Acid reflux is also known as gastroesophageal reflux (GORD), or simply heartburn because of the familiar burning sensation experienced behind the sternum in the vicinity of the heart. This occurs  following a meal or upon lying down sometime afterwards, and may make the sufferer think of a heart attack. Fortunately it is a common and insignificant symptom, simply due to the acidic contents of the stomach refluxing into the oesophagus.

Other possible symptoms include the regurgitation of food, an acid taste in the mouth,  nausea, vomiting, cramp-like chest pain, difficulty swallowing, cough and laryngitis. The consequence of chronic inflammation in the oesophageal tissues due to reflux include esophagitis, strictures, tissue metaplasia (Barrett’s oesophagus), adenocarcinoma, and pulmonary fibrosis.

The acidic contents of the stomach are normally prevented from refluxing back into the sensitive oesophagus by a band of muscular tissue at the lower end of the oesophagus, immediately above the stomach, called the lower oesophageal sphincter (LOS). The LOS must relax to allow food into the stomach or excess air out.

A loss of muscle tone and therefore adequate closure may result from both lifestyle and dietary causes. In the first case, increased abdominal or stomach pressure, arising from obesity, excessive food consumption, pregnancy and tight clothing, may force stomach contents back through the LOS. Sedentary habits, smoking, certain medications, hiatal hernia, hypothyroidism, Zollinger-Ellison syndrome and stress can also weaken the LOS. In the second case, there are many foods and beverages including sugar, chocolate, coffee, milk, spices, juices, alcohol, soft drinks, fried factory foods, and certain herbs (peppermint, spearmint) which affect LOS tone, or simply irritate the membranes of the oesophagus.

Furthermore, the problem can be exacerbated if a meal remains too long in the stomach due to delayed gastric emptying (gastroparesis). Emptying of the stomach is largely controlled by hormones and nerve impulses from the autonomic nervous system. High fat foods and refined carbohydrates slow emptying, i.e. the modern urban diet. Other causes are diabetes mellitus and scleroderma.

The conventional strategy for treating reflux or peptic ulcers is to take one or a combination of pharmaceutical drugs: ant-acids, H2-receptor blockers, or Proton pump inhibitors (PPIs). PPIs block acid production from parietal cells in the lining of the stomach, while H2 receptor blockers block histamine receptors on the parietal cells. The rationale is that there is too much acid, but it is doubtful that such a state exists unless you have Zollinger-Ellison syndrome, just optimal acid with poor containment, leading to irritation, inflammation and ulcers.

The side-effects of PPI use include nausea, dysbiosis, food sensitivities, nutrient deficiency (protein, iron, magnesium, calcium, vitamin B12), abdominal pain, headache, fatigue, dizziness and mood disorders. PPI use can also exacerbate damage to the sensitive lining of the intestines caused by aspirin or non-steroidal anti-inflammatory drugs (NSAID). There is also an increased risk of osteoporosis, pneumonia, COPD, and chronic kidney disease. Reflux is determined by inserting an oesophageal catheter through the nose into the lower oesophagus. This instrument measures the pH over a non-fasting period of 24 hours.

Treatment

General

In order to protect nutrient status, PPIs, H2 blockers and antacids must be tapered off and discontinued. This is done gradually over four weeks to prevent or limit rebound acidity, which may last up to two weeks. A PPI-taper can be supported by taking herbs to protect the oesophagus, doing exercise, losing weight, and practicing relaxation.

Simple measures will support treatment such as not reclining within 2-3 hours of a meal, elevating the head of the bed, reducing smoking, and checking for any underlying food sensitivities.

Diet

Nutrition is a fundamental factor in treating reflux, the condition being largely diet-related. Sugary foods and drinks, fried factory foods and food-manufacturing additives should be avoided. Meals should be reduced in size and simplified to one course, while fluid intake during a meal is reduced.  Snacks should be consumed away from main meals as with fruit juices, the rationale being similar to that of ‘food combining’ where the compatibility of food elements is considered.

Alkalising vegetables are alfalfa, celery and asparagus. A broth can be made from potato skins and used as a temporary antacid, but organic potatoes should be used. Papaya fruit can also be tried. A diet high in vegetables and low in refined carbs and meat will alkalise the whole body and not just the gut.

Relax while eating and chew adequately as Horace Fletcher exhorted more than a century ago, because this encourages parasympathetic nervous stimulation via the vagus nerve, a state called ‘rest and digest’. By contrast, haste favours sympathetic activation which draws energy away from the digestive system for the purpose of alertness and immediate physical activity, aka ‘fight or flight.’ Fletcher also advised his American audience to only eat when hungry and not too much, and to do plenty of exercise—advice that is no doubt still sound in the treatment of most chronic digestive system diseases.

A blood type diet should be considered because more than half of the population is type O and that means the optimum diet is Paleo, according to Dr. Peter D’Adamo. Type O’s are intolerant of carbs and therefore symptoms of indigestion are reduced by avoiding refined carbohydrates, excess grains and dairy foods. Paleo is, however,  high in protein and in order to support protein digestion we need adequate acid in the stomach.

Counter-intuitively, reflux may be due to low stomach acid or hypochlorhydria which delays gastric emptying. Low acid can be tested by sipping diluted apple cider vinegar (ACV) with a meal to see if symptoms such as burning and discomfort worsen (excess acid) or are ameliorated (low acid). Alternatively, a betaine hydrochloride supplement can be taken along with a small protein-rich meal to see if symptoms worsen or improve (low acid).

Herbs

Excess acid is treated with meadowsweet which normalises acid, is anti-inflammatory and soothes the mucous membranes. Ginger, parsley, dandelion root coffee or teaspoon of crushed coriander seeds in boiling water can be tried. Marshmallow root sooths and cools. A gruel made of liquorice and slippery elm taken 30 minutes before a meal will help protect sensitive membranes.

Treating stress or anxiety is important because stress causes chronic sympathetic activation. Stress herbs are chamomile, withania, oats, and vervain. Stress nutrients are magnesium, potassium, vitamin C, and B-vitamins.

Protective healing herbs to support PPI withdrawal are fenugreek, slippery elm, marshmallow, aloe vera, liquorice and chamomile. Vitamin A, zinc and glutamine (cabbage juice is a rich source of glutamine) are also necessary for the repair of the mucous membranes. Turmeric is a useful herb, being a good anti-inflammatory and it can also be used as an antacid.

Tissue salts

Natrum phos is for acid balance and can be used as an acute ant-acid where there is sour belching and flatulence. Ferrum phos is for treating inflammation and anaemia. Kali-phos and Mag-phos are for treating stress.

Disclaimer: this article is intended for the purpose of general education only, and is not a substitute for diagnosis, treatment advice, or a prescription that is given in a consultation with a qualified physician.