Digestion & GI health
Acid reflux — what’s eating you?
Is your body burning to tell you something? In functional medicine, practitioners
consider the health of your digestive system to be as crucial as the health of your
brain. In fact, many chronic conditions start with poor digestion, sending out clues
in the form of indigestion and heartburn. For many women, ignoring these signs over
time can lead to a more severe condition, such as acid reflux.
Scientists estimate that more than 15 million Americans suffer from acid reflux
disease, also known as gastroesophageal reflux disease or GERD, in which
acid from the stomach flows up into the esophagus, causing discomfort, inflammation
and sometimes scarring. Thanks to incessant advertising, many people go to their
doctors looking for an antacid or proton pump inhibitor (PPI) when they
have acid reflux. But using these pills long-term could mask the signals your body
is sending out and keep you from finding the real cause of your acid indigestion.
If you think you may have acid reflux symptoms
or you’ve already received a diagnosis, it’s important to know that
you have much more control than popping a pill gives you. It may take urging your
healthcare practitioner to help you find the root cause. It may take doing the investigating
yourself. Either way, the good news is that symptoms of acid reflux respond extremely
well to natural changes in diet and lifestyle — and you just may not need
that prescription for a PPI to stop your body’s acid production. It’s
simply a matter of figuring out where to begin.
What is GERD?
GERD — or gastroesophageal reflux disease — is the medical term for
acid reflux. And it can cause, among other symptoms, heartburn in the chest. Occasional
heartburn can happen after a large meal or with foods
you are sensitive to, but GERD is diagnosed when the burning happens frequently
or even continuously.
The problem of acid reflux begins when the gradient of pressure between the lower
esophageal sphincter (the valve between the esophagus and the stomach)
and the stomach is altered. Under normal circumstances, our muscles act with gravity
to create pressure to push the food we eat downward from the esophagus into the
stomach. With GERD, the pressure from the stomach below increases over the pressure
from above, and the mixture of food and acid that should stay in the stomach comes
splashing back up. A similar pressure gradient effect applies whenever we belch.
This reverse in flow can happen for many reasons, the most common being a loss of
tone in the lower esophageal sphincter or LES. Think of the LES as a one-way valve
similar to what controls the flow of water out of the spigot in your sink. When
you turn the handle, the valve opens and water flows out. Likewise, when you eat,
the LES opens to allow the contents of your meal to flow down into the stomach.
The water should never reverse back into the faucet, and neither should the gastric
contents in your stomach splash back up into the esophagus. But when the valve loses
its tone, it can’t keep the acidic mixture down and you begin to feel the
Some of the acid reflux symptoms you may experience include:
- Burning pain in your chest (heartburn) or upper abdomen
- Irritation in your throat
- Acid taste in your mouth
- Bad breath
- Chronic cough
- Difficulty swallowing
Although acid reflux is common, it can be serious. Over time, regurgitation of acidic
stomach contents can wear away the esophagus, eroding the delicate tissue, and causing
inflammation and scarring. It can sometimes even lead to erosion of tooth enamel
and, in extreme cases, to esophageal cancer. In fact, one in ten people with GERD
go on to develop dangerous changes in the esophagus (known as Barrett’s esophagus)
that can increase their chances of esophageal cancer.
Because of these long-term effects and because the symptoms are associated with
many other diseases, including heart disease, H. pylori infection, gastritis
(inflammation of the stomach lining), and ulcers,
it is important to heed your body’s signals and discuss your symptoms with
your healthcare practitioner early. If your practitioner does diagnose you with
GERD, be wary of easy solutions.
