Heartburn Ė GERD Ė Acid Reflux

Acid Reflux and Heartburn: The Underlying Causes
The Prevalence of Acid Reflux Disease 
Symptoms of Acid Reflux
So Why Is Acid Refluxing? 
The Myth About Heartburn 
What Causes Heartburn?
Stomach Acid: Why You Need It
Surgery for GERD?
What's Wrong with Antacids, Proton Pump Inhibitors and H2 Blockers?
References

Acid Reflux and Heartburn: The Underlying Causes
Heartburn or acid reflux or GERD -- whatever the name, if you are like millions of others, you are experiencing this gastrointestinal malady. 
You may take your acid reflux problem for granted and buy your antacids at Costco, but you should be aware of the negative effects this has on your entire body. You also should know that heartburn is a sign of other problems, and can almost always be treated without acid blockers. 

The Prevalence of Acid Reflux Disease
Acid rising from the stomach and irritating the lower esophageal sphincter (LES), the valve that separates the esophagus from the stomach, results in the feeling of what is commonly called heartburn. 
Some 35 to 45 percent of the population experiences heartburn, often called GERD or "gastroesophageal reflux disease". Thatís a whopping 116 million people! Itís also the most profitably treated symptom in America. Last year Prilosec was the top selling prescription drug in the world, earning Astra Zeneca, the drug's maker, 6 billion dollars. 
This sad state of affairs means that it is almost considered normal to have GERD and to take drugs for it. However, heartburn is far less than normal, and those experiencing it are definitely nowhere near optimal health. 

Symptoms of Acid Reflux 
Acid reflux is generally felt as a burning pain in the middle of the chest. It may also feel like a pressure in the chest. In some people it can be so bad that it is difficult to keep food down and may even result in dental erosion. 
Over time reflux can result in damage to the LES, called Barrettís Esophagitis, and even cancer. If you have chronic heartburn or reflux then be sure to have a thorough examination by a gastroenterologist to rule out this serious conditions. 
Sometimes this chest pain is confused with heart pain. If you are unsure about the cause of any pain in your chest, be sure to have a thorough exam by your doctor. 

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So Why Is Acid Refluxing? 
There are several causes of acid reflux, but the common thread is the relaxation of the LES. Once the LES relaxes, acid is afforded the opportunity to rise from the stomach and damage the esophagus, resulting in a burning feeling. 
Once the esophagus has been damaged it is very slow to heal. Antacids, histamine blockers and proton pump inhibitors only shut down acid production, they donít promote healing of the LES, nor do they cure the cause of the heartburn. 

The Myth About Heartburn 
Itís commonly believed that heartburn is the result of overeating. And although 116 million Americans may overeat, the size of the meal has no scientific correlation with the frequency of heartburn. 
ďThen we must be producing too much stomach acid,Ē you say. Having too much acid production is very rare. In fact, the opposite is the case. In most people, stomach acid decreases with age. 

What Causes Heartburn? 
In order to cure acid reflux disease, you must remove the cause of the problem and promote the healing process. The following are the most common causes: 

Food allergies: In my practice I have found that a majority of cases of heartburn are caused by food allergies. Food allergies often cause a host of other problems and can be diagnosed with a simple blood test. 

Foods: certain foods cause the lower esophageal sphincter to relax, thus leading to heartburn. These include peppermint, coffee, alcohol and chocolate. 

Hiatal hernia: This is a physical condition where part of the stomach protrudes through the diaphragm. It can generally be reduced without surgery, though even when present it is not necessarily the sole cause of heartburn 

Low Acid Production: Ironically, low stomach acid levels can result in heartburn. This is much more common than increased acid. This problem can be assessed clinically and is readily treatable. 

Medications: Many medications cause heartburn as a side-effect, including, several acid blockers. These include:

  • Acid Blockers: Prevacid, Prilosec, Zantac, etc. 
  • Asthma inhalers (beclamethasone, flovent, etc). 
  • Corticosteroids 
  • Nonsteroidal anti-inflammatory medications (NSAIDs), such as aspirin, ibuprofen, and naproxen. 
  • Antianxiety medications, such as diazepam (Valium) and lorazepam (Ativan). 
  • Osteoporosis drugs such as alendronate (Fosamax).

