GERD: Burning to Hear the Holistic Healthcare Answer?

Burning from too much stomach acid?  Think again.

If you have followed me for any length of time, you have probably gathered that I am a big proponent of using holistic health care practices and especially ensuring that you have adequate stomach acid (HCl).  By the end of this post, you will have a better understanding as to why it is so important.

Digestive challenges abound in the US and for anyone on a standard American diet.  SO many people rely on over-the-counter digestive aids such as Prilosec, Tums and Beano (to name a few).  Digestive problems are indeed common, but they are NOT normal.  Heed the early warnings so you don’t have to deal with more serious consequences down the road.

To understand what is going on with a gastroesophageal reflux disease (GERD) situation, we first need to look at the process of digestion as it should be.  WARNING: If you’re not a naturopathic medicine/science/physiology/pathology nerd, you can skip to the bottom of this post, no worries.

Here’s what happens in normal/healthy digestion¹:   

• You chew your food well and then swallow.  Chewing is important because your stomach doesn’t have teeth!
• After you swallow, your food travels down your esophagus and is propelled into your stomach via peristalsis (contractions in the esophagus that are stimulated when the nerves sense that food is present) .
• Once in the stomach, the muscles of the stomach push the food around to break it down further.  This process triggers hormones to be released in the stomach which releases digestive juices consisting of hydrochloric acid (HCl) and digestive enzymes which dissolve the food particles even more, especially proteins.  When HCl is released, it causes the muscle at the lower end of the esophagus to contract.
• These hormones in the stomach also trigger the gallbladder to release bile that was made in the liver and also the pancreas to release more enzymes for the further break down of fats and carbohydrates.
• At this point your food is more of soupy liquid called chyme.  The chyme now moves into the small intestine.
• The first part of the small intestine is called the duodenum.  Here, fats are further digested and broken down into fatty acids and glycerol.
• Further into the small intestine, called the jejunum and ilium, proteins are broken down into amino acids; and carbohydrates broken into glucose molecules, all so they are easier for the body to actually use. 
• The small intestine is coated in small, hair-like villi that increase its surface area, making it easier for small particles to be absorbed through the wall of the intestine and into the blood stream.  This is where most nutrients get absorbed.
• Whatever is left over (fiber, water, dead cells, undigested food particles, etc.) are moved from the small intestine to the large intestine/colon. 
• In the colon, fibers are used as food for various beneficial bacteria (often referred to as your microbiome) which helps promote better digestion, immunity and the assimilation of nutrients.  Most of the fluid is absorbed into the colon and the stool is what’s left.  The colon moves the stool into the rectum.
• When the nerves in the rectum sense the expansion of surrounding tissues, this sends a message to your brain that it’s time to use the restroom.
• From that point, the stool passes through the anus and exits the body.

This is a basic summary of what happens under relatively normal circumstances.  Of course there are many individual nuances having to do with your stress, diet, how well you chew, digestive capacity and more, but this is a basic understanding of what usually takes place.

What is going on in gastroesophageal reflux disease (GERD) and esophagitis:

Although gastroesophageal reflux (GER) is a normal short-term physiological response that many people have a few times per day, when it becomes chronic and long term it can create a more serious condition called GERD. 

GERD is most often diagnosed when the acidic juices from the stomach rise up into the esophagus and throat enough to cause mucosal damage (normally at least twice/week for several months).  Typical symptoms include a burning feeling in the chest (often referred to as heart burn) especially after meals, abdominal pain, an acidic taste, nausea, bloating and belching.²  As compared to normal physiology where the HCl stays in the stomach, in the case of GERD, the lower esophageal sphincter (LES), basically the doorway between the esophagus and the stomach, relaxes and allows the contents of the stomach (including the stomach acid) to rise up into the esophagus.  If GERD persists untreated, it can become even more serious resulting in esophagitis, Barrett’s esophagus, ulcers and cancer.

Esophagitis refers to an inflammatory condition of the esophagus.  Remember that the esophagus is the tube that runs from the throat down to the stomach.  This tube can become inflamed or irritated due to GERD (most common cause), certain medications and various infections.⁹  Esophagitis progresses to Barrett’s esophagus (damaged esophagus tissue due to stomach acid exposure).  This condition can advance into cancer (adenocarcinoma) of the esophagus as well.¹⁰  The ideal would be to take this serious when it is minor so it does not advance.  But if you’re reading this having already been diagnosed with GERD, or worse, there is still hope for you as well; you will just have to work a bit harder!

