Are You Suffering with GERD symptoms?
One of the most asked questions I get about acid reflux or GERD, Karen, why I am always suffering with pain and burning and no one seems to know how to fix it? I take the drugs I avoid the spicy foods, I do every thing right and I am still suffering..what can I do?
The answer might surprise you.
Here is a GERD definition….Acid reflux sucks!
OK, you probably need a better GERD definition. But, if you ask any one suffering with Gastroesophageal reflux disease (GERD for short), also known as acid reflux, they will tell you it is no fun!
What causes acid reflux?
There are numerous causes including too little stomach acid. I hear you saying it.. what?? Karen, isn’t it usually too much acid?
No, quite the opposite. If we do not have enough stomach acid our stomach becomes alkaline instead of acidic and leads to our food fermenting in our stomach creating bubbles-these bubbles then explode pushing open our esophagus and splashing acid where it irritates and burns the lining. If you are looking for a more technical answer to what causes acid reflux or GERD according to WebMD;
Gastroesophageal reflux disease, or GERD, is a digestive disorder that affects the lower esophageal sphincter (LES), the ring of muscle between the esophagus and stomach. Gastroesophageal refers to the stomach and esophagus. Reflux means to flow back or return. Therefore, gastroesophageal reflux is the return of the stomach's contents back up into the esophagus.
Simple terms, acid reflux is actually the result of not enough stomach acid. What happens is, the food you eat sits in your stomach and ferments. Of course there will be some stomach acid, which then gets pushed up via fermentation bubbles into the esophagus causing the painful burning sensation.
We have a special lining in our stomach to protect agains acid. Because the essophagus is a one way tube, and stomach contents are not supposed to be in there, there is not special lining. This is why it hurts and you can feel the burning in your throat.
The stomach is meant to be quite acidic; think battery acid, quite corrosive. This is designed on purpose so that the proteins in your food can be cleaved apart, minerals released and a glycoprotein called intrinsic factor attach to the cobalamin (B12) in your food for absorption. The stomach is about breaking apart and separating your food into subcategories. It is done with the help of pepsin enzymes which can only be activated by stomach acid (hydrochloric acid; [HCl]).
When the food begins its journey to the bottom of the stomach, the Ph changes ever so slightly, and triggers the shut off (if you will) of HCl production. Then in the small intestine other mechanisms are at work to further break down the food.
When there is too little stomach acid, the ph of the stomach (including the pyloric canal) becomes more alkaline. This does not trigger the production of stomach acid to the degree it needs to be for incoming food. There is not enough enzyme production and the food sits and ferments, uncleaved, unchanged. This results in lost nutrients.
If you have ever made beer, kombucha or fermented vegetables, you know that there are bubbles (or gas) production. If food is sitting and fermenting, it is going to create gas. Gas rises up towards the esophageal sphincter, and the pressure forces the ring open and splashes acid into the esophagus which causes burning.
Think of a burn on our outer skin, what does it do? It bubbles up and depending on the severity may lead to a rougher, tougher type of skin. The cells change the tissue matrix. The same thing can happen inside. So, we have damage to the cells making them vulnerable to bacteria.
Why are GERD symptoms a problem?
Why are GERD symptoms a problem?
Besides the fact GERD symptoms are painful, annoying and downright bothersome. They can also lead to damage of the intestinal lining and lead to other conditions. Studies have shown an association with chronic GERD symptoms and
What causes GERD or Acid Reflux
This is where it can tricky. There are numerous things which can lead to GERD symptoms. We already talked about one which is low stomach acid. Food sensitivities can lead to GERD symptoms. The top most common allergens or sensitivity foods include milk, (dairy) eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat and soybean. There can be other foods because sensitivities are individualized to the person. In other words, what bothers one person may not bother another. Foods such as
Other non GERD food items which may contribute to GERD symptoms include
With these types of symptoms it surprising that not everyone suffers from GERD. More than 60 million American adults experience acid reflux-symptoms at least once a month, and more than 15 million adults suffer daily.
What Are Reflux and GERD symptoms?
There are numerous GERD symptoms and you may experience some or one of these. Which ones are you suffering with?
What is the typical GERD treatment plan?
