GERD Symptoms and Treatment
Cure means healing or restoring to health. Cure is applied to the eradication of disease or sickness. When a disease is cured, the symptoms don’t return once the treatment is removed. Curing a disease happens when its cause is eliminated. This of course is not the case with drugs for heartburn and GERD. As soon as the patient stops taking them, the symptoms return. And often they’re worse than they were before the patient started the drug
Now, before going to see how GERD can be cured, we must know some facts about the GERD per se.
If you ask any average person on the street what causes heartburn, he’ll tell you “too much acid in stomach” or in simple terms he’ll say it as “acidity.” That’s what most of the ads in media (social media, TV, magazines etc) seem to suggest too. The idea that heartburn is caused by too much stomach acid is still popular in the media and the public.
But there’s a big problem with this theory:
Consider these two well established facts about Stomach acid & GERD.
Fact no 1: Stomach acid levels generally decline with age: Numerous studies have shown that stomach acid secretion declines with age. In one study researchers found that over 30 percent of men and women past the age of 60 suffer from atrophic gastritis, a condition marked by little to no acid secretion. Another study found that 40% of women over the age of 80 produce no stomach acid at all
Fact no 2: The incidence of heartburn and GERD increases with age.
Now, if stomach acid is the cause for GERD, then as per above facts, GERD should decrease with age but the opposite of what we see… rather GERD increases with age as mentioned in Fact no 2.
I’m not denying that the fact that symptoms of heartburn and GERD are caused by stomach acid refluxing into the esophagus. Nor am I arguing that reducing or eliminating stomach acid with drugs doesn’t relieve those symptoms.
What’s crucial to understand is that any amount of acid in the esophagus is going to cause problems. That’s because its delicate lining isn’t protected against acid like the stomach lining is. You don’t have to have excess acid in your stomach to have heartburn.
Also, symptom relief doesn’t imply that the underlying cause of the problem is being addressed. Too often acid reducing medicines focuses on suppressing symptoms without paying attention to what is causing the symptom in the first place.
Then What causes GERD?
Scientific literature could tell you that heartburn and GERD are not considered to be diseases of excess stomach acid.
The Role of LES
Instead, the prevailing scientific theory is that GERD is caused by a dysfunction of the muscular valve (sphincter) that separates the lower end of the esophagus and the stomach. This is known as the lower esophageal valve, or LES. The LES normally opens wide to permit swallowed food and liquids to pass easily into the stomach. Except for belching, this is the only time the LES should open.
If the LES is working properly, it doesn’t matter how much acid we have in our stomachs. It’s not going to make it back up into the esophagus. But if the LES is malfunctioning, as it is in GERD, acid from the stomach gets back into the esophagus and damages its delicate lining.
GERD Is Caused by Increased Intra-Abdominal Pressure
It is well accepted in the literature that GERD is caused by an increase in intra-abdominal pressure (IAP). Acid reflux occurs when pressure causes gastric distention (stomach bloating) that pushes the stomach contents, including acid, through the LES into the esophagus. According to current thought, factors contributing to this include overeating, obesity, bending over after eating, lying down after eating, and consuming spicy or fatty foods.
The Two Primary Causes of Increased Intra-Abdominal Pressure: In his excellent book, Heartburn Cured, microbiologist Dr. Norm Robillard argues that carbohydrate malabsorption leads to bacterial overgrowth, resulting in IAP which drives reflux. one of the chief roles of stomach acid is to inhibit bacterial overgrowth. At a pH of 3 or less (the normal pH of the stomach), most bacteria can’t survive for more than 15 minutes. But when stomach acid is insufficient and the pH of the stomach rises above 5, bacteria begin to thrive. The gastrin knockout mouse, which is incapable of producing stomach acid, suffers from bacterial overgrowth—as well as inflammation, damage and precancerous polyps in its intestines. It is also well documented that acid-suppressing drugs promote bacterial overgrowth. Low Stomach Acid Causes Maldigestion of Carbohydrates. Stomach acid (HCL) supports the digestion and absorption of carbohydrates by stimulating the release of pancreatic enzymes into the small intestine. If the pH of the stomach is too high (due to insufficient stomach acid), the pancreatic enzymes will not be secreted and the carbohydrates will not be broken down properly.
Bacterial Overgrowth + Maldigested Carbohydrates = GAS.
The resulting gas increases intra-abdominal pressure, which is the driving force behind acid reflux and GERD.