Overeating: Of course. The stomach is only so big, even if the eyes and the mouth are bigger. 

Pregnancy & Obesity: These are related in that both put pressure on the stomach, decreasing itís volume and forcing food back from whence it came. 

Stress: Stress is a small word with big health consequences. Stress can be the sole cause of heartburn, but often it is exacerbating other causes. Regardless, there are nutrients, herbs and therapies that will help you deal with your stress. 

Smoking: Smoking also causes the lower esophageal sphincter to relax, leading to heartburn. 

If you experience heartburn please schedule an appointment so that we can sort through the possible causes and provide you with permanent relief. Even heartburn caused by necessary drugs can be treated in a way that is much healthier and more effective than acid blockers.

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Stomach Acid: Why You Need It
Stomach acid is vital to good health. It is the first major step in breaking down your food, which is so critical to proper nutrition. The myth is that you are what you eat. But in fact, you are what you absorb. Acid is especially important for breaking down proteins into amino acids and is required for the optimal release and preparation of minerals such as calcium, magnesium and iron for absorption. 

Vitamin B12 also isnít adsorbed without it. The same cells that produce acid produce intrinsic factor, which is required for B12 absorption. Without B12 you become B12 deficient, leading to fatigue and neurological problems. 
Decreased acid levels can also cause digestive problems further on down the line. Pancreatic enzymes, bicarbonate and bile are all released in the small intestine in response to the acidic load that normally leaves the stomach. Without these digestion continues to degenerate, resulting in a far less than optimal nutritional gain from your food and potentially damaging byproducts. The pH, now off in the entire digestive tract, damages the environment for billions of normal/good bacteria, critical to proper digestion and good health.

Stomach acid is also your primary defense against food-borne infections. Bacteria donít usually survive the stomach, therefore decreased acid increases your risk of food poisoning.

Nutrients provide the building blocks for our entire biochemistry. Optimal health requires optimal nutrition. And that is why you need stomach acid. 

Surgery for GERD?
Surgery has virtually no role in the management of this mostly physiologic problem and future generations will realize how foolish our current medical model has been by trying to treat GERD with surgery.

GERD is consistently one of the most treatable conditions that I see in my clinical practice. My success rate is well over 90%, and it is quite rare for patients to fail to respond to conservative, non-drug, non-surgical treatments. 

The Digestive System Made Simple: The stomach connects to the small intestine connects to the large intestine ending with the rectum. The liver (waste products), gallbladder (bile and cholesterol) and pancreas (digestive enzymes) dump products into the small intestine to be used, excreted and/or reabsorbed. Nutrients and liquids are absorbed across the intestinal lining.

What's Wrong with Antacids, Proton Pump Inhibitors and H2 Blockers?
Ever heard of the antacids Alka-Seltzer, Maalox, Mylanta, , Rolaids, or TUMS? How about the proton pump inhibitors Prevacid, Prilosec, Aciphex, or Nexium? Or the H2 blockers Zantac, Tagamet, and Pepcid AC. This could be a list of whoís who in drugs. What do these drugs have in common (other than a HUGE marketing budget)? They all reduce stomach acid, either by neutralizing it or blocking its production. They also earn a ton of money.

The problem with all this is that you actually need your stomach acid. You donít need a medical degree to understand that the acid in the stomach is there for a good reason - to help you digest your food.

Drug companies have created a market for these products based on the premise that acid is the enemy, and that if you have acid reflux, then youíve got too much acid. Keep fighting it with these miracle drugs and it wonít win.

However, scientific studies have demonstrated that this is simply not the case. Itís quite rare to have too much acid. 40 million people do not have super acidic stomachs. In fact, quite the opposite is the case. Itís much more common to have inadequate stomach acid. Decreasing stomach acid may temporarily solve the burn, but it wonít cure the problem. Over time it will also create many more problems, and the longer you go on knocking it down, the further your health declines 
Finally, these drugs have many side effects, including heartburn (ironically), diarrhea, constipation, and many others. Whatever the name -- acid reflux disease, GERD, or heartburn -- there is a much better way than drugs. 