But what really causes GERD? Or, better yet, why does the LES relax when it shouldn’t, allowing this condition to occur in the first place?  This occurs when the stomach acid is so low in a person that there’s not enough sensed to stimulate the closing of the esophagus.  In this case, it is not so much the stomach acid (HCl) that refluxes back up into the esophagus as much as the rotting and fermenting food from the stomach due to the lack of HCl.³ 

Low stomach acid causes so many challenges for the body.  Digestion is hindered as HCl is important for the breakdown of proteins.  It converts the pepsinogen into pepsin, an enzyme that breaks down proteins into amino acids so your body can use them.  In carbohydrates and fats, HCl is what stimulates the release of pancreatic enzymes and bile to break carbohydrates into glucose and fats into fatty acids to be used for energy by the body.³  Low HCl also results in many vitamins and minerals being poorly absorbed and assimilated (calcium and B12, for example).⁴  In the long term this can be both catastrophic and frustrating.  Catastrophic, because many vitamins and minerals are considered essential which means you need them in the diet regularly for your body to remain healthy.  (For those nutrients that don’t have long-term reserves, you can quickly end up with nutrient depletions causing various types of problems in the body.)  Frustrating, because even if you are working hard to eat the right foods, following healthy lifestyle tips, chewing well etc, you may not be getting the usable nutrition from them.  You’re paying for great healthy foods, chopping them, cooking them, choosing to eat them… and not getting the benefit!  Ugh… and you may not be getting the results you were hoping for either.  Hang in there… There is hope!

Adequate stomach acid is also protectant against potentially ingested pathogens.⁵  This happens because the pH (acidity/alkalinity level) of the stomach, due to the HCl, is really low/acidic (around 2).  In this environment, most pathogens just can’t survive.  HCl also prevents fungal overgrowths in the small intestine³ and, in sufficient enough quantities, can even kill helicobacter pylori (found in the stomach wall of over 80% of those with stomach cancer)⁶ as well as e. coli (a bacterial infection that can cause food poisoning and other major forms of gastric inflammation⁷).  If you are experiencing frequent bacterial or fungal infections, it’s likely that you are low in HCl.

Although medications are normally helpful for remediating painful symptoms of GERD, they do come at a price in terms of side effects and they do not deal with the root cause.⁸

Common risk factors for developing GERD include: Obesity, smoking, hiatus hernia, consuming high fat/high acid foods and alcohol.¹¹  Of course this means that you can at least begin to improve this condition with healthy living habits like losing weight, quitting smoking, reducing alcohol and high fat/ high acid foods (fatty meats, fried foods, coffee, etc.).

How does GERD impact digestion and the absorption of essential nutrients?

There are really two factors here, one being the impact of the GERD itself and the other is the impact of medications that are most often used.

As mentioned above, GERD creates digestive and absorption issues by reducing HCl and increasing inflammation in the gastrointestinal tract.

Next, the proton pump inhibitors (PPI’s) that are most often prescribed work by reducing stomach acid (HCl).  Although this may sound like a good thing when you’re in pain due to the acid coming up and burning your chest and throat, it’s actually quite problematic.  Stomach acid is important (see above) and plays a significant role in digestion.

A couple of dietary changes that will help with GERD:

1. Reduce or eliminate meat and reduce the fat in your diet.¹²  Meat can be difficult to digest and break down, which means that it stays in the stomach for a longer period of time.  This increases the amount of time that there is pressure on the lower portion of the esophagus, causing it to eventually give in and relax, allowing the stomach contents to leak in the wrong direction.  Fats also tend to spend more time in the stomach being broken down, so they also create pressure for longer periods of time than other foods.
2. Increase dietary fiber.¹³  Fiber helps move food through your digestive tract quicker so that you don’t have extended periods of prolonged stomach distention/pressure pushing up on the LES.  Increasing your intake of fresh fruits, vegetables, beans, lentils and whole grains can be of great help.

