It used to be common knowledge that indigestion or heartburn was a sign that you were eating too much of the wrong foods. Avoiding certain foods and the occasional antacid, purchased over-the-counter, were the typical means of treatment. If a patient was ahead of the game, they may have taken steps to improve their digestive function with any number of remedies such as apple cider vinegar or swedish bitters, remedies that have been used for this purpose for hundreds of years. How then did we get to the point where a high-priced pharmaceutical drug has arisen to treat a full-blown disorder named GERD?
GERD, or gastroesophageal reflux disease, is a disorder termed to diagnose chronic heartburn. It is thought to be associated with an overproduction of stomach acid which gets pushed up into the esophagus causing irritation and, over time, cell damage. GERD may be complicated by an ulcer and is usually triggered by eating certain foods.
What holistic medicine has to offer is a radically different version of the reflux story, one that has been known in traditional medicine circles for hundreds of years. Fundamentally, most all cases of reflux are due to an impairment of proper digestive function. Modern day proton pump inhibitors are drugs that were designed to treat a very small cohort of patients with reflux; those whose stomach’s overproduce hydrochloric acid. What proper holistic medicine diagnosis finds is that the overwhelming majority of patients with reflux do not produce too much stomach acid, but ironically, not enough.
When you eat a meal, signals from your tongue and stomach inform your brain about the kind and amount of the food consumed. Your gut and brain then decide what proportions of acid and enzymes needed to completely breakdown and assimilate the nutrients therein. Special cells called parietal cells secrete gastric acid until the pH of your stomach gets to be a 1 or 2 (very acidic) which functionally liquifies the stomach contents. The release of acids initially signals the hiatus to close trapping the foods into the stomach. When the pH is sufficiently acidic, a signal is then sent to the sphincter surrounding the duodenum to open up and allow the liquified contents to pass through to the small intestine. If this system is working adequately, your meal should be well out of your stomach within a couple of hours.
One pathology that can ensue is a malfunction in these parietal cells such that they secrete gastric acids over-exuberantly and at inappropriate times. Stopping the hyper-secretion of stomach acids is the rationale behind the development of proton pump inhibitor drugs such as Prilosec, Prevacid, and Nexium, all of which impair the release of stomach acid. Getting reflux on an empty stomach may be a sign that someone is producing too much stomach acid.
What is far more common is reflux that occurs within an hour or so after eating. What is happening here is a result of insufficient production of stomach acid, slowing the digestive process and preventing your stomach from emptying in a timely manner; a condition known as gastroparesis. With less acid at its disposal, the signal to the hiatal sphincter is weak, allowing for a gap in the esophageal opening at the same time that your stomach is working harder, churning more assertively in its attempt to do more work with less acid. This combination of effects causes the buildup of what stomach acid is present to be pushed upwards resulting in reflux.
In this latter case, the solution is to utilize remedies that improve digestive function and ensure proper stomach emptying. Stay tuned for the next post which will discuss how you can tell whether you might be hypersecreting (too much) or hyposecreting (not enough) stomach acid and what you can do about it.