Just the tip of the acid iceberg
Conventional Western medicine treats acid reflux on the premise that if we can stop
or neutralize the hydrochloric acid (HCl) produced in our stomachs, we can solve
the problem. If the acid is causing the burning, then take away the acid —
right? This can certainly help some people in the short-term. But in truth, the
approach only solves a portion of the problem: the symptoms. And inappropriate or
long-term use of antacids (like TUMS or Mylanta), proton pump inhibitors (like Nexium
— the “Purple Pill ”, Protonix, and Prilosec), or H2-receptor
antagonists (like Tagamet, Pepcid or Zantac) can set you up for more problems down
In my experience, most patients with GERD or acid reflux are suffering from too
little acid, not too much. Let me explain. During healthy digestion,
your stomach uses an acid cocktail made up of hydrochloric acid (HCl) and the powerful
digestive enzyme pepsin
to break down food into the vital nutrients your body needs. Pepsin requires a highly
acidic environment to do its job, and when HCl is low — which can happen for
many reasons, including age, poor diet, infection and overusing antacids or other
medications — it becomes increasingly difficult for your stomach to fully
process your food.
Wanting to get the job done, the stomach may initially respond to low acidity by
releasing more gastric acid. This effect, sometimes referred to as acid
rebound, can also occur after taking antacids such as TUMS: in response
to the acid-neutralizing effect of the tablets, the stomach works to replenish its
acid supply. But ultimately, prolonged use of acid-inhibiting medications such as
PPI’s or H(2)-receptor blockers can induce a state of
hypochlorhydria, or chronic low acid, perpetuating the cycle of
indigestion. And once you stop the meds, you may yet face the issue of acid indigestion
because you have not yet addressed its underlying causes.
So, even if medication to block acid production helps in the short-term, it’s
not a solution, and over time it can actually exacerbate the problem. Instead of
masking your symptoms, investigate the root causes. This is the best way to prevent
GERD from worsening — and even cure it.
Finding the root cause of acid reflux
In my practice, the health of a woman’s stomach and gut is paramount. For
patients with digestive complaints, we often recommend in-depth
diagnostic tests. In the case of acid reflux, for example, testing for the
presence of antigens from the bacterium H. pylori or IgE and IgG testing
for food sensitivities may be useful. In some women, we may also check to see if
hormone levels such as estrogen, progesterone, or cortisol are unusually high or
otherwise off-balance. Be forewarned, however, that conventional doctors may be
unfamiliar with this type of testing and look askance when you request it. That
said, I have seen the information that this kind of testing provides totally transform
Because we are all individuals, the path back to where your GERD began can be different
for everyone. Here are some common causes to investigate:
Hiatal hernia. A hiatal hernia is a structural problem
that occurs when the lower esophageal sphincter (LES) and stomach wall below it
partially bulge up through the opening in the diaphragm. Normally, the diaphragm
muscles serve as an extra barrier for the LES. In a hiatal hernia, the diaphragm
encircles and impinges on the upper stomach wall, throwing off the pressure gradient
at the LES and allowing the acidic contents of the stomach up into the esophagus.
Research shows that the larger the hernia, the greater the acid reflux. Some people
can have a hernia and never experience symptoms, but persistent heartburn and chest
pain are common complaints of hiatal hernia patients.
Hernia pain can be misconstrued as a heart attack, so it’s important to get
an accurate diagnosis from your doctor. There is also a danger that the stricture
can cause the upwardly bulging portion of the stomach to become strangled and its
blood supply cut off completely. Osteopathic treatments or surgery can help shift
organs back into place.
Hypochlorhydria. This is the scientific term for chronic
low stomach acid, as we discussed above. Remember that acid is essential in the
digestion of food. Without it, you can compromise your ability to fully break down
and absorb nutrients, as well as set yourself up for prolonged indigestion and possibly
GERD. Many health problems are associated with hypochlorhydria, including vitamin
B12 deficiency, anemia, skin conditions and autoimmune disorders, so it’s
important that it be diagnosed and addressed as early as possible.
Food allergies and intolerances. If you’re allergic
or intolerant to certain foods, for example wheat or dairy, your gastric juices
can’t break the proteins and sugars in those foods into their useable and
non-reactive subcomponents. This can cause a host of allergic symptoms as well as
post-meal discomfort in the form of gas, bloating, or acid reflux.
