A few weeks back we looked at SIBO and touched on its link to stomach acid issues.  This week we’re doing a deep dive into acid reflux, heartburn and GERD.  These three terms are often used interchangeably, but they are not the same.  For example, heartburn is a typical symptom of GERD and acid reflux, but not a condition.  Also, heartburn is not limited to GERD and acid reflux.  GERD and acid reflux are conditions in and of themselves, and we’ll take a look at them in more detail.

Where do we start?

Let’s start where we left off on stomach acid.  We’ve already learned that stomach acid in and of itself is not a bad thing.  In fact, it’s necessary for proper digestion of food, absorption of nutrients, and killing off unwanted bacteria.  Problems arise when stomach acid travels to other places where it becomes uncomfortable and can do some damage.  The lining of the stomach is coated in mucous that can withstand the highly acidic environment of the stomach.  This mucous is there to protect the stomach from the acid.  However, when acid backs up into the esophagus we get the sensation known as heartburn, and the condition known as acid reflux.  Although the esophagus has a mucosal lining, it is not equivalent to that of the lining of the stomach and cannot withstand the environment created in the stomach.  When the contents of the stomach flow back up into the esophagus the lining becomes irritated.  The cells in the lining are sensitive to the hydrochloric acid of the stomach.  Hydrochloric acid burns the lining of the esophagus, which is where the burning sensation comes from.

How does acid get back up into the esophagus?  Remember way back in the beginning when we talked about the esophageal sphincter?  There are multiple sphincters throughout the digestive system which are valves that act like doors that open and close to let stuff through at the appropriate time.  The “stuff” is food at its different phases of digestion.  The esophageal sphincter will open to bring food down that we swallow.  It will also act reflexively when the body needs to quickly expel food that it needs to get rid of (vomiting) or too much air through burping.  The problem occurs when the sphincter opens when it’s not supposed to and food, mixed with the acid in the stomach, flows back up in the esophagus.

Why do we refer to this sensation as heartburn?  Because that’s the region of the chest where this burning occurs.  The esophagus run through the chest to get to the stomach.  (Refer back to the diagram of the digestive system.)

To provide some perspective, the liver sits behind the rib cage on the right side of the body.  The liver is a critical organ protected by the structure of the rib cage.  As you can see, the esophagus runs past the heart, which is slightly off center to the left.

Heartburn is the most common symptom of acid reflux.  Acid reflux, when the acid backs up into the esophagus, indicates a malfunction of the lower esophageal sphincter.  Heartburn may also be caused by stomach ulcers – sores caused by erosion of the lining of the gastrointestinal tract; and also by gastroparesis – incomplete emptying of the stomach during digestion.  Stress can also cause heartburn-like symptoms, but this scenario does not include acid in the esophagus.

Acid Reflux Causes

The top five causes of acid reflux are:

• Eating foods that weaken or irritate the muscular lining of the esophageal sphincter
• Magnesium deficiency
• Eating too much food, too quickly
• Hiatal hernias
• Bacterial overgrowth (SIBO)
• Smoking

Great, but what does this mean?  What kinds of foods, what’s magnesium all about, and how does a hernia cause acid reflux?

Let’s look at foods first, since that’s the easiest way to take control of the situation.  Foods that are high in acid can cause irritation.  Some examples of high acid foods include:

• Spicy foods
• Citrus
• Tomatoes
• Chocolate
• Alcohol
• Coffee
• Peppermint and Spearmint

The acid in these foods/beverages decrease the pressure of the lower esophageal sphincter, causing it to relax (open).  When the sphincter opens, food in the stomach can move back up into the esophagus where it doesn’t belong and burn the lining of the esophagus.  Other irritants include carbonated beverages and NSAIDS.

Magnesium plays its role in another sphincter; the one at the bottom of the stomach.  Magnesium helps to relax this sphincter so food can travel on into the duodenum (the first section of the small intestine).  You can get testing for your magnesium levels and most people are magnesium deficient.  So if you regularly experience acid reflux symptoms, it wouldn’t hurt to get your magnesium level tested.  This would be another easy solution to addressing such a distressing problem.

We covered SIBO last time, so let’s look at hernias as a possible culprit.  A hernia occurs when an internal organ pushes into a part of the body where it doesn’t belong.  A hiatal hernia refers to the stomach.  With an abdominal hernia, the muscle and/or tissue of the abdominal wall is weakened, allowing the underlying organ to protrude through this thin spot.  When the hernia is in the groin area it involves the large intestine/colon.  Hiatal hernias are located at the diaphragm, and occur when part of the stomach slides through the opening in the diaphragm where the esophagus passes from the chest into the abdomen.  The bulge created by the hernia becomes a potential spot for the buildup of stomach acid.  Common causes of hiatal hernias include: excess coughing or vomiting, straining for bowel movements, pregnancy or obesity.