The Typical GERD treatment includes taking either over the counter acid blockers or reducers or a prescription including what are called proton pump inhibitors (PPI’s). These prevent the body from producing stomach acid. The doctor then may advise you to stay away from the typical foods that lead to acid reflux or GERD symptoms. OR, some will simply say “take these” and you can eat what you want.”
When you go back to the doctors because the PPI is not working, you may be put on another one. Up to 4 is the standard treatment these days.
When this does not work, then the doctor may refer you to a specialist for some exploratory procedures to see if there may be something else going on.
I find this so sad. There are so many other options that could have been explored because no one has a deficiency of acid blockers.
Perhaps it was a food allergy, food sensitivity, or perhaps just needed a boost with a diet change. Maybe it was a gut overgrowth of bacteria. You will never know because these strategies are never discussed because it is beyond the scope of the medical profession's practice.
One of my email subscribers Sandra, asked
Don’t acid reducers increase the alkalinity in the stomach?
To which I replied;
Acid reducers and acid blockers either block acid production or greatly reduce it. PPIs, inhibit the proton/potassium pump of parietal cells in the stomach from producing the digestive acids. This then causes the pH to raise slightly in the stomach; to the point of alkalinity? Probably not, but, the proper lower pH will not be the case. This then affects the bacteria not only in the stomach but the small intestine including the duodenum. The bacteria then release substances which can then change the environment to help regulate a higher pH so they can continue to grow and cause infections.
What Your Doctor Won't Tell You About GERD
Like I said above, the doctors know of a short list of GERD foods to avoid however, they do not talk about testing for food sensitivities or allergies as possible culprit. The GERD diet plan from a doctor is to avoid acidic foods and take medications either prescribed or over-the-counter or, sometimes a combination of both.
Have you ever heard your doctor talk about how your gut microbiome could be related to your GERD symptoms?
Let’s talk about what the medical profession seems to poo-poo; your gut microbiota and how it may be the answer to alleviating your burning, painful symptoms.
One of the most important parts of my virtual practice is having my clients complete a stool test especially if they are suffering with symptoms of acid reflux or are taking any type of acid reducer or blocker.
Numerous studies have indicated what is going on in our intestinal tract has a direct link to acid reflux symptoms. Take for instance the bacteria Helicobacter pylori, previously known as Campylobacter pylori, or H. Pylori for short.
H pylori is often a culprit when it comes to GERD symptoms. H Pylori is a part of our microbiome and has beneficial effects in our body. We need H Pylori.
But when our stomach acid has been altered or can no longer properly produce stomach acid… this changes the pH of the stomach which allows for an overgrowth of this bacteria.
Studies have shown an association with low stomach acid, an overgrowth of H pylori and its virulence factors with
The very early warning signs of an overgrowth of H Pylori include those often associated with acid reflux.
When the stomach is working properly, it has a very low pH (1.5 to 3.5) keeping it quite acidic. This helps protect the stomach and the digestive tract from hitchhiking pathogens that could make us sick.
In other words, if you drink or eat something that has a bug that could make you sick such as listeria, e.coli, salmonella even parasites, your stomach acid should be able to burn them up or greatly reduce their numbers to the point we don’t get sick.
If you watch the news with all of the food borne outbreaks happening in Canada and the US, I think we have an epidemic of low stomach acid.
When there is low stomach acid, or if someone is put on one or more acid blockers (also known as PPIs) the pH of the stomach dramatically shifts making it more alkaline and now alkaline loving bacteria can attach to the stomach wall and burrow.
This causes inflammation which helps feed the bacteria and then they release what are called virulence factors (or toxins) which are more dangerous than the bacteria. These virulence factors can lead to more serious complications. H. pylori pathogens have been linked to peptic ulcer disease, gastric adenocarcinoma, and gastric mucosa-associated lymphoid tissue lymphoma.
It is not the H Pylori itself, rather its virulence factors. In fact, in this study H. pylori has been described by some as being “protective” against esophageal adenocarcinoma. In the same study, it is also hypothesized among patients with established GERD, H. pylori status does not appear to influence the risk of Barrett’s esophagus development.
I have had clients with severe GERD and their GI MAP did not show H Pylori infection. But they did have moderate to severe bacterial overgrowth of commensal bacteria in their upper small intestine. When we cleared the bacteria, balanced their microbiome, upgraded their diet, they no longer had GERD symptoms. When there is a disruption in how the body is supposed to work, cells change, our physiology changes to try and protect itself. We must look at the microbiome.
