Do you experience burning pain in your chest (heartburn) or upper abdomen, irritation in your throat, acid or bitter taste in your mouth, bad breath, laryngitis, a chronic cough, difficulty swallowing, nausea, and chronic belching?
You could have âGERDâ â or gastroesophageal reflux disease â which is the medical term for acid reflux or âheartburnâ.
Acid reflux is common, but 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 Barrettâs 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 bodyâs signals and discuss your symptoms with your healthcare practitioner early.
There are many natural solutions available. One of my favourites is Aloe Vera. You may know aloe as a natural treatment for burns and skin irritations, but it is a wonderful solution for heartburn too. I went all the way to China to investigate, and you can watch what I discovered here.
Now, where Aloe may be the solution youâve been waiting for, letâs determine the cause. And, there are many contributing factors. However, years of practice has lead me to realize that stress â North Americaâs #1 silent killer â may indeed be the most important contributing factor to heart burn.
People with heart burn often report that symptoms worsen during times of increased stress. Stress can impact our bodies in multiple ways. The digestive system is compromised and this contributes hugely to acid reflux. We know that production of cortisol, the stress hormone, inhibits your digestion. When I ask a patient âWhatâs eating you?â âIs there a loss you need to grieve or forgiveness you need to grant?â, âIs your job stressful or are your finances a wreck?â. The answers donât often flow so easily. A thorough investigation of the emotional state along with an assessment of cortisol, is always warranted to determine whether treatment for stress will ultimately help in the curative process.
Combining Aloe Vera with an herbal âadaptagenâ, a meditative practice or biofeedback device, a cleaner diet, and moderate exercise routine is often what it takes.
Posture is another important signal of your emotional state. If you are literally weighed down by the burden of your emotional life, typically your shoulders are rounded with stress and your abdomen curved into a âCâ. But, keep in mind that 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.
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.
There are many other causes including hypochlorhydria (the scientific term for chronic low stomach acid). 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 itâs important that it be diagnosed and addressed as early as possible. NOTE: Drugs that suppress stomach acid are not the solution. (read the New York Times article below).
Food allergies and intolerances can also be a problem. If youâre allergic or intolerant to certain foods, for example wheat or dairy, your gastric juices canât break the proteins and sugars in those foods into their useable form. This can cause a host of allergic symptoms as well as post-meal discomfort in the form of gas, bloating, or acid reflux. Alcohol and tobacco also alter gastric emptying and lower LES pressure.
Prescription medications such as certain 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, itâs important to note that hormone replacement therapy has also been found to be strongly associated with gastroesophageal reflux.
Obesity is another cause. Studies have demonstrated 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.
In my practice, the health of the digestive system gets major attention. For patients with digestive complaints, I often recommend in-depth diagnostic tests. In the case of acid reflux, for example, testing for the presence of H. pylori or IgE and IgG in relation to food sensitivities discussed above. But in so many, I find that the most common denominator in particular are the stress levels and the hormones cortisol and epinephrine that are unusually high or otherwise off-balance. In order to determine what might be eating you, you can test those for yourself using the MyStatusâą line of test kits.
If you are on “PPI” heartburn medication, the following New York Times article written by RONI CARYN RABIN, is a must read!
Combating Acid Reflux May Bring Host of Ill
by Roni Caryn Rabin
The first time Jolene Rudell fainted, she assumed that the stress of being in medical school had gotten to her. Then, two weeks later, she lost consciousness again.
Blood tests showed Ms. Rudell’s red blood cell count and iron level were dangerously low. But she is a hearty eater (and a carnivore), and her physician pointed to another possible culprit: a popular drug used by millions of Americans like Ms. Rudell to prevent gastroesophageal acid reflux, or severe heartburn.
Long-term use of the drugs, called proton pump inhibitors, or P.P.I.’s, can make it difficult to absorb some nutrients. Ms. Rudell, 33, has been taking these medications on and off for nearly a decade. Her doctor treated her anemia with high doses of iron, and recommended she try to manage without a P.P.I., but that’s been difficult, she said. “I’m hoping I’ll get off the P.P.I. after I complete my residency training,” she said, “but that’s still several years away.”
As many as four in 10 Americans have symptoms of gastroesophageal reflux disease, or GERD, and many depend on P.P.I.’s like Prilosec, Prevacid and Nexium to reduce stomach acid. These are the third highest-selling class of drugs in the United States, after antipsychotics and statins, with more than 100 million prescriptions and $13.9 billion in sales in 2010, in addition to over-the-counter sales.
But in recent years, the Food and Drug Administration has issued numerous warnings about P.P.I.’s, saying long-term use and high doses have been associated with an increased risk of bone fractures and infection with a bacterium called Clostridium difficile that can be especially dangerous to elderly patients. In a recent paper, experts recommended that older adults use the drugs only “for the shortest duration possible.”
Studies have shown long-term P.P.I. use may reduce the absorption of important nutrients, vitamins and minerals, including magnesium, calcium and vitamin B12, and might reduce the effectiveness of other medications, with the F.D.A. warning that taking Prilosec together with the anticlotting agent clopidogrel (Plavix) can weaken the protective effect (of clopidogrel) for heart patients.
Other research has found that people taking P.P.I.’s are at increased risk of developing pneumonia; one study even linked use of the drug to weight gain.
Drug company officials dismiss such reports, saying that they do not prove the P.P.I.’s are the cause of the problems and that many P.P.I. users are older adults who are susceptible to infections and more likely to sustain fractures and have nutritional deficits.
But while using the drugs for short periods may not be problematic, they tend to breed dependency, experts say, leading patients to take them for far longer than the recommended 8 to 12 weeks; some stay on them for life. Many hospitals have been starting patients on P.P.I.’s as a matter of routine, to prevent stress ulcers, then discharging them with instructions to continue the medication at home. Dr. Charlie Baum, head of U.S. Medical Affairs for Takeda Pharmaceuticals North America Inc., said its P.P.I. Dexilant is safe when used according to the prescribed indication of up to six months for maintenance, though many physicians prescribe it for longer.
“Studies have shown that once you’re on them, it’s hard to stop taking them,” said Dr. Shoshana J. Herzig of Beth Israel Deaconess Medical Center in Boston. “It’s almost like an addiction.”
P.P.I.’s work by blocking the production of acid in the stomach, but the body reacts by overcompensating and, she said, “revving up production” of acid-making cells. “You get excess growth of those cells in the stomach, so when you unblock production, you have more of the acid-making machinery,” she said.
Moreover, proton pump inhibitors have not been the wonder drugs that experts had hoped for. More widespread treatment of GERD has not reduced the incidence of esophageal cancers. Squamous cell carcinoma, which is associated with smoking, has declined, but esophageal adenocarcinomas, which are associated with GERD, have increased 350 percent since 1970.
“When people take P.P.I.’s, they haven’t cured the problem of reflux,” said Dr. Joseph Stubbs, an internist in Albany, Ga., and a former president of the American College of Physicians. “They’ve just controlled the symptoms.”
And P.P.I.’s provide a way for people to avoid making difficult lifestyle changes, like losing weight or cutting out the foods that cause heartburn, he said. “People have found, ‘I can keep eating what I want to eat, and take this and I’m doing fine,’ ” he said. “We’re starting to see that if you do that, you can run into some risky side effects.”
Many patients may be on the drugs for no good medical reason, at huge cost to the health care system, said Dr. Joel J. Heidelbaugh, a family medicine doctor in Ann Arbor, Mich. When he reviewed medical records of almost 1,000 patients on P.P.I.’s at an outpatient Veterans Affairs clinic in Ann Arbor, he found that only one-third had a diagnosis that justified the drugs. The others seemed to have been given the medications “just in case.”
“We put people on P.P.I.’s, and we ignore the fact that we were designed to have acid in our stomach,” said Dr. Greg Plotnikoff, a physician who specializes in integrative therapy at the Penny George Institute for Health and Healing in Minneapolis.
Stomach acid is needed to break down food and absorb nutrients, he said, as well as for proper functioning of the gallbladder and pancreas. Long-term of use of P.P.I.’s may interfere with these processes, he noted. And suppression of stomach acid, which kills bacteria and other microbes, may make people more susceptible to infections, like C. difficile.
Taking P.P.I.’s, Dr. Plotnikoff said, “changes the ecology of the gut and actually allows overgrowth of some things that normally would be kept under control.”
Stomach acid also stimulates coughing, which helps clear the lungs. Some experts think this is why some patients, especially those who are frail and elderly, face an increased risk of pneumonia if they take P.P.I.’s.
But many leading gastroenterologists are convinced that the benefits of the drugs outweigh their risks. They say the drugs prevent serious complications of GERD, like esophageal and stomach ulcers and peptic strictures, which occur when inflammations causes the lower end of the esophagus to narrow.
The studies that detected higher risks among patients on P.P.I.’s “are statistical analyses of very large patient populations. But how does that relate to you, as one person taking the drug?” said Dr. Donald O. Castell, director of esophageal disorders at the Medical University of South Carolina and an author of the American College of Gastroenterology’s practice guidelines for GERD, who has financial relationships with drug companies that make P.P.I.’s. He added, “You don’t want to throw the baby out with the bathwater.”
Most physicians think that GERD is a side effect of the obesity epidemic, and that lifestyle changes could ameliorate heartburn for many.
“If we took 100 people with reflux and got them to rigidly follow the lifestyle recommendations, 90 wouldn’t need any medication,” Dr. Castell said. “But good luck getting them to do that.”