Gastro-oesophageal reflux disease (or GERD) is one of the most prevalent medical conditions in developed nations today. In line with this, the second highest grossing pharmaceutical drug sold throughout the world is Nexium, an acid-suppressing medication that claims to ‘treat’ reflux. However as I will explain in this article, these acid suppressing drugs are far more likely to worsen and perpetuate the causative factors involved in the progression of reflux rather than provide treatment (beyond a suppression of symptoms of course).
The cause of reflux is a weakened oesophageal sphincter valve, not too much stomach acid
This valve separates the stomach and oesophagus, and under ideal conditions will only allow the passage foods and liquids into the stomach, and gas from the stomach back into the oesophagus. However if this valve is placed under excessive pressure for extended periods of time, it will begin to weaken and will be unable to maintain a fully contracted (ie closed) state, thereby allowing the movement of the contents of the stomach back up into the oesophagus.
The source of this excessive pressure is widely proposed to be from large volumes of gas produced in the stomach and small intestine, and this gas in turn is produced by unchecked populations of microorganisms such as bacteria and yeasts feeding off undigested carbohydrates in these environments.
The logical question then is to ask how these microorganisms have been able to proliferate. The answer is not enough stomach acid.
Reflux is associated with not enough stomach acid, rather than too much
Low levels of stomach acid create an environment that favours the growth of undesirable microorganisms in the stomach or small intestine. Additionally, low stomach acid reduces the secretion of pancreatic enzymes that normally break down carbohydrates in the small intestine, increasing the amounts of the substrates that feed and encourage the growth of these microorganisms. In the process of digesting these carbohydrates, the microorganisms release vast amounts of gasses, which then place a huge amount of pressure on the oesophageal sphincter valve and cause it to weaken. Undigested food, along with hydrochloric acid, is then ejected back into the oesophagus causing the hallmark symptoms of reflux.
But why does taking acid suppressing medication make me feel better?
Even though the levels of stomach acid in a person with reflux are likely to be lower than that of a healthy individual, any acid present in the stomach contents is likely to cause discomfort and corrosive damage in the unprotected oesophagus. Thus taking an acid suppressing medication will eliminate the symptoms of reflux, however as I hope I’ve explained above this will ultimately perpetuate a weakening of the lower oesophageal sphincter through creating an environment favourable to pathogenic microorganism overgrowth. Furthermore, long term usage of acid suppressing medication is associated with a raft of side effects and illnesses including:
- Malabsorption of crucial nutrients such as B12, B9, B6, B3, calcium, magnesium, iron and zinc
- Poor digestion of proteins, leading to amino acid deficiencies that can be associated with depression, anxiety and insomnia
- Overgrowth of detrimental microorganisms such as H. pylori, salmonella, listeria, campylobacter, C. difficile, and Candida
- Stomach cancer
- Allergies
- Diabetes
- Osteoporosis
How do I treat reflux?
I have found the best treatment for reflux is a combination of therapies designed to increase the production of stomach acid, as well as dietary interventions to reduce the volume of carbohydrates consumed. Often there is the need to re-establish a healthy microbiome in the GIT. Other factors that may come into play include weight loss (obesity is strongly correlated to the development of GERD), elimination of chronic infections, and adrenal support.
Note that in those patients that have been on acid suppressing medications for a long period of time (despite the fact that the medical literature proposes that these drugs are taken for no longer than 5 weeks!), it is very important to wean off the medication slowly as the protocols mentioned above are underway. A sudden cessation of the medication will cause a dramatic rebound production of stomach acid while the lower oesophageal sphincter is still in a weakened state, and severe reflux symptoms will result.
I hope this has cleared up the true cause of reflux, and explained why taking acid suppressing medications is likely to perpetuate rather than treat this all too prevalent health issue.
In wellness,
James
