Acid Reflux and GERD

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

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The study of gastroesophageal reflux disease (GERD) shows that this is a multifaceted health problem that requires a more complex and individualized assessment and treatment protocol than simple blocking of stomach acid production.
In a New York Times article of June 26, 2012, Dr. Joseph Stubbs, former president of the American College of Physicians, stated: "When people take proton-pump inhibitors, they haven't cured the problem of reflux. They've just controlled the symptoms." By utilizing Complementary and Integrative Medicine (CIM/TCM) to restore gastric homeostasis, the problem can be cured with a comprehensive holistic treatment protocol. Guidelines state that these acid reflux drugs are intended for short-term use, less than 12 weeks, and in that time, the patient needs to correct the homeostatic functions and avoid the serious consequences of long-term use of these drugs. In 2014, the American Geriatric Society added proton pump inhibiting drugs for gastric reflux to their Beers Criteria for Potentially Inappropriate Medication Use in Older Adults due to the proven increased risk of bone loss (osteopoenia and osteoporosis), fractures, and risk of Clostridium difficile infection during hospitalization, causing enteritis. In 2016, a very large cohort study conducted by The Johns Hopkins School of Medicine showed that a significant increase in chronic kidney disease resulted from long-term use of proton pump inhibiting drugs, and FDA warnings of significant magnesium as well as calcium deficiency may result from chronic use of these drugs. Also in 2016, a large study from the German Center for Neurodegenerative Diseases showed a strong relationship between chronic use of proton pump inhibitors to treat GERD and a 44 percent increased risk of dementia. There is no longer any doubt that we should integrate other treatments into the protocol to manage and cure gasric reflux and GERD, yet the number of prescriptions and now over the counter use of these drugs continues to rise, showing that public health concerns and patient safety do no longer have sway over profits. The choice in treatment is not between these drugs and some alternative, but instead a sensible choice to prescribe and direct the use of these drugs responsibly, with short term use when necessary, and to integrate safe and effective treatments with acupuncture and herbal medicine to achieve a restoration of gastrointestinal health.


What you can do to restore your health and end the need for treatment of gastric reflux, heartburn and other gastrointestinal symptoms

I'm sorry to say that there is no magic pill. Advertising clams of miraculous simple herbal cures for GERD are false. There is a treatment plan, though, that combines a step-by-step approach to restore your health, stomach function and esophageal tissues. Your Complementary Medicine physician can guide your therapy and insure success. You need to commit yourself to the complete regimen, which includes dietary changes, herbal formulas and acupuncture, and integrate these therapies with your standard medical assesment and treatment. A proper assessment will determine whether the problem involves hyperacidity, hypoacidity, and/or other problems of the esophagus. If you also suffer from asthma, or have triggers of esophageal hyperreactivity from inflammatory mechanisms, this can be addressed as well. The good news is that when all the factors are addressed properly, your problem may resolve and healthy function be restored without chemical dependancy.

More and more respected authorities in standard medicine now recommend integration of Complementary Medicine into the treatment of gastrointestinal disease, and restoration of GI function. A wealth of studies, some of which are cited below, prove that acupuncture, herbal and nutrient medicine works in a variety of ways to achieve such functional restoration and the end of both symptoms and chronic dependency on problematic drugs to control symptoms. The implications in preventive medicine are enormous when this strategy is successful. Finding a knowledgeable Complementary Medicine physician, such as a Licensed Acupuncturist and herbalist may be the key to both solving gastroesophageal reflux (GERD), and the related related esophageal diseases (RED) now recognized by the U.S. National Institutes of Health (NIH), and which are linked to a host of other chronic diseases and health problems.

Adequate assessment is necessary to guide your therapy. As stated, the problem could be related to either high acidity or low acidity, or slow acid responses. The symptoms are similar in high acid conditions and in deficient acid production, and the acidity of the stomach changes in the cycle of digestion, making attention to details in therapy all important. Increased patient understanding of the stomach function is very helpful to correct use and choice of therapeutic tools. Testing by a GI specialist is important, and the patient may insist that these tests are performed. The Gold standard test for stomach acidity is the Heidelberg Gastric Analysis, but other tests are also helpful to differentiate various parameters in analysis. Sometimes, the treating physicians may prescribe a series of herbs and supplements and note responses, adjusting the therapy over time to achieve the right results. Persistence in therapy is the key with Complementary and Integrative Medicine when treating difficult chronic disorders. The restoration of health and homeostasis may be relatively quick, or may take a longer time.

