GERD: A MISUNDERSTOOD AND MISTREATED CONDITION

GERD, or gastroesophageal reflux disease, affects approximately 40 million Americans at a cost of almost $10 billion per year.  Antacids alone are $0.5 billion of the $10 billion. 

Patients with GERD have a dysfunction of the lower esophageal sphincter, the valve at the top of the stomach, which keeps food in the stomach from backwashing into the esophagus.  In this dysfunction, this muscular valve opens for random periods of time and then does not fully close, which allows for stomach contents to rise into the esophagus.  This, in turn, causes the patient to experience the sensation of heartburn, the main symptom of GERD.  Other symptoms can include dry cough, asthma-like symptoms, difficulty swallowing, belching, chronic sore throat, bad breath, and waterbrash (a sudden flood of saliva into the mouth).  If left untreated, GERD can lead to inflammation of the gums, erosion of tooth enamel and/or a condition called Barrett’s Esophagus.  Barrett’s Esophagus is a precancerous condition of the lower esophagus in which stomach-type cells grow into the lower esophagus to protect it from acid.  Although these cells protect the esophagus from damage, they can also lead to cancer.  The initial symptoms of GERD are experienced once or twice yearly by 60% of Americans and weekly for up to 30% of Americans.  It seems that all one would need to do is suppress stomach acid to solve this problem.  As this approach can stop the immediate symptoms, it might not fix the condition and could worsen the underlying cause of GERD.

For many years, suppressing stomach acid production has been the conventional treatment for GERD.  However, it is found that most patients with symptoms of GERD actually have LOW stomach acid production.   This fact seems counterintuitive.  How can a person with heartburn have LOW stomach acid?  As it is true that some people with heartburn produce too much stomach acid, this appears to be the minority of GERD patients.   Further, since stomach acid performs a major role in the passage of food from the stomach to the intestines, absorption of nutrients, and the killing of bacteria and parasites ingested with food, suppression of hydrochloric acid can lead to chronic ill health.   So, how can this condition truly be helped?  Let’s first examine the physiological causes of GERD. 

• Low stomach acid diminishes the ability of food to move out of the stomach.  In many cases, the pyloric sphincter, which is the valve at the bottom of the stomach between the stomach and the intestines, is so constricted that it will not allow food to pass into the intestine (a condition called gastroparesis).  The pyloric sphincter is much stronger than the esophageal sphincter (the valve at the top of the stomach between the esophagus and the stomach), therefore when the pyloric sphincter is constricted, the partially digested foods can be pushed up through the esophageal sphincter causing symptoms of heartburn.  Furthermore, when food stays in the stomach too long, carbohydrates can ferment , proteins will peutrify and fats can rancidify.  These rotting food can cause symptoms such as gas and bloating, belching and heartburn, or sour stomach.  Hydrochloric acid relaxes the pyloric sphincter to allow food to be passed into the small intestine.  This is normal physiology.  
• Low stomach acid can provide an environment that is perfect for the growth of bacteria.  H. Pylori, the bacteria that is a common cause of stomach ulcers, can easily overgrow in a low acid environment.  It should be understood that H. Pylori is a normal bacteria in the stomach.  However, it’s overgrowth further decreases stomach acid due to the production of this bacteria’s self-protective enzymes.   Initial symptoms of bacterial overgrowth in the stomach are similar to GERD, the main symptom being heartburn.  A study published in “Gastroenterology, the Official Journal of the AGA Institute”, has shown that use of proton pump inhibitors or PPI’s (pharmaceuticals that decrease stomach acid such as Nexium and Prilosec) predispose the stomach to bacterial overgrowth resulting in inflammation (2002;122:119-133.)  From this, it could be concluded that long- term use of PPI’s decrease stomach health through the overgrowth of bacteria.   Further, since nutrients such as calcium, iron, folic acid and B vitamins require high levels of hydrochloric acid to be absorbed, PPI’s could cause malnutrition leading to chronic disease.   In recent years, according to the Journal of the American Medical Association (2006; 296:2947-2953), it has been found that extended use of PPI’s are linked to hip fractures in people over 50.  Furthermore, the longer PPI’s are used, the greater the chance of hip fractures.

If GERD is actually caused by LOW hydrochloric acid production, then the question remains “What causes the initial decrease in hydrochloric acid production?”  Although these authors are unaware of any research done in this area, it can be argued that the cause of low hydrochloric acid production, like most chronic dysfunctions, is due to long term nutritional deficiencies and/or toxic overload.  Since it is the job of the cells of the stomach lining to produce hydrochloric acid, long term nutritional deficiencies can deplete the necessary vitamins, minerals and other nutrients necessary for these cells to make hydrochloric acid.  Just as any production factory needs the correct raw materials to make it’s product, so do the cells of our bodies need proper nutrition to make their products, keeping our bodies functioning optimally.  Unfortunately, the Standard American Diet (S.A.D.) does not provide such.   Add to this, a stressful lifestyle which demands higher levels of nutrition for optimal function, we have a formula for poor function leading to chronic diseases such as GERD.

Once a body is in the predicament of low hydrochloric acid production, the question then becomes “How can this be corrected?”  First and foremost, any treatment must be based upon a correct diagnosis.  Therefore, a thorough history, physical examination and proper laboratory testing should be performed.  Once an accurate diagnosis is made, treating only the symptoms will not reverse the condition.  The underlying cause must be addressed.  It is necessary to rehabilitate the stomach cells’ ability to make hydrochloric acid without irritating an inflamed stomach (called gastritis).  If gastritis is present, which is often the case, then the gastritis must be handled first.  There are excellent natural medicines and nutritionals that do just that.  For example, Vitamin U from cabbage is an excellent anti-inflammatory for the stomach.  Next or possibly concurrently, supplementing with hydrochloric acid at the proper time and in the proper amount is a key ingredient to rehabilitating the stomach cells.  Hydrochloric acid to the stomach’s cells is like water to a thirsty plant. 

If you or anyone you know is taking PPI’s for a stomach condition, help them by directing them to a natural health physician who is experienced in diagnosing and treating the underlying cause of their condition.  Their long-term health may be at risk if they do not.