In this two part series, I will discuss our holistic approach to addressing the root causes of GERD/acid reflux which are missed by the current medical care model.
Occurrence of GERD/Acid Reflux
2 in 5 Americans experience acid reflux symptoms and the proton pump inhibitor (PPI), Nexium, is the 4th most commonly prescribed acid reflux drug with 15.9 million people taking it. Mind you, this doesn't include those taking over-the-counter antacids on a regular basis which is millions of more people!
Studies suggest that up to 70 percent of PPI use may not be necessary (😳). Further, Nexium should only be given for 4 to 8 weeks only, but most people are on it for months or even years, which can lead to a whole host of other GI related problems and nutrient deficiencies down the road.
Common Causes + Risk Factors of GERD/Acid Reflux
Talk to a medical professional or search the internet and you will find that the common causes are laid out as such:
Bulging of the top of the stomach up into the diaphragm (hiatal hernia)
Connective tissue disorders, such as scleroderma
Delayed stomach emptying
Factors that can aggravate acid reflux include:
Eating large meals or eating late at night
Eating certain foods (triggers) such as fatty or fried foods
Drinking certain beverages, such as alcohol or coffee
Taking certain medications, such as aspirin
However, at Thrive Nutrition we work with clients who have addressed these causes and still experience GERD/acid reflux. What is conventional treatment missing?
Some Hidden Causes of GERD/Acid Reflux
Low Stomach Acid
Yes, you read that right. If you ask the average Joe on the street what causes heartburn, he’ll tell you “too much stomach acid.” That’s what most of the ads seem to suggest too. But there’s a big problem with this theory: the incidence of heartburn and GERD increases with age, while stomach acid levels generally decline with age. Numerous studies have shown this and in one study researchers found that over 30 percent of men and women past the age of 60 suffer from atrophic gastritis, a condition marked by little to no acid secretion. Another study found that 40% of women over the age of 80 produce no stomach acid at all.
Just as studies show acid secretion declines with age, it is also well established in the scientific literature that the risk of GERD increases with age. If heartburn were caused by too much stomach acid, we’d have a bunch of teenagers popping Rolaids instead of elderly folks. But of course that’s the opposite of what we see. In fact, according to Jonathan Wright, MD of the Tahoma Clinic in Washington state, when stomach acid is measured in people suffering from heartburn and GERD it is almost always low, not high.
Antacids and PPIs provide relief because they neutralize your stomach acid. Too often western medicine focuses on suppressing symptoms without paying attention to what is causing the symptom in the first place. The misguidedness of this approach is clearly demonstrated by the use of acid inhibiting drugs to treat heartburn and GERD – problems which are caused by not enough stomach acid!
What We Do: We help clients determine if they have low stomach acid levels with a simple at home baking soda test and follow up dietary and supplemental support as necessary such as betaine HCL, fermented foods, digestive bitters and/or apple cider vinegar.
Though digestion requires plentiful amounts water, our body needs water for numerous other bodily processes which makes it even more important to stay hydrated. Your body uses water in all its cells and in between cells, it hydrates your nose, throat and lungs, cushions joints, contributes to spinal fluid, is used to help regulate temperature and helps eliminate waste through urination, breathing (exhaling), bulking stool and sweating.
The stomach relies on mucus lining the walls to shield it from the effects of the stomach's hydrochloric acid. A bicarbonate solution is produced from the cells in the lining which neutralizes any acid attempting to break through the mucus. Water is needed to maintain this effective defense system. Too little water, and the mucus barrier is ineffectual, the acid will penetrate and will lead to pain. Ideally, water should be consumed half an hour before a meal, in time to anticipate the production of digestive acid from glands in the stomach wall.
What We Do: We assist clients with setting goals to increase their water intake to half of their body weight in ounces over time. Goals include having clients purchase insulated stainless steel water bottles, drinking 8-16 ounces upon waking by keeping water by the bed, drinking a glass while lunch is being microwaved, etc. A good way to tell if you're well hydrated is that you can eat a meal without an strong urge to drink something. However, it is important to note that our body is extremely adaptable so you may not be thirsty, even if you are dehydrated. Urine color is an objective way to see your hydration status. Very faint yellow or clear is what you're aiming for.
Carbohydrate Malabsorption/Gut Overgrowths
It is well accepted in the literature that GERD is caused by an increase in intra-abdominal pressure (IAP). Acid reflux occurs when pressure causes gastric distention (stomach bloating) that pushes the stomach contents, including acid, through the LES into the esophagus. According to current thought, factors contributing to this include overeating, obesity, bending over after eating, lying down after eating, and consuming spicy or fatty foods. In his excellent book, Heartburn Cured, microbiologist Dr. Norm Robillard argues that carbohydrate malabsorption leads to bacterial overgrowth, resulting in IAP (gas) which drives reflux. Low stomach acid can contribute to both bacterial overgrowth (independently of carbohydrate intake) and carbohydrate malabsorption.
At a pH of 3 or less (the normal pH of the stomach), most bacteria can’t survive for more than 15 minutes. But when stomach acid is insufficient and the pH of the stomach rises above 5, bacteria and other microorganisms begin to thrive. Pathogens in food can easily survive in a stomach treated with PPIs and antacids. At Thrive, at lot of our gut health clients who have been on PPIs tell us IBS symptoms (carbohydrate intolerances, gas, bloating) started after taking them; an indicator of small intestinal bacterial overgrowth.
What We Do: We find bacterial, yeast, parasitic and viral overgrowths with a stool test and we work hard to resolve the overgrowths and restore good gut ecology. We utilize diets like Paleo, low-carb and the Specific Carbohydrate Diet when necessary (2-3 months on average) in addition to herbal antimicrobials and probiotics.