate, taken 2 capsules every 2 hours, can promote motility.
- Soothe irritated lining with Metabolic Maintenance L-Glutamine, 500 mg capsules, 2 every 4 hours.
Healthy Steps: GERD—Full Program
Time to address a whole host of factors if you want to reverse a chronic problem with GERD. Let’s start with food:
Savor these foods:
- Bone Broth Soup. Take 2-3 cups daily of homemade bone broth soup to soothe the irritated intestinal walls and provide necessary minerals. For someone with a severe GERD problem, a full week of bone broth soup, simmered with some meat and vegetables, can be very healing.
- Fermented foods. Sauerkraut and fermented dairy both provide probiotics to help restore normal gut flora.
- Concentrate on healthy sources of protein and fat as described in The Ideal Diet, to provide nourishment without adding to possible dysbiosis. It is important to eat a nutrient-dense diet from protein and fat sources, keeping carbohydrates from fruits and vegetables to a minimum until normal digestion is restored.
- Salt your food to taste!
Avoid Problematic Foods:
- Excess and/or fermentable carbohydrates. It’s hard to know what is “excess”, but until symptoms are controlled, it’s wise to avoid all grains, root vegetables, and fruits, other than berries.
- Fiber supplementation is rarely a good idea, if ever, and can cause a marked increase in bloating. Even pre-biotics, usually recommended with probiotics, should be avoided at first if there is much bloating.
- Avoid all fried foods (always avoiding vegetable and industrial seed oils, whether or not you have GERD!), large meals, caffeinated and carbonated beverages. If tomato, spicy, and citrus is an irritant for you, avoid them.
- FODMAPS is an acronym that covers many of the commonly offending foods in IBS. The list of foods is long and includes fructans (wheat, onions, leeks, asparagus, chocolate and artichokes are examples of fructans), galactans (legumes), polyols (apples, pears, nectarines, avocados, cauliflower, mushrooms and artificial sweeteners), lactose (dairy), and high fructose sources. Do a two-week trial avoidance of these foods to see if it helps.
Supplements can help:
- I like to start with clearing the farthest downstream obstacle, if one exists, so I recommend starting with probiotic supplementation. Designs for Health Probiotic Synergy Powder is excellent, if there is not much bloating: start with 1/8 tsp daily or less and work up to ½ tsp once or twice a day. If much bloating is present, start with a simple mixture such as Integrative Therapeutics Probiotic Pearls. Probiotics are particularly important for folks who have taken frequent courses of antibioticsAfter colon health is restored, I like to address the small intestine’s digestive function by adding digestive enzymes such as Pure Encapsulations Digestive Enzymes Ultra, 1-2 taken at the beginning of each meal.
- If GERD symptoms persist I like to encourage optimal stomach acid function, first with Gaia Herbs Sweetish Bitters, 5-10 drops in an ounce of water before meals. If symptoms persist, I recommend actually replacing stomach acid, using Thorne Research Betaine HCl with Pepsin, taking 1 capsule before each meal and increasing every 2 days until the slightest sensation of warmth occurs in the stomach, and going back to the previous dose.
- How long does one need supplements? Probiotics are a good life-time habit; digestive enzymes are often helpful long-term, particularly if one is over 50 years old; and stomach acid boosting should only be necessary short-term (1-2 months.)
- Optimizing peristalsis is important. Two supplements that can be helpful are magnesium (almost everyone is deficient), and Hops Tincture. Thorne Research Magnesium Citrate, taken 2 capsules every 2 hours, can promote motility; Herb Pharm Hops Tincture can also help promote healthy peristalsis. It is quite bitter! Take 5-30 drops in 1 ounce of water before meals.
- Green Pastures Blue Ice Infused Coconut Oil provides fat-soluble vitamins needed for healing. Start with ¼ tsp before a large meal and gradually increase until you are taking 1-1/2 tsp daily.
- Replace possibly missing B-vitamins with Innate Response Formulas, B Complex, taking 1-3 tablets daily with meals.
- Melatonin is showing promising results in early research. Take 5 mg of melatonin (Thorne Research Melaton-5) every night at bedtime, and expect improvement over 3-6 weeks. In some studies, symptom relief has come for melatonin subjects before those taking prescription medications, without any other changes.
Daily Life Activities
- Nourish the rest-and-digest system and make its work easier: slow down before and during mealtime, taking care to chew each bite thoroughly. Thorough chewing not only breaks down the food, it also helpfully slows the pace of the meal, and encourages digestive enzyme production.
- Avoid eating in the 2-3 hours before bed.
- Walk for 15 minutes during the first hour or two after eating.
- At least once a week do some strenuous exercise.
If you ever have an episode of GERD and don’t want another one, you are well motivated to consider prevention! You will avoid another occurrence if you can do the following:
- Keep a normal weight, particularly reducing excess abdominal fat.
- Pay attention to every aspect of your digestion. Remember the “rest-and-digest” (parasympathetic) nervous system and help it work at its best.
- Keep mealtime relaxed and chew your food well. Keep excess liquids to a minimum and avoid carbonated beverages during meals.
- Notice if your digestion seems slow or weak, and supplement with (in order) probiotics, digestive enzymes or extra stomach acid if any part of your normal digestion is sluggish.
- Choose foods that nourish, from deeply healing bone broth or soups made with bone broth, to high quality nutrients. Protein and fats in particular should be organic and carefully prepared.
- How is your overall stress level? What can you do to reduce it if it’s too high?
One of my regular patients, Barbara, finally convinced her husband, Jared, to come in for a consultation. He was having trouble balancing his sinus and asthma medications, his hypertensive drugs and his reflux treatment. And how to get out of the antibiotic cycle? When to take what? And which drugs were aggravating which problem? “And, while we’re complaining, how on earth to get rid of this big belly I’ve developed from sitting at my desk working all the time?”
Jared was highly motivated so we took the time to go over every aspect of his life and problems. I recommended he follow the advice above, take a look at the low-carbohydrate eating plan (Weight Loss Eating Plan), and add in some supplements (Fermented Cod Liver Oil, vitamin D) and some pro-active interventions, such as gentle sinus lavage.
At his next visit, we discussed getting up and away from the desk, introducing some interval exercise and just some nice walks around their lovely rural property. His wife was happy to go along with the new eating plan, and it was making good changes in her life as well.
A year later, he’s off all the medications and down 40 pounds, his wife says he’s more of a joy to live with! But perhaps he became too ambitious: he contacted me recently when he took down a giant felled tree on his property and wanted some support for a hernia operation that was the unwelcome result of working perhaps a little too hard.
This information is provided for educational purposes only, and any individual diagnosis or treatment should be determined by you and your doctor. See Additional Information.