Over 15 million Americans currently take a type of heartburn medication known as proton pump inhibitors, or PPIs, to treat their gastroesophageal reflux disease (GERD). But these powerful little pills can cause a whole lot of trouble with their side effects long term.
Prolonged use of these medicines can cause kidney disease, certain cancers, lead to heart attacks, and bone fractures. Other side effects include vitamin B12 deficiency, low magnesium, low calcium levels, and opportunistic infections.
If you have GERD and have been wanting to get off PPI’s or avoid them altogether, personalized treatment strategies like nutrition and lifestyle modifications may help with symptom relief and recovery.
This article will discuss common reasons for chronic heartburn, how to test for these conditions, and ways to get your stomach acid back to doing the job it was meant to do.
What is GERD
GERD, short for gastroesophageal reflux disease, is caused by frequent acid reflux.
When you swallow, the muscle around the bottom of your esophagus relaxes to allow food and liquid to flow into your stomach. After the food moves down, the sphincter closes behind it. If that muscle relaxes abnormally or weakens, stomach acid can flow back up into your esophagus, causing acid reflux or "heartburn."
Many people experience acid reflux occasionally. But GERD is officially diagnosed if mild acid reflux occurs at least twice a week or moderate to severe acid reflux occurs at least once a week.
GERD Signs & Symptoms
- A burning sensation in your chest (heartburn), usually after eating, which might be worse at night
- Chest pain
- Difficulty swallowing
- Regurgitation of food or sour liquid
- Sensation of a lump in your throat
- Chronic cough
- New or worsening asthma
- Disrupted sleep
Risk Factors for GERD
- Bulging of the top of the stomach up into the diaphragm (hiatal hernia)
- Pregnancy (changes in hormones and the growing baby can cause digestion to slow down)
- Hormonal Imbalances (Estrogen and Progesterone)
- Delayed stomach emptying (this can be for many reasons, including prior viral infection, damage to the vagus nerve, diabetes, and autoimmune disorders)
- Fatty, fried, processed foods (Standard American Diet)
- Eating large meals or eating late at night
- Drinking certain beverages, such as alcohol or coffee
- Taking certain medications, such as aspirin or Motrin
- Low Stomach Acid aka Hypochlorhydria (more on this below)
Acid Reflux Caused by Hypochlorhydria (Low Stomach Acid)
This subject (in my opinion) needs its own paragraph because it is very commonly overlooked. And it is something that definitely needs to be considered when a patient presents with chronic heartburn or GERD symptoms.
We need proper stomach acid to break down the foods we ingest. When our stomach acid is low, it can leave undigested food particles, slowing down digestion. This causes a buildup of gas and pain, mimicking signs and symptoms of GERD such as indigestion, burping, bloating, and stomach pain (or burning after eating).
Most Common Reasons for Hypochlorhydria
- Age (acid levels decrease as we get older)
- Long-term use of over-the-counter antacids and proton pump inhibitors (used to treat ulcers and acid reflux)
- Vitamin deficiency (deficiency of zinc or B vitamins may lead to low stomach acid production)
- H. pylori infections (a common cause of stomach ulcers)
- Chronic Stress
- Gastric Bypass Surgery
If a patient doesn't know how to distinguish between low stomach acid symptoms and GERD properly, they may be prescribed a PPI that just adds fuel to the fire.
But don't stress if you think you have low stomach acid; there is a simple at-home test you can try out.
At-Home Test for Hypochlorhydria
- Mix ¾ tsp of Baking Soda first thing in the morning on an empty stomach
- Set a time and wait 5 mins
- If you create any upper GI gas or burp in the first 5 mins, you have sufficient stomach acid
- If you do not belch within 5 mins, you most likely have low stomach acid
Functional Medicine Labs to Test for GERD
While there are no current functional lab tests that directly test for GERD, there are a few standard tests that practitioners use to rule out the possible underlying causes of GERD.
An unhealthy GI tract, food sensitivities, and female hormonal imbalances are three common conditions that can lead to slower digestion, inflammation, and GERD symptoms.
Comprehensive Stool Test
These stool tests can assess digestive function, dysbiosis (balance of good vs. bad bacteria), intestinal inflammation, and if there is a need for digestive support, including stomach acid (HCL) increase, enzymes support, and nutritional changes that the patient may need to consider. This is always one of my go to test when a patient comes in with GERD symptoms (after Hypochlorhydria has been ruled out).
The Standard American Diet is one of the most common reasons for food sensitivities. Food sensitivities plays a major role in disrupting the gut microbiome and contributes to symptoms such as gas, bloating, inflammation in the GI tract, and slower digestion leading to Acid Reflux.
Studies have shown that elevated levels of estrogen and progesterone, either through endogenous or exogenous sources, can increase gastroesophageal reflux. These hormones are commonly out of balance in post-menopausal women.
Functional Medicine Treatment for GERD
PPI's come with a laundry list of side effects, so the more we can avoid them, the better the patient will be overall.
Instead, personalized treatment strategies that include nutrition and lifestyle modifications can help patients with chronic acid reflux find effective symptom relief and recovery.
Functional medicine focuses on the whole body, and we are always asking, "why is this happening?" This means we discuss your diet, daily activities, how you sleep, and many other components of your lifestyle to get to the root of what's causing your illness.
Once we figure out the root cause, small steps towards healthy lifestyle modifications can really add up over time. Learning how to cook at home and focus on eating organic whole nutrient-dense foods is critical to feeding your gut microbiome, increasing food transit time, reducing inflammation, and reducing acid reflux symptoms.
Paleo, Nutritarian, Whole 30, and the Pegan Diet are nutrition plans commonly used by functional medicine practitioners. Each of these plans encourages increasing whole foods consumption and comes with extensive literature and research to back the science behind treating disease with nutrition.
If you have a food sensitivity triggering your symptoms, working with a practitioner to eliminate and slowly reincorporate that food once your GI tract has healed can make a dramatic difference.
Large meals may also be a problem for those who suffer from GERD. Learning how to modify your diet to a smaller nutrient-dense meal can help you feel satisfied while giving your stomach and esophagus a much-needed break.
Stress reduction is a crucial component to reducing acid reflux. The gut-brain axis is a real thing. If we are constantly in fight or flight, our digestion gets all out of whack. Learning what our stressors are and how to cope with them can significantly impact overall digestive health.
If your practitioner finds your hormones are out of balance, low-dose hormone replacement therapy may help.
Hypochlorhydria Treatment for GERD
If you have lower stomach acid and this is causing your acid reflux, it's important to address this. Untreated acidity problems can lead to stomach lining damage or gastric ulcers.
In the short term, you can supplement your acid levels to allow the rest of the digestive process to work properly. Natural supplements, including apple cider vinegar and digestive bitters, have been shown to help rebalance stomach acid.
There are also professional-grade supplements that include Pepsin, HCL, and digestive enzymes to assist with digestion. Over time these supplements will retrain your stomach to get to the correct pH levels.
It's essential to work with an Integrative Healthcare Professional when using these supplements to ensure you are getting the proper dosage.
If you suffer from GERD and want to avoid PPIs or eventually get off them, nutrition and lifestyle changes can make a huge difference.
Working with an integrative practitioner is highly recommended if you don't know where to start.