ACID REFLUX (GERD)

Acid reflux, known medically as gastroesophageal refl ux disease (GERD), is a disease in which stomach acid flows back (refluxes) into your esophagus (food pipe). This causes burning and pain, which is commonly known as heartburn. Many people experience an occasional episode of heartburn, which is usually not a cause for concern, but when it occurs continually, it could indicate GERD.

GERD is a common disorder, affecting up to 60 percent of people at some point during the course of a year, and 20–30 percent of people at least weekly.

Normally when you swallow, the lower esophageal sphincter, which is a circular band of muscle around the bottom of the esophagus, relaxes to allow food and liquid to fl ow down into your stomach. Then it closes again. If this valve becomes weakened or relaxes when it shouldn’t, stomach acids can fl ow up into the esophagus, causing heartburn.

When stomach acids continually reflux upward, it can cause irritation and inflammation of the lining of the esophagus, which is known as esophagitis. This can cause chest pain after eating, difficulty swallowing, and breathing problems. Although GERD is uncomfortable, there are a number of dietary and lifestyle modifications that can help relieve symptoms.

SIGNS & SYMPTOMS: 

• Chest pain that may be worse when lying down
• Coughing, wheezing, asthma, and sore throat
• Difficulty in swallowing
• Heartburn, a burning in the chest that may go up into the throat
• Regurgitating food
• Sour taste in mouth
If left untreated, GERD can lead to other conditions such as esophageal narrowing (due to formation of scar tissue) and esophageal ulcer.

RISK FACTORS: 

• Asthma: Coughing and laboured breathing put pressure on the stomach; asthma medications may relax the esophageal sphincter.
• Connective tissue disorders (scleroderma) and diseases that affect the muscles.
• Diabetes: Gastroparesis (delayed stomach emptying) is a complication of diabetes.
• Hiatal hernia: The stomach protrudes into the lower chest, worsening heartburn and weakening the esophageal sphincter.
• Obesity: Excess weight puts pressure on the stomach, forcing open the esophageal sphincter and allowing stomach acids to back up.
• Overeating and eating high-fat meals puts pressure on the lower esophageal sphincter, allowing stomach acids to back-up.
• Peptic ulcer can affect stomach emptying, causing a buildup of acids.
• Pregnancy: The growing belly puts pressure on the stomach; higher progesterone
levels relax the muscles (esophageal sphincter), allowing stomach acids to refl ux.
• Smoking increases stomach acid, weakens the esophageal sphincter, and dries up
saliva, which helps dilute the stomach acid.

DOCTOR’S ORDERS: 

Most cases of heartburn and GERD can be treated effectively with over-the-counter (OTC) and prescription medications. The most commonly used classes of drugs include the following:
• Alginic acid forms a protective seal at the top of the stomach to prevent acid reflux. It is found OTC in a product called Gaviscon.
• Antacids contain ingredients such as magnesium, aluminum, and calcium, which work quickly to neutralize stomach acids. However, they do not reduce inflammation or promote healing. Antacids are available OTC and include Tums, Rolaids, Maalox, and Mylanta.
• H2 receptor blockers reduce the production of acid and reflux. They take longer to work, but provide longer relief. Side effects include dry mouth, bowel changes, dizziness, and drowsiness. Examples include famotidine (Pepcid) and ranitidine
(Zantac). They are available full strength by prescription, or in lower dosages OTC.
• Proton pump inhibitors block acid production and allow the damaged esophagus to heal. These are long-acting products and the most effective medical treatment for GERD. Examples include Losec (omeprazole), Pantoloc (pantoprazole), and Prevacid (lansoprazole). These products are well tolerated; side effects are rare and include headache and dizziness.

Dietary Recommendations
Foods to include: 

• Drink caffeine-free herbal teas that contain chamomile, ginger, marshmallow, and slippery elm, herbs that are soothing and help relieve heartburn.
• Drinking fluids between meals rather than with meals will also help prevent reflux.
• Eat vegetables, non-citrus fruits, whole grains, beans, fish, and lean meat.
• Eating small, frequent meals (instead of one or two large meals) will prevent excess production of stomach acid and is also less stressful to the esophageal sphincter. Eat slowly and chew your food thoroughly.
• Small amounts of olive and vegetable oils are fine.
• Stay upright after eating and don’t eat within three hours of bedtime.

Foods to avoid: 

• Alcohol, carbonated beverages, spicy foods, tomatoes, citrus fruits, spearmint, peppermint, and onions are irritating to the esophagus.
• Chocolate and coffee relax the esophageal sphincter and increase the risk of reflux.
• High-fat foods worsen symptoms because they stay in the stomach longer and increase the time the esophagus is exposed to stomach acids. Avoid or minimize cream, butter, icecream, gravy, oils, fried foods, sausage, and processed fatty meats and cream soups.

Lifestyle Suggestions: 

• Lose excess weight by eating healthy and exercising regularly.
• Do not bend over, lie down, or exercise right after eating. Wait two hours after eating to exercise and three hours after eating before lying down.
• Do not wear tight belts or pants that are tight at the waist.
• Don’t smoke.
• Raise the head of your bed—use pillows or a block under the head of your bed. Keeping your head higher than your stomach will help prevent acids from refluxing.

Several studies have shown a link between elevated body mass index (a scale used to
determine overweight and obesity) and symptoms of GERD. The risk of GERD symptoms,
such as heartburn and acid reflux, rises with BMI. Studies have also shown that
losing excess weight can reduce symptoms.

Top Recommended Supplements: 

Calcium carbonate: This is the main ingredient in many OTC heartburn products and is also available as a supplement. Calcium helps to neutralize stomach acid and provides short-term relief. Dosage: 500 mg three times daily with meals and before bedtime.
Deglycyrrhizinated licorice (DGL): This herb soothes and coats the mucous membranes of the stomach. It helps restore the mucous lining that protects the stomach from hydrochloric acid (stomach acid). Dosage: Two to four tablets before meals and at bedtime.

Complementary Supplements: 

Aloe vera juice: Helps reduce acid output and is soothing to the mucous membranes. Research is limited at this point, but it is widely used by naturopathic physicians. Dosage: 1 tbsp two or three times daily.
Digestive enzymes: Improve digestion and may help reduce refl ux. Dosage: One capsule with each meal.
Probiotics: Contain friendly bacteria, which improve digestion. Dosage: One capsule twice daily.

FINAL THOUGHTS: 

To prevent or relieve the symptoms of acid reflux, consider the following:
1. Work on losing excess body weight.
2. Don’t smoke.
3. Raise the head of your bed.
4. Avoid high-fat and spicy foods, alcohol, and other triggers, and don’t overeat.
5. Consider supplements of calcium and DGL.