What is GERD?

Most people will experience the symptoms of heartburn at least once in their lives. For most, hopefully, the painful sensation in the chest is limited to a one-time indulgence in jalapeno-flavored donuts, a significant amount of meat-lovers pizza, a pot of coffee, a few beers and a recent break-up after being fired from a job. For many others, heartburn occurs more frequently and it’s causes are harder to pinpoint. It is for just such an audience that I write this paper.

Heartburn that occurs frequently is called GERD, or gastroesophageal reflux disease. It is a disorder in which the contents of the stomach, (gastro) including digestive juices and partially digested food, get by the barrier between the stomach and the esophagus (the lower esophageal sphincter) and come up (reflux) into the esophagus. This is problematic since the esophagus is not designed for digestion, but is rather a conduit from the mouth to the stomach, where digestion begins.

Acids that break down proteins and enzymes that break down protein, fats, and carbohydrates, are present in the stomach juices. This combination of acid and enzymes irritates the lining of the esophagus producing what most people describe as a burning sensation in the chest. Occasionally people have GERD that is pain free—these people may experience a hoarse voice that is more pronounced upon waking.

GERD and Cancer

The symptoms of GERD can be extremely irritating. GERD that exists for a period of time causes changes in the esophagus. The constant aggravation to the esophageal lining can lead to pre-cancerous changes (called Barrett’s esophagus) that greatly increase one’s risk for—you guessed it, cancer. For this reason, it is necessary to take very good care of your esophagus—and by extension, your digestive tract in general, and while we’re at it, the rest of your physical, mental, and spiritual being.  Rates of esophageal cancer are increasing in industrialized nations at a rate faster than any other cancer.

What Not to Do

In order to discuss how to treat GERD, it is important to discuss how not to treat it. GERD is a big drug company's dream disease. Our adherence to the SAD approach to nutrition (Standard American Diet), our stressed out lifestyles, our lack of physical activity, and our desire for a “quick fix” that will allow us to continue the above mode of living make us perfect victims for expensive drugs that are not needed 90% of the time. Drug companies have created a concept that if you suffer from GERD your stomach produces too much acid. The concept further extends itself to the logical conclusion that if you are of the unfortunate sort whose stomach is by nature overly acidic, you are suffering of a severe Prilosec or Tagament deficiency (at this point I should say that if you are on medication for your heartburn/GERD under a medical doctor’s supervision you should not discontinue the medication without discussing it with your doctor).

Drugs used for GERD fall into several categories; H2 receptor antagonists (Tagament, Zantac), proton pump inhibitors (Prilosec, Prevacid), and antacids (Tums and baking soda). All of these drugs decrease the acidity of your stomach. The problem, of course, is that the stomach is supposed to be acidic. Acid in the stomach is needed to break down protein into its constituent parts, called amino acids. If the protein is not completely broken down and gets into the blood stream, your body can develop an allergy against that protein. This can cause both food allergies and autoimmune disease.

The problem with H2 receptor agonists (Tagament, Zantac) is that while these relieve symptoms, they may do nothing to stop the reflux. This is a very comfortable way to slowly digest your esophagus and die of esophageal cancer!

Proton pump inhibitors (Prilosec, Prevacid) actually stop the production of acid in your stomach. Your digestive tract does not, however, just give up. Your stomach detects the low-acid environment that the drug has created. It then secretes large amounts of the hormone gastrin—a hormone that stimulates the proton pumps to create acid. Elevated levels of gastrin are associated with many digestive tract cancers including esophageal, pancreatic, and stomach cancer. Remember too, that while proton pump inhibitors stop stomach acid production, they do not stop reflux. Bile acids and stomach enzymes still reflux into the esophagus and aggravate it. Excess gastrin binds with receptor sites in pre-cancerous and cancerous cells in the esophagus and may actually hasten and promote esophageal cancer.

Remember, proton pump inhibitors are one of the most profitable drug classes in this country (in 2000 Prilosec was the top selling drug in the country, earning 6 billion dollars per year), and esophageal cancer is increasing at a rate faster than any other cancer! Obviously this treatment is not effective. The risks associated with proton pump inhibitors are greatest with long-term use. A recent study by University of Michigan scientists found that mice given proton pump inhibitors for gastritis (inflammation of the stomach lining), acquired more “bad” bacteria and developed more inflammatory changes in their stomach linings than untreated mice.

All this being said, there are times when the aforementioned pharmaceuticals may be appropriate to treat GERD. Discuss this with your doctor.

Natural Treatment

The seduction of drug therapy is near immediate relief. I am going to pose two levels of natural treatment in the remainder of this article; first, natural, safe means for immediate relief, and second, lasting lifestyle changes that are aimed at curing your heartburn.

Treatment Level One: Immediate Relief

Rule number one is do not lie down within three hours of eating. Simply being vertical helps your stomach contents to stay where they belong. Lying down with an incompetent lower esophageal sphincter encourages stomach contents to reflux (hopefully the lower esophageal sphincter {LES} is your only incompetent sphincter!).

