What is Acid Reflux?
Chronic acid reflux, known medically as Gastro-oesophageal Reflux Disease (GORD), is the most common digestive condition in the UK affecting around 1 in 5 adults(1). Causing a wide range of symptoms including a burning pain in the chest, sore throat, regurgitation and dental issues, GORD is a debilitating condition that can have a dramatic effect on the quality of life of its sufferers.
Conventional treatment centres around making basic lifestyle changes (avoiding overeating, stopping smoking etc..) and the prescription of acid-suppressing drugs known as Proton Pump Inhibitors (PPI’s) to reduce acid levels in the stomach and subsequently calm inflammation.
The problem with this approach is that PPI’s do nothing to address the root cause of the condition, and although they may be effective in the short term, symptoms almost always return as soon as treatment is discontinued. What’s more, due to their powerful effect on the body’s natural acid production, PPI’s are associated with a wide range of uncomfortable side effects including abdominal pain, gas and nausea(2).
So what causes it?
Contrary to popular belief, acid reflux is not caused by excess acid. Rather, it occurs when acid escapes the stomach and comes into contact with the delicate tissue of the oesophagus. This happens when a key valve known as the Lower Oesophageal Sphincter (LOS) malfunctions and fails to properly close.(3)
A number of factors can lead to LOS malfunction including obesity, overeating and the presence of a hiatus hernia, but a growing number of doctors and functional medicine practitioners now believe that the main cause of LOS malfunction (and subsequently acid reflux) is actually an increase in Intra-abdominal pressure (IAP)(4). In other words, a build up of pressure in the stomach forces the LOS to open, allowing acid to escape and irritate the oesophagus.
Several lifestyle factors can contribute to an increase in IAP (including overeating and Obesity) but it is my belief that for individuals where such factors have been excluded, the primary causes are:
- Food Intolerances
- Low Stomach Acid
- Slow Gastric Emptying
I genuinely believe that food intolerances are the number 1 cause of acid reflux in the UK. Unlike food allergies (which are fairly easy to diagnose as they have dramatic and obvious symptoms) food intolerances are much more difficult to pin down. The symptoms they cause may be very subtle, and may take many hours or even days to manifest, but over time the cumulative effect on the digestive system can be quite destructive.
So what exactly do we mean by a ‘food intolerance’? For the sake of this article, a food intolerance is defined as:
Any ingested substance that causes an adverse (but non-allergenic) response.
Classic symptoms of intolerances are bloating, gas, acid reflux, stomach cramps and diarrhoea, but less obvious signs are tiredness, headache, or even mild depression.
Unlike allergies, intolerances do not involve the body’s immune system. They arise from an inability to digest and absorb certain compounds.(5) One of the most common examples of this is Lactose intolerance, which according to some estimates affects up to 70% of the world’s adult population.(6) With lactose intolerance, the body does not produce a sufficient quantity of lactase, which is the enzyme for breaking down lactose. As such, undigested molecules make their way to the intestines where they ferment releasing gas.
As we know, excess gas can cause an increase in IAP, which is why acid reflux is one of the major symptoms of lactose intolerance.
Another common food intolerance, and one that is certainly worth ruling out, is a sensitivity to gluten. Unlike Coeliac disease, which is a serious condition affecting less than 1% of the population, gluten intolerance is very common and can cause a range of mild to moderate symptoms including bloating and acid reflux. Despite its prevalence there are no specific diagnostic tests for gluten sensitivity, although some researchers define it simply as “an improvement in symptoms when following a gluten-free diet”.(7)
Low Stomach acid
It’s well-established that healthy stomach acid levels are crucial to properly digesting key micro and macro-nutrients. By stimulating the release of pancreatic enzymes and bile into the small intestine, stomach acid plays a crucial role in metabolising carbohydrates and fats. (8) But in the absence of sufficient acid, these compounds are not properly absorbed; instead they become food for bacteria in the gut which can lead to the production of hydrogen gas. This can in-turn lead to increased IAP.
Furthermore, healthy stomach acid levels play a vital role in the function of the immune system, acting as a first line of defence against many pathogens. Without a highly acidic environment to kill them off, harmful bacteria can make their way along the rest of the digestive tract and wreak havoc on the gut. The end result is impaired digestion, excess gas production and – you guessed it – increased IAP.
So how do we end up with low stomach acid?
Stomach acid levels naturally decline as we get older (which is one reason why acid reflux is more common in the elderly) but other factors such as chronic stress and a reliance on PPI’s can also have a big impact on our natural acid levels.
Slow Gastric Emptying
Known medically as Gastroparesis, slow gastric emptying occurs when the stomach cannot empty in the normal way. Food passes more slowly into the small intestine and as such there is a build up of IAP in the stomach which ultimately leads to acid reflux.(9)
There are a number of health conditions that can cause gastroparesis, including nerve damage, viral infections and diabetes, but simply eating too much of the wrong foods can also delay gastric emptying in many people. This is one reason acid-reflux sufferers are often advised to avoid fatty foods and large portions of red meat – because our stomachs can take a long time to process these foods and they can linger for many hours after eating.
One effective treatment for gastroparesis (and subsequently acid reflux) is that of a prokinetic agent. (10) Prokinetics are a group of drugs that help strengthen the LOS and speed up the emptying of the stomach. They achieve this primarily by enhancing gastrointestinal motility; increasing the frequency and strength of peristaltic contractions to move food through the stomach faster. Popular prokinetic drugs include Metoclopramide and Domperidone.
