GERD is an abbreviation for gastroesophageal reflux disease. Mayo Clinic defines GERD as a “chronic digestive disease that occurs when stomach acid or, occasionally, bile flows back (refluxes) into your food pipe (esophagus). The backwash of acid irritates the lining of your esophagus and causes GERD signs and symptoms”. They also state “signs and symptoms of GERD include acid reflux and heartburn”. And finally, “when these signs and symptoms occur more than twice each week or interfere with your daily life, doctors term this GERD”.
OK, first of all, I am completely opposed to the use of the word “disease” when referring this symptom. According to dictionary.com the definition of “disease” is: “a disordered or incorrectly functioning organ, part, structure, or system of the body resulting from the effect of genetic or developmental errors, infection, poisons, nutritional deficiency or imbalance, toxicity, or unfavorable environmental factors; illness; sickness; ailment.” The key in this definition are the words “resulting from”.
Mayo Clinic says this about the causes of GERD: “GERD is caused by frequent acid reflux — the backup of stomach acid or bile into the esophagus. When you swallow, the lower esophageal sphincter — a circular band of muscle around the bottom part of your esophagus — relaxes to allow food and liquid to flow down into your stomach. Then it closes again. However, if this valve relaxes abnormally or weakens, stomach acid can flow back up into your esophagus, causing frequent heartburn and disrupting your daily life. This constant backwash of acid can irritate the lining of your esophagus, causing it to become inflamed (esophagitis). Over time, the inflammation can erode the esophagus, causing complications such as bleeding or breathing problems.”
First off, Mayo Clinic (and WebMD) make no reference to GERD “resulting from the effect of genetic or developmental errors, infection, poisons, nutritional deficiency or imbalance, toxicity, or unfavorable environmental factors; illness; sickness; ailment”, as stated in the definition of “disease”. So why then, is this condition labeled a disease? Well…I’ll avoid the politics of why it may be more advantageous for certain special interest groups to label a condition a “disease”. However, when related to a nutritional deficiency, (which I commonly find to be the cause), I suppose it’s appropriate to label it a “disease”. Mayo Clinic and WebMD do not mention nutritional deficiencies as the cause, therefore I can’t figure out why they are still calling it a disease. I also don’t know “who” first declared it a “disease”.
Second, it makes little sense to me that Mayo Clinic says “GERD is caused by frequent acid reflux”. Think about that, is GERD caused by frequent acid reflux? I would say “NO”! GERD is frequent acid reflux, as they mention in the definition. To me that’s like saying, your cancer is caused by cancer. So the question remains: What causes (frequent) acid reflux?
WebMD states that the following can be causes of acid reflux:
1) Foods such as chocolate, onions, peppermint, coffee, high-sugar foods, and possibly high-fat foods. “Alcohol, tobacco (nicotine), and some medicines can also relax the lower esophageal sphincter.” Other possibilities are spicy, citrus, and tomato foods.
2) Hormonal changes during pregnancy that can relax the lower esophageal sphincter.
3) A weak lower esophageal sphincter; no cause for that was mentioned.
4) Hiatal Hernia: when part of the stomach protrudes upward into the diaphragm. The esophagus travels through a hiatus in the diaphragm to reach the stomach. The “hernia” relates to the protrusion of the stomach into the esophageal hiatus.
5) Slow digestion – that is, if food stays in the stomach too long before emptying into the intestines.
6) Overfull stomach- from eating very large meals.
WebMD states the following for conventional treatments: lifestyle changes (presumably food choices); over-the-counter or prescription acid blocking drugs such as: Tums®, Pepsid®, Prilosec®, Nexium®, and Tagament®; and surgery.
Here is my approach to treating patients with stomach and heartburn symptoms. I do NOT treat GERD (or symptoms). I treat people.
1) Avoiding foods may be necessary, but I often (not always) do not see them as the cause of the problem. If they were the cause, then probably most (or all) people eating those foods would develop heartburn symptoms and GERD. Additionally, eating smaller meals, and combining foods properly can help (i.e.: no starches with proteins, high fats, or high acid foods). But, as you know, for most people, I’m against eating starches all together – so that fixes the food combining problem. Also, it might worth it to avoid combining fruit with anything if you suffer from heartburn or GERD symptoms.
2) Eating just before going to bed is a bad habit for a number of reasons, and I especially don’t recommend it if you have heartburn or GERD. Also, you should not lie down within at least 2 hours after eating.
3) GET READY FOR THIS ONE – Very often, the cause of heartburn is a LACK of enough (hydrochloric) stomach acid, not too much. The reason is because when you don’t have enough necessary hydrochloric acid, the food in your stomach will ferment. It is then excessive acids of fermentation that cause the burning sensation, not excessive amounts of necessary hydrochloric acid. So some conventional ideas and treatment are totally off base when treating these symptoms with antacids. Don’t get me wrong, the medication will certainly bring quick relief, because it will neutralize the acids of fermentation also. However, it will bring a whole host of additional problems, which I’ll be writing about soon. Some people may in fact be making too much stomach acid, but they are very few and far between – at least from what I (and my colleagues) see in patients. So what’s the solution – perhaps actually taking a supplement with hydrochloric acid in it. And then, I make sure to get at the root of the problem for the low stomach acid to begin with.