Age. Like many of the muscles in our bodies, the LES can
lose tone and mobility as we age, making it more likely for stomach contents to
push up through the weakened valve. The parietal cells in the stomach can also become
less responsive as we age, so HCl levels naturally tend to decline and digestion
becomes more sensitive.
Pregnancy. The pressure of a growing fetus within the
expanding womb can push up on our digestive organs, putting added pressure on the
LES and forcing the pressure gradient to shift and allow stomach contents into the
esophagus. There is also a theory that the changes in estrogen and progesterone
(along with other hormones) during pregnancy allow the LES to relax more than it
generally would. Whether or not this is the precise mechanism, a hormonal component
to GERD symptoms in women has been suggested.
Obesity. A Scandinavian study published in 2003 in the
Journal of the American Medical Association showed a direct link between
obesity and acid reflux. This may have something to do with larger meals or extra
weight increasing pressure on the LES, causing it to remain partially open and allowing
regurgitation. Weight loss is
obviously an effective treatment.
Prescription medication. Certain medications can directly
or indirectly lead to GERD. For example, anticholinergic agents (such as those used
for IBS and chronic diarrhea) can slow the muscular waves
of digestion and reduce the pressure gradient in the esophagus. Similarly, codeine
and other opiates slow down the action of smooth muscle tissue and affect LES tone.
Tricyclic antidepressants have also been linked with GERD, most likely because the
neurotransmitters they work on in the brain are the same as those in the gut. And
for women in perimenopause and menopause, it’s important to note that hormone
replacement therapy has also been found to be strongly associated with gastroesophageal
reflux. Studies suggest that elevated levels of estrogen and progesterone, whether
they’re the body’s own hormones or coming from sources outside the body, such as
supplemental HRT or SERM’s (selective estrogen receptor modulators), can
increase GERD symptoms.
Alcohol and tobacco. Likewise, alcohol and nicotine are
non-prescription drugs that can influence your digestive system. While the connection
between nicotine and GERD is not entirely clear, smoking appears to be associated
with a decrease in LES pressure. Alcohol, on the other hand, is directly linked
to GERD because of its role in delaying gastric emptying and lowering LES pressure.
Chronic conditions. It’s also possible for your
reflux symptoms to arise from an abnormal arrangement of your internal organs, an
injury, or some other unusual condition that needs to be ruled out, such as scleroderma,
Zollinger–Ellison syndrome, or post-surgical scarring.
As you can see, there are many potential factors leading to GERD and its ensuing
discomfort. Look carefully at your history and lifestyle to address causal issues
over which you may have some control. And while you’re tuning into these physical
pieces, don’t forget that your emotions are intrinsically linked to your health.
In the case of acid reflux, it’s usually something “burning” to
Stress and acid reflux
Women with acid reflux often report that symptoms worsen during times of increased
stress. Stress can impact our bodies in multiple ways. The digestive and immune
systems can both be compromised and may contribute to acid reflux. We know that
production of cortisol, the stress hormone, inhibits your digestion. And your immune
system isn’t as strong during times of stress either, leaving it less equipped
to fend off the infectious agents you come into regular contact with in your food
and drink. Both of these things can increase the likelihood of acid reflux.
So ask yourself, “What’s eating me?” Is there a loss you need
to grieve or forgiveness you need to grant? Is your job stressful or are your finances
a wreck? The answers may not come easily, but a thorough investigation of your emotional
state may help your system “digest” the emotions that are stuck and
making you sick.
Posture is another important signal of your emotional state. Are you literally weighed
down by the burden of your emotional life? Are your shoulders rounded with stress,
your abdomen curved into a “C?” Your inner organs need space to function.
If your posture or body structure is cramping your stomach, this will exacerbate
poor digestion and possibly lead to more severe issues, such as a hiatal hernia.
Acid reflux relief — the Women to Women approach
Natural prevention and treatment can be very useful when it comes to acid reflux.
I encourage you to give priority to the natural approach, using any medication or
antacid as a temporary bridge, with the hope that you can wean yourself of those
little purple pills in time. In my experience, use of antacids is not a long-term
answer — whereas employing optimal nutrition, healthy digestive habits, good
quality supplements, and emotional well-being provide long-term solutions. (Note
that these measures all promote healthy hormonal balance, and help soothe other
digestive disorders as well, such as IBS,
ulcers, and gastritis.)
