Gastroesophageal reflux disease (GERD), or chronic acid reflux, occurs when stomach acid frequently flows back up into the esophagus, the tube which connects your throat to your stomach.
One of the most common complaints I get asked about alongside suffering from stress and fatigue as well as feeling fat, is all manner of issues that stem from the digestive system. Most commonly I hear about constipation, diarrhoea, bloating, gas, and abdominal pain. With the digestive system there are many causes for it to go wrong and a multitude of names for conditions that ultimately result from this.
Sometimes we can be dealing with issues that are simple enough in nature but all come together to cause problems at the same but might yet be classified as a medical condition, definitely inconvenient, uncomfortable and still require you to change how you eat or live your life, but not medical. Other times similar symptoms but having on for long and be more severe in nature are actually medical conditions but they haven’t yet resolved or medicine or surgery alone haven’t reduced symptoms or the condition to a degree to allow you to live the life you want. This is where nutrition and lifestyle come in to support a more medical approach or nip things in the bud before they need to go down that route.
Irritable Bowel Syndrome (IBS) is one of the most common digestive conditions and is most commonly categorised by alternating periods of constipation and diarrhoea. IBS is related to dysfunction in the small and also the large intestine. If the small and large intestine is principally where your food and water is absorbed and waste products are removed.
However, the first part of your digestion starts in the stomach. It is in the stomach that one of the key digestive complaints I didn’t mention above, acid indigestion or heartburn, originates. When things get really bad and you’ve a trip or serval to the doctors it goes to be referred to as Gastro-intestinal Reflux Disease or GERD for short. It is very common to hear about heartburn as its far less embarrassing to say you have heartburn than it is to say you haven’t been to the toilet for the best part of a month and your incredibly windy! Most people simply blame having too much acid in the stomach as the clue to why after just having a steak it sits there at the top of your stomach for what feels like forever and the inside of your chest is on fire. As we will see there is more to it than that and knowing a fuller picture of what you eat and whether you have any digestion infections are parts of unravelling the actual reason you have heartburn which is probably not because you don’t drink enough Gaviscon.
The job of the stomach is to start chemical and mechanical breakdown of your food with; acid, enzymes and muscular action. If intestines are very long tunnels for our food to be digested the stomach is a sac, it acts like a pit stoop fo four food to be churned over. We all think of cows having four stomachs to churn the food to breakdown hard to digest grass with the end result being milk production. With the human stomach outwith the muscles, smooth muscle contracting to churn the food the stomach has 4 types of cells that secret what you might call our digestive juices.
- Mucous cells: secrete an alkaline mucus that protects the epithelium against shear stress and acid.
- Parietal cells: secrete hydrochloric acid!
- Chief cells: secrete pepsin, a proteolytic enzyme.
- G cells: secrete the hormone gastrin.
So as the muscles do their thing and mix things up they also mix these digestive juices in with the food to increase the amount of surface area the juices cover and therefore achieve more fully digested food, which is called chyme, to make the passage to the small intestine for the next part of the journey. The name for the muscular action that starts from when food is swallowed and carries on down the tube to the throat, the oesophagus, is called peristalsis. This peristalsis is controlled by complex signals from the nervous system and hormonal system. The branch of the nervous system that covers the gut is called the enteric nervous system. The part of this nervous system predominantly sending the signals is the parasympathetic nervous system through the vagus nerve. The hormones involved are called gastric and cholecystokinin.
There are several factors that regulate how available for the body to use and how easily absorbed nutrients and contaminants in the gut are, such as:
- blood and gut pH
- gastric emptying (contents leaving the stomach to the small intestine)
- intestinal motility (process created by the smooth muscles moving the food through the the gut)
- mucosa (the protective physical barrier lining of the digestive tract)
- blood flow to the gut
The stomach absorbs:
- Water
- Alcohol
- Iodide
- Copper
- Molybdenum
- Fluoride
- Intrinsic Factor (protein that helps vitamin B12 absorption)
A further important aspect to stomach function that is based on its anatomy is the fact that it has two smooth muscle sphincters, one at the top of the stomach that is supposed to shut the door after food or fluid enters called the cardiac or lower oespahageal sphincter (LES). The other is called the pyloric sphincter at the bottom of the stomach and it controls when food exits the stomach to the small intestine or the duodenum.