3 Supplements that could prove helpful:

1. Betaine HCl. In the case of low stomach acid, it can be helpful to take Betaine HCl.⁸  In the scenario described above where the stomach acid is too low to even activate the contraction of the LES, this will help.  HCl tends to decrease with age, making supplementation even more important.³  I recommend to most of my adult clients to take 2-3 capsules after each meal with water.  It is important to stay hydrated when taking HCl.  If you experience burning after taking HCl, it’s likely that you are dehydrated.  Drink a glass of water and that usually takes care of it.
2. Aloe Vera. Aloe Vera has also proven to provide relief from GERD symptoms.¹⁴  This is likely by soothing the inflamed mucous membranes of the esophagus and stomach.  Take 1 ounce three times per day (keep refrigerated).
3. Digestive enzyme.  Take 2 capsules with each meal to help break down your food and thereby easing digestive stress.

The body is profoundly powerful in its self-healing qualities.  Small changes over time will be helpful in creating and restoring health to the gastrointestinal tract.  It’s never too late to support your best health!  If you need help to get healthy now please feel free to call my clinic to schedule a holistic health care consult. Please remember although I am a Naturopathic Doctor with a clinic in southwest Michigan I work with great people from all over the country (who travel in), just like you.

Resource List:

1. Bryce E. How your digestive system works. Youtube.

2. Badillo R, Francis D. Diagnosis and treatment of gastroesophageal reflux disease. World J Gastroenterol Ther. 2014;5(3):105-112.

3. Gastric Balance: Heartburn Not Always Caused by Excess Acid. Nutr Rev. 2018.

4. Keller J, Layer P. The pathophysiology of malabsorption. Visz Gastrointest Med Surg. 2014. doi:10.1159/000364794

5. Smith JL. The role of gastric acid in preventing foodborne disease and how bacteria overcome acid conditions. J Food Prot. 2003. doi:10.4315/0362-028X-66.7.1292

6. Goldschmiedt M, Barnett CC, Schwarz BE, Karnes WE, Redfern JS, Feldman M. Effect of age on gastric acid secretion and serum gastrin concentrations in healthy men and women. Gastroenterology. 1991. doi:10.1016/0016-5085(91)90724-Y

7. Takumi K, De Jonge R, Havelaar A. Modelling inactivation of Escherichia coli by low pH: Application to passage through the stomach of young and elderly people. J Appl Microbiol. 2000. doi:10.1046/j.1365-2672.2000.01193.x

8. Kines K, Krupczak T. Nutritional interventions for gastroesophageal reflux, irritable bowel syndrome, and hypochlorhydria: A case report. Integr Med. 2016.

9. Grossi L, Ciccaglione AF, Marzio L. Esophagitis and its causes: Who is “guilty” when acid is found “not guilty”? World J Gastroenterol. 2017. doi:10.3748/wjg.v23.i17.3011

10. Glarrett MD DM, Hachem MD C. Gastroesophageal Reflux Disease (GERD). Mo Med. 2018;115.

11. B. M. Management of gastroesophageal reflux disease in adults: A pharmacist’s perspective. Integr Pharm Res Pract. 2018. doi:10.2147/IPRP.S142932 LK  – http://jq6am9xs3s.search.serialssolutions.com/?sid=EMBASE&issn=22305254&id=doi:10.2147%2FIPRP.S142932&atitle=Management+of+gastroesophageal+reflux+disease+in+adults%3A+A+pharmacist%E2%80%99s+perspective&stitle=Integr.+Pharmacy+Research+and+Practice&title=Integrated+Pharmacy+Research+and+Practice&volume=7&issue=&spage=41&epage=52&aulast=Macfarlane&aufirst=Brett&auinit=B.&aufull=Macfarlane+B.&coden=&isbn=&pages=41-52&date=2018&auinit1=B&auinitm=

12. O’Doherty MG, Cantwell MM, Murray LJ, Anderson LA, Abnet CC. Dietary fat and meat intakes and risk of reflux esophagitis, Barrett’s esophagus and esophageal adenocarcinoma. Int J Cancer. 2011. doi:10.1002/ijc.26108

13. Morozov S, Isakov V, Konovalova M. Fiber-enriched diet helps to control symptoms and improves esophageal motility in patients with non-erosive gastroesophageal reflux disease. World J Gastroenterol. 2018. doi:10.3748/wjg.v24.i21.2291

14. Wilson D. An Effective, Natural Treatment for GERD: Aloe Vera Syrup. Nat Med J. 2016;8(9).

Nothing said or implied in this post is intended to treat, cure, diagnose or prevent any disease.  It does not take the place of a qualified health care practitioner and is intended for educational purposes only.