Dr. Roy Murrell, DC 200 NE 20th Avenue, Suite 140 Portland Oregon 97232 - disclaimer - 971-312-9497
WHAT EXACTLY IS GASTRIC REFLUX?
One out of every two people will experience gastric reflux (commonly called heart burn) in their life time. It has an official name of GERD (Gastroesophageal Reflux Disease). It is caused by acid in the stomach migrating back up the esophagus causing a burning sensation in the chest and sometimes in the throat. It happens frequently in the middle of the night and can easily wake you from a deep sleep with extreme discomfort. Some feel the problem is not too much acid but a failure of the esophageal sphincter (a small muscle at the bottom of your esophagus) to stay closed when it should. Some patients do have esophageal hernias (this is where a part of the stomach lining gets pushed up through into the esophagus) but these cases comprise a very small percentage of the total GERD problems. If you make an appointment with your doctor you will most likely get a prescription for a proton pump inhibitor (PPI) such as Prilosec, Nexium (second generation of Prilosec) or Prevacid. These drugs do not neutralize acid, they block it from ever being produced by the stomach. These drugs are very effective at relieving symptoms of reflux but unfortunately they do not address the source of the problem. In fact, in the long run, they make the problem worse and, in addition, can possibly cause serious side effects.
WHAT EXACTLY IS THE CAUSE?
There is complete consensus that the symptoms are from acid getting into the esophagus. As to why this happens, there is considerable debate. The approach of the drug companies is based on stopping the production of all acid in the stomach which definitely resolves the symptoms. I think most medical doctors go along with this partly because it takes too long to explain and convince patients to change their diet and lifestyle. The problem lies in that the stomach acid is there for a very good reason.
Some of the important functions of stomach acid are:
--Stomach acid is designed to be the first phase of digestion. It breaks down food into simple molecules (especially protein).
--It is essential for the absorption of minerals which are crucial to our health in general.
--It sends a signal for the pancreas to gear up with digestive enzymes to be secreted into the small intestine.
--It acts as the first line of defense against bacteria that we might ingest with food.
These are all very important and when we take a drug like Prilosec, we totally eliminate these functions. Ironically, 75% of patients with GERD have evidence of helicobacter pylori, a bacteria that causes a low level inflammation of the walls of the stomach. This causes the stomach to increase the acid production to try to kill the bacteria which can lead to a reflux problem. When you stop acid production, you prevent your body from killing the bacteria which just prolongs the problem. These bacterial infections can lead to ulcers. An easy test for ulcers is to mix 2 tablespoons of apple cider vinegar in 4 ounces of water and drink on an empty stomach. A burning sensation in your stomach would indicative of a possible ulcer. You would want to contact a doctor for antibiotic treatment.
Another possible cause is thought to be a lack of acid. This is always hard for patients to understand; how could acid reflux be a problem of too little acid? Reflux acid is not always from acid produced by the stomach. When you eat a meal, especially a high protein meal, and your stomach does not produce enough acid to digest it, the food essentially starts to rot in the stomach giving off an organic acid that can cause a reflux reaction. What are the causes of reduced stomach acid?
There are a number of factors that cause low acid production but some of the most common are:
--Stress: Sympathetic overload shuts down the parasympathetic nervous system responsible for digestion. People often think stress causes too much acid production; when in reality, it is doing just the opposite.
--Too Much Protein: Large protein intake requires more acid production.
--Lack of Thiamine/Zinc: Vitamin B1 and Zinc are both necessary for HCL production in the stomach. Zinc is the #1 most deficient mineral in the average diet.
--Alcohol: It can inhibit the body's ability to make HCL. (Hydrochloric Acid)
--Aging: We just get less efficient at making HCL as we age.
--Medication: Certain medications can inhibit acid production. (Both prescription and over the counter reflux medications are top of the list.)
In either case, the PPIs (Prilosec) give the patient total relief from the awful feeling of reflux. The catch is you can never stop taking it and at a cost of $120/month the financial toll on the health care system is staggering. It is estimated the US will spend close to $200 billion on PPIs this year, more than the government spends on education, agriculture, transportation, and the environment combined and all for one drug that is most often not necessary and often dangerous. By stopping acid production you inhibit your stomach's ability to start the digestive process. Your food then gets dumped into the small intestine essentially undigested where the pancreas has to drastically increase enzyme production to try to break down the food for absorption. This can lead to an enlarged pancreas and pancreatitis as well as a malabsorption problem. You can become deficient in essential trace minerals (especially calcium) which can have extensive multiple health issues. Stopping acid production also leaves you more vulnerable to bacterial infections which lead to more inflammation and possibly ulcers and stomach cancer. Essentially the drug perpetuates the inflammatory problem making what might have been a short term problem with some diet changes into a long term use of a dangerous medication. It truly becomes an addictive drug; some doctors are even calling it the "Purple crack". Astra-Zeneca pharmaceutical company has built an empire on this one drug.
SO HOW DO YOU MANAGE GERD WITHOUT THESE DRUGS?
Most problems are easily managed with some simple dietary changes. One of the easiest is to increase your water intake, up to a gallon/day. The most important one though is to decrease your simple carbohydrate consumption, especially sugar. It has been shown that decreasing your sugar/simple carbohydrate consumption alone can improve the function of the esophageal sphincter and decrease your symptoms of reflux. You also want to avoid any foods that you are allergic to. Other common triggers are alcohol, caffeine, and nicotine products. You also want to stay away from typical processed salt and substitute good quality sea salt which will have good natural minerals along with chloride which is essential for your stomach to make hydrochloric acid. One of the most helpful things to do is take an HCL supplement along with some digestive enzymes which will help digest your food and kill any bacteria present. (I would advise doing the test for ulcers described above using the vinegar and water. If this test is negative, i.e., no pain, it is safe for you to use an HCL product.) Some of the more serious cases might need antibiotics to kill the bacterial infection. It is also helpful to take a good probiotic (the good bacteria in your gut that help with digestion). Optimal Vit. D levels are important as well so if you don't get sun you will want to take 2000 to 4000 IUs/day. It is wise to have your doctor check your vitamin D levels with a blood test to get a base line of where you are. If you are someone who has been on a PPI drug for several years, you might want to work with a good Naturopath or Chiropractor to help you get off of this drug. I use Standard Process formulas in my office and they have excellent organic whole food-based formulas that help your body solve this common problem.
What ever you do, if you are currently taking one of the PPIs, do not stop it cold turkey; your stomach will secrete a massive amount of acid and you will get an intense reflux. You have to slowly decrease the dose a little at a time while implementing these dietary changes. You can also substitute some over the counter H2 blockers like Tagamet or Zantac as you are weaning off the Prilosec. Getting off these drugs is not easy so be patient. It is why they have become blockbuster drugs. They take care of the immediate symptoms and allow the patient to eat what ever they want, even foods that their body would not tolerate late at night. Unfortunately, in the long run, you will pay a heavy price for this freedom.
Feel free to contact me if you have further questions on this important health issue.
Yours in Health