Rule number two is to avoid those things that cause the LES to relax:

• Peppermint
• Chocolate
• Soda
• Coffee
• Tea (herbal teas are OK)
• Smoking
• Alcohol
• Bad fats—especially fried foods
• Old Bee Gees albums

Rule number three is to rebuild the lining of the esophagus and stomach with herbs. The single best herb for this purpose is licorice extract. The extract is better than plain old licorice because in the amounts indicated for therapy there is a substance in licorice (glycyrrhizinic acid) that may increase blood pressure. This substance is removed in the extract. The extract is called DGL, which stands for deglycyrrhizinated licorice—think about that next time you play scrabble. DGL actually increases the number of mucus secreting cells in the upper part of the stomach and esophagus that protect the lining from stomach acid. There are no known side effects and many people experience immediate relief. Most people experience complete relief within a few days. It is important to get chewable DGL, the pills that you swallow do not work as well. Take 700-800mg 2-3 times per day between meals.

Other useful herbs that help to maintain healthy lining throughout the digestive track are turmeric, cinnamon, fennel seed, and ginger. These can be included in the diet or taken in supplement form. I always recommend organic herbs.

Treatment Level 2: Long Term Cure

Chiropractic

The first thing to do is to schedule an appointment with a chiropractor. Do not wait, go, now. Pick up the phone and call. Chiropractic can work in two ways to help you to heal your GERD. First, chiropractic is the most effective means of treating a hiatal hernia, a common but often overlooked cause of GERD. A hiatal hernia is when the top part of your stomach “pops through” (herniates through) your diaphragm. The diaphragm muscle pinches the top part of your stomach and can cause reflux. A chiropractor trained in reducing hiatal hernias can fix this rapidly and your troubles are over. Some of my most rewarding experiences with patients involved reducing hiatal hernias that had been causing problems for years. These patients have often tried every drug and every dietary change and continued to suffer. Then with one chiropractic treatment they are cured!

The second way chiropractic can help is through manipulation of the spine. Research has shown that people with stomach ulcers who receive chiropractic adjustments heal much faster than people who do not. Often people who suffer from GERD and/or stomach ulcers develop pain in the upper back-between the shoulder blades. This is because the nerve supply is the same to both areas. Chiropractic adjustments to the upper back can “reconnect” the nerve supply to the esophagus and stomach and hasten healing.

Lifestyle Changes

Lifestyle changes include the following:

• Lose weight if you are overweight. I know that’s a tuffy, and that’s why its in the “long term” section of this paper. I have written articles on weight loss that outline extremely effective weight loss concepts that are relatively easy to adopt. Check them out.
• Consider your bowel bacteria. In a healthy gut there are more good bacteria than there are cells in the gut! These little guys do a lot of work and its time we gave them some respect. Here’s how you can help them out;
• Eat a good organic whole yogurt on a regular basis, preferably raw. (Note that organic yogurt has 60% more omega-3 fatty acids, more vitamin A, and does not contain hormones and pesticides.) Other foods high in good bacteria include kim chee, sauerkraut, kombucha tea, and Miso.
• Quit eating refined sugars and carbohydrates. This excess sugar and lack of fiber and nutrients disturbs the balance of bugs in your gut. The worst culprits are white flour, white sugar, and corn syrup.
• Cut down on coffee and alcohol. Do not have either on a daily basis, and when you do have them limit yourself to one cup of coffee or one alcoholic drink.
• Cut out bad fats. These include hydrogenated oils, saturated fats from commercial meat products (moderate consumption of organic meat is ok), and many vegetable oils. Instead eat cold pressed organic olive, flaxseed, coconut, and sesame oils, organic butter, avocados, fresh nuts, and fatty fish. At high temperature cooking coconut oil is best.
• Eat lots of fresh fruits and veggies. These foods contain the vitamins and minerals that your digestive track needs to function properly. The fiber and minerals also act as an acid buffer.
• Check in with yourself regarding your stress levels. Your stress levels can play a large role in the state of your digestive track. If you are high strung learn some technique of stress reduction. This is much more practical than trying to change the world around you. As the saying goes, “you can cover the world in leather, or you can put on shoes.” Learn to control your stress by practicing stress reduction daily. This can be in the form of prayer, meditation, exercise—whatever you enjoy and can commit to on a daily basis.
• Lastly, aspirin, ibuprofen, alleve, Motrin, and other pain pills eat the lining of your stomach and esophagus. In my opinion you have to be crazy to take these pills on a regular basis—they are destructive to your cardiovascular system, your joint tissue, you liver, and your gastrointestinal track. Even Tylenol, which doesn’t have the systemic effect on your gastrointestinal tract, will eat your esophagus if it spends any length of time there. Tylenol is also the leading cause of liver failure in this country.

In Conclusion

GERD can pose serious risks to your health over time. Do not let this disease go untreated. If you follow the outline above you are healing yourself at a much more meaningful level than just drugging your stomach into creating less acid. GERD is often a symptom of a much greater problem involving diet, lifestyle, stress, the digestive tract as a whole. As always, I urge you to treat the disease, not the symptom.