Acid reflux will literally keep you up at night. Some people wake up feeling like they are choking or have a chronic cough. Bloating, burping, and that familiar burn in your chest are familiar to almost everyone with gastroesophageal reflux disease (GERD). It’s estimated that 20% of people in the U.S. suffer from GERD.1
Between 1998 and 2005, there was a 216% increase in the number of hospitalizations with GERD as the diagnosis.2 The same study found that elderly Medicare patients alone spent over $5 billion on GERD medications in 2005. Between 1998 and 2005, there was a 216% increase in the number of hospitalizations with GERD as the diagnosis.2 The same study found that elderly Medicare patients alone spent over $5 billion on GERD medications in 2005.
Conventional GERD Treatments
The current medical model for treating GERD comes from the idea that excess stomach acid creeps up into the esophagus, causing irritation and burning. The therapies used to treat chronic acid reflux or GERD are lifestyle modifications (smoking cessation, weight loss), medications, and in some cases, surgery.4 Medications focus on neutralizing stomach acid (antacid) or are designed to reduce stomach acid secretion. H2 receptor blockers and proton pump inhibitors (PPI) are two types of medications that work to reduce the stomach’s ability to secrete acid.5 Prilosec, Nexium, and Prevacid are common PPI drugs. Zantac and Pepcid AC are two common names of H2 receptor blocker drugs. H2 receptor blocker medication hinders specific stomach wall receptor cells which reduce the stomach acid they release. PPI drugs block the enzyme that allows acid to be produced.
Common Complications
Both H2 receptor blockers and PPI drugs reduce stomach acid and can have side effects. Long term PPI side effects include reduced vitamin B12 and magnesium levels, reduced carbohydrate absorption, and increased risk of dementia, heart attack, and chronic kidney disease.6 Long term H2 receptor blocker drugs have long term side effects like headaches, tiredness, gastro disturbances, and reversible impotence and gynecomastia.7 Recently, the FDA found a cancer-causing contaminant in a popular H2 receptor blocker drug, Zantac.8
Another common result for people that take PPI medication is rebound acid hypersecretion. This is when the stomach secretes a lot more stomach acid when PPI medication is stopped. The symptoms are very similar to GERD.9 As acid-suppressing medication wears off, the body realizes it’s behind in acid production and rushes to keep up. The extra stomach acid creates uncomfortable symptoms and prompts you to take more acid-suppressing medication to stop the acid reflux symptoms. This creates a chronic cycle for patients.
Acid-suppressing medication is also linked with bacteria overgrowth (SIBO) in the small intestine.10 SIBO causes diarrhea, stomach pain, and decreased nutrient absorption.
Another digestive disease complication that’s linked with acid-suppressing medication is the deadly stomach bug, clostridium difficile.11 C-diff infections are rising in frequency and affecting populations that were not considered at risk.12
There is a huge long term cost in dollars and increased risk of health complications if you use acid-suppressing medication long term. But you can’t live with acid reflux symptoms long term either.
Causes of Chronic Acid Reflux
The underlying cause of chronic acid reflux is slowly being redefined. Initial research proposed that GERD is caused by a combination of excessive stomach acid13 and an improperly-working lower esophageal sphincter (LES).14 None of the medication treatments address why the LES is not working well. Instead, the medications address the symptom by reducing the acid available to bubble up.
The functional medicine model seeks to address the underlying cause behind symptoms instead of just masking them. The prevailing theory behind recent studies is that low stomach acid results in food fermentation in the stomach. The food fermentation causes the LES to swell and close improperly. Low stomach acid mimics the symptoms of excessive stomach acid since you can only feel the heartburn of what is in your lower esophagus. As we age, GERD15 becomes more common, but stomach acid production is actually less.16 This supports the theory that low stomach acid is the underlying cause for many cases of GERD.
Low stomach acid can be treated with an HCL challenge.17 This treatment uses HCL pills in rising doses until patient tolerance is found. This treatment has been effective in resolving patient reflux symptoms. Unlike treatments that mask symptoms with a lifetime commitment to medication, the HCL treatment is for a short duration. Functional medicine is a whole body approach that uses evidence-based tests, holistic therapies, and nutrition to uncover the root cause of many illnesses. A healthy digestion system is critical for your overall health. Instead of masking GERD symptoms with medication that is tied to severe long term effects, you can heal the root cause naturally.