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References
This is a limited list of articles about GERD - Acid Reflux. More is available on the Innate Health Foundation Research Page.

Carroccio, et. al. (2009). Clinical symptoms in celiac patients on a gluten-free diet. Scand J Gastroenterol. 2008;43(11):1315-21.

Cavataio, F., Carroccio, A., & Iacono, G. (2000). Milk-induced reflux in infants less than one year of age. Journal of Pediatric Gastroenterology and Nutrition, 30(Suppl.), S36-S44.

Forget P, Arends JW. (1985). Cow's milk protein allergy and gastro-oesophageal reflux. Eur J Pediatr. 1985 Nov;144(4):298-300.

Garrean C, Hirano I. (2009). Eosinophilic esophagitis: pathophysiology and optimal management. Curr Gastroenterol Rep. 2009 Jun;11(3):175-81.

Heine, RG. (2008). Allergic gastrointestinal motility disorders in infancy and early childhood. Pediatr Allergy Immunol. 2008 Aug;19(5):383-91.

Heine, RG. (2006). Gastroesophageal reflux disease, colic and constipation in infants with food allergy. Curr Opin Allergy Clin Immunol. 2006 Jun;6(3):220-5.

Janiszewska T, Czerwionka-Szaflarska M. (2003). [IgE-dependent allergy--the intensification factor of gastroesophageal reflux in children and youth][Article in Polish] Med Wieku Rozwoj. 2003 Apr-Jun;7(2):211-22.

Levy et. al. (2009). Diagnostic clues for identification of nonorganic vs organic causes of food refusal and poor feeding. J Pediatr Gastroenterol Nutr. 2009 Mar;48(3):355-62.

Nielsen et. al. (2004). Severe gastroesophageal reflux disease and cow milk hypersensitivity in infants and children: disease association and evaluation of a new challenge procedure. J Pediatr Gastroenterol Nutr. 2004 Oct;39(4):383-91.

Rashid M. et. al. (2005). Celiac disease: evaluation of the diagnosis and dietary compliance in Canadian children. Pediatrics. 2005 Dec;116(6):e754-9.

Semeniuk J, Kaczmarski M. (2008). Acid gastroesophageal reflux and intensity of symptoms in children with gastroesophageal reflux disease. Comparison of primary gastroesophageal reflux and gastroesophageal reflux secondary to food allergy. Adv Med Sci. 2008;53(2):293-9.

Semeniuk J, Kaczmarski M. (2007). 24-hour esophageal pH monitoring in children with pathological acid gastroesophageal reflux: primary and secondary to food allergy. Part I. Intraesophageal pH values in distal channel; preliminary study and control studies--after 1, 2, 4 and 9 years of clinical observation as well as dietary and pharmacological treatment. Adv Med Sci. 2007;52:199-205.

Semeniuk J, Kaczmarski M. (2007). 24-hour esophageal pH monitoring in children with pathological acid gastroesophageal reflux: primary and secondary to food allergy. Part II. Intraesophageal pH values in proximal channel; preliminary study and control studies--after 1, 2, 4 and 9 years of clinical observation as well as dietary and pharmacological treatment. Adv Med Sci. 2007;52:206-12.

Semeniuk J, Kaczmarski M. (2006). Gastroesophageal reflux in children and adolescents. clinical aspects with special respect to food hypersensitivity. Adv Med Sci. 2006;51:327-35.

Spergel JM. (2007). Eosinophilic esophagitis in adults and children: evidence for a food allergy component in many patients. Curr Opin Allergy Clin Immunol. 2007 Jun;7(3):274-8.

Usai P. (2008). Effect of gluten-free diet on preventing recurrence of gastroesophageal reflux disease-related symptoms in adult celiac patients with nonerosive reflux disease. J Gastroenterol Hepatol. 2008 Sep;23(9):1368-72.

 

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