GERD (Gastroesophageal Reflux Disease) and LPR (Laryngopharyngeal Reflux) remain controversial. Part of the problem is that it is represented by three medical specialties (ENT, GI, and PUL), each focusing on different parts of the aero-digestive tract.
In its most elemental form, reflux or heartburn (silent or painful) is the back-flow of gastric (stomach) content into the esophagus.
Mainstream medicine’s approach to treating heartburn and GERD/LPR involves taking acid suppressing drugs for as long as these problems occur. Unfortunately, because these drugs may make it worse, it means that people who start taking antacid drugs end up taking them for the rest of their lives. When these drugs were first introduced, it was recommended that they be taken for no more than six weeks! Six weeks–not 6 decades.
Also, about 10 % of people taking Prilosec, Nexium, etc. do not respond to them, and another 15-20 % have ill side effects. This is a serious problem because acid stopping drugs promote bacterial overgrowth (SIBO), weaken our resistance to infection, reduce absorption of essential nutrients, and increase the likelihood of developing IBS, other digestive disorders, and cancer. The manufacturers of these drugs have always been aware of these problems.
On rare occasion is heartburn caused by too much stomach acid, in fact it’s most often caused by (1) not enough stomach acid (hypochlorhydria); (2) a lower esophageal sphincter (LES) dysfunction; (3) SIBO (Small Intestine Bacterial Overgrowth), and/or (3) eating the standard American diet (SAD).
Since 1976 testing for stomach acid production at Jonathan Wright’s, MD, Tahoma Clinic showed that low stomach acid occurred in over 90 percent of patients tested. If you’re having digestive symptoms such as heartburn, burping, gas, bloating, or nausea after eating it’s very likely that you may have low stomach acid issues.
If you’ve made several diet and lifestyle changes and you’re still not seeing the results, low stomach acid might be holding you back.
Proper levels of stomach acid are needed to adequately absorb many nutrients, vitamins, and minerals (iron, copper, zinc, magnesium, and calcium), vitamin B12, folic acid and proteins.
Stomach acid is also a crucial part of the immune system. The acid barrier of the stomach, during normal states of health, easily and quickly kills bacteria and other bugs that enter the body. It also prevents bacteria from the intestines from migrating up and colonizing the stomach.
In these cases, replacing stomach acid with HCL supplements is almost always successful. Therefore successful treatment is based on restoring adequate stomach acid production and eliminating bacterial overgrowth.
Treating GERD or LPR can be accomplished by following the “three Rs” naturally:
- Reduce factors that promote bacterial overgrowth and low stomach acid.
- Replace stomach acid, enzymes and nutrients that aid digestion and are necessary for health.
- Restore beneficial bacteria and a healthy mucosal lining in the gut.
Step One: Reduce Factors that Promote Bacterial Overgrowth & Low Stomach Acid
Eliminate most Carbohydrates — a high carb diet promotes SIBO – in particular H. pylori – which can suppress stomach acid. This creates a vicious cycle where bacterial overgrowth and low stomach acid reinforce each other in a continuous decline of digestive function. It follows, then, that low-carb diets, like SCD,GAPS, or Paleo would reduce bacterial overgrowth. It’s important to note that obesity is also an independent risk factor for GERD/LPR, because it increases intra-abdominal pressure and causes dysfunction of the lower esophageal sphincter (LES).
- Eliminate all fructose and artificial sweeteners: they have been shown to increase bacterial overgrowth. Fructose (in processed form especially) should be totally eliminated.
- Eliminate “most” fiber: Remember, almost all of the fiber and approximately 15-20% of the starch we consume escape absorption. Carbohydrates that escape digestion become food for intestinal bacteria. The other problem with fiber is that it can bind with nutrients and remove them from the body before they have a chance to be absorbed. This is particularly problematic in GERD sufferers, who may already be deficient in key nutrients due to long term hypochlorydria (low stomach acid) and/or suppressing drugs like proton pump inhibitors, tums, Nexium, the purprle pill, etc. etc.