Studies including this one indicate we need gastric acidity and it is likely a key factor shaping the diversity and composition of microbial communities found in our gut. We must maintain the gut microbial community by filtering out novel microbial taxa before they pass into the intestines.
H Pylori can not become a problem unless there is a disruption of the microbiome and, a problem with the pH of the stomach and duodenal.
How Does SIBO Contribute to GERD Symptoms? Is there a connection?
Here’s the thing, unless you find out, you will never know for sure if it is H Pylori or another bacteria. With this said, not all acid reflux symptoms will be associated with H Pylori overgrowth.
One of my clients who was on two acid blockers was having a tough time eating anything because no matter what she ate, she would be suffering with the effects of burning and pain. And, this is while taking 2 PPI’s.
She was tired all the time, and was really at her wits end when we started working together. She had a stool test done and it revealed no detectable limits of H Pylori but, she did have an overgrowth of bacteria associated with Small Intestinal Overgrowth or SIBO.
You are probably thinking, wait a second Karen, I thought SIBO was in your small intestine……how can this be affecting my GERD symptoms of burning and pain in my chest?
Comparison of stomach pH (mean±S.E.) across trophic groups with gastrointestinal tracts of representative birds and mammals.Differentletters above error bars represent statistically significant differences (P<0.05) using ANOVA and Tukey-Kramer post-hoc test. Obligate scavengers(1.3±0.08), facultative scavengers (1.8±0.27), generalist carnivore (2.2±0.44), omnivore (2.9±0.33), specialist carnivore (3.6±0.51), hindgut herbivore(4.1±0.38) and foregut herbivore (6.1±0.31). doi:10.1371/journal.pone.0134116.g001
Your small intestine is attached to your stomach via the pyloric sphincter all the way down to your colon. In the case of SIBO, it can be anywhere along the small intestinal tract.
In the case of my client it was in the upper part of her small intestine. This meant constant burning pain, belching and just plain feeling miserable from the constant pain.
When she was eating certain foods it would feed the bacterial overgrowth. In return the bacteria would then release its own gasses and toxins changing the pH of the small intestinal tract and affecting the stomach and giving her those GERD symptoms.
Keeping a food journal, we quickly found which foods were affecting her the most, removed them from the diet, while we worked with natural products to get her stomach acid ramped up, her liver and gallbladder flowing well, and supported her pancreas so we could change the ph back to that which the bacteria would not like thus, getting rid of the overgrowth contributing to the awful GERD symptoms she was having.
Then we introduced most of the foods back into her diet and the symptoms were no longer a problem. At this point, her doctor weaned her off of the PPIs and she was finally not reliant upon acid blockers to try and eat food and, no more GERD symptoms.
What can you do to relieve the GERD Symptoms?
If you have been suffering a long time with acid reflux-like symptoms get a stool test done. Especially, if you have tried everything else under the sun, and the diets and food elimination have failed.
Here is the thing, It could be one bacteria causing all of your symptoms or it could be some or more. You will never know unless you find out.
The stool test I trust is the GI MAP by Diagnostic Solutions.* If you are in the USA, this FDA approved stool test is covered by some insurance companies and is used by integrative and functional Gastroenterologists.
If you were working with me I would insist on you having a GI MAP done by Diagnostic solutions. I don't actually order it because I can not for the scope of my practice. But, this has not stopped me from spending the last 10 years investigating the gut microbiome connection to gut illnesses including GERD and acid reflux. I have taken numerous courses and programs learning about gut bacteria, fungi, yeast and parasites and how it affects our health. I have also taken numerous courses on different stool test and the best and the easiest to understand is the GI MAP.
What I do is tell my clients about the GI MAP, have them call Diagnostic Solutions (who have incredible customer service) to find out if their insurance covers it. If so, then go to the doctor and have them sign up for an account and get the kit shipped to the doctor for the client to pick up.
Here in the USA, Medicare for some also covers this FDA approved test. This should give you a better validity of this test. I wish it was covered for everyone (me included).
Some doctors are not willing to do this simple task for a million reasons including malpractice or simply not having the insurance billing codes. If the client happens to live in a direct to consumer lab testing state they can order the test themselves, however, it will not be covered by health insurance.