I’d love to hear more from you about your experiences with GERD. Join me on Facebook and tune in for more information on GERD.
Endnotes
1 Antunes C, Curtis SA. Gastroesophageal Reflux Disease. [Updated 2019 May 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441938/
2 Zhao, Yafu, and William Encinosa. “Gastroesophageal Reflux Disease (GERD) Hospitalizations in 1998 and 2005.” Statistical Brief #44, Jan. 2008, www.hcup-us.ahrq.gov/reports/statbriefs/sb44.jsp.
3 Gawron, A. J., French, D. D., Pandolfino, J. E., & Howden, C. W. (2014). Economic evaluations of gastroesophageal reflux disease medical management. PharmacoEconomics, 32(8), 745–758. doi:10.1007/s40273-014-0164-8
4 Antunes C, Curtis SA. Gastroesophageal Reflux Disease. [Updated 2019 May 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441938/
5 Antunes C, Curtis SA. Gastroesophageal Reflux Disease. [Updated 2019 May 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441938/
6 Harvard Health Publishing. “Should You Keep Taking That Heartburn Medication?” Harvard Health, Apr. 2016, www.health.harvard.edu/digestive-health/should-you-keep-taking-that-heartburn-medication.
7 Sabesin, S M. “Safety Issues Relating to Long-Term Treatment with Histamine H2-Receptor Antagonists.” Alimentary Pharmacology & Therapeutics, U.S. National Library of Medicine, 1993, www.ncbi.nlm.nih.gov/pubmed/8103374.
8 Howard, Jacqueline, and Jamie Gumbrecht. “FDA Finds Low Levels of Cancer-Linked Impurity in Common Heartburn Drugs.” CNN, Cable News Network, 14 Sept. 2019, www.cnn.com/2019/09/13/health/fda-zantac-ranitidine-carcinogen-impurity-bn/index.html.
9 “MEDSAFE.” Proton Pump Inhibitors and Rebound Acid Hypersecretion – A Recurring Issue, 7 June 2019, www.medsafe.govt.nz/profs/PUArticles/June2019/Proton-pump-inhibitors-and-rebound-acid-hypersecretion.htm.
10 Lombardo, Lucio, et al. “Increased Incidence of Small Intestinal Bacterial Overgrowth During Proton Pump Inhibitor Therapy.” Clinical Gastroenterology and Hepatology, vol. 8, no. 6, 8 June 2010, pp. 504–508., doi:10.1016/j.cgh.2009.12.022.
11 Dial, Sandra. “Use of Gastric Acid–Suppressive Agents and the Risk of Community-Acquired Clostridium Difficile–Associated Disease.” Jama, vol. 294, no. 23, 2005, p. 2989., doi:10.1001/jama.294.23.2989.
12 “C. Difficile Infection.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 26 June 2019, www.mayoclinic.org/diseases-conditions/c-difficile/symptoms-causes/syc-20351691.
13 Kines, K., & Krupczak, T. (2016). Nutritional Interventions for Gastroesophageal Reflux, Irritable Bowel Syndrome, and Hypochlorhydria: A Case Report. Integrative medicine (Encinitas, Calif.), 15(4), 49–53.
14 “Gastroesophageal Reflux Disease (GERD).” Mayo Clinic, Mayo Foundation for Medical Education and Research, 9 Mar. 2018, www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940.
15 Greenwald, David A. “Aging, the Gastrointestinal Tract, and Risk of Acid-Related Disease.” The American Journal of Medicine Supplements, vol. 117, no. 5, 2004, pp. 8–13., doi:10.1016/j.amjmed.2004.07.019.
16 Krasinski, Stephen D., et al. “Fundic Atrophic Gastritis in an Elderly Population: Effect on Hemoglobin and Several Serum Nutritional Indicators.” Journal of the American Geriatrics Society, vol. 34, no. 11, 1986, pp. 800–806., doi:10.1111/j.1532-5415.1986.tb03985.x.
17 Kines, K., & Krupczak, T. (2016). Nutritional Interventions for Gastroesophageal Reflux, Irritable Bowel Syndrome, and Hypochlorhydria: A Case Report. Integrative medicine (Encinitas, Calif.), 15(4), 49–53.