4) You may to need to be checked for an overgrowth of yeast, fungus, parasites, bacteria, and viruses in your digestive tract that may compromise digestion in general and contribute to heartburn symptoms and GERD.
5) When the heartburn symptoms or GERD stem from a hiatal hernia, I can often relieve the symptoms doing simple structural adjustments. You see, one of the hip flexor muscles (the (ilio)psoas) has a direct attachment to the diaphragm (not shown in the picture). Often, if one them is inhibited or “weak”, the other will be over-facilitated and “tight”. As a result, the diaphragm becomes compromised and can result in a hiatal hernia, where the stomach protrudes into the esophageal hiatus and may cause the burning sensation. Therefore, treatment would be aimed at correcting the muscle dysfunction and adjusting cervical, thoracic, lumbar, pelvic, and/or extremity joints in order to get the hip flexors and diaphragm functioning properly.
One last thing – aberrant emotional complexes almost ALWAYS affect the stomach and digestion in general. So you may want to consider Neuro Emotional Technique® or Emotional Freedom Techniques®.
Heartburn symptoms and GERD which cause people a lot of distress is usually very simple to correct; and it’s something I see in my patients on a regular basis. Be very, very afraid of acid-blocking medications (unless you truly have too much hydrochloric acid in your stomach which can cause ulcers), because of the harmful problems they cause. Again, I’ll discuss that in another article.
I’d like to make it clear that I am not saying all heartburn symptoms and GERD are a result of the problems I find. However, it would be worth your while to have those potential problems investigated instead of taking medication.
Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology
Interesting take on Acid Reflux. I think that TRUE GERD is rare and that often people are being overdiagnosed. Also there are different intensities of medication that you referenced and you should always start on the least strong medication and work your way up as needed (if you choose to treat it pharmacologically) rather than the other way around. There is much research supporting prolonged use of strong medications that phsyically block acid production in the GI system can be damaging to the digestive system if used when not needed over a prolonged time.
I do agree that GERD is Acid Reflux. I think that the differentiating factor is that acid reflux can occur in the absence of GERD . . but that ongoing or chronic acid reflux IS GERD. GERD is a disease because the material being refluxed (whether from too much acid or not enough acid) is indeed toxic, and the repetive act of it causes erosion and destruction of the sensitive tissues lining our esophagus, pharynx, and lungs.
As a medical speech-language pathologist I deal with dysphagia or swallowing disorders. So there is a bit of cross over between esophageal issues and pharyngeal (throat) isses with swallowing. In severe cases of retroflexive motion of the bolus (whether from reflux, esophagitis, candida, GERD, motility issues, etc) its very harmful when the upper esophageal sphincter (UES) is malfunctioning. . . which is the constrictor between your esophagus and your pharynx and remains closed at rest and opens when you swallow. Perhaps its just my profession that gives me this slant, but the worst thing i see with GERD is that the reflux is so severe (or the lower sphincter is not opening causing a severe back up of material) that the material flows back up through the UES and into the throat (the path to the airway is only protected during the swallow. . soo) leaving it to gravities path of least resistance taking it straight into your airway past your vocal folds and into your lungs. This “acid” burns your vocal folds–causes nodules and irritation and in worst case scenarios causes aspiration during each and every meal eventually resulting in respiratory issues and developing lung damage and aspiration pneumonia. Some of my patients have such devestating GI issues, often complicated by reflux, that it is not safe for them to eat by mouth at all and they have to bypass the throat, esophagus and stomach, and use tube feedings straight to their jejunum (small intestine).
If you do suffer from “heartburn” indigestion, GERD whatever you want to call it. I would try managing it behaviorally first.
Watch what you eat. It doesnt mean you need to never eat your favorite foods again. . just eat with awareness knowing that. . ohhh if i have this jalepeno taco covered in hotsauce with tomatoes and orange juice. . im going to reflux. . . and make the conscious decision if thats okay for you at that moment.
There is a great resource at http://www.heartburnalliance.org that I share with my patients. Its a fridge and pocket version of the green, red, yellow light food system letting you know which foods are most to least acidic so you can make these conscious food choices through out your day.
Also, research heavily supports eating 6 smaller meals a day vs 3 large meals to aide in digestion and reduce food back up.
Not eating right before you lay down (yes really stay upright for two hours) This was the biggest one for me personally because I like to keep a glass of water by my bedside. . . but for those that dont know, liquids are acutally harder to swallow than solids because of how fast they move!! Anddd the same applies for when they come back up. . the liquids are able to come up before anything heavier can. . and the water’s thin scattered nature makes those liquids the first thing to go the wrong way when you reflux too. So be aware. . when you chug that glass of water and lay down for bed or when you bend over to tie your shoes after eating. . and that uncomfortable feeling occurs. . .that thats “positional reflux.”
If you wake up with bad breath, a sore throat, in the absence of sickness and allergy often. .you may be experiencing reflux in your sleep. Sleeping at a 35 degree angle via pillows (or some of my patients even put blocks under their headboards) can reduce the backflow of stomach contents up into the throat and airway.