If this is the case, I have a direct link to the GI MAP you can order yourself. I use this link with my clients because it is not easy to find. Please note, I have no monetary affiliate with MyMedLab and I can not see what you order or your results. It is merely a convenience link I give to my clients when their insurance won't cover it and/or the doctor refuses to participate (which happens 50% of the time).
Here is the direct link to MyMedLab's GI MAP
All you have to do is create an account, order the kit and it will come to your home. It also comes with a prepaid FedEX envelope to send it back or you can schedule a pickup. You will get the results in your accounts portal. If we were working together you then have the option to "share" your results with me, or send me the PDF via email. It is this simple.
Other options include going to a Naturopathic doctor or a Chiropractor so long as they have an NPI number (see, I told you there are options).
Although Diagnostic solutions has just an H Pylori panel, I do recommend getting the entire GI MAP which will include the H Pylori and 8 virulence factors plus other pathogens, parasites, commensal bacteria, fungi and a nice immune and digestive panel.
Remember my client who showed no detectable limit for H Pylori? Getting the whole GI MAP we were able to see which culprits were causing her GERD symptoms and reverse the symptoms.
Are there other tests for GERD problems?
You could have an H Pylori breath test done a on the same day you have your GI MAP done. It is not conclusive, meaning it can end up in a false negative or false positive. The other problem is you need at least 4 weeks to prepare for the test. No antibiotics or over the counter medications of acid blockers, which, could be quite painful.
You could also have a SIBO breath test done, however, there are too many false positives and negatives. The GI MAP would be the better way to go so long as you have someone who knows how to read it correctly. The GI MAP is a snap shot of the colon. Depending on what bacteria come back outside or normal ranges, will indicate where the overgrowth is.
Food sensitivities also play a role here. However, I would not get a food sensitivity test done because just about everything on the list will come back as a sensitivity especially if the zonulin test comes back high. This is because the digestive system is more than likely leaking food proteins which will adversely effect the test; essentially a false positive.
For GERD relief, some of the GERD foods which are known to cause problems include gluten, sugar, caffeine, soda, processed and refined foods. Spicy foods are the not the problem, unfortunately, they cause grief and should be avoided.
Most GERD Associations including the American Gastroenterological Association states that coffee as well as alcohol, chocolate, fatty foods and acidic foods that may precipitate heartburn (eg, citrus, carbonated drinks, spicy foods should be avoided.
What is a good GERD diet plan?
Here are some remedies for GERD relief you can try to help alleviate occasional acid reflux. There is no one GERD diet plan because there is not a one set of GERD foods causing the problem. It is going to be different for everyone.
In the beginning, it is best to stick to soft foods; mushy green veggies as they do not require a lot of digesting, high quality 100% pasture raised pork, beef, poultry, wild game. Add in fatty fish such as salmon and sardines for their rich omega fatty acids. Be sure to drink half your body weight in ounces of water each day.
Once you have calmed your gut microbes down and the GERD symptoms are better, You can also incorporate the polyphenol foods as much as possible because they will help feed the bacteria in your gut which will increase short chain fatty acids. The short chain fatty acid we really want is butyrate. Butyrate decreases inflammation particularly in the mucosal lining. If you have not downloaded the Polyphenol chart I put together, you can get it here.
Are there any GERD Home remedies?
The following recommendations may seem too simple to be true. Seriously, there are GERD home remedies you can try from properly eating to things in your cupboard. Check these out and give them a try.
Chew your food. When you chew your food you release enzymes and other properties into your saliva that start to break your food down, as well aid in your stomach having a better chance of breaking it down and decreasing the effects of acid coming up through the lower esophageal sphincter. Chewing also increases properties in saliva such as bicarbonate (natural baking soda) that can help protect the esophageal mucosal barrier. Aim to chew your food 20-50 times before swallowing.
Start moving; do something gentle, walking or yoga, which would be the easiest to do. This will help with metabolism and help your food to be metabolized better. Numerous research indicates that people who are over weight have a greater incidence of occasional or chronic GERD symptoms than those who get at least 30 minutes a day of exercise.
