Gastroesophageal Reflux Disease
(GERD)
The prevalence of GERD in the general population is estimated to be as high as 35%.
GERD is commonly believed to result from excess acid production in the stomach. However, most of the medical literature on GERD indicates otherwise.
A key cause of GERD is failure of the valve mechanism between the esophagus and the stomach, allowing the acidic stomach content to reflux into the esophagus – creating the symptoms referred to as “heartburn” or “acid reflux. But what causes this failure in the first place?
We still don’t know what causes the failure of the valve mechanism but gastric acid can easily damage the fragile tissue of the esophagus and wear away the lining.
Recent research points to delayed emptying of the stomach as a possible cause. A heavy or fat-rich meal can slow stomach emptying and allow stomach pressure to overwhelm the function of this valve.
Other research suggests that incomplete digestion of protein and carbohydrate leads to increased production of gas by intestinal bacteria. This build-up of gas in the intestinal tract leads to intra-abdominal pressure, which may impede the valve mechanism.
Conventional Treatment of GERD
Stomach acid suppression with the use of PPIs is an oversimplification of the problem that has led to a $14 billion per year bonanza for pharmaceutical companies in the sale of PPI medications.
Studies indicate that as many as 70% of people taking PPIs don’t require them.
While reducing acidity in the stomach helps to relieve the burning sensations that the acid causes, the reflux of stomach contents to the esophagus is not changed.
The reduced acidity simply does not cause as much pain and inflammation when it reaches the esophagus.
A classic case of treating the symptoms and neglecting the cause.
In 2010, the FDA issued a warning that the use of PPIs increased risk of bone fractures of the hip, wrist and spine. Since then, the FDA has issued numerous warnings to the public related to the use of these drugs. These medications have been associated with increased risk of osteoporosis and bone fractures, increased risk of C. difficile (C. diff) and other GI infections, pneumonia, food allergies and a number of nutritional deficiencies, including calcium, iron, vitamin B12, folic acid and magnesium.
Recent evidence is even more startling as they are now being associated with increased risk of chronic kidney disease (CKD) and dementia. One of these studies found cognitive impairment in response to even short-term use of the most commonly-used PPIs.
“It is never ideal to treat one abnormality by creating another, as was the case for many years with management of ulcer disease before the discovery of (the root cause): H. pylori infection”
Functional Medicine Management of GERD
Assessment
In addition to assessment for GERD-related symptoms, nutritional deficiencies are also assessed. Referral to a specialist is recommended in cases of chronic, persistent GERD or severe burning sensations in chest.
Management
Functional Medicine focuses on the causes rather than symptoms.
Why is there an acid reflux issue and can we work towards permanently correcting it?
The answer is yes – a resolution of the dysfunction with no side effects is often possible.
Nutritional intervention usually involves:
Betaine HCl
Supplementation of hydrochloric acid in the form of betaine HCl is usually recommended to restore normal acidity in the stomach.
Zinc carnosine
Zinc carnosine has been shown to help regenerate the damaged stomach lining, stimulate mucus secretion, reduce inflammation and promote gastric healing.
Digestive Enzymes
Digestive enzymes are often used to support proper digestion of nutrients in order to minimize incomplete digestion and malabsorption, which promotes increased gas production leading to acid reflux.
Nutritional supplementation of deficient nutrients
Nutritional deficiencies are common in people with GERD. Supplementation with those nutrients that are found to be deficient is often recommended.