If things are all going to plan once food enters the stomach the LES then closes to keep those contents inside the stomach. When the LES isn’t working correctly, it becomes weak and relaxes, allowing stomach acid and stomach contents to flow back up into the oesophagus. This is known as “reflux”, the symptom that is referred to as acid indigestion or heartburn. It feels like acid has come back up your throat or oesphagus and is felt in the area of the chest in line with where the heart is and it is a burning sensation.
Heartburn is something many of us do experience from time to time but not everyone with reflux has heartburn but if it is frequent and on a weekly basis as much as I am going to explain several remedies it is a symptom that should be discussed with your doctor.
Overtime, the reflux of stomach acids damages the lining of the esophageal wall and can cause the cells to become abnormal and potentially lead to oesophageal cancer. This change in the cells, which line the lower part of the oesophageal wall, is known as Barrett’s Oesophagus, a sometimes precancerous condition. However, Barrett’s Oesophagus isn’t the only precursor to oesophageal cancer.
Although not conclusive there are several factors that seem common to those that experience reflux and heartburn on a regular basis and also have a diagnosis of GERD, these factors place pressure on the midsection:
- being overweight or obesity
- frequently eating large meals
- hiatal hernia
- being pregnant
- smoking or inhaling secondhand smoke
A hiatal hernia can also increase the chance of getting GERD or make GERD symptoms worse. A hiatal hernia is a condition in which the opening in your diaphragm lets the upper part of the stomach move up into your chest
Some medicines can cause GERD or make GERD symptoms worse. Examples include:
- benzodiazepines, sedatives that make you calmer or sleepy
- calcium channel blockers, which are used to treat high blood pressure
- Certain asthma medications
- Non-steroidal anti inflammatories (NSAIDs)
- Tricyclic antidepressants
For those that fancy some anatomical detail this link has a cool close up animation of the sphincter doing its thing.
Gastroesophageal reflux disease (GERD) symptoms
The main symptoms of Gastroesophageal reflux disease (GERD) include:
- heartburn, a painful, burning feeling in the middle of your chest, behind your breastbone, rising from the lower tip of your breastbone toward your throat
- regurgitation, or stomach contents coming back up through your oesophagus and into your throat or mouth, which may cause you to taste food or stomach acid
- chest pain
- loss of appetite
- persistent vomiting
- problems swallowing or pain while swallowing
- signs of bleeding in the digestive tract;
- vomit that contains blood or looks like coffee grounds
- stool that contains blood or looks black and tarry
- unexplained weight loss
There may be days when symptoms are better and days when they get worse. Some foods, drinks and other lifestyle factors can trigger flare-ups.
Heartburn: Is it high or low stomach acid?
The stomach secrets hydrochloric acid when food enters the stomach which leads to the release of the enzyme, pepsin to start protein digestion and kill bad bugs (disease causing microbes such as parasites, fungi, bacteria) crawling all over your food. So stomach acid cleans your food and reduces the likelihood of developing digestion infections as well as the stress and damage these infections place on your digestion and overall health. Digestive infections can result in development of food intolerances and allergies. A lighter load on your immune system can only be a good thing. It is also necessary for the breakdown and utilisation of minerals, especially calcium. In my opinion stomach acid is something to be celebrated and not demonised, to be fair I don’t have indigestion, but I do take steps to maintain my overall gut health and trust periodically to make sure all is working tip top. I cant say that has always been the case but you live and learn and once you identify your problem areas it is easier to stay focused on resolving then know what not to do for the future.
For the stomach to produce HCl, the body needs to absorb zinc from our diet. Zinc-rich foods include:
- Pumpkin seeds,
- Oysters and crab,
- Beef and pork,
- Fortified breakfast cereals,
- Baked beans,
- Cashew nuts.
Low levels of stomach acid can result in deficiencies;
- Iron,
- Vitamin B-12,
- Calcium
Low acid can also cause many digestive problems;
- Heartburn
- Burping,
- Belching,
- Gas,
- Bloating,
- Sour stomach,
- Stomach upsets,
- Nausea,
- Abdominal pain
- Undigested food in stool,
- Voracious appetite (due to cellular “starvation”),
- Food sitting in stomach too long,
- Slow digestion,
- Inability to eat a large meal due to feeling full quickly,
- Constipation and diarrhoea
These problems are often associated with excess acid but in fact low stomach acid can also cause these issues. Research shows that far more people suffer from low stomach acid than from excess acid. The digestive process involves a series of changing pH levels that rely on the stomach as part of that being at the right acidic pH. People only seem to stress about too much acid so when it is low the condition gets left untreated and lab testing is rare and its a difficult test to use.