The best remedy I have found with my clients and personally is ice and ice water. The cold water turns stomach acid off and dilutes what is present. Every time you feel the burning sensation sip some cold water and chew some ice. Fair warning, you will end up drinking several glasses of ice water but it will alleviate the pain.
I have also found apple cider vinegar to be helpful. Sounds awful right? Try a tablespoon at first. It may burn a little but then it soothes. You may have to try it 1-2 times to neutralize the acid. If this does not work, go back to the iced water.
Keep a food journal. Seriously, can you remember what you ate yesterday? Everything you ate? Probably not. Keeping a food journal will quickly show which foods are affecting you. Take them out for a period of time while you work on healing the gut; at least. 30 days, then give them a try again.
Are there Natural GERD Relief Remedies?
I use a gut healing powder with L-glutamine and zinc carnosine in it. It is quite effective. Studies show that zinc and L-carnosine has a long history of more than 20 years of clinical use in Japan for the treatment of any condition that requires a mucosal protection and mucosal repair within the gastrointestinal tract including GERD. The product I use is GI revive. Hop on over to my store and use Code GIREV in the search bar and it will pop right up. You always are guaranteed what is in the bottle is safe. I also give you 10% off your order and free shipping.* I would love your business.
Deglycyrrhizinated Licorice (DGL) stimulates normal defense mechanisms that research shows can prevent duodenal and gastric ulcers as well as enhance the quality of mucus excreted and increase the span of surface epithelial cells. Some findings reveal that taking DGL before a meal can help protect the mucosal lining of the esophagus and stomach. Take 20 minutes before eating twice a day. The product I use is GastroMend-HP. Code GAS21
Deglycyrrhizinated licorice (DGL) is a supplement containing licorice with glycyrrhizin removed os there is no worry about high blood pressure. Taking this before you eat will help coat the esophagus and protect from acid eruptions. You can also take it after you eat.
Melatonin is another supplement you can try for alleviating chronic, hard to treat acid reflux. Melatonin is something I use with my GERD clients and we get good results. Taking melatonin daily at bedtime might improve symptoms of acid reflux, as well as help you get a good nights sleep. It is better to start with a low dose melatonin (like 1mg) until you know how your body responds. Some may find melatonin makes them groggy the next morning. I always start with the lowest dose possible and work up to body tolerance.
There are reports that beta-carotene (found in orange fruits and vegetables-naturally occurring vitamin A) may help those with esophageal lesions due to Barrett’s esophagus.
What else can I do to protect myself for GERD symptoms?
The biggest indicator on what to do next will be dependent upon the GI MAP results. Please do not skip this step. This simple test is what can make the biggest impact on healing from the symptoms of GERD and acid reflux. Especially when everything else has failed.
I would also encourage having a CMP blood panel done and include ferritin, vitamin B12, magnesium and a urine MMA test especially if you are taking any type of acid blocker.
Stomach acid is required for the absorption of minerals and vitamin B12. When these are low it will result in low energy, and the inability of the cells to repair the tissue lining.
If magnesium range comes back low, the rest of your minerals will more than likely be low. If MMA comes back high this also indicates a vitamin B12 deficiency. I would add in a good multi/mineral complex. I like to use Mediclear which helps support the liver, and is loaded with antioxidants, vitamins and minerals. Use this Code T45016 in the search results and it will pop right up.
How Do I Avoid GERD symptoms in the Future?
To avoid acid reflux in the future try these tips.
If you are thinking about trying Melatonin or Deglycyrrhizinated licorice (DGL) and need help picking out a supplement. Sign up for a free account to get 10% off, then contact me, I can help you pick out the right one.
If you would like to work together to get you back to enjoying life from GERD symptoms, you know I am here to start working with me. Schedule your free 15 minutes with me right now. Stop hurting and start healing. You have a life to get back to.
Karen Langston is a Certified Nutritionist trained in Functional Nutrition and Functional Health. Overcoming and living Crohn's Free has made her the most sought after for reversing the symptoms of gut issues. Are you on her email list? If not get on it now.
*supplement orders over $49.00 qualify for free shipping. But you always get 10% off your order. The GI MAP, I have no affiliation with, I do not have the credentialing to work with this stool test. I ave however in an indirect way have taken functional medicine courses which has given me the ability to learn, understand and from a nutritional standpoint interpret the results.