The mainstream conventional treatments for GERD may include food choices, medications, and possibly surgery. Initial treatment is frequently with a proton-pump inhibitor such as omeprazole.In some cases, a person with GERD symptoms can manage (short term) or mask them by taking over-the-counter drugs. This is often safer and less expensive than taking prescription drugs. Some conventional guidelines recommend trying to treat symptoms with an H2 antagonist before using a proton-pump inhibitor because of cost and safety concerns. Because all of these techniques don’t get to the root causes, we prefer the Holistic and Lifestyle approach.
The Holistic Approach
An anti-inflammatory lifestyle has been shown to beat acid reflux naturally. Upon eating, food naturally passes from the throat to the stomach through the esophagus. The esophagus contains a group of muscle fibers in the shape of a ring that prevent food from moving backward from the stomach to the esophagus. These muscle fibers make the lower esophageal sphincter (LES).
If the LES is not closing well it allows for food, liquid and hydrochloric acid to leak back into the esophagus. The inner esophageal tissue is not designed to handle the strong acidity which inflames the region. This causes the characteristic heartburn sensation. Chronically damaging the esophageal tissue often results in esophageal cancer and other more serious conditions (1, 2).
Removing Common Risk Factors
The most common risk factors for GERD include anything that obstructs the esophagus or stomach region, including, but not limited to obesity, smoking, fiber-low diet, bowel straining and hard alcohol usage. Many prescription medications list GERD or acid reflux as a common side effect so this should always be considered (3). Eating too quickly, chronic stress, SIBO and infections are other risk factors that need to be addressed. The conventional belief is that acid reflux is due to an excessive amount of hydrochloric acid in the stomach. New findings has revealed that this is not the case. GERD is most often caused by too little hydrochloric acid being secreted by the stomach (4, 5).
Understanding the lower esophageal Sphincter (LES)
First off, it’s important to understand that for the LES to work well, we need to nurture our Central Nervous system and avoid chronic stress. The lower esophageal sphincter is innervated by both parasympathetic (vagus) and sympathetic (primarily splanchnic) nerves. The the vagal pathways are the ones that are essential for reflex relaxation of the lower esophageal sphincter (LES), such as that which occurs during transient LES relaxations. (Am J Med. 2000 Mar 6;108 Suppl 4a:90S-98S).
For the transport of ingested contents into the stomach, relaxation of both the LES and the diaphragmatic sphincter is essential. Deglutition and distention of the esophagus are the two major stimuli that induce EGJ relaxation. Deglutition-induced LES relaxation starts within 2 seconds of the onset of swallowing and lasts 6 to 10 seconds. (5 a)
Lower esophageal sphincter relaxation is terminated by the arrival of esophageal peristaltic contraction at the LES and is followed by an after-contraction that may last up to 10 seconds. After-contraction is seen only in the upper part of the LES; in the lower part, LES pressure simply returns to the resting pressure level. Electrical recordings show that swallow-induced LES relaxation is associated with cessation of spike activity when present. (Ibid).
This sphincter, a circular band of thickened muscle, surrounds the lower esophagus and pinches it closed. The LES is usually closed. It opens to allow the passage of swallowed food or drink, a reflex that is triggered by the act of swallowing.
I’ve seen a claim that LES is suppose to be a pH sensitive valve, like its sister Pylori sphycter at the bottom of the stomach. It is still unknown to what degree it initiates closure when the stomach pH drops at a certain pH level. In this hypothesis framework, when the stomach does not have enough acid, then it would make sense that LES would remain open and acid could spill into the esophageal region and damage the tissue. The experts are still working on this mechanism to better substantiate it’s workings and in order to ascertain the pH level at which LES is sensitive in terms of contracting its muscle so that reflux is avoided. So far I have seen an alleged claim of pH of 3. (Source) But this needs to be corroborated. Additionally, when the diaphragm herniates through the stomach sphincter (hiatal hernia), this can lead to the worsening of the symptoms relative to acid reflux. Likewise with the bacteria H Pylori. There seems to be more GERD with those who are also burdened with H. Pylori.
The Use of Antacids is unsustainable
Many people use antacids to relieve the pain of heartburn. This covers up the symptom (reducing acidity) but only makes the problem worse by decreasing the acidity. This process limits the body from effectively digesting the food and undermines the. body’s endogenous restoration mechanisms.
This causes further stress on the enzymatic system of the pancreas as well as the other digestive organs. Furthermore, antacids, processed foods and many iatrogenic medications deplete the body of critical b vitamins and trace minerals that are necessary to create a sufficient supply of stomach acid (6, 7).
H Pylori and Acid Reflux
H.Pylori is an evolutionary smart microorganism that has learnt how to survive the stomach’s harsh environment. It does this by producing an enzyme called “urease” which breaks down the urea in the stomach into carbon dioxide and ammonia. This causes belching and halitosis (bad breath) for the individual and it neutralizes the acidifying effects of hydrochloric acid (8).
As a consequence, Hydrochloric acid (HCL) can’t do its job of creating an acidic environment in the stomach to digest protein and ionize minerals. H. Pylori in exccess also hinders bile release from the gallbladder, so fat in the small intestine is not well metabolized. When the body is unable to secrete enough HCL, we have poor protein and fat digestion and may develop key nutrient deficiencies.
