antacidsThey look so innocent, those pink colored tums, or antacids. But in reality they might be the cause of many of your health concerns, including maldigestion, irritable bowel syndrome (IBS), and even depression.  Not only do they not cure the cause of your symptoms (they just suppress them), they also create a whole list of new problems, especially when used on a regular basis. Let me explain this before talking about natural treatment options. First of all – and contrary to popular belief – heartburn, or acid reflux, or GERD is not caused by too much stomach acid, but rather by stomach acid in the wrong place, and potentially too little acid.

Why is my stomach acid in the wrong place?

When you experience heartburn, the acid from your stomach has traveled up into your esophagus, which doesn’t have the protective layer against acid the stomach has. The reason it is in the wrong place is that the lower esophageal sphincter (LES), the muscle that separates the stomach from the esophagus, is not closing properly, it is too relaxed. When the LES is working properly, it doesn’t matter how much acid you have in your stomach: it will not regurgitate up into your esophagus.

The pathophysiology of GERD

How is too little stomach acid a bad thing?

The stomach needs stomach acid to do its job. By suppressing the acid your stomach naturally secretes, you stop it from doing its job properly. It might go in overdrive and start secreting more acid to compensate for what was lost, thus creating a vicious cycle and making it more and more difficult to get off antacids. But most importantly, it interferes with a cascade of processes in your body that are important for good health. Stomach acid is the “turn on switch” to start the entire digestive cascade, which determines how much of your nutritional intake is actually taken up and used by your body. For example, stomach acid aids in:

  • Absorbing minerals (iron, calcium, zinc)
  • Absorbing vitamin B12
  • Resisting infection and preventing bacteria overgrowth (e.g. H. pylori)
  • Communicating satiety to the brain
  • Breaking down protein by activating pro-enzymes
  • Facilitating the closure of the LES

No matter how healthy your diet is, if the food is not broken down and absorbed, it will remain useless for your body. Thus, low stomach acid can cause nutrient deficiencies, which can disrupt your health in many, many ways. For example, proteins are required to manufacture hormones and neurotransmitters such as dopamine and serotonin, which are important for the regulation of mood. Hence the relationship to depression I mentioned earlier.

In addition to nutrient deficiencies and increased risk of infections, low stomach acid can increase the risk of stomach or esophageal cancer and other diseases. Long term use of antacids can cause diarrhea, altered calcium metabolism, and buildup of magnesium in the body.

Dr Wright, author of Why Stomach Acid is Good For You, has been measuring stomach acid in people suffering from heartburn and GERD for 25 years, and found that it is almost always low, especially with increasing age (Fig 1).  Yet the incidence of heartburn and GERD increases with age, simply because the LES tone decreases as we get older. If this did not convince you yet, I should mention that Dr Wright, and many other clinicians (including naturopathic doctors) supplement with hydrochloric acid (HCl), which often cures the problem – again demonstrating that low acid is the real problem.
Why stomach acid is good for you
A naturopathic approach to the treatment of heartburn/ reflux/ GERD

The good news is that, when adhered to faithfully, diet and lifestyle changes work exceptionally well for the treatment of GERD.

General tips

Dietary recommendations for heartburn and GERD

  1. Avoid foods and drinks that weaken the LES: coffee, alcohol, chocolate, (pepper) mint and fried foods.
  2. Avoid substances that can irritate a damaged esophageal lining: citrus fruits & juices, tomato products, spicy foods, pepper, carbonated drinks, NSAIDs/ Aspirin.
  3. Quit smoking: cigarette smoking weakens the LES.
  4. Relax while eating: sit down, eat slowly and deliberately, without distractions such as TV or reading.
  5. Eat small meals, e.g. 4-5 per day, with the last meal at least two hours before bedtime.
  6. Avoid drinking during meals, to avoid diluting the concentration of stomach acid.
  7. Take demulcents. Demulcent herbs, such as Althea officinalis or Ulmus vulva, are rich in mucilage and can soothe and protect irritated and inflamed mucosal tissue. In addition, chamomile tea, sipped throughout the day can be helpful to reduce inflammation.
  8. Raise the head of the bed: using gravity to minimize reflux of stomach contents into the esophagus
  9. Decrease intra-abdominal pressure (IAP): Avoid stooping, tight clothes, etc; Increase fiber intake; Weight loss (if overweight).

If that’s not enough….

If diet and lifestyle changes are not sufficient to resolve your symptoms, there are several supplements that have shown to be effective in the treatment of GERD. Please consult with your ND or other qualified medical practitioner for more information.

  • Melatonin and phosphatidylcholine supplementation have been shown to enhance LES tone and protect the esophagus.
  • Betaine hydrochloride: if your stomach levels are low (which was the case in over 90 percent of people tested in Dr. Wright’s clinic), supplementation with HCl will almost always solve the problem. Before supplementing HCl, testing should be done to confirm low stomach acid; otherwise supplementation can cause harm.
  • Bitter herbs: another way to stimulate acid production in the stomach.

References

  1. Greenblatt, J. Integrative Medicine for the treatment of depression. An evidence based orthomolecular approach. CSOM seminar 2012
  2. Wright JV, Lenard L. Why Stomach Acid Is Good For You. New York, NY: M. Evans and Company, Inc, 2001
  3. Prousky J. Textbook of Integrative Clinical Nutrition. Toronto: CCNM Press Inc, 2012
  4. Hoffmann D. Medical Herbalism. The science and practice of herbal medicine. Vermont: Healing Arts Press, 2003
  5. Shehab El-Hashemy. Family Medicine & Integrative Primary Care. Toronto: CCNM Press Inc, 2011
  6. Konturek SJ, Zayachkivska O, Havryluk XO, Brzozowski T, Sliwowski Z, Pawlik M, Konturek PC, Cześnikiewicz-Guzik M, Gzhegotsky MR, Pawlik WW. Protective influence of melatonin against acute esophageal lesions involves prostaglandins, nitric oxide and sensory nerves. J Physiol Pharmacol. 2007 Jun;58(2):361-77. http://www.ncbi.nlm.nih.gov/pubmed/17622703
  7. Pereira Rde S. Regression of gastroesophageal reflux disease symptoms using dietary supplementation with melatonin, vitamins and aminoacids: comparison with omeprazole. J Pineal Res. 2006 Oct;41(3):195-200. http://www.ncbi.nlm.nih.gov/pubmed/16948779
  8. Eros G, Kaszaki J, Czobel M, Boros M.Systemic phosphatidylcholine pretreatment protects canine esophageal mucosa during acute experimental biliary reflux. World J Gastroenterol. 2006 Jan 14;12(2):271-9. http://www.ncbi.nlm.nih.gov/pubmed/16482629
  9. de Oliveira Torres JD, de Souza Pereira R. Which is the best choice for gastroesophageal disorders: Melatonin or proton pump inhibitors? World J Gastrointest Pharmacol Ther. 2010 Oct 6;1(5):102-6. http://www.ncbi.nlm.nih.gov/pubmed/21577303