Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
7 Sep

GERD: Symptoms, Causes and Remedies

The symptoms can be abject misery: searing abdominal pain, debilitating stomach cramps, an excruciating, rising burn, acid-filled hiccups, tightened throat, constant sleep disturbance, and even the rare but terrifying bouts of choking from nighttime acid inhalation. I’m talking of course about acid reflux or GERD as it’s commonly called these days. I personally suffered from occasional bouts of GERD and experienced all the symptoms above for years during and even after my endurance days. (It wasn’t until I gave up grains that my GERD completely disappeared.) Maybe you’ve had it. Maybe you know someone who’s had it. GERD, by the way, isn’t your run-of-the-mill occasional heartburn (which isn’t much fun either) but a chronic pattern of heartburn in which you experience symptoms at least a few times a week. I get emails about it all the time, and it’s little wonder. Statistics suggest that 25-30% of American adults experience GERD related heartburn multiple times a week (PDF). Of all the pharmaceutical categories, proton pump inhibitors (a predominant prescription for GERD) have ranked consistently in the top twenty for years. And that doesn’t even take into account the old-fashioned antacids like Tums and Rolaids that people pop like candy. What, for the love, is going on here? It used to be heartburn was generally confined to women in their last months of pregnancy or to the annual Thanksgiving overindulgence. It certainly wasn’t a chronic condition plaguing a large percentage of the population. I sense a familiar pattern here, no?

What is GERD anyway? What causes – or at least contributes to it? How do everyday lifestyle choices influence the condition, and what measures – beyond the CW pharmaceutical schtick (e.g. the happy, ubiquitous “purple pill”) – can we employ in treating, let alone curing the condition. (While the establishment might be content with taming the reflux beast, most folks I know who have GERD would rather beat it to death with a stick.)

First off: the what. The standard explanation for GERD goes like this. When someone suffers from a bout of heartburn, acid in the stomach essentially rises into the esophagus following a spontaneous lapse of the lower esophageal sphincter. Although the stomach lining can inherently withstand the caustic digestive acid, the esophagus has no such protection. The result of the chemical invasion is the characteristic pain and cramping those with reflux experience. Over time, the esophagus can build up scar tissue. In more serious cases, the scarring can narrow the passageway, so to speak, and make swallowing more difficult and painful. Worse than that, prolonged exposure to digestive acid can induce changes in the cells of the esophagus themselves, which can – in relatively rare but increasing instances – result in esophageal cancer, one of the deadliest forms of cancer.

As for the why, the medical community doesn’t point to a specific cause, but the conventional pharmaceutical treatments address “excessive” production of stomach acid. (Yes, do the double take.) The most common drugs used for GERD are H2 blockers and the aforementioned proton pump inhibitors, which block the stomach’s production of acid (just at differing points of the signaling-production-release process). The old style antacids neutralize stomach acid that’s already there. The irony of treating people with GERD by raising the pH of their gastric juices (making it less acidic) is that food doesn’t digest as well, which can be a contributing factor to GERD. Decreasing the acidity of your stomach acid may provide short term relief, but it’s not a long term solution.

Prescription medication usually accompanies practical suggestions like eating small meals, limiting alcohol and avoiding nicotine (which relax the lower esophageal sphincter) and raising the head of your bed to discourage acid from rising too far up your esophagus at night and disrupting sleep. (On a personal note, some of my worst bouts with GERD occurred in the reclined position of an airline seat, so that final bit of advice never worked for me.) GERD sufferers are also advised to steer clear of common “trigger” foods like chocolate, alcohol, mint, citrus, tomatoes, onions, and spicy dishes, and (drum roll, please) fatty foods because they contribute to what’s known as slow stomach emptying, which can make GERD symptoms feel worse.

All this leaves GERD sufferers with few answers and no real solutions unless you count a lifelong pharmaceutical dependency as a solution. This doesn’t even take into account the countless people who take acid reflux medications who actually report a worsening of their symptoms with medication. The response? A higher dose prescription. Never mind that research connects long-term use of these drugs with a higher risk for serious infection and fractures. Keep in mind that the stomach acid’s job is to both digest for absorption of key nutrients and to kill off pathogens.

I know a number of people who’ve felt utterly wrecked by their long-term battles with GERD, many MDA readers included. I’ve heard stories from folks (on medication, yes) who said they would get a bad bout of GERD and be in agony for days unable to eat anything, unable to sleep or even find a comfortable position. When they were finally able to lick the condition, they felt they finally got their lives back.

So, if it’s not excess stomach acid, what the heck is it then? Let me put it this way. It’s not about excess stomach acid (unless there’s some other kind of underlying and unusual medical problem). The acid itself is a red herring. It’s ultimately the weakened esophageal sphincter itself. While some things like alcohol and nicotine genuinely relax the sphincter, most of the other maligned food categories are simply irritants to an already irritated stomach and esophagus.