H Pylori disrupts the digestive process so it can lead to inflammation throughout the gut and gastrointestinal permeability. This state of leaky gut can also cause iron-deficient anemia, irritable bowel symptoms with fluctuating diarrhea and constipation and ulcerative colitis. By damaging the gut lining, we also develop an increased risk for anemia, thyroid problems, osteoporosis and, inter alia auto-immunity (9). Furthermore, H. Pylori, in excess is a major trigger of stomach cancer. So any credible treatment needs to address this beast.
Strong stomach acid is necessary, especially for the elderly
Hydrochloric acid is necessary for creating an acidic environment in the stomach to digest protein and ionize minerals and, inter alia, remove microbes. This also helps to stimulate bile release from the gallbladder to effectively metabolize fat in the small intestine. Without these key functions working optimally we become at risk for anemia, thyroid disorders, osteoporosis and auto-immunity (10,11,12).
Low stomach acid in a very common problem especially in older individuals or those who have suffered from various infections like H Pylori, been on anti-biotics and other medications like non-steroidal anti-inflammatories (13, 14, 15). Low stomach acid sets the stage for damage to the delicate lining of the digestive tract and the formation of leaky gut syndrome.
With low stomach acid, the patient is unable to effectively breakdown protein in the stomach. This allows very large proteins to get into the small intestine and creates major stress on the pancreas to produce enough enzymes to metabolize the proteins. This ultimately wears out the pancreatic enzyme stores and creates stress and irritation throughout the gut. It also leads to insufficient absorption and utilization of key amino acids that make up the protein molecules (16)
Large proteins and incomplete digestion can cause leaky gut syndrome and trigger auto-immune activity in different regions of the body. Improper protein digestion also leads to hiatal hernia, small intestinal bacterial overgrowth, fuels Candida and other parasites. It also creates an acidic blood stream and depletes minerals throughout the body. Mineral depletion leads to the inability to form stomach acid and the vicious cycle continues.
A Holistic Anti-Inflammatory Protocol
An anti-inflammatory lifestyle incorporates a diet rich in phytonutrient dense vegetables, healthy fat and proteins. Healthy fat sources include coconut products, avocados, olive oil, omega 3s and the like. Anti-inflammatory herbs such as turmeric, cinnamon, ginger, oregano & garlic are also powerful aids. Non-processed pink or Celtic salts, sea vegetables, sea algae and cereal grasses can be used regularly to provide an abundance of critical trace minerals.
Patients should avoid eating excessively large meals and in an ambiance of stress. Food should be eaten at least 4 hours before bed to allow gravity to push food through the system. Digestive enzymes and probiotics are particularly helpful at enhancing the digestive process.
Raw apple cider vinegar (rich in acetic acid, digestive enzymes and good bacteria) bitters or the like can assist the digestive process. 2 tsp of raw apple cider vinegar in water before a high protein meal is particularly helpful at improving stomach acid levels to prepare for digestion. Gluten, pasteurized dairy, peanuts, corn most animal foods and refined vegetable oils should be avoided.
Drinking green drinks and smoothies during the day can be useful These are easier on the digestive system. One good quality solid food meal daily along with several protein shakes or smoothies and green drinks will help the digestive system to heal.
Have a few tablespoons of organic kimchi, saeurkraut, pickles, coconut milk yogurt or kefir are recommended as are digestive enzymes, at least in the beginning of the protocol. The unique probiotics and enzymes within these foods also help to improve the microbiome and enhance HCL production.
Making green drinks with a whole lemon or lime and ginger is also helpful. Both of these have key nutrients that enhance HCL production.
Improving stomach acid production is one of the biggest factors in improving someone’s health. Until the stomach gets restored to produce enough HCL, it may be useful to use supplements of HCl (hydrochloric acid) as this will support nutrient absorption and helps maintain a healthy gastric pH, which, in turn, supports healthy gastric ecology.
Exercising to lose weight may be effective in reducing the severity and frequency of symptoms. Elevating the head of the entire bed with blocks, or using a wedge pillow that elevates the individual’s shoulders and head, may inhibit GERD when lying down. Although moderate exercise may improve symptoms in people with GERD, vigorous exercise may worsen them and so much more.
In order to meaningfully treat any disorder, it is necesary to understand its underlying mechanisms of action. This means that we must have a good grasp of LES. Recent research now suggests that LES as a anatomical concept should be subsumed under the term esophagogastric junction (EGJ), which is an anatomically and physiologically complex region, with several functions such as preventing gastro esophageal reflux, while being able to allow bolus passage during swallowing, evacuation of air during belching or gastric contents during vomiting (17)
In this perspective, the EGJ consists of a combination of the lower esophageal sphincter (LES) and diaphragmatic crura. The LES may be anatomically aligned with the crural diaphragm (CD) or misaligned in the form of a hiatus hernia. The lower esophageal sphincter is a smooth muscle region in the lower esophagus, tonically contracted at rest, but with the capacity for swallow, reflex or distention-based relaxation. (Ibid.)
The LES receives vagal input from the brainstem via myenteric non-adrenergic non-cholinergic neurons (18) , which release primarily nitric oxide, but also vasoactive intestinal peptide in order to induce LES relaxation (19, 20) [5,6].
These studies show that inhibitors of NO synthase selectively antagonize LES relaxation to all three modes of intramural inhibitory nerve stimulation including physiological swallowing. These studies suggest that the L-arginine-nitric oxide pathway is involved in physiological relaxation of the LES. (Source)
Passage of bolus through the EGJ region thus requires relaxation of the LES, aided by distraction of the LES region and CD by contraction of distal esophageal longitudinal muscle. The CD is therefore an important constituent of the EGJ and hence, the term EGJ is thus preferred over LES to functionally describe this region.
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