What is GERD
GERD or, Gastroesophageal Reflux disease, can occur when stomach acid frequently flows back into the oesophagus, The oesphagus is the tube connecting your mouth all the way to the stomach. Any backwash, or Acid Reflux, can cause irritation to the lining of the oesophagus.
Whilst many people may occasionally experience this, GERD sufferers will often expreince this at least twice a week.
GERD is a chronic and very common condition – A published review showed the gerd is found all around the world is is becoming more common.
Reference Yamasaki, T., Hemond, C., Eisa, M., Ganocy, S. and Fass, R., 2018. The Changing Epidemiology of Gastroesophageal Reflux Disease: Are Patients Getting Younger?. Journal of Neurogastroenterology and Motility, 24(4), pp.559-569.
Research showed the following levels of gerd around the world.
North America 18.1–27.8%
Europe 8.8–25.9%
East Asia 2.5–7.8%
Middle East 8.7–33.1%
Australia 11.6%
South America 23.0% .
Silent reflux, A condition that is linked to gerd often doesn’t cause any symptoms in especially in the chest however some people do experience a mild cough and bad breath.
Silent reflux is also known as laryngopharyngeal reflux (LPR), and happens when stomach acid flows backward from the stomach up the tube (oesophagus) into the voice box (larynx) and throat.
Symptoms of GERD?
Common symptoms of GERD include:
- Regurgitation of food or a sour liquid.
- A frequent sensation of a ‘lump in your throat.’
- Difficulty swallowing
- Chest pain
- Heartburn – a burning sensation in your chest – typically after eating and may be worse at night.
- Irritating cough
- Bad breath
- Poor teeth enamel
When to see a doctor with GERD?
Ensure you seek immediate medical attention if you have chest pain alongside shortness of breath and/or jaw or arm pain. These are potentially signs and symptoms of a heart attack.
Potential causes or Contributory factors for GERD?
Frequent acid reflux can contribute towards developing GERD. This is often the result of an issue or weakening of the muscles at the lower end of the food pipe (the oesophagus and oesophageal sphincter), that prevents acid flowing back up into your oesophagus.
Risk factors for GERD:
- Obesity
- Hiatal hernia (a bulging at the top of the stomach into the diaphragm)
- Connective tissue disorder ie, autoimmune conditions rheumatoid arthritis, scleroderma and lupus
- Delayed stomach emptying
- Smoking
- Eating ‘pro-inflammatory’ foods, including fatty and fried foods
- Taking aspirin
- Pregnancy
- Excessively drinking alcohol or coffee
- Eating regularly late at night
- H-Plyori infection – a common bacteria that causes ulcers and indigestion/heart burn. This should be ruled out by your GP or via a simple breath/ stool test that you can do at home.
- Medications – Some medications such as acid blockers, asthma inhalers, corticosteroids, pain killers such as aspirin and ibuprofen, anti-anxiety medications and osteoporosis drugs cause heartburn as a side-effect. If you regularly use these pharmaceutical and suffer from heartburn you might like to consider seeing a nutritional therapist who will be able to help you manage your digestive symptoms and may be able to aid you in dealing with the underlying condition that means you require these drugs in the first place.
- Leaky gut – Gerard Mullin MD has also done a lot of research about the integrity of the lining of the oesophagus. He has shown that if this is damaged that the stomach acid can directly reach the nerve endings that sit close to the oesophagus lining and can cause increased pain.
- Digestive problems – Imbalances in stomach acid levels, digestive enzymes and gut flora have all been correlated with heartburn. Ironically, heartburn can be found to be caused by low stomach acid at meal times and due to excess acid that is produced away form meals but of course it could be an excess is produced all of the time or a lack at meal times. SIBO small intestinal bacterial overgrowth is also a leading cause of indigestion or gerd as the bacteria in the small intestines ferment
PPI’s
Over the past few decades, the use of PPI’s or Proton Pump Inhibitors has risen exponentially, alongside the rise in GERD. A recent 2019 study (please find the reference below) from the BMJ Journal has now linked long term usage of PPI’s with cardiovascular disease, chronic kidney disease and upper gastrointestinal cancer. The study concluded that the risk of taking PPI’s continued with duration of use, even when administered at low doses. It advised that PPI’s should only be taken when medically necessary and if advised, should be taken at the lowest dose and for the shortest duration. PPI use is also correlated with reduced vitamin B12 and iron, calcium, zinc, iron alongside increased risk of C.difficile (CDC) infection, SIBO and IBD.
Ref [1] Xie Y, Bowe B, Yan Y, Xian H, Li T, Al-Aly Z. Estimates of all-cause mortality and cause specific mortality associated with proton pump inhibitors among US veterans: cohort study. BMJ. 2019;265:l1580. doi:10.1136/bmj.l1580
TREATMENT FOR GERD
MEDICATIONS
Whilst long term use of PPI’s are not generally advised certain H2 receptor antagonists or histamine receptor-2 antagonist (H2RA’s) medications can provide symptomatic relief from GERD. Please discuss this with your P or health care provider.
LIFESTYLE MODIFICATIONS
Elevating the head of the bed at night can prove very effective, as can avoiding alcohol, caffeine, tobacco and late-night meals. Avoiding foods which can aggravate symptoms as is the case with IBS can also help, including spicy foods, chocolate, acidic foods (tomatoes, oranges) and fatty foods.
DIET
Avoid:
Chocolate
Wheat
Citrus fruits/fruit juices – oranges, grapefruit, lemons, limes, and pineapple
Tomatoes
Peppermint
Onions & garlic
Spicy foods
High-fat meals / chips / French fries / Potato chips / Fried onion rings
Butter, Whole milk, Cheese, Ice Cream, Sour cream
Creamy salad dressings
High-fat cuts of red meat (such as marbled sirloin or prime rib)
High carbohydrate diet
Large meals
Coffee and tea (caffeine)
Alcohol
Carbonated beverages
Nitrates (e.g. found in bacon, Pepperami etc)
TESTS & SUPPLEMENTS
SUPPLEMENTS
The following supplements may be recommended by the clinic, after consultation with one of our nutritional therapists to best advise you:
Biotics Research Lab’s Gastrazyme which has “vitamin U”,
Methionine,S-Methyl Sulfonium Chloride, in it – taken as directed on label https://smartsupplementshop.co.uk/product/biotics-gastrazyme-90-tabs/
DGL (deglycyrrhizinated licorice) 400 mg 3-6 per day between meals to support the increase of mucous production, to protect the stomach from excess acid.
Slippery elm tea 2 tbs in 2 cups hot water 3 times a day or 400 – 500 mg capsules 3 times a day. Two hours before or after meals, medications, supplements. To soothe inflamed tissue in the throat.
Zinc carnosine 75 – 150 mg two times a day with meals. Zinc carnosine acts as a gastric cyto-protective agent by increasing mucous secretion, thereby enhancing the protection of the mucosal stomach lining
Digestive enzymes before meals – Do not take with antacids and certain diabetic medications as they may react. And do not take if you have gastritis
https://smartsupplementshop.co.uk/?s=digestive+enzymes
Melatonin 1-3 mg before bed is available on private prescription. Dr Ruscio advises that While there is evidence that people build a tolerance to melatonin, it’s best not to take it alongside pharmaceutical sleep medications or alcohol, to avoid over-sedation.
Reference Grossen, A., Yohannan, B., Bitar, H. and Orr, W., 2021. S3334 Melatonin Effects on Sleep Quality and Symptoms in Inflammatory Bowel Disease. American Journal of Gastroenterology, 116(1), pp.S1373-S1374.
Peppermint oil, enteric coated 2-4 ml 3 times a day