In addition to therapy, as always, there are therapeutic activities that you, the patient, must also try and take responsibility for. Causes and aggravating factors need to be eliminated. If certain foods, excess alcohol, caffeine or smoking aggravates the acid reflux or heartburn, these obviously need to be curtailed, at least until you are healthy. Mechanical aspects may also be aggravating your condition. Try avoiding lying flat after eating, and avoid eating anything substantial for 2 hours before bedtime. Elevating the head of the bed helps many patients with acid stomach at night. Even a small riser under the head posts, or a few small boards, may help greatly without creating too much of a slant to the bed. Sometimes, losing a little weight and exercising the abdominal muscles will help to take pressure off of the stomach and esophagus, as will myofascial release of the diaphragm. Avoiding stress with meals is essential, and taking a little walk after eating often helps digestive function. Decreasing simple carbohydrates in the diet has also proven helpful, and a diet with whole grains and fresh vegetables predominant is recommended.

Many medications may slow stomach function and emptying and thus contribute to this problem, including antacids containing aluminum hydroxide, antidepressants, Lithium, narcotic pain meds and calcium channel blockers prescribed to relieve reflux and other problems. Stomach emptying may also be inhibited by poor response of the pancreas in excreting digestive enzymes into the upper small intestine, or duodenum, and problems with bile production and movement as well. Calcium channel blocking drugs are a large class of medication prescribed for a variety of health problems. Calcium channel blockers are most often prescribed to treat high blood pressure and racing heart (tachycardia), as well as angina and arrhythmias, but their use has expanded to treat migraine and cluster headaches, Raynaud's phenomenon, and other problems.

Improper levels of bile salts may also lead to a slow response of stomach emptying. Bile stones or other obstructions related to ductal inflammatory scarring, or poor function of the liver and bile formation may contribute to this problem. If the gallbladder has been removed, bile salt deficiency may be significant and the patient may consider supplementation with oral bile salts. Studies have shown that patients with deficient bile excretion and poor intestinal function have a higher incidence of tissue irritations in the body from poor breakdown of toxins, malabsorption of fatty acids etc. This often leads to increased psoriasis, muscle inflammation and arthritis, as well as gastroesopohageal reflux. Bile salt supplementation, when prescribed properly, has been shown to help with these problems.

Excess bile salts may also cause problems with stomach function and GERD. Excess bile salts, caused by a high fat consumption, poor stomach and small intestine function, or poor colon health, along with aspirin, alcohol and other irritants, are directly injurious to the mucosal linings and may alter the permeability. This allows back diffusion of stomach acids, or hydrochloric acid, injuring tissues, especially blood vessels, and liberating excess histamine, which is a stimulant of increased acid and pepsin secretions. This vicious cycle needs to be corrected, not just subdued. Health of biliary system and restoration of healthy mucosa needs to be achieved with a holistic approach. The Complementary Care Physician may help you to properly assess your problem and take the right approach to treatment.

Overuse or chronic use of aspirin and other NSAIDS (non-steroidal anti-inflammatories) may also damage gastroesophageal linings and cause reflux. This problem is very serious, and each year thousands of people die of GI bleeding when taking these common pain relievers. Why does this happen? Study shows that these drugs, which work by blocking inflammatory regulating chemicals called prostaglandins, inhibit the protective role of these prostaglandins in the mucosal linings of your stomach, esophagus and the sphincter between your stomach and esophagus. Prostaglandins are abundant in this mucosa and play an important role in gastric mucosal defense. When this defense is compromised, normal stomach acids, or pepsin, is allowed to autodigest these mucosal linings. This mucosal lining also prevents backflow of hydrogen ions from the lumen to the blood even with periods of high acidity. When the mucosa is compromised, blood acidity may increase, causing total body acidity that disrupts normal metabolism, and threatening cardiovascular irritation that eventually may lead to areas of atherosclerotic plaque accumulation. Compromise of mucosal integrity may also lead to unwanted toxins and larger molecules getting through your body's defenses into the blood stream. This is called 'Leaky Gut Syndrome' and may cause muscle inflammation and pain as well as increased stress for the liver detoxification process.

