Many people have the occasional heartburn symptoms. In fact estimates are that sixty percent of American adults have heartburn at least once a year. When do we decide it isn’t just regular heartburn and something more serious, such as GERD? Some people look at the frequency of the heartburn. Twenty to thirty percent of American adults have heartburn on a weekly (or even more frequent basis. Looking at the frequency has been a factor in the diagnosis of GERD increasing by 216 percent between 1998 and 2005. But it isn’t just adults that get GERD. More and more infants are being diagnosed and treated for this ailment.
Most people think of heartburn or GERD as being caused by too much stomach acid, simply because that is what it feels like. In reality it is most commonly caused by a week muscle or sphincter at the bottom of the esophagus. When this sphincter is week it lets the content of the stomach come back up into the esophagus. The stomach contents are supposed to be acidic, but the esophagus isn’t meant to handle that acid. This causes the burning sensation that people are experiencing. Over time this acid can eat a hole in the esophagus, sometimes called a hiatal hernia.
What causes this sphincter to become weak? In babies it is being linked to antibiotics used by the mom during pregnancy, or her diet before and after the birth. These can cause the babies to be born with the wrong mix of good bacteria in their intestines. This lack of good bacteria can cause digestion to be impaired, which leaves the stomach fuller longer and puts pressure on that sphincter. Being born by C-section can upset this balance as well. What foods the baby eats, or what food the breastfeeding mothers eat is also a risk factor. If baby has intolerance to a food and it is in the formula, or mom is eating it this can cause digestive problems.
Adults are faced with the same risk factors, plus some additional ones. Sometimes it is not having enough stomach acid to help the stomach work efficiently. Without the stomach acid foods ferment, and give off gases that expand the stomach, pushing on that sphincter. Other times it is medications, either prescription or over the counter, that relax the muscles. This causes that sphincter to weaken and open at inappropriate times.
Are antacids and/or PPI’s the best thing to reach for when you feel the beginning or heartburn?
For most of us the answer is a resounding no! We need an appropriate amount of stomach acid in order to properly digest our food. Without it there is a cascading effect of health problems, including:
• Reduced absorption of essential nutrients (including B12, magnesium, calcium, iron, folate, and zinc) These nutrients are important for adults, but they’re even more important for developing babies. So folate and B12 in particular are needed to form new red blood cells, and they play an important role in methylation, which silences and activates gene expression, which, in turn, regulates just about anything in the body. Vitamin C is important for collagen development and the structural development of the body, in addition to immune function. Iron is also involved in red blood cell function. Without enough iron, babies will become anemic and not develop properly. Magnesium plays a role in over 300 different enzymatic reactions in the body, it’s one of the most important nutrients that we need. And all of the other B vitamins—B6; B5, which is pantothenic acid; B1, which is thamine; B2, which is riboflavin; B3, which is niacin—are all essential. Again, they’re all there for a reason. We need them. They’re all essential nutrients. And PPIs inhibit their absorption. We could potentially see an increase in things like neurological issues from B12 deficiency; problems with development, like I said, of the structural tissue in the body from vitamin C deficiency; behavioral disorders like ADHD, autism, et cetera because of folate and B12 deficiency. These things are on the rise in kids. There may not be enough kids now taking PPIs that this is making a significant contribution, but this could certainly happen if we continue with our current course.
• Increased risk of bone fractures (likely a consequence of impaired nutrient absorption). PPIs have been associated with decreased bone mineral density, because calcium absorption is impaired, and also maybe the fat-soluble vitamins—like vitamin D, which plays a role in calcium metabolism, and K2.
• Increased bacterial overgrowth in the intestines.
• Decreased resistance to infections (including life-threatening ones like pneumonia and clostridium difficile). We’re exposed to bacteria, viruses, and fungi all the time. They’re all around us in the environment. But a lot of times, if we get exposed to them through food or water that we swallow, the stomach acid just takes care of that. Many of these organisms cannot survive in a really low pH, acidic environment like the stomach. The stomach acid is our first line of defense against these organisms entering through our mouth and when we swallow. As you might suspect, PPI use has been associated with an increased risk of infections of all types, but particularly gut infections and something like Clostridium difficile, which is a potentially fatal gut infection. Very serious. It’s a cause of concern. It’s been shown that there’s an increased risk of community-acquired pneumonia in people using PPIs.
• Increased risk of cancer and other diseases, such as irritable bowel syndrome (IBS), Crohn’s disease, depression, anxiety, autoimmune disease, and asthma.
• Increase in weight gain. One study in adults showed an average increase of about 10 lbs in weight in about 70% of patients that were taking PPIs over a two-year period, whereas only 9% of patients in the control group gained weight over that period.
If you don’t want to use medications for your GERD what are your options?
• Reduce carbohydrates and follow a mostly Paleo type diet.
• Take baking soda and water. This reduces the amount of acid in the stomach.
• Take apple cider vinegar and water.
• Take ginger, either in tea, capsules, as a spice when cooking, or in lozenge form.
• Take aloe vera.
• Take enzymes. These are what the stomach acid activates in order to digest food. By increasing the enzymes you increase the efficiency of digestion and lower the need for stomach acid.
• Take probiotics, and prebiotics. Probiotics are the good bacteria we are supposed to have in our digestive tract. Prebiotics are substances that ‘feed’ or help the good bacteria grow.
• Avoid foods you are sensitive to. This can include anything from gluten to tomato based dishes and anything in between. Everyone is a little different.
• Ditch the carbonated beverages. Carbonation adds volume to the stomach contents that the human body has trouble getting rid of.
• Look for herbal bitters. These are plants that have a bitter flavor. They aid in digestion.
• Avoid greasy foods, especially those fried foods made with canola and other vegetable oils. Even worse are the oils that have been hydrogenated. They are then called trans fats.
The biggest problem with a dietary based treatment is that some people have a problem being consistent. They want to fit in with their friends and family members more than they want to feel good. Then they complain that the natural methods don’t work. They do work, if you are consistent in following them.