- Prebiotics: Should be avoided in patients with heartburn and GERD/LPR. Studies show that fructo-oligosaccharides (prebiotics) increase the amount of gas produced in the gut.
- H-pylori: There may be a possible relationship between H. pylori and GERD/LPR. There is some evidence that H. pylori is a normal resident on the human digestive tract, and even plays some protective and health-promoting roles. If this is true, complete eradication of H. pylori may not be desirable. Instead, a Specific Carbohydrate Diet (SCD) or GAPS diet is probably a better choice as it will simply reduce the bacterial load and bring the gut flora back into a state of balance. The exception to this may be in serious or long-standing cases of GERD/LPR that aren’t responding to the GAPS or SCD diets. In this situation, it may be worthwhile to get tested for H. pylori and treat it more aggressively. Jonathan Wright’s, MD, Tahoma Clinic, author of “Why Stomach Acid is Good For You”, suggests using Mastic Gum (a resin from a Mediterranean and Middle Eastern variety of pistachio tree) to treat H. pylori. A 1998 in vitro study in the New England Journal of Medicine showed that mastic killed several strains of H. pylori, including some that were resistant to conventional antibiotics. Mastic may be a good first-line therapy for H. pylori, with antibiotics as a second choice if the mastic treatment isn’t successful.
Step Two: Replace stomach acid, enzymes, & nutrients that aid digestion.
- HCL with Pepsin: in cases of mild to moderate heartburn replacing stomach acid with HCLsupplements is almost always successful (click here to learn more about how to test yourself for the appropriate dosage or call 301-882-7765). Note: HCL should never be taken (and this test should not be performed) by anyone who is also using any kind of anti-inflammatory medication such as corticosteroids (e.g. predisone), aspirin, Indocin, ibuprofen (e.g. Motrin, Advil, etc.) or other NSAIDS. These drugs can damage the GI lining that supplementary HCL might aggravate, increasing the risk of gastric bleeding or ulcer.
- Bragg’s Raw Apple Cider Vinegar (ACV), lemon juice, raw (unpasteurized) sauerkraut, Kimchi, probiotics, and Nato are other time-tested, traditional remedies that often relieve the symptoms of heartburn and GERD/LPR. However, although these remedies may resolve symptoms, they do not increase nutrient absorption and assimilation to the extent that HCL supplements do. This may be especially important for those who have been taking acid suppressing drugs for a long period of time.
- Avoid consuming liquid during meals, (other than a cup of water with 1 tablespoon of ACV). Water alone is problematic, because it dilutes the concentration of stomach acid.
- Replace nutrients that have not been absorbed without sufficient stomach acid. These include B12, folic acid, MAGNESIUM, calcium, iron and zinc (please call 301-882-7765 for your personal DNAA analysis).
- D-Limonene — Orange Peel Extract: recent studies demonstrate that a low-cost orange peel extract (one capsule every other day for 20 days) can relieve heartburn symptoms for up to six months at a time. Based on both anecdotal and clinical research studies, the intake of just one 1000-mg capsule of purified d-limonene every other day for 20 days has been shown to reduce or eliminate GERD symptoms in most people for six months or longer. (For more information click the d-Limonene image or link–you will be taken to Amazon’s Customer reviews.)
By coating the esophagus, d-limonene may protect the esophagus against caustic contents that would have otherwise been regurgitated from the stomach. D-limonene may also promote quicker movement of food and gastric juices out of the stomach so that these esophageal irritants do not promote as much reflux. And it may also provide a barrier in the stomach and esophagus against bacterial infection.Finally, d-limonene may reduce the amount of gastric juices that reflux (regurgitates) back into the esophagus. All of these mechanisms help explain why so many heartburn sufferers find long-term relief by taking just one 1000-mg capsule of d-limonene every other day for only 20 days
- Zinc — Carnosine is a unique product that enhances the stomach’s mucosal defenses, providing significant improvements in gastric ulcer patients. It also supports small intestinal mucosal integrity and inhibits the inflammatory responses in H. pylori. Zinc — Carnosine is also helpful in patients who do not have gastric ulcers, but have heartburn or other symptoms as a result of gastroesophageal reflux. Given the challenge of treating this condition successfully without over the counter and prescription medications, Zinc — Carnosine should be considered a first line of defense.