Regarding treating GERD or reflux with hydrochloric acid im a lil hesitant and very curious. How much hydrocholoric acid are we talking here? I just worry about the severe corosive nature of hydrochloric acid based on the MSDS (Materials Safety Data Sheet re: hydrochloric acid http://www.jtbaker.com/msds/englishhtml/H3880.htm) Its pretty toxic stuff. ANd thats being measured at only 33% with heavy dilution. . . However it is something the stomach produces naturally on its own. . . or should in most cases so i can understand the validity of trying it. . but am cautious.
I think the real question you are battling here is how to differentiate what the cause of the GERD is from person to person. . . because sometimes its too much hydrochloric acid. . and sometimes its probably too little.. . but the most common way people find out is by trying “something” for 2 to 3 months and if it works for them they stick with it. If nothing works then hopefully the go get a diagnostic work up like an egd to identify if there is a diverticulum or a stricture or other structural issue.
Which in turn creates the question of which treatment method has the least negative long-term effects so that you can try them out in order.
I personally suffer from GERD as do many of my friends, patients, and co-workers so I encourage research on alternative treatment fo the disease. Thanks for the write-up!
Ali – Thank you so much for your generous contribution to this article, I truly appreciate it.
I agree with you that people are being over/mis-diagnosed with GERD. That is one of the major points I’d hoped to get across with this article. And I will be writing about the dangers of prolonged use of antacids and acid-stopping medications.
I do not consider hydrochloric acid (HCl) as being toxic, but I suppose if it is introduced into the esophagus, pharynx, or lungs, it can be. Therefore, it may be appropriate to coin GERD as a “disease”.
I also agree with you in that people may want to consider lifestyle/eating habits as the first remedy. Although, I believe an evaluation from a licensed physician would be the best route. I must say that I find it hard to believe that certain foods CAUSE reflux, heartburn GERD, etc. because if they actually CAUSED the problem, then everyone eating them would most likely experience the same problem. In my opinion, it is more the individuals’ response to those foods, which has to do with individuals’ structure, biochemistry, physiology, and neurology. They may exacerbate symptoms, but I can’t see them as a cause as if often stated.
As far as HCl supplementation is concerned, I am referring to “food-grade HCl”. See these links: http://tinyurl.com/modenb and http://tinyurl.com/mfpvkq.
There is a test called the Heidelberg test, which is capable of measuring the amount of HCl a person can/does produce – see this link- http://www.seattledigestivehealth.com/Heidelberg.htm. Does your facility utilize this test before dispensing acid-blocking medications? I also wonder how many times this is performed by doctors before they prescribe acid-blocking medications. I personally do not use this test, because of how benign the potential side-effects of HCl are. Though now I am going to look into it. And, to date, I’ve only had one patient complain of discomfort in his stomach after taking an HCl supplement. It was so mild he even continued to use it, however I instructed him to stop. Please note, patients are instructed not to chew this supplement, in addition to taking some baking soda with water if they experience pain or burning. Acid-stopping medications on the other hand can be extremely harmful with long-term use, as you mentioned.
To delve even deeper, research shows that there are actually 4 types of stomachs a human can have. See here for more on that- http://tinyurl.com/lqtup8. I wonder if any research has been done on which type of stomach people with “TRUE GERD” are more likely to have.
Additionally, sympathetic and parasympathetic nervous system activity has a lot to do with digestion. Perhaps those with “TRUE GERD” have an under-lying imbalance in the nervous system.
Hormones also have much to do with the function of the pyloric sphincter, which leads into the duodenum (upper small intestine). If this sphincter remains closed due to a hormonal imbalance, food will sit in the stomach longer and perhaps cause and/or exacerbate symptoms of GERD, reflux, or heartburn. See here about hormones – http://tinyurl.com/nayqmp and http://tinyurl.com/m6fzht.
Lastly, substances called prostaglandins affect cardiac sphincter (or lower esophageal sphincter) muscle function, at the junction of the esophagus and stomach – the one blamed for GERD. These chemicals can often be mediated through fatty acid balance in the system and are often imbalanced with poor fats in the diet as well as inflammation. See here for more on prostaglandins – http://tinyurl.com/lygnth.
I hope research is done on the CAUSE of GERD and it’s symptoms. Finding the cause is always better than “painting over the rust” with medication or even supplements; especially when they have the potential deleterious effects of antacids and acid-stopping medications. I often see the cause of low stomach acid as a result of zinc-deficiency, and nervous system dysfunction. As a result, I am able to eventually discontinue the use of supplements in my patients, once those imbalances are completely resolved.
In conclusion, I speak about this condition(s) as I see it in my patients, from my (and my colleagues) experience and in regards to how my patients respond to treatment. Ali, something tells me we see different patients with the same symptoms of GERD, reflux, heartburn, etc., stemming from a different cause. And I will certainly keep you and your facility in mind if I encounter a patient with unremitting symptoms of GERD, reflux, or heartburn. Thank you again for your generous, knowledgeable contribution.