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.
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