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Heartburn, Reflux, and GERD



One estimate is that 40% of the US population has some degree of esophageal reflux, with 20% of adults complaining of weekly episodes of heartburn and 7-10% complaining of daily symptoms. Esophageal reflux occurs when the lower esophageal sphincter malfunctions, allowing the backward flow of acid, bile, and other contents from the stomach into the esophagus.

Gastritis (inflammation of the stomach itself), peptic or duodenal ulcers, and chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) can result in reflux. A hiatal hernia may also result in esophageal reflux. Stress is a major factor in reducing the flow of stomach acid. During stressful situations, blood flow is shunted from the digestive organs to the brain and muscles, so they can be ready to react in case of emergency. If there is stress all the time, the stomach will never receive enough blood to adequately function in producing sufficient acid. Some studies have shown that, on average, acid production is significantly decreased in about 50% of those over the age of 60. There are other factors that come in to play as well. Two common culprits are H. Pylori, now known to be a major cause of stomach ulcers, and Candida Albicans. Both of these organisms like an acid free environment and will work at shutting down stomach acid production.

The most obvious symptom of esophageal reflux is heartburn. It occurs after eating and can last from a few minutes to a few hours. Heartburn feels like a burning sensation in the pit of the stomach. The pain may also move up into the chest and throat. GERD (gastroesophageal reflux disease) can cause esophageal scarring or Barrett syndrome, a chronic irritation from acid-bile reflux that causes the normal esophageal lining cells to be replaced by precancerous cells. These cells are associated with an increased risk for development of cancer.

Diagnosis An endoscopy test is used for the diagnosis of GERD. This test involves examining the esophagus through a flexible viewing tube, which can also take a biopsy to correctly identify acid reflux.

Conventional Treatment of GERD H2 antagonists (Tagament, Pepcid, Zantac, and Axid) and antacids (Tums, Maalox, etc.) are usually the first line of treatment. If these fail to work, then proton-pump inhibitor drugs (Nexium, Prevacid, or Prilosec) are initiated. However, many physicians now prescribe proton-pump inhibitor drugs as a first-line therapy. These medications block the absorption of zinc, folic acid, B12, calcium, and iron.

Long-term use of these medications can block all stomach acid (hydrochloric acid). The stomach needs hydrochloric acid to break down proteins for digestion. Failure to do this can lead to all sorts of problems, including intestinal permeability, anemia, fatigue, increased allergy disorders, depression, anxiety, and bacterial and yeast overgrowth. Many minerals and vitamins appear to require adequate concentrations of stomach acid to be absorbed optimally-examples are iron, zinc, and B-complex vitamins, including folic acid. People with achlorhydria (no stomach acid) or hypochlorhydria may therefore be at risk of developing various nutritional deficiencies, which could presumably contribute to the development of a wide range of health problems. One of the major functions of stomach acid is to initiate the digestion of large protein molecules. If this digestive function is not performed efficiently, incompletely digested protein fragments may be absorbed into the bloodstream. The absorption of these large molecules may contribute to the development of food allergies and immunological disorders.

Are Antacids the Answer? No! First, the esophageal sphincter is stimulated to close by the release of stomach acids. When there not enough stomach acid present-because antacids have neutralized them-the esophageal sphincter may not close properly. This allows acid to travel back up into the esophagus and cause heartburn, also called esophageal reflux or gastro-esophageal reflux disease-GERD. GERD is usually treated by antacids, but antacids could make the GERD worse. Acid receptors are found in the lower end of the stomach and they control the function of the Pyloric Sphincter. The Pyloric Sphincter controls how fast or slow the stomach empties. If the acid level in the stomach does not reach the right level, the Pyloric Sphincter will not open. The food is trapped in the stomach and will start to ferment. The fermentation causes gas and creates a different kind of acid that the acid receptors are not sensitive to, and the gas wants to go up. The stomach wants to empty, and the peristalsis will increase in an attempt to force the food out of the stomach. The sphincter at the top of the stomach is weaker then the Pyloric Sphincter and will give way first, letting the food and gas go up into the esophagus. This causes heartburn. Second, the stomach needs an acidic environment for hydrochloric acid to turn the enzyme pepsinogen into pepsin. No acid equals no pepsin, which is needed for digestion, especially protein. No protein digestion means no amino acids. No amino acids, no neurotansmitters (serotonin, dopamine, norepinephrine, etc.).

Last, an acidic environment is one of the body first lines of defense, destroying viruses, parasites, yeast, and bacteria.

Achlorhydria (Low Stomach Acid) Protocol Low stomach may also cause the very same symptoms associated with GERD. Unless you had an upper GI endoscopy, biopsy, or blood test that shows a definitive case of GERD or H. pylori, then you may be causing more problems be using antacid medications. For example, one study found that 34% of those with low stomach acid reported indigestion and excessive gas. Forty percent complained of fatigue. We need gastric acid and pepsin for optimal digestion of food, absorption of nutrients, and release of pancreatic enzymes. Some symptoms associated with achlorhydria

o Bloating o Gas o Indigestion o Heartburn o Distention after eating o Diarrhea o Constipation o Hair loss in women o Parasitic infections o Rectal itching o Malaise o Multiple food allergies o Nausea o Nausea after taking supplements o Restless legs o Sore or burning tongue o Dry mouth

Other associated signs

o Abnormal intestinal flora o Chronic Candidacies o Chronic intestinal parasites o Dilated capillaries in the cheeks and nose (in non-alcoholics) o Iron deficiency o Post-adolescent acne o Undigested food in the stool o Fingernails that are weak, peeling, and cracked

Diseases linked to low gastric acidity

o Vitiligo (skin disorder of milky white patches) o Urticaria (itching) o Celiac disease o Asthma o Addison disease o Chronic autoimmune disorders o Eczema o Psoriasis o Rosacea o Pernicious anemia o Lupus o Gastritis o Food allergies o Diabetes mellitus o Osteoporosis

Heartburn/GERD Protocol

If you suffering from heartburn, try the solutions below rather than antacids.

Take a pancreatic digestive enzyme with each meal. If you been taking Nexium, Prevacid, Pepcid, Prevpac, Prilosec, Propulsid, Reglan, or Zantac for over three months, then you may have to stay on the medications along with taking digestive enzymes. Many of my patients have found that they don need these prescription medications once they start taking a good high potency digestive enzyme which can be purchased over the counter at any health food store.