The truth about GERD & how to fix it without medication
Gastroesophageal reflux disease (GERD), also referred to as acid reflux or ‘heartburn’, affects around 20% of the population of the Western world (1).
And it’s estimated to be almost double that figure in the US – about 40% of people present with GERD symptoms, while it affects about 10% of adults in Europe (2).
That’s a huge number of people.
The risk of being regularly affected by GERD increases as you age, with older people being impacted much more than younger people (3).
Fortunately, a Functional Medicine approach to GERD can help – GERD isn’t something you need to live with.
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Many more people suffer from occasional symptoms of GERD.
But despite becoming more and more common, GERD isn’t normal, and ‘common’ definitely doesn’t mean ‘normal’ when it comes to gastroesophageal reflux disease.
In fact, many of the conventional medical treatments you may be offered for GERD are not only ineffective in dealing with the root cause of the problem, but may do more harm than good.
What is GERD?
Your stomach has two sphincters, which control the inflow and out flow of food through our stomach.
There’s one sphincter at the top of your stomach – the Lower Oesophagael Sphincter (LES), and one at the bottom.
GERD happens when the sphincter at the top of your stomach (the LES) becomes weak or relaxes when it shouldn’t, causing stomach acid to flow back up into your oesophagus (acid reflux).
The constant escape of stomach acid causes irritation to the lining of the oesophagus, which is then felt as a burning sensation.
Basically, GERD happens when stomach acid is where it shouldn’t be – in your oesophagus instead of in your stomach.
Because GERD has become very common, many people have come to think of ‘heartburn’ as a normal reaction to eating specific foods, but it’s not normal.
Signs & symptoms of GERD
Signs and symptoms of GERD can include:
Heartburn is a (a burning sensation in your chest), often after eating (there are common triggering foods, see below). It doesn’t always follow that the more severe the heartburn, the greater the damage to the oesophageal lining (4).
Regurgitation (of food or sour tasting liquid), is common in GERD, and it is common to also have gastroparesis (slower emptying of the contents of the stomach)
Trouble swallowing (dysphagia) usually happens when there has been long-standing heartburn (4), and which should be further investigated e.g. via an endoscopy.
Atypical symptoms of GERD include:
Longer term complications of GERD can include:
Unfortunately, as we’ll cover in a second, a conventional medicine approach to GERD may do more harm than good.
And as we’ll also explain, a Functional Medicine approach to GERD can lead to natural, significant improvements in this condition without the need for medication.
The conventional medicine approach to GERD
If you go to your doctor / GP with regular symptoms of GERD, you’re more than likely to come out of your appointment with a prescription for a PPI (proton pump inhibitor) medication.
These medications are also known as ‘acid blockers’.
PPIs are normally a life long medication – there’s rarely (if ever), a plan to stop them.
The most popular PPIs are:
Proton pump inhibitors suppress the production of acid from the parietal cells that line the inside of your stomach.
This in turn means that no stomach acid escapes into the oesophagus, and the symptoms of GERD are alleviated.
This approach reflects the assumption that GERD is caused by high or excess stomach acid.
So the answer to GERD in conventional medicine is to lower stomach acid by blocking its production.
Problem solved, right!
But what if it’s not high stomach acid that’s the cause of GERD?
And what if you don’t really need that repeat, life long prescription for those acid blockers?
And what if the low stomach acid (hypochlorhydria = the technical name) caused by the PPIs themselves, go on to cause a range of problems?
Low stomach acid problems
Stomach acid plays a critical role in your body.
It’s essential for:
So having low stomach acid is probably not a great idea.
Especially if artificially lowering stomach acid with PPIs, in order to relieve the symptoms of GERD, isn’t necessary (because there’s a different, natural way to achieve the same outcome).
Some of the symptoms of low stomach acid can include:
And that’s before we get to some of the chronic health conditions that are associated with low stomach acid, such as:
There are other (sometimes complex) problems that low stomach acid and increased levels of bacteria can cause:
Small Intestinal Bacterial Overgrowth (SIBO)
Small Intestinal Bacterial Overgrowth (SIBO) is the overgrowth of bacteria in the small intestine, this can increase intra-abdominal pressure too, and GERD is a symptom we commonly see in our clients with SIBO.
You can read the full article on our Functional Medicine approach to SIBO here.
Low stomach acid and bacterial overgrowth can increase food sensitivities, for example through poorly digested foods that then trigger an immune response (8) or increased intestinal permeability (9) (‘leaky gut’).
So to summarise: you don’t want to suffer with GERD, and you don’t want to suffer with the low stomach acid caused by PPIs.
As you can see, both GERD and the low stomach acid caused by PPIs are not just a gut issue, they have a much wider impact on health.
The Functional Medicine approach to GERD assesses and treats the root cause (or causes) of the condition.
This means that you can say goodbye to the symptoms of GERD and have optimal levels of stomach acid.
What's the root cause of GERD?
To understand how a Functional Medicine approach to GERD can help, it’s useful to first understand the real root cause or causes (spoiler alert: it’s not high stomach acid).
So what’s the real reason that stomach acid is ending up in the oesophagus instead of staying where it’s supposed to be?
Firstly, let’s explore the hypothesis put forward by conventional medicine, that GERD is caused by excess levels of stomach acid:
Stomach acid production declines significantly with age.
And prescriptions of PPIs – to block acid production – increase with age.
But if stomach is declining, why – in the same age group – are acid blockers being prescribed to huge swathes of the population for high stomach acid?!