First, address your eating habits. How and when you eat
do matter! Shifting your meal pattern from three meals a day to five smaller meals
puts less pressure on your digestive system — and keeps your
stress hormones on an even keel. Try to eat your largest meal earlier in
the day and have a light dinner. This will allow your system ample time to digest
before you go to bed. Try not to eat for three hours before going to bed, but if
you do have a snack make it light and easy to digest. Eat plenty of high-fiber fruits
and vegetables to keep your intestinal flora happy and your bowels moving. Keep
greasy foods to a minimum, as digesting fat can prolong the digestive process and
exacerbate GERD. Remember to enjoy your meals without rushing. For more information
on creating healthy eating habits, read our
Nutritional and Lifestyle Guidelines.
Chew your food thoroughly. Just like your mother said,
digestion begins in your mouth! The digestive
enzyme amylase targets starches in the mouth and gets the whole digestive
cycle going, signaling production of gastric juices in the stomach, which then trigger
production of pancreatic enzymes that go to work further down. When we eat on the
go, we practically inhale food instead of breaking it down, which puts added stress
on the stomach. The smaller the pieces are when they get swallowed, the easier it
is for your digestive system to break them down and absorb their valuable nutrients.
And speaking of chewing, if you think you have a problem with your teeth or the
way your teeth fit together, consider seeing a dentist to help you correct the problem.
Work with gravity. Try not to lie down within three hours
of eating, when acid production is at its height. Gravity helps keep your stomach
contents down where they belong. When you lie down to sleep or rest after a meal,
you lose this assistance. Some patients find relief from nighttime GERD by simply
elevating the head of their beds. Others find that taking a casual walk after a
meal helps move digestion along.
Find your triggers. Try our
Quick-Cleanse diet for a few weeks to root out the trigger foods that upset
your system. Keep a food journal to record what you eat and when, as some foods
may bother you only if you eat them at certain times, like close to bedtime. Some
of the most common problem foods to avoid with acid reflux are stimulants such as
chocolate, coffee and tea (even decaf), soda, alcohol, dairy and wheat. Others include
fatty foods, onions, tobacco, and acidic juices like orange and tomato. Simply avoiding
these foods can often clear up the problem. People assume that spicy foods cause
heartburn, yet there is little evidence to support this. But we are all individuals,
and if avoiding certain spices helps you, this is what you should do.
Examine your stress levels. Whether it’s through
meditation, reading or getting more exercise, finding ways to cut back on stress
will help your symptoms. It’s especially important to relax when you eat and
for a while afterward. Think about what’s eating you before you sit down to
a meal. Consider talking with a therapist or another trusted individual to help
you learn to cope with your stress.
Consider digestive support. At Women to Women, we’ve
had great success improving digestion and acid reflux by boosting stomach function
naturally with digestive enzymes and supplemental fiber. Visit your local health
food store for bitters or probiotics
to restore your natural acid balance and digestive function or consider our
Digestive Reset Program.
Enrich your diet. Try a high-quality nutritional supplement
like the one we offer in our Personal Program to give yourself the nutrients you
need as you are working through your acid reflux. One of the concerns with undigested
food is that your body never gets the important nutrients it needs to function well.
This can send you on a downward spiral quickly.
Acid reflux — the mystery solved
Years ago, the first thing a patient would be asked about was her digestion. Today
conventional practitioners hardly explore this topic at all. That’s unfortunate
because our nutrition and digestion are the foundation of our health.
In the end, your body is burning to tell you something. You just have to
pay close enough attention to hear the story. Remember that you are your greatest
healer — and acid reflux doesn’t have to rule your life. Listen to your
body, talk to your practitioner and call us — we are here to help.
Related to this article:
References & further reading on acid reflux
Last Modified Date: 05/09/2011
Principal Author: Marcelle Pick, OB/GYN NP