Am I going to tell you going low carb is the answer? Partly, yes. There’s been scant research done in this area (as is generally the case with low carb eating). One small study highlights the effectiveness of eating low carb, but the connection has been noted for years in the low-carb community (check out some of the reader success stories) – but without clear rationale. Sure, obesity is a clear culprit, and a low-carb diet will undoubtedly address that condition. Yes, there’s the potent anti-inflammatory power of a low-carb diet. We’ve always known there’s more to the story, however.

Although the research will continue to hone in on the exact mechanism, one microbiologist expert presents a compelling explanation. Dr. Michael R. Eades has written in the past about researcher, Norm Robillard, and his book Heartburn Cured. Like Dr. Eades, I believe Robillard’s theory provides the most sound explanation for the growing incidence of GERD in Western society. If you have GERD, I’d encourage you to read the entire book, but the gist is this. When we eat a high carbohydrate diet, our digestive systems can become overloaded with their breakdown. (Remember, of course, that our systems aren’t evolutionarily designed to consistently handle the common 250-350 grams of carbs per day). The malabsorption of carbohydrates in the small intestine (the seat of many digestive ills) can result in a damaging overgrowth of bacteria. As anyone who’s suffered from digestive bloating knows, gas is created in the process and can be excessive when something is awry. According to Robillard’s theory, the gas “pressurizes the upper digestive system,” which sets in motion the reflux mechanism. Robillard, a long-term GERD sufferer himself, reports being fully cured by adopting a low glycemic diet.

But there’s more. Many people who are diagnosed (and pharmaceutically treated for GERD) can trace to a variety of medications that take a major toll on the stomach. NSAIDs constitute one. (Do you know those people – often chronic trainers – who down Costco size bottles of Advil in the course of a few weeks just to keep doing what they do? Add to this list oral antibiotics, which dermatologists often prescribe for long-term use in cases of acne. Others? Try nitrates, calcium channel blockers, theophylline, and one more of note….

You won’t hear this one from many people, but it’s important. Higher estrogen levels can relax the lower esophageal sphincter and can irritate the stomach and even cause the GERD or GERD-like symptoms (which – as in many cases in general – may be more simple stomach irritation than actual reflux). Most women who’ve been pregnant experienced heartburn in their later months. Sure, a growing fetus and all its supportive baggage (e.g. amniotic fluid and the like) pushing up on all of your organs can impact digestion, but rising estrogen has a hand in this as well.

Pregnant women usually have the baby and that’s that. The hormones shift again, and the reflux goes away. But there are millions of women who every day effectively supplement estrogen with the birth control pill or post-menopausal hormone therapy. For most, the uptick won’t be a major issue. For others, however, this medication may cause significant irritation and inflammation in the stomach as well as encourage GERD by its effect on the esophageal sphincter. In follow up research to the expansive Nurses Health Study, GERD symptoms were more common in those who were taking estrogen hormonal therapy. The larger the dose and longer the use strongly correlated with a rising severity of symptoms. Although the nature of the study didn’t isolate other risk factors, it does begin to illuminate a connection we’ve known for years and should expect now. On an anecdotal and wholly unscientific note, I knew a woman who took Nexium for three years before a nurse practitioner suggested the Pill might be related to her debilitating stomach pain. After going off the Pill (which she’d been on for 10 years), her symptoms finally subsided.

If you experience GERD even on a low-carb diet (and without medications known to negatively impact digestive function), a food allergy (often dairy or grains related) or chronic infection (including H. pylori) might be the culprit. Keep in mind also that for some people, an acid reflux problem can become imbricated (today’s fifty-cent word) with a whole host of other conditions (e.g. a systemic yeast overgrowth or other internal inflammation, etc.) A complete work over might be in order, and an intensive, very low carb period can help starve systemic yeast.

As Melissa from Hunt.Gather.Love. suggests (in relation to her own battle with GERD), it’s important to have patience with the healing process. Once you get rid of the underlying cause(s) of your GERD (and get off the pharmaceuticals), there’s a weak, out of order digestive system to bring back into balance. Commit yourself to a restorative mindset and regimen for a few months.

Here are a few things you can do to support healthy digestion:

  • Take an HCl or other digestive enzyme supplement for at least a few weeks if not months (if your reflux is bad). I believe Robb Wolf recommends NOW Super Enzymes.
  • Try old-fashioned bitters (remember those?) with or after each meal which can encourage better digestion.
  • Repopulate your system with healthy bacteria with hefty probiotics (e.g. Primal Flora) and frequent fermented foods.
  • Up your intake of anti-inflammatory omega-3s (e.g. Vital Omegas).
  • To contend with lingering symptoms while your system heals, try slippery elm, ginger, or DGL (deglycyrrihizinated form of licorice).
  • Some people – men and women – have luck with the various morning sickness teas, which contain a combination of stomach soothing and pro-digestive herbs.