It’s much more likely that people with already low stomach acid are being prescribed acid blockers that further lower their stomach acid.
And while this relieves their GERD symptoms, it causes other problems, because it doesn’t address the real, root cause, reason that stomach acid is ending up in the wrong place.
Added to that, in our clinical experience, when we give our clients who are suffering with GERD, HCl supplements (hydrochloric acid – the same acid that the stomach produces), they tend to get better.
But surely if we’re raising stomach acid levels by supplementing with HCl, the result should be significantly worse GERD symptoms?
There’s a lot here that doesn’t make sense.
The real cause(s) of GERD
High stomach acid is not the cause of the GERD epidemic.
The real cause of GERD is because the sphincter at the top of your stomach, a ring of muscle that’s called the lower oesophageal sphincter (LES), relaxes when it shouldn’t (the LES should only open when you swallow, or when you burp).
Regardless of the level of acid in the stomach, a relaxed LES lets acid into the oesophagus.
So why is the lower oesophageal sphincter relaxing when it shouldn’t be?
One answer is intra-abdominal pressure (IAP)
Intra-abdominal pressure is a build up of pressure in the abdomen.
This pressure causes the LES to relax (5), allowing stomach acid into the oesophagus.
So why does intra-abdominal pressure build up?
Low stomach acid.
And there are two main steps in how low stomach acid increases intra-abdominal pressure:
1/ Bacterial overgrowth
Proper levels of stomach acid (resulting in a low pH) can kill pathogens – including bacteria.
When there is low stomach acid levels, and the pH rises, then this provides an environment where bacteria can thrive.
Bacterial overgrowth can then lead to the fermentation of carbohydrates.
2/ Poor digestion of carbohydrates
An adequate level of stomach acid is critical for the proper digestion of food – including carbohydrates.
Where there is poor digestion of carbohydrates, intestinal bacteria ferment them, causing gas.
This gas increases intra-abdominal pressure (6), which causes the LES to open when it shouldn’t.
The poorly digested carbohydrate problem is compounded where there’s also bacterial overgrowth, because the increased bacteria cause even more gas and intra-abdominal pressure.
Other factors associated with IAP
- Lower oesophageal sphincter (LES) relaxation is influenced by factors such as:
- A hiatus hernia also affects LES function (10) – this is where part of the stomach moves up into the chest through an opening in the diaphragm, allowing food and stomach acid to go back upwards into the oesophagus.
Other factors associated with GERD
- The oesophageal mucosal lining may be damaged (10) causing an increased reaction to stomach acid, and therefore exacerbating symptoms
- Peristalsis – the contractions of smooth muscle to help move food down the digestive system – may not be functioning optimally in the oesophagus. Impaired peristalsis in the oesophagus can affect the movement of food and acid down to the stomach. A study found that those with severely impaired oesophageal peristalsis also had more severe reflux and slower acid clearance (11)
- Obesity is a risk factor for GERD, central weight gain (around the middle) is more closely correlated with the increased risk, rather than BMI. Increased adipose tissue around the middle increases pressure, risk of developing a hiatus hernia and LES abnormalities (12)
- Low stomach acid caused by factors such as stress, nutritional deficiencies e.g. zinc, stomach acid lowering medications and helicobacter pylori infection
- SIBO (small intestinal bacterial overgrowth), also shows a strong correlation in those with GERD. In fact, one study showed that 50% of patients taking PPIs also had SIBO, against only 6% in healthy control subjects (13)
The Functional Medicine approach to GERD
The Coho Functional Medicine approach to GERD addresses the root cause or causes of the condition.
Addressing GERD naturally and without medication can be quite straightforward if there are no complicating factors.
For instance, working with our clients to increase their stomach acid through designing a detailed HCl supplementation plan can be both cheap and very effective, together with personalised dietary recommendations.
Identifying and temporarily avoiding any trigger foods for GERD can help to bring about quick symptom improvement.
There are foods and drinks that frequently trigger GERD symptoms such as citrus fruits, caffeine, tomatoes, fried foods, and chocolate.
Keeping a food and symptom diary can be helpful.
Reducing stress levels (or better managing stress through various techniques), meal timing, avoiding trigger foods, and sleep position can also be important considerations.
Functional testing can help to pinpoint gastrointestinal imbalances that may be influencing intra-abdominal pressure and the function of the lower oesophageal sphincter (LES).
In cases where SIBO and / or IBS have developed alongside GERD, addressing all of the causes and effects of GERD can be a much more involved process.
In these cases, we work closely with clients to design a protocol to address the multiple imbalances, in a logical manner, to help resolve symptoms in the long term, rather than providing only temporary relief of symptoms.
Functional testing in GERD
Testing markers that help us to understand how the digestive system is functioning, can be extremely helpful.
A comprehensive stool test assesses:
Testing specifically for overgrowth of bacteria in the small intestine (SIBO test) can also be helpful, if there are signs and symptoms suggestive of SIBO.
Assessing stress levels through hormone testing may be of help in some cases.
GERD can be a really unpleasant, uncomfortable, and debilitating condition, that can compromise your quality of life.
Beyond the unpleasant feeling that acid reflux and heartburn can give you, GERD can also result in more serious health problems.
Not only that, but the conventional medical approach, and the medications prescribed, can not only make things worse in the long term, but can also bring health complications of their own.
That’s not what we want for you, especially when naturally addressing GERD through a functional medicine approach can achieve outstanding outcomes.
To your optimised, healthy future,
Dee & the Coho Health team
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