Acid Reflux – Why Acid Blocking Medications Are Not the Solution

Acid reflux also known as GERD (Gastroesophageal Reflux Disease) or heartburn affects millions of people on a daily basis.  As a result, acid blocking medications like Pepsid, Prilosec, and Nexium are some of the worlds best selling drugs with annual sales in the billions.  These powerful pharmaceutical drugs were originally developed and marketed as a short-term solution for severe cases of peptic ulcers with a suggested use of no longer than six weeks.  Despite this fact, the majority of patients I see who have reported reflux symptoms to their doctor have been placed on one of these medications as a long term solution and have been taking it for years.  Prilosec is even available over the counter now without a prescription.

The danger of taking these drugs in this fashion is that you need stomach acid to digest food and absorb nutrients properly.  Long term use of acid blocking medication has been shown to lead to a myriad of vitamin and mineral deficiencies like magnesium, calcium, and B12 and increased risk of osteoporosis, insomnia, depression, anemia, fatigue, nerve damage, and dementia.  Long term use of acid blockers can also lead to overgrowth of bacteria in the stomach and small intestine leading to peptic ulcer disease and irritable bowel syndrome.

The Underlying Cause

Believe it or not, acid reflux is not typically caused by too much stomach acid but by too little.  Confused?  Well here is a little anatomy and physiology lesson.

Your esophagus is separated from your stomach by a ring of muscles called the Lower Esophageal Sphincter (LES).  This sphincter is responsible for keeping the contents of the stomach including food and stomach acid from entering back up into the esophagus.    The single most important determinant of the LES staying closed and preventing acid reflux into the esophagus is adequate levels of stomach acid.  When there is sufficient acid production in the stomach there is direct feedback to the LES which causes  increased tone and prevents the stomach contents from rising back into the esophagus.  If stomach acid is low when food enters the stomach, the tone of the LES is compromised and is not able to keep the stomach contents, including acid, in the stomach thereby leading to acid reflux.

So what causes low stomach acid production?  On-the-go, high stress lifestyles fool our body into responding as if we are being chased by a tiger instead of peacefully eating dinner.  This stressed state leads to a decreased ability to properly digest our food.   Your nervous system has two main states you are constantly oscillating between.  A sympathetic nervous state is when you are being chased by the tiger and need to move quickly and make fast decisions, a.k.a. “fight-or-flight.”  A parasympathetic nervous state is the “rest-and-digest” state.  One of the main underlying causes for acid reflux is people are eating when they are in a sympathetic dominant state.  This causes insufficient stomach acid production leading to laxity in the LES and regurgitation of the stomach contents into the esophagus.  Bingo.

So why are acid blocking medications dispensed like candy for acid reflux?  The answer is in order to experience relief it is much simpler and quicker to just eliminate the acid altogether than to try and change someone’s lifestyle and dietary habits.  When you take an acid blocker the tone of the LES plummets, but there is no acid left to rise up into the esophagus.  Once again, suppressing the symptom but not treating the cause.

The Real Solution

The following are some simple steps you can take to address the underlying cause of acid reflux and get off your acid blocker for good.

• Practice good food hygiene.  Take a few deep breaths before meals to relax, smell your food, chew your food thoroughly.  These simple steps will signal to your stomach and pancreas that food is coming and dramatically reduce incidence of acid reflux and increase absorption of vital nutrients.

• Eat smaller meals slowly and more frequently.  Overeating causes distention of the stomach and decreases LES tone.

• Get analyzed for a condition called hiatal hernia syndrome (not to be confused with an actual hiatal hernia).

• Avoid foods and substances which tend to decrease tone of the LES.  Citrus fruits, tomatoes, chocolate, mint, spicy foods, alcohol, caffeine, oral progesterone, refined carbohydrates and cigarettes have all been correlated with decreased LES tone.

• Find a doctor who will work with you to improve acid production in your stomach.  For more severe cases it is sometimes necessary to use a tapered dose of hydrochloric acid with digestive enzymes until the stomach can produce enough acid independently again.

Conclusions

Acid blocking drugs are effective at temporarily relieving heartburn but when taken long term can lead to serious health consequences.  The real underlying issue with acid reflux is insufficient tone in the lower esophageal sphincter which is caused by stress, improper mealtime habits, and a poor diet leading to decreased stomach acid levels. Addressing the underlying cause of this issue is very important for long term health and wellness.