This mucosal breakdown also allows permeability of large proteins, both into the blood, and out of damaged blood vessels, sometimes causing significant loss of plasma proteins which carry many essential chemicals in to body, including steroid hormones. This permeability may also allow antigen proteins to enter the blood, stimulating allergic hyperreactions. When the issue of mucosal health is not addressed, health problems arise that the patient did not realize were connected to poor stomach and intestinal health. When symptoms of acid reflux and heartburn were controlled by anti-secretory drugs, the patient felt that all was well, but this may have been a serious mistake. Abundant research has revealed that poor gastrointestinal health leads to a host of common and chronic health problems, and that the treatment approach in standard medicine was too simplistic, and itself caused other health problems. Traditional Chinese Medicine has always stated that one cannot ignore the health and homeostasis of the GI system, or healthy sleep homeostasis, with chronic disease, and modern research is revealing the wisdom of this approach.

An article from Duke University Medical Center, published in the Journal of Gastroenterology, May, 2006, stated that acupuncture has been shown to alter acid secretion, GI motility and visceral pain, and that it is expected that acupuncture will be used in the standard treatment of patients with functional GI disorders in the future. A study headed by Dr. Richard Holloway of the University of Adelaide, South Australia, found that one of the known causes of GERD, transient lower esophageal sphincter relaxations, were inhibited 40% by electrical stimulation at the P6 point on the wrist. The study was published in the August, 2005 issue of the American Journal of Physiology-Gastrointestinal and liver Physiology. Further study by the NIH is underway to confirm these studies and provide well-funded research evidence to duplicate evidence from Chinese studies. Of course, none of these studies will incorporate the entire protocol routinely used by the competent Licensed Acupuncturist and Herbalist. Utilizing such acupuncture to correct chronic transient lower esophageal relaxations, and other GI dysfunctions, while using herbal and nutrient medicines to restore the health and function of the gastrointestinal tract is needed to address the cycle of dysfunctions.

Current pharmaceutical approaches to inhibit stomach acids are associated with health problems and gastroesophageal dysfunction in a large number of patients. One clinical study in Europe measured the acidity in the stomach over 24 hour periods in patients taking standard drugs to inhibit acid production, and found that in almost all the patients studied, that the stomach became very acidic during the night, or when supine, that esophageal motility was decreased in nearly all patients, and that emptying of the stomach from the lower sphincter was inhibited in a majority of patients. pH below 7 indicates acid condition, and the pH of 4 or below indicates severe acidity. While the patients assumed the drug was working since normal episodes of stomach acidity were controlled, the gastroesophageal dysfunction was worsening with continued use of the drug. To see the results of this study, click on the following address: http://www3.interscience.wiley.com/journal/119377789/abstract?CRETRY=1&SRETRY=0, or google interscience wiley.com journal 119377789. The chronic use of acid inhibiting drugs without an integrated protocol to restore gastrointestinal function resulted in an alarming condition of the gastroesophageal pathway and contributed to a host of chronic diseases, as well as insomnia and chronic fatigue.

To treat this condition of GERD and dyspepsia, as well as the problems acquired by chronic use of acid inhibiting drugs, patients often need to be guided professionally to taper the dependence on these drugs while slowly restoring gastric function and membrane health, and then proceed to restoration of small intestine health, proper release of pancreatic enzymes, proper bile flow, and biotic health. If Irritable Bowel Syndrome has occurred, this functional GI disorder has to be addressed as well. A persistent step-by-step approach will not only finally restore gastrointestinal health, but the health of the esophageal tissues, perhaps bronchial issues, and resolve related health issues. When gaining a full understanding of these problems, patients begin to realize the amount of persistent work needed to get back to a healthy state, and that oversimplification of the problem of chronic GERD and heartburn has led to a serious threat to future health. Each patient will need a different course of therapy.

To end the problem of heartburn and acid regurgitation, and to avoid the health problems that may arise when these become chronic, try integrating a Complementary Care physician, such as a Licensed Acupuncturist, to guide a complete and comprehensive course of therapy that will lead to restoration of healthy stomach function and an end to these problems. A combination of acupuncture, herbal formula, nutrient medicine, and individualized advice on diet and habits may be very effective with short courses of repeated therapy. The holisitic approach also will address related underlying health problems, as well as health problems that may have arisen due to acid reflux and GI dysfunction. The best benefits of this approach in the long run is better overall health and prevention of future health problems.