Not many people will be that keen for having a tube shoved down the throat to then have some of their stomach contents suctioned out to measure the acid level following a meal. Another option available more these days that is less stressful but expensive, is the Heidelberg Test where you swallow a small capsule about the size of a vitamin pill that measures stomach acid. Although relatively simple to diagnose hypochlorhydria the test is seldom used based on the belief it is not worth treating – which is kind of crazy with the amount of money spent worldwide on lowering acid through the use of antacids, acid blockers and ulcer medications.
There have been countless conversations with clients where the available evidence points to low and not high stomach acid even though the symptoms are similar as listed above. As you age over 40 and more significantly over 60 years of age your stomach acid tends to decrease which can be a further finger pointing to the likelihood of low stomach acid. For those people, reaching for their Gaviscon, Tums, Maalox or Milk Of Magnesia it is the worst thing that they can do since it only alleviates the burning symptoms but actually over the long haul just contributes to the real problem!
The following conditions have been linked to hypochlorhydria:
| Acne Rosacea | Coeliac Disease | GERD – misdiagnosed acid reflux – hypochlorhydria | Poor Night Vision |
| Adrenal Fatigue | Chronic Fatigue | Hypoglycaemia | Psoriasis |
| Allergies | Chronic Hepatitis | Infections increased – parasitic, bacterial, yeast | Rheumatic Arthritis |
| Aneamia | Diabetes Mellitus (Type 2) | Lupus Erythematosis | Stomach Cancer Risk Increased |
| Arthritis | Dry Skin | Nail Weaknesses | Thyroid Disorders |
| Asthma | Gallbladder Disease | Osteoporosis | Vitiligo |
| Autoimmune Disease |
Ultimately the aim would be to combine symptoms and health history with investigating underlying cause and related loss of function through stool testing, looking at what is called organic acids with a urine test, even hormones have a role to play in leading to the loss of digestive function. Digestive infections, nutrient deficiencies, hormone imbalances all play their part as does vagal nerve dysfunction in disrupting stomach levels and the development of GERD.
Changing your diet if the above symptoms describe your digestive health is the first step on the road to restoring digestive function.
Foods to avoid
We are all different so different foods can be a trigger for different people, it can be worthwhile trying to use a food diary for even just two or three days to try and spot the foods that reproduce symptoms. For some people it is very obvious as the symptoms are distinct after consuming a certain a food or the amount of a certain food, but for others it can be very variable and a large range of foods.
1. Difficult to digest foods
- Gluten containing grains, such as wheat, corn, barley, oats, and basmati rice
- Heavy fat foods eg deep-fried, creamy foods, dairy products (such as whole milk, cheese exception yogurt), saturated fat, processed meats
2. Beware of ingredients in processed foods that may contain gluten
- Modified or hydrolysed food or vegetable starch,
- Caramel colouring,
- Dextrin,
- Malt or Maltodextrin
- Medications eg Antacids and nutritional supplements fillers and binders
3. Gas-farming foods
- Carbonated drinks,
- Potatoes,
- Beans.
4. LES relaxing foods
- Coffee or tea (caffeinated or decaffeinated),
- Alcohol,
- Tobacco,
- Spicy foods
7. Refined carbohydrates or sugar
Cause bacterial overgrowth and candida (yeast/fungi)
8. Food additives
9. Acid-containing foods
- Tomatoes (citric and malic acid)
- Citrus fruits
10. Mint
11. Sugar alcohols
- Sorbitol,
- Mannitol,
- Xylitol,
- Lactitol,
- Isomalt,
- Erythritol,
- Maltitol
Tips to improve digestive capacity
1. Regularly consume foods containing digestive enzymes such papaya and pineapple.
2. Try foods that soothe the gut and help rescue inflammation;
- Bone broth
- Cabbage
- Garlic
- Ginger
- Grapefruit
- Green Tea
- Turmeric
3. Increase fibre from fruit and vegetables
You can also read my article on 7 ways to improve digestion for more tips on digestive health.