Do You Suffer From Heartburn or Acid Reflux?
Gastro-oesophageal reflux disease( GORD) is a condition where the lower oesophageal sphincter (or LOS – the muscular ring at the lower end of the oesophagus) is abnormally relaxed and allows the stomach’s acid contents to flow back or reflux into the oesophagus. It can also cause heartburn.
Causes
- Symptoms typically occur after eating a large or fatty meal or drinking alcohol
- Lying down, bending over or bending and lifting can all cause reflux
- Pregnancy – because the uterus increases in size during pregnancy, it presses on the stomach, creating higher pressure inside it, which increases the tendency to reflux. In addition, hormonal changes lead to relaxation of the oesophageal sphincter during pregnancy
- Meals – the more the stomach is stretched by food, the higher the tendency to reflux. Avoiding large rich meals, particularly in the evening, reduces the tendency to reflux
- Foods – chocolate, peppermint, coffee, fruit juices and alcohol all prevent the oesophageal sphincter from working properly
- Tobacco prevents the oesophageal sphincter from working properly, reduces the rate at which the stomach empties and increases stomach acid production
- Constipation increases the tendency to reflux by raising pressure inside the upper abdominal cavity
Symptoms
- A painful or burning sensation in the upper abdomen or chest, sometimes radiating into the back – this is what is commonly referred to as heartburn
- The acid reflux may reach the pharynx and mouth, causing a sour taste and burning
- A small number of patients have difficulties breathing and suffer from hoarseness because the refluxed fluid irritates the larynx and respiratory tract
- Excess belching is common
Risk factors
Prolonged exposure to acid reflux may lead to oesophagitis (inflammation of the oesophagus). Long-standing oesophagitis may eventually lead to the formation of scar tissue that contracts and results in a narrowing (or “stricture”) in the affected part of the oesophagus. This can make it difficult or even impossible to swallow. It is a serious condition that requires urgent assessment and treatment, but, fortunately, this complication is relatively rare.
It can cause ulceration, leading to bleeding and an iron deficiency, which may develop into anaemia due to chronic blood loss.
Dietary modification
Historically, low-fat diets have been recommended to patients with GORD because fatty foods appeared to be associated with increased heartburn and had been shown to weaken the LOS in both healthy people and people with GORD. However, a number of recent studies have found no correlation between the fat content of a meal and subsequent symptoms of heartburn and reflux.
One study compared different fast foods for their likelihood to cause reflux symptoms and found that chilli and red wine caused more symptoms than higher-fat foods such as hamburgers and French fries. Studies show that eating a very-low-carbohydrate diet (less than 20 grams of carbohydrate per day) leads to a significant improvement in symptoms of GORD, especially if the person is obese.
Eating foods or drinking beverages flavoured with spearmint, peppermint, or other spices with strong aromatic oils causes relaxation of the LOS and can exacerbate symptoms of GORD. Chocolate also relaxes the LOS and can cause heartburn. Acidic beverages like juices, coffee and tea have also been linked to increased heartburn pain, as have carbonated drinks, alcohol and milk.
Infants who suffer from GORD may have a true allergy to cows’ milk. (Studies range from 20-40% incidence in children with GORD). It is probably always worth a trial of cows’ milk elimination to see whether the symptoms improve.
Lifestyle modification
Smoking weakens the LOS and is a strong risk factor for GORD. Research shows that even second-hand smoke exposure can directly contribute to symptoms in babies and children. The risk of GORD increases with obesity – in part, due to weaker sphincters in the diaphragm and the increased incidence of hiatal hernia.
It is generally recommended that people with GORD do not lie down within three hours after eating. This is because lying flat removes the assistance of gravity in keeping stomach contents below the diaphragm. Elevating the head of the bed is also a good generalised precaution to reduce night-time symptoms.
Symptoms of GORD generally occur more frequently during exercise than at rest. Running seems to be worse than less impactful exercises such as cycling. Eating prior to exercise will further exacerbate symptoms. On the flipside, people who participate in little or no exercise are more likely than active people to develop more serious symptoms of GORD. So, on balance, it makes sense for people with GORD to use exercise as part of a healthy lifestyle, perhaps choosing activities that are less likely to cause reflux symptoms.
Conventional treatment
The so-called “proton pump inhibitors” such as omeprazole, lansoprazole, pantoprazole and rabeprazole, and the H2 blocker agents such as Zantac, Pepcid and Tagamet, are commonly prescribed for oesophageal reflux.
However, these drugs dramatically reduce the amount of hydrochloric acid production in the stomach, thereby drastically diminishing the ability to digest food properly. This reduction in the amount of stomach acid also reduces a very important defence mechanism against food-borne infections and increases both the likelihood of food poisoning; as well as internal dysbiosis, frequently leading to problems such as fungal or candida overgrowth.
In the absence of sufficient hydrochloric acid in the stomach, partially digested food enters the gastro-intestinal tract. This in turn increases the risk of inflammation, autoimmune disorders and food sensitivities. Studies have repeatedly shown that reducing the concentration of hydrochloric acid in the stomach is overtly detrimental to overall health and digestive capacity.
Many people suffering acid reflux in later years do so due to the naturally diminishing production of hydrochloric acid by the stomach. This leads to partially digested proteins passing from the stomach into the duodenum and the ensuing putrefaction leads to burning, gas and discomfort. The best solution for such people is:
1) Supplementing with a hydrochloric acid capsule before each main meal
2) Avoiding protein and carbohydrate combinations in the same meal; due to the extreme variation in breakdown time in the stomach
3) Eating smaller, more frequent meals
Nutritional supplement treatment options
Hydrochloric Acid and Pancreatic Enzymes will generally improve digestion and will help prevent reflux.
Probiotics help to maintain a normal gut bacterial flora.
Bromelain is a proteolytic enzyme which helps the body break down and digest proteins.
l-Glutamine improves nutrient absorption and minimises the amount of undigested food or environmental toxins passing through the intestinal barrier.
Proteolytic enzymes are naturally produced by the stomach and pancreas; but can be taken as a supplement to promote the breakdown of carbohydrates, protein and fat.
Botanical treatment options
Licorice – studies suggest that licorice may help relieve symptoms of indigestion and GORD
Other herbs traditionally used to treat reflux and heartburn include soothing agents (called digestive demulcents) such as aloe vera, slippery elm, bladderwrack and marshmallow. None of these have been scientifically evaluated for effectiveness in GORD. However, the popular drug Gaviscon®, contains magnesium carbonate (as an antacid) and alginic acid which is derived from bladderwrack.
Article contributed by Dr Tracy S Gates, DO, DIBAK, L.C.P.H., Consultant, Pure Bio Ltd. Copyright © Pure Bio Ltd 2023. All rights reserved. Pure Bio Ltd are a leading UK supplier of the highest quality PURE nutritional supplements, based in Horsham, West Sussex.
Proud Winners of Southern Enterprise Awards, Best Nationwide Hypoallergenic Nutritional Supplements Distributor 2022. Visit www.purebio.co.uk for all your nutritional supplement needs.
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