Acid Reflux & GERD
WHAT IS IT?
Acid reflux, is the regurgitation of acid from the stomach into the esophagus. When acid reflux is recurrent and chronic it is known as GERD (gastroesophageal reflux disease).
WHAT ARE THE SYMPTOMS?
- Heartburn
- Abdominal discomfort
- Chest pain
- Bloating or belching
- Indigestion
- Regurgitation
- Bitter taste in the mouth
- Hoarse voice
- Constantly clearing throat
WHAT IS ACTUALLY HAPPENING?
When we swallow food, it travels down a tube called the esophagus, and into the stomach for further digestion. At the entrance of the stomach is a valve called the lower esophageal sphincter (LES). This valve needs to stay closed to prevent stomach acid from traveling into the esophagus which is much more sensitive to acid than the stomach. The LES only opens with release of gas such as burping or when food is entering into stomach for digestion.
WHAT CAUSES IT?
The number one cause of acid reflux is actually low stomach acid. Low stomach acid can be caused by a variety of different factors including:
- Chronic stress
- Aging
- H. pylori
- PPI use
A sufficient amount of acid is required to breakdown food in the stomach. When stomach acid is low, food is poorly digested, causing it to ferment, causing gas and intra-abdominal pressure. It is actually the intra-abdominal pressure that causes the acid to be pushed up into the esophagus causing your heartburn symptom.
Other causes of intra-abdominal pressure included hiatal hernia, pregnancy and abdominal obesity.
HOW DO YOU MANAGE IT?
1. Diet:
The Standard American Diet (SAD) can often exacerbate intra-abdominal pressure by contributing to dysbiosis, malabsorption of carbohydrates and excess gas production. Some food triggers to be mindful of include: acidic foods, fatty foods, chocolate, coffee, alcohol, processed foods and sugar. Monitoring your consumption of carbohydrates can also be beneficial, as many have found improvement with a low carbohydrate diet.
2. Stress Management
Stress often shifts us away from our "rest and digest", parasympathetic nervous response into our "fight-or-flight", sympathetic nervous response. This can result in a variety of health concerns including poor digestive function. Practicing mindful eating by taking a pause before meals and eating without distractions can be very beneficial. Creating a stress free environment and implementing stress management practices can not only improve digestion but your overall health.
3. Lifestyle
- Drinking too much water with meals, can further dilute stomach acid
- Not eating right before bedtime
- Raising the angle at which you sleep to prevent regurgitation
- Avoiding tight clothing
- If indicated weight loss
- Avoiding smoking as it can increase high chances of esophageal cancer and GI cancer
4. Supplementation
Where possible speak to a healthcare practitioner that can guide you in terms of the appropriate use of specific nutraceuticals that can help address the root cause of your acid reflux. These can include a good quality digestive enzyme, probiotics, formulas to support acid production and help tone the LES.
References:
Weekes LM. Proton pump inhibitors: Too much of a good thing? Med J Aust. 2015;202(9):464.
Imhann F, Bonder MJ, Vich Vila A, et al. Proton pump inhibitors affect the gut microbiome. Gut. 2016;65(5):740–748.
Revicki DA, Wood M, Maton PN, Sorensen S. The impact of gastroesophageal reflux disease on health-related quality of life. Am J Med. 1998;104:252–258.
El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014;63:871–880.