Consuming food to quickly puts pressure on the lower esophageal sphincter, causing it to open to relieve the pressure.  Because the food is not ready to move on the small intestine, it moves back up.

This takes you to GERD and beyond

Chronic acid reflux, ongoing symptoms more than twice a week, can eventually lead to damage and inflammation of the esophagus, a.k.a. GERD (Gastroesophageal Reflux Disorder).  The most common symptoms of GERD are:

• Heartburn
• Indigestion
• Belching
• Upset stomach
• Regurgitation
• Difficulty swallowing
• Damage to the esophageal lining

Both acid reflux and GERD have something important in common:  they are not caused by excessive stomach acid.  In fact, research shows that as stomach acid declines with age, the incidence of GERD increases.  If excess stomach acid was the cause, this negative correlation could not exist.  However, one positive correlation does exist.  Obesity is highly related to GERD.  The excess weight of obesity puts added pressure on the stomach.  Additionally, research has tied increases in BMI (Body Mass Index) to cancer of the esophagus.

Adenocarcinoma of the esophagus begins in the cells of mucus-secreting glands in the esophagus and occurs most often in the lower portion of the esophagus.  When any part of the body is injured, damaged or sufficiently irritated as we’ve discussed here; the body sends resources to repair and heal in a process called inflammation.  At this point, it is broadly acknowledged that chronic inflammation is a contributor to the growth of cancerous cells, cells whose DNA has mutated due to damage.  I mention this and cancer of the esophagus because the constant damage to the lining of the esophagus creates an inflammatory environment, making acid reflux a very slippery slope since there are no additional signs of this cancer.  The same symptoms of acid reflux and GERD continue as the cancer develops.

Take Steps to Reduce your Risk

Whew!  That’s a lot of information.  Were you aware of all the implications and risks associated with symptoms like heartburn?  Would you like to reduce your risks and start looking for healthier, long-term ways to address these symptoms?  Here’s a list of some actions you can take today to support your esophagus and increase your overall wellness as a result:

• Identify your triggers – take note of when your symptoms occur by tracking your mood and food.  Did you consume high acid food or beverages?  What was your mood while you were eating?  Were you stressed?  Start a log to help you quickly identify if foods or stress are contributing to your symptoms.
• Examine your meal environment – we’ve discussed this before.  Are you eating mindfully by taking time away from activities to eat in a calm environment?  Are you working while eating?  Are you rushing to eat your meals to get on to something else?  Add these elements to your log as they may provide insights into when your symptoms are occurring.  And as strange as it sounds, don’t wear tight restrictive clothing, as this creates added pressure that can impair digestion.
• See your doctor for testing – I say it a lot, but it needs repeating: test, don’t guess.  We talked about magnesium deficiency as one possible cause, but there are others that can contribute and be tested such as zinc.  Zinc plays a role in the production of hydrochloric acid, which in turn signals the stomach to release the enzyme pepsin.  Pepsin is necessary for digesting proteins.  Undigested food particles in the stomach can contribute to acid reflux and gastroparesis.  You can also test your levels of hydrochloric acid.

You always want to get to the root cause of the problem.  Although taking medication may temporarily relieve your symptoms, it does not fix the problem and can cause further issues.  For example, by taking acid blockers (HRAs and PPIs) or neutralizers (over-the-counter antacids), you are reducing stomach acid which can increase your risk of developing GERD, SIBO and infections caused by the bacteria that are not being contained by adequate stomach acid.  Feeling good is not a sign the problem is gone.  Just like taking a pain reliever only addresses the pain and not the injury, numbing any symptom does not get to the root of the problem; leaving it to linger and simmer.

Always remember that you are in charge.  Never go against your gut when it comes to your health, literally and figuratively.  If you don’t feel right adopting a recommended course of action, get a second opinion.  If you can locate a doctor practicing functional medicine, you will find a partner in your health journey unlike any doctor you have worked with in the past.  Functional medicine includes an entire realm of practitioners and professionals focused on optimal functioning of the body and its organs, utilizing systems of holistic or alternative medicine.  FM doctors do not abandon conventional medicine wholesale, rather they incorporate all of the knowledge we’ve accumulated over thousands of years and apply that to each case individually based on the facts and circumstances.  They look to get to the root cause of the issue, rather than treat the symptoms.   They listen to your gut because they realize you are your best healer.

I know this was a long one, but I really didn’t want to take any shortcuts on this topic.  The number of people suffering from these issues is growing at a rapid rate and I wanted to look at it from a perspective that may actually help.  If you are struggling to implement lifestyle changes to improve your health and wellness, consider using a health coach who aligns with your goals and beliefs.  You can read about me, my journey to health coaching and what I can do for you throughout the pages of this website.

Yours in Wellness,

Jackie

Previous post:  Put Your Mask on Before Assisting Another