Step Three: Restore beneficial bacteria for a healthy mucosal lining in your gut.
A. Probiotics: because SIBO is a major factor in heartburn and GERD/LPR, restoring a healthy balance of intestinal bacteria is an important aspect of treatment. Numerous studies have demonstrated their effectiveness in treating a variety of G.I. conditions: Crohn’s disease, ulcerative colitis, and other digestive conditions.
I am often asked what type of probiotics I recommend. First, attempt to get the nutrients we need from food. Fermented foods have been consumed for their probiotic effects for thousands of years. What’s more, fermented milk products like kefir and yogurt offer more benefits than beneficial bacteria alone, including minerals, vitamins, protein, amino acids, L-carnitine, fats, CLA, and antimicrobial agents. Studies have even shown that fermented milk products can improve the eradication rates of H. pylori by 5-15%.
However, I generally do not recommend buying fermented foods, it’s beter to make them yourself at home, because the microorganism count will be much higher and safer.
Amazon.com sells good home yogurt makers, and Dom’s Kefir site has exhaustive information on all things kefir. If you do buy a home yogurt maker, I suggest you also buy glass jars to make it in (rather than using the plastic jar it comes with).
Another option, and my favorite, is to eat non-dairy (and thus lower-carb) unpasteurized (raw) sauerkraut and pickles and/or drink a beverage called kombucha–check the sugar content if you are diabetic. Raw sauerkraut can easily be made at home, or sometimes found at farmer’s markets. Bubbies brand raw pickles are sold at health food stores, as is kombucha, but both of these can also be made quite easily at home.
If you do choose to take capsules, make sure the brand you choose is reputable and the viability of their product has been independently verified. I recommend three:
- Prescript – Assist with 20 strains of beneficial microflora;
- Acidophilus Pearls, by Enzymatic Therapy; or
- Now Foods Probiotic-10.
B. Bone broth and DGL: Homemade bone broth soups (a staple of the GAPS diet) are effective in restoring a healthy mucosal lining in the stomach. Deglycyrrhizinated licorice (DGL) has been shown to be effective in treating gastric and duodenal ulcers, and works as well as Tagamet or Zantac, with far fewer side effects and no undesirable acid suppression. In animal studies, DGL has even been shown to protect the stomach lining against damage caused by aspirin and other NSAIDs. DGL works by raising the concentration of compounds called prostaglandins,
which promote mucous secretion, stabilize cell membranes, and stimulate new cell growth – all of which contributes to a healthy gut lining.
Unfortunately, the corruption of our “disease-care” system by the financial interests of the pharmaceutical companies virtually guarantees that most of this crucial information will remain obscure.
Drug companies make billions a year selling acid suppressing medications. And since most of all medical research is sponsored by drug companies, it’s virtually guaranteed that we won’t see any large studies on the effects of diets (SCD or GAPS), supplementation (DGL and HCl), and lifestyle changes on GERD/LPR.
So once again it’s up to us to discover the truth and be our own advocates. Here is a summary of some alternative solutions that may help.
- SCD or GAPS diet,
- Lifestyle changes, and
- Supplements to consider:
- Mastic Gum, Jarrow Brand
- Zinc — Carnosine, Doctor’s Best Brand
- Licorice (DGL) by Nature’s Plus
- HCl, NOW Brand
- MSM (Methyl-Sulfony_Methane) — Jarrow Brand
- Vitamin B Complex with extra B12 and B6
- d-Limonene — 1000-mg every other day for 20 days–Jarrow Brand
- Essential Enzymes by Source Naturals
For more information please read, Jonathan Wright, M.D.,
Why Stomach Acid Is Good for You: Natural Relief from Heartburn, Indigestion, Reflux and GERD