So, Reduce Factors That Promote Bacterial Overgrowth and Low Stomach Acid have been shown to greatly improve, and in some cases completely cure, acid reflux and GERD. A highcarbohydrate diet promotes bacterial overgrowth. It follows, then, that a low-carb diet would reduce bacterial overgrowth. In studies done to test this hypothesis, the results have been overwhelmingly positive. It’s important to note that obesity is an independent risk factor for GERD, because it increases intra-abdominal pressure and causes dysfunction of the lower esophageal sphincter (LES). The advantage to a low-carb diet as a treatment for GERD for those who are overweight is that low-carb diets are also very effective for promoting weight loss. It is not recommended very-low-carb diets for extended periods of time, as they are unnecessary for most people. Once you have recovered your digestive function, a diet low to moderate in carbohydrates should be adequate to prevent a recurrence of symptoms. An alternative to a verylow-carb is something called a “specific carbohydrate diet” (SCD), or the GAPS diet. In these two approaches it is not the amount of carbohydrates that is important, but the type of carbohydrates. The theory is that the longer chain carbohydrates (disaccharides and
polysacharides) are the ones that feed bad bacteria in our guts, while short chain carbohydrates (monosacharides) don’t pose a problem Another alternative to very-low-carb that I increasingly use in my clinic is the low-FODMAP diet
Fructose and Artificial Sweeteners: Fructose and artificial sweeteners have been shown to increase bacterial overgrowth. Artificial sweeteners should be completely eliminated, and fructose (in processed form especially) should be reduced.
Fiber: High fiber diets and bacterial overgrowth are a particularly dangerous mix. Remember, Almost all of the fiber and approximately 15 to 20 percent of the starch we consume escape absorption. Carbohydrates that escape digestion become food for intestinal bacteria
The Role of H. Pylori in GERD
I believe that H. pylori infection plays a significant role in the pathogenesis of GERD and other digestive disorders.
H. pylori is the most common chronic bacterial pathogen in humans. Statistics indicate that more than 50% of the world population is infected. Infection rates increase with age. In general, the prevalence of infection raises 1% with every year of life. So, we can expect that approximately 80% of 80 year-olds are infected with H. pylori.
Second, we know that H. pylori suppresses stomach acid secretion. In fact, this is how it survives in the hostile acidic environment of the stomach, which would ordinarily kill all bacteria. Treating an asymptomatic H. pylori infection with antibiotics increases stomach acidity and eradicating H. pylori with antibiotics improves nearly all patients suffering from hypochlorhydria.
Restore Beneficial Bacteria and a Healthy Mucosal Lining in the Gut
Because bacterial overgrowth is a major factor in heartburn and GERD, restoring a healthy balance of intestinal bacteria is an important aspect of treatment.
Along with performing several other functions essential to digestive health, beneficial bacteria (probiotics) protect against potential pathogens through “competitive inhibition” (i.e. competing for resources).
Probiotics have also been shown to significantly increase cure rates of treatment for H. pylori. In my practice I always include a probiotic along with the anti-microbial treatment I do for H. pylori.
Some other Lifestyle and behavior changes can help relieve GERD
Eat moderate amounts of food and avoid overeating.
Avoid eating 2 to 3 hours before sleeping.
Quit or avoid smoking.
Do not wear clothing that is tight around the abdomen.
Sleep at a slight angle with the head slightly elevated.
Highly intensive physical exercise can predispose the occurrence of gastroesophageal reflux episodes in GERD patients.
Some forms of yoga helps to decrease the stress-induced increase in gastric acid secretion, thereby helpful in GERD patients.
When Natural Treatments May Not Be Enough.
If dietary & lifestyle changes do not significantly improve the symptoms of GERD, a gastroenterologist consultation is recommended. In some cases, depending upon the severity of GERD, some patients will also be advised medications to help control the reflux episodes. When there is structural problem in the esophagus (Hiatal hernia, Wide Lax LES), for example, a surgical procedure called “fundoplication” which repairs the LES valve may be necessary. These procedures address the structural cause of this disease, thereby helpful in curing of the disease. It is advisable for anyone suffering from a severe case of GERD to consult with a knowledgeable physician.
GERD is a complex disease with multitude of factors involved in its causation. Unless its cause is treated, cure for this problem is very unlikely. The mainstream medical approach to treating heartburn and GERD just by prescribing acid stopping drugs, for as long as these problems occur, without addressing the underlying cause of these problems, is not going to cure this disease but may make it worse. Most people who start taking antacid drugs end up taking them for the rest of their lives. It requires a commendable commitment from a GERD patient to maintain a dietary and lifestyle advise to defeat this complex disease.