 

Ryan Sweeney, NMD

Naturopathic Medical Doctor at Root Natural Health, Flagstaff AZ

Gluten: Why All the Hype?

Most Americans realize by now that a steady diet of cheeseburgers and soda will lead to heart disease and diabetes.  What they don’t know is there is another offender in the typical American diet that most people would never suspect to be causing them a problem.  That silent villain is gluten, a protein found in wheat, rye, barley, kamut, spelt, and oats.  Gluten is a major component of most breads, pastas, flour tortillas, and the majority of processed foods like crackers and cookies.  Gluten is the part of these foods that makes the dough light and fluffy yet still stick together.

For years it was thought that only people with Celiac disease had difficulty digesting gluten.  There is recent evidence however that there is a spectrum of gluten intolerance throughout our population that ranges from the mildly gluten sensitive to completely allergic (Celiac disease).  Current estimates are that six out of ten people are now gluten sensitive and would benefit from cutting gluten out of their diet.

Why is gluten such a problem?

The most likely reason is that the human digestive tract has not evolved to digest grasses yet, especially the new “super-gluten” molecule that has now taken over the majority of American wheat.  The term “super-gluten” applies to American wheat strains which have a much higher gluten content than their European counterparts.  It is how we are able to produce such giant bagels, fluffy biscuits, and pliable pastas.  In fact, many people who suffer from Celiac disease here in the States are able to eat bread products over in Europe without the health consequences.

Perhaps the most dangerous aspect to gluten is that the majority of people who are gluten sensitive do not even suspect it to be a problem.  For those who are sensitive, gluten can be the hidden culprit in a multitude of problems.  Inflammatory bowel disease, multiple sclerosis, depression, muscle and joint pain, neuropathy, osteoporosis, canker sores, migraines, autism, auto-immune disease, chronic fatigue, and rheumatoid arthritis are just a few of the health problems with evidence to show gluten sensitivity is a common cause.

For pretty much anyone suffering from a chronic condition it is worth investigating whether or not gluten sensitivity is a contributing factor.  If gluten is the underlying problem the good news is it is 100% curable!   Just cut gluten containing products out of your diet.  If that seems like too daunting of a task there are a few other options.

Testing

There are many diagnostic tests available to help you determine whether or not you may be sensitive to gluten.  Some of the most common blood tests are:  IgA or IgG anti-gliadin antibodies, IgA anti-endomysial antibodies, Tissue Transglutaminase antibody, Total Secretory IgA, and HLA DQ2 and DQ8 genotyping for celiac disease.  There are also stool and salivary testing options which tend to have similar sensitivity and specificity percentages to the above blood tests.  Intestinal biopsy is the conventional standard for diagnosing celiac disease but there has to be significant damage to the intestinal wall for this to come back positive.  In truth, none of these test are 100% accurate.  They can provide an initial screening to help people decide if they should do a gluten-free trial but the gold standard for determining if you have a gluten sensitivity is to completely cut gluten out of your diet for six weeks and see how you feel.  Then slowly add gluten back into your diet and see if your symptoms return.  Not only is this method the most accurate in determining gluten sensitivity but it is also the cheapest.

Conclusion

Gluten sensitivity is an under diagnosed cause of many chronic medical conditions.  For anyone who is suffering from fatigue, chronic muscle or joint pain, digestive problems, skin issues, any of the other conditions mentioned earlier in this article, or anyone who is simply interested in improving their health and wellness it is highly worth doing a six-week trial period of cutting gluten out of your diet to see how you feel.  It is important to remember that going gluten-free does not mean turning to the multitude of processed and packaged gluten-free foods available.  We recommend a strong focus on a whole foods diet including plenty of whole grains, healthy proteins, fresh fruits and vegetables.  Remember a short term elimination of gluten may have a profound effect on your health and you can always go back to eating that fluffy delicious slice of good ole American bread product.

In health,

Dr. Ryan Sweeney

Naturopathic Physician at Root Natural Health, Flagstaff, Arizona

3 Simple Steps for Improving Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome is a gastrointestinal (GI) disorder characterized by chronic abdominal pain, bloating and irregular bowel habits in the absence of any identifiable cause. It is the most commonly diagnosed gastrointestinal condition in this country affecting approximately 60 million people.  That is about 20% of our total population and is the second most common cause of lost time at work in the country after the common cold.