Thanks for reading today, everyone. I’d love to hear from folks who have beaten GERD and those who are still working toward a full solution. Share your thoughts and perspectives, and have a great hump day!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Anyone know whether the following is a GERD symptom?

    Esophagus will occasionally become constricted, preventing even water from going down.

    My m-in-law who eats terribly SAD has always been in and out of GI doc’s office having her esophagus stretched. Now my husband is afraid his esophagus is starting to do the same (although we eat fairly Perfect Health Diet). He had a scary episode a few weeks ago. Couldn’t swallow & felt like he was having a heart attack.

    I’m having him take probiotics, and GI-capsules, plus eat fermented vegetables, etc. But he is considering having the stretching procedure done.

    St wrote on May 5th, 2014
  2. Hi Mark (or anyone else who wants to answer my question) I’m curious as to why you recommend bitters? I was under the impression bitters was just an alcohol (like in lemon lime & bitters)? What effect does it have, and how should one consume it if not in LLB? Just in water or?

    I’m also curious as to whether progesterone would have an effect as well as estrogen? Two weeks ago I had a Mirena (hormonal IUD) inserted which is progesterone-only.

    I’ve been wracked with coughing fits for the past week, which start any time I take a deep breath (which tends to be often, as a singer and voice coach). Went to the doctor last week and he said it was too early to tell as it could have been a developing cold or flu or something muscular, because it wasn’t bothering me at all at night when laying down. But last night it definitely started messing with my sleep and I had a coughing fit at 2am and felt like I was about to puke and had to have a couple pieces of toast because I felt like I needed something really bland and basic to calm my stomach down. Bleh.

    Bec Tilley wrote on August 25th, 2014
  3. Hey guys! Hoping someone can share some insight or advice. Around last July on a long car ride down to a vacation spot I started to feel dizzy and nauseous. That whole week I had those symptoms as well as strange things such as tingling and numbness in my right arm, chest pain, etc. ran to ER they couldn’t really see anything wrong, came home and after a few more ER/DR visits later I was put on pills for super high blood pressure. Thinking that was the end of it. Well after that I started to get my glands / throat swelling up or least it felt like they were swelling up. I thought maybe a tooth issue, so after ruling that out I went to a ENT (Ear Nose Throat) DR. and she diagnosed me with LPR (Reflux). Now I’ve read other peoples stories and I never get “burning” or heartburn or even upset stomach. I was just getting the throat swelling feeling and a slightly nauseous blah feeling. Now just recently I ate a spicy dish of pasta and did get a burning that lasted days, not a typical heartburn burning feel but almost like a menthol cigarette burn if that makes sense. I also noticed the back of my tounge on the top was maybe “burnt”. Has since gone away but I’m wondering if anyone else has been diagnosed with LPR? I’ve been on Omeprazole (40MG) for a few months now can’t really tell if it works or not. I try my best to stay away from tomato based foods or spicy but seems just by eating 1 spicy dish (in one case 1 spicy noodle) and BOOM I’d get that burning. Has anyone ever gotten other weird symptoms with reflux like myself? As of now I get very odd things like it feels like the back of my neck hurts or has pressure, if I eat semi bad for days in a row I get a blah feeling that’s hard to describe but its enough to where you wouldn’t really go out. And I’ve had tons of tests on head, spine, etc. (not stomach yet, but I did one in 2011 and all was clear). Blood work multiple times, I’m 99% sure its reflux just haven’t seen anyone else mention the symptoms I have. I’ve yet to go to a GI DR. or have a scope down my throat yet, guess that’s next.

    Anthony wrote on January 31st, 2015
  4. I have been suffering for years with Gerd nothing seems to work i have done everything that has been mentioned .I am now in a situation going through tests i have been unable to tolerate solid foods even oatmeal or pudding for 26 days now it just sits right under my sternum and causes scope showed slight narrowing it was stretched and biopsies were negative just showed constant reflux .My modified swallow was of course inconclusive they were only able to get through oatmeal it causes so much pain to eat they just kept asking was a doctor helping with this pain i said no they told me to take tylenol of course because of all the abuse this is what everyday people have to go through .They did say its like my food just sets at the bottom of the esophagus then eventually goes down and comes back up with bubbles .I have seen a Gastro doctor which was horrid he told me he thinks this is stress induced because at this point there is no medical knowledge why i am unable to eat .He did however after a struggle order a mobility test of the esophagus and tell me no worries i can live on fluid forever .I feel so lost my regular doctor left the practice .I did have a recent death in my family so i don’t know i just feel the doctor immediately jumped on that for reasoning but i know my body and feel something is wrong .