Unfortunately, there is a major problem with prokinetics – they almost always come with a host of serious and potentially dangerous side-effects.(11) In fact, the side-effects of Metoclopramide are so serious that many doctors don’t recommend taking it for more than a few days!
HOW TO CURE ACID REFLUX IN 5 EASY STEPS
1. Determine (and eliminate) your food intolerances
This might seem an obvious point, but in order to eliminate your food intolerances, you first must determine what they are. There are many companies out there that offer DIY intolerance testing kits, claiming to check for everything from coeliac disease to the presence of heavy metals, but unfortunately there is little scientific evidence to back these tests up.
Fortunately, there is an easy and highly effective way to test for intolerances: an elimination diet. Quite simply, you eliminate a number of common trigger foods from your diet (e.g. gluten; lactose) and monitor the affects on your digestion. You then re-introduce the foods one-by-one and see if your symptoms return. The best way to do this is by keeping a food diary and recording your digestive symptoms following each meal.
The good news is that even when you have determined your trigger foods, you don’t need to avoid them forever. Unlike people with allergies, those with food sensitivities tend to be able to tolerate small quantities of the offending food without too much trouble. The key is to find your limits and stick to them!
2. Promote healthy stomach acid levels
Given what we know about the importance of stomach acid and its role in digestion, it’s vital that we address any deficiencies in this area. This is particularly true for people who are taking, or have previously taken, acid-suppressing drugs such as PPI’s, or those with hectic lifestyles who are at risk of chronic stress.
The easiest way to boost stomach acid levels is by taking a supplemental form of Betaine HCL.* This is generally available in capsule form and is often combined with Pepsin which is a powerful enzyme to digest protein. Simply take 5-10 minutes before each main meal to gently increase stomach acid levels and promote healthy digestion.
Apple cider vinegar is another great option and comes with a host of positive health benefits including reducing body fat and helping to control blood sugar. Simply mix 1 tablespoon with 200ml of water and consume before each meal.
*Always consult your doctor before taking any supplements if you are taking medication. Never use HCL supplements if you have an active stomach ulcer.
3. Take a digestive enzyme supplement
As we have established, food intolerances generally stem from an inability of the body to digest certain compounds. Digestive enzymes address this issue by helping to break down these compounds and promoting healthy nutrient absorption in the small intestine. As a result, potentially troublesome molecules like lactose are prevented from reaching the gut intact and causing the uncomfortable symptoms associated with food intolerances.
In addition to targeting specific compounds, quality digestive enzymes also work more broadly, helping to break down carbohydrates, fats and proteins; assisting the body’s natural enzyme production and promoting overall digestion.
As with Betaine HCL and apple cider vinegar, digestive enzymes are best taken shortly before a meal to prime the digestive system for action.
4. Eat more ginger
Remember what I said about the dangerous side-effects of prokinetic drugs? Well the good news is there is one powerful, natural prokinetic that has been used for centuries and has no harmful side effects…
In a 2008 study researching the effects of ginger on gastric emptying, 24 volunteers were given either ginger capsules or a placebo and then ingested a meal of soup. Their rates of gastric emptying were measured and the results compared. In the group that took the placebo, their stomachs emptied in an average time of 26.7 minutes but in the group that took the ginger this time was more than halved to just 13.1 minutes! (12)
In addition to its effect on gastric emptying ginger has also been proven to reduce flatulence and be an effective remedy for nausea, even outperforming the popular anti-sickness drug Dramamine in one leading study. (13)
To enjoy the full benefits of ginger, add one teaspoon of freshly grated root to a cup of boiling water and enjoy as herbal tea; introduce it at meal times (it’s prevalent in many popular Asian dishes) or find a quality ginger supplement that contains a minimum of 1000mg per serving.
5. Try Fermented Foods
Fermented foods, specifically fermented vegetables, are a great addition to any diet but are particularly beneficial to sufferers of acid reflux and other digestive disorders. Rich in enzymes and beneficial bacteria, fermented vegetables help promote a healthy microbiome, which is crucial not only for digestion, but also for the regulation of the immune system.
Some great examples of fermented vegetables to try are: Kimchi, sauerkraut and pickled ginger. Other fermented foods such as natural yoghurt and kefir may also be beneficial, but these are generally not recommended for acid reflux sufferers as they contain lactose.
Acid reflux is a debilitating condition that affects up to 1 in 5 UK adults. Conventional treatment centres on the administration of powerful acid-suppressing drugs, which come with a host of harmful side-effects and do nothing to address the root cause of the problem. What’s more, by suppressing acid production the drugs actually make digestion worse, reducing the body’s ability to absorb important compounds and jeopardising the effectiveness of the immune system.
Contrary to popular belief, the true cause of Acid reflux is not excess acid but a malfunction of the lower oesophageal sphincter, caused in-turn by an increase in Intra-Abdominal pressure. This can be triggered by a range of conditions but in otherwise healthy individuals may primarily be caused by food intolerances, low stomach acid and slow gastric emptying.
The good news is that through simple lifestyle changes, smart dietary choices and targeted supplementation, it is possible to naturally and permanently restore digestive health and enjoy life without the burden of chronic acid reflux.