GERD

graphic showing heartburn acid reflux or gerd

Heartburn, Acid Reflux, and GERD

by Dr. Pamela Frank, BSc(Hons), ND

Heartburn, GERD or acid reflux is where stomach acid is regurgitating up the esophagus (the tube that leads from your mouth to your stomach). Long-term acid reflux can damage the esophagus and lead to Barrett’s esophagitis and esophageal cancer. Medical treatment for acid reflux involves neutralizing stomach acid either through over the counter products that contain calcium carbonate or through prescription proton pump inhibitors. This will often alleviate the symptoms but does not address the underlying cause of the disease and long-term use of PPI medications can lead to osteoporosis. PPI’s can be difficult to discontinue as there can be a rebound hyperacidity after discontinuing them which worsens heartburn symptoms.

What Causes Heartburn?

There are a number of possible explanations for why heartburn occurs:

Excessive acid production in the stomach

This is the usual assumption, however, it’s not often the case.  In fact, as people age, their stomach acid production declines.  So seniors on antacid medications are unlikely to have excess stomach acid.

Low stomach acid production

This is more often the case in GERD sufferers. Because stomach acid is low, food ferments in the stomach and creates bloating and gas, which creates pressure and forces stomach contents up the esophagus.  What causes low stomach acid?  It can be due to vitamin or mineral deficiencies that can arise from poor digestion and absorption or due to inflammation in the stomach blocking normal secretion of stomach acid.

Inflammation in the stomach and/or intestines

Food sensitivities (mild food allergies that almost everyone has but are usually unaware that they have) are often responsible for this inflammation which impairs secretion of digestive juices like stomach acid and digestive enzymes, leading to poor digestion, bloating, gas and pressure. The inflamed tissue and low acid in the stomach that ensues make for a good environment for bacteria growth like Helicobacter pylori, a bacteria that is often associated with GERD and this bacteria can also cause stomach ulcers and contribute to stomach cancer development. Chronic inflammation also promotes cancer development.

Floppy valve

There is a valve or sphincter at the top of your stomach that is meant to clamp tightly shut to keep stomach contents contained in the stomach.  Many of my patients are often told that this sphincter is the problem but receive no explanation for why it’s “floppy”. My opinion is that it is due to either low stomach acid not signaling tight closure of the valve or inflammation inhibiting function of the valve or both.

Pregnancy

GERD or acid reflux is a common occurrence in pregnancy.  The changes in hormones that accompany pregnancy coupled with the increased abdominal pressure from a developing baby seem to be the cause of pregnancy GERD.  There are natural means of helping to relieve acid reflux symptoms during pregnancy, our naturopathic doctors are a great resource for help with this.

What are the symptoms of heartburn, acid reflux and/or GERD?

  1. A burning sensation in the centre of your chest or throat and/or an acidic taste in your mouth
  2. Chest pain
  3. Difficulty swallowing
  4. A chronic cough or hoarseness
  5. A sore throat

What is the natural treatment for heartburn?

  1. Determine food sensitivities either through an elimination diet or through food sensitivity testing.
  2. Eradicate any harmful bacteria that may be inhabiting the stomach, this is easier to do once you’ve removed the food sensitivities which allows the tissue to heal.
  3. Stomach acidity and enzyme production may normalize themselves once the inflammation in the gut has been reduced. If not, there are herbs and supplements to increase stomach acidity, supplement digestive enzymes and increase bile production and flow.

Our naturopathic doctors and Registered Dietitian can advise you as to what to eat when you have heartburn and how to treat GERD.

Why is it Important to Fix GERD?

Having acid reflux over the long term can cause damage to your esophagus (the tube from your throat to your stomach).  Chronic acid damage to your esophagus can lead to a condition known as Barrett’s esophagus which can develop into esophageal cancer.

Natural Treatment for Acid Reflux/Heartburn/GERD: Research

Smoking, BMI, and depression were associated with GERD

Kim O1,2, Jang HJ3,4, Kim S5, Lee HY6, Cho E7,8, Lee JE9, Jung H10, Kim J11. Gastroesophageal reflux disease and its related factors among women of reproductive age: Korea Nurses’ Health Study. BMC Public Health. 2018 Sep 21;18(1):1133. doi: 10.1186/s12889-018-6031-3.

Diet and Deep Breathing in GERD

Roman S1, Mion F2. Refractory GERD, beyond proton pump inhibitors. Curr Opin Pharmacol. 2018 Sep 18;43:99-103. doi: 10.1016/j.coph.2018.09.001.

Quince Sauce and GERD in pregnancy

The efficacy of Quince sauce for the management of pregnancy-related GERD is similar to ranitidine.  Shakeri A1, Hashempur MH2,3, Mojibian M4, Aliasl F5,6, Bioos S1, Nejatbakhsh F1. A comparative study of ranitidine and quince (Cydonia oblonga mill) sauce on gastroesophageal reflux disease (GERD) in pregnancy: a randomised, open-label, active-controlled clinical trial. J Obstet Gynaecol. 2018 Mar 19:1-7. doi: 10.1080/01443615.2018.1431210

Water:

Drinking water with meals should be avoided as this may result in a worsening of acid reflux symptoms.  Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012

Astaxanthin:

Patients who took astaxanthin saw a reduction in acid reflux symptoms with a dose of 40 mg.  Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012

Licorice Root:

Licorice might help protect the stomach and duodenum from gastric acid irritation. Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012

Melatonin:

Melatonin has been found to improve acid reflux symptoms such as heartburn and epigastric pain after supplementation.  Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012

Weight Loss:

Weight loss in acid reflux patients was found to be an effective lifestyle intervention. Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012

Peppermint:

Peppermint oil has been found to enhance gastric emptying and therefore may be beneficial to acid reflux patients.  Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012

Caffeine & GERD:

Higher instances of acid reflux have been reported after ingesting coffee.  Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012

Meals:

Meals should be eaten at least 2 to 3 hours before lying down to decrease the likelihood of acid reflux  Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012

Mastic Gum & GERD:

Mastic is the resin from a shrub found in the Mediterranean, and it has been found to soothe and relieve symptoms of acid reflux.  Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012

Overeating:

The portion size of meals should be decreased and/or eat 4 or 5 small meals instead of 3 large ones.  Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012

Vitamins & PPIs:

Proton Pump Inhibitors are acid-blocking drugs that increase pH in the stomach. Higher pH limits the absorption of many vitamins and minerals such as beta-carotene, calcium, chromium, folic acid, iron, vitamin C, B12 and zinc.  Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012

Salt:

Intake of table salt should be limited because it is a risk factor for acid reflux symptoms.  Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012

Exercise:

Physical exercise has been shown to protect against acid reflux.  Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012

Fiber:

Increased intake of dietary fiber has been found to protect against acid reflux.  Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012

Tobacco:

Patients who smoke should undergo a smoking cessation program, as tobacco smoking is a risk factor for acid reflux symptoms. Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012