The difficulty with evaluating and treating IBS is that there is no known cause and no test to confirm a diagnosis.  When certain symptoms are present such as abdominal pain, diarrhea, or constipation, IBS can be diagnosed if no other condition is identified.  In other words, once all other diagnosable conditions have been ruled out, IBS becomes the diagnosis by virtue of exclusion.

For this reason I believe there are several functional conditions that are likely being grouped together inappropriately as IBS.  This is likely due to only partial understanding of the disease.

There are three main causes of IBS that I have found once addressed, will dramatically improve the health and well-being of people suffering from this condition.

• Microbial imbalance in the large intestine
• Food Sensitivities
• Bacterial overgrowth in the small intestine

Microbial imbalance in the large intestine

There are 10-20 times more bacteria living in your gut than total cells in the human body.  In fact, there is more bacterial DNA in your body than human DNA!  These microbes play a vital role in proper GI and immune health.

Some of these microbes are beneficial to your health and some of them are destructive. A healthy balance of beneficial intestinal microflora is responsible for maintaining the gut lining and keeping your immune system functioning correctly.  The gut lining determines what nutrients are able to pass into your blood stream and what becomes waste.  When there is overgrowth of bad bacteria in the large intestine, inflammation ensues and the intestinal barrier becomes porous allowing larger food particles and pathogens to enter the blood stream.

Most antibiotics are not selective between beneficial and harmful bacteria and will destroy the good flora maintaing the gut lining.  This provides the opportunity for pathogenic bacteria and yeast to grow in the large intestine resulting in many negative effects throughout the body including the symptoms associated with IBS.

A functional stool analysis can assess the bacterial balance in your large bowel and determine if there is overgrowth of pathogenic microbes including yeast.  This is a vital test for anyone that has a history of antibiotic use.  Treatment then consists of killing off the identified harmful pathogens and then repopulating the GI tract with high potency probiotics.

Food Sensitivities

It might be surprising to learn, but roughly 70% of your immune system is located in your GI tract.  This immunity is what determines what is safe to assimilate and what needs to be destroyed.  At birth and throughout the first few years of life your immune system is becoming programmed to determine what is safe and what is harmful and needs to be destroyed.  Increasingly, we are seeing immune systems that are programmed to destroy common foods in the diet leading to food sensitivities.

Corn, gluten, dairy, nightshade vegetables, eggs, and soy are some of the most common food sensitivities.  When your immune system is programmed to destroy a certain food molecule and you continue to eat it on a regular basis it will fatigue your gut immunity and result in inflammation of the gut lining.

Identifying and removing food sensitivities through IgG/IgA antibody testing or through an elimination diet dramatically improves symptoms associated with IBS in the majority of my patients.

Bacterial Overgrowth in the Small Intestine

The small intestine is normally free from bacteria.  The acid in your stomach serves as a barrier to the bacteria you consume with your food helping to keep the small bowel sterile.  Acid blocking drugs like Prilosec, Prevacid, or Nexium remove this vital barrier and allow bacteria to move through the stomach and set up shop in the small intestine.

These bacteria can ferment food as it travels through your small intestine causing a production of hydrogen and methane gas that results in bloating, cramping and a feeling of fullness after meals.  The bacteria in your small intestine are having lunch on your lunch!

Small Intestinal Bacterial Overgrowth (SIBO) is diagnosed with a simple breath test.  Treatment consists of killing off the bacteria in the small bowel with an antibiotic called Rifaximin and then repopulating with probiotics.  Reestablishing optimal acid production in the stomach helps to prevent the problem from coming back.

Conclusions

People who have symptoms of IBS do not need to suffer.  Following these three simple steps has helped the majority of my patients be free of IBS and improve their quality of life.

1. Get a stool analysis to assess the balance of bacteria in your large intestine. If there is overgrowth work with your doctor to eliminate the bad guys, heal your gut lining and repopulate with good guys.
2. Get an IgG/IgA antibody test for food sensitivities and eliminate the offending foods from your diet. Following a hypoallergenic diet for 6 weeks and then reintroducing suspected foods is another option for determining food sensitivities
3. Do a hydrogen/methane breath test to assess for Small Intestinal Bacterial Overgrowth (SIBO).  If it is positive, ask your doctor to prescribe Rifaximin (two 200 mg tablets BID for 7-10 days).  Repopulate the gut with a high potency probiotic and reestablish optimal acid levels in the stomach.

Dr. Ryan Sweeney

Naturopathic Physician at Root Natural Health, Flagstaff AZ