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Wednesday, May 24 2017

Acid reflux, or what is now commonly referred to as G.E.R.D. (gastroesophageal reflux disease) afflicts about 40% of adult Americans.  One can hardly watch an hour of television without an advertisement for one of the following drugs appearing to treat it.  Drugs like Nexium, Prilosec, and Prevacid.  These drugs are classified as proton pump inhibitors (P.P.I.’s) which means they suppress the secretion of hydrochloric acid in the stomach.  OTC drugs such as TUMS,and Gaviscon provide short term relief by blocking acid irritation, and another group of drugs called H-2 Blockers are also used to treat GERD by blocking histamine production in the stomach. This medical approach as it so often does, treats the symptom but ignores the real cause.  Most people would be surprised that many of those who suffer from GERD are deficient in hydrochloric acid.This is especially true for those over 40 years of age. 

Where, What, and Why

Where:  Acid reflux and the irritation that results is at the bottom of the esophagus, (the food pipe that runs from the throat to the stomach).  A valve sits between the esophagus and the stomach.  This valve is called the lower esophageal sphincter.  The pain does not occur in the stomach. The stomach lining itself is specially adapted to protect itself from the powerful acid.  In a normal stomach the pH before food is introduced, is about a 2 on a 1-14 acid scale.  

What:  What is happening is that the digestion that is taking place in the stomach is weak and the result is bloating and acid from the stomach is regurgitated upwards irritating the lower esophageal sphincter and the bottom of the esophagus causing pain. 

Why:  There are multiple reasons for why reflux occurs. A lack of HCL in the stomach is a common one. Stress causes us to release hydrochloric acid at inappropriate times and results in a deficiency when we need it to digest food. Then the pH may rise to an abnormal level of 2.5-3.0 before food, a level where abnormal bacteria can then thrive in this less acidic environment, a common reason for chronic G.E.R.D.  H. Pylori is one specific bacteria that has been implicated in its association with G.E.R.D.  Other causes are a host of food sensitivities like gluten which could activate an immune response to the parietal cells in the stomach.  This could be tested with a parietal cell antibody test.  Parietal cells secrete hydrochloric acid.  Other causes could be thyroid problems, obesity, smoking, certain medications such as calcium channel blockers, a lack of dietary calcium that could slow contractions in the esophagus (food pipe) and slow down transit time, or cause a leaky lower esophageal valve. 


Risks from long term GERD, and the medical approach

The risks from long term esophageal inflammation are serious.  Ulcerations causing bleeding or strictures caused by scarring to the esophagus are the most common.  Barrett’s esophagus is a more serious complication where the cells of the esophagus change and the potential for them to develop into cancer cells are increased.  In more advanced situations endoscopies, esophageal manometry(which measures the contractions of the esophagus), a Heidelberg capsule test(a capsule when swallowed gives among other things a measurement of the pH level of the stomach), tissue

biopsy’s, and surgical intervention with a procedure called fundoplication is a last-ditch effort to treat chronic GERD.  


Decreasing the stomach acid with the use of proton pump inhibitors and other antacids interferes with our stomachs ability to absorb iron, B12 and possibly calcium and other minerals.  There have been several studies suggesting that bacterial infections such as C. difficile, pneumonia, and fractures all increase with those who have been taking these drugs. The FDA saw fit to issue a warning in 2010 regarding fracture risk with those taking these drugs.  Perhaps most alarming was that the Journal of the American Medical Association Neurology in February of 2016 evaluated 74,000 participants aged 75 or older and found a strong statistical relationship between regular use of proton pump inhibitors and a 44% increased risk of developing dementia.  That 44% increase would translate into 10,000 new cases annually of dementia.  This study followed a 2015 study done with 60 healthy volunteers aged 20-26 taking P.P.I.’s and within one week cognitive decline was seen in all 60 subjects.  The same proton pump inhibitors that block acid in the stomach also impairs acid production in the brain’s cleanup cells called microglia.  Microglia contain lysosomes which are cellular garbage collectors that accumulate junk proteins like beta-amyloid proteins which has been associated with dementia and Alzheimer’s.  Some studies have shown that the lysosomes of Alzheimer’s patients are less acidic than those of healthy patients.  There is growing interest whether proton pump inhibitors might also be associated with other neurodegenerative diseases such as Parkinson’s disease.


Natural Approaches to G.E.R.D.

For some people avoiding foods that they are sensitive to, which may be increasing histamine release is important.  For others taking hydrochloric acid alone or with pepsin an enzyme helpful for digesting protein is important.  Takingcalcium in a liquid or chewable form might help the contractions of the esophagus and increase the motility of the food through digestive tract. For many treating an underlying bacterial overgrowth is essential for improved symptoms.  Zinc and carnosine (a combination of two amino acids) is helpful for digestion.  In others, taking D.G.L. (deglycerized licorice) which has one active ingredient, glycyrrhizin, found in licorice removed, or aloe vera juice, slippery elm, or marshmallow root can have a soothing effect on the esophagus.  Bitters have long been used in folk medicine as a remedy.  Gentian one of the most bitter substances known, has two glycosides, gentiopicrin and amarogentin which stimulate the secretion of saliva in the mouth and hydrochloric acid in the stomach.  Drinking a teaspoon oforganic apple cider vinegar mixed in water prior to eating can have similar results.

Posted by: Dr. Goldstein AT 10:30 am   |  Permalink   |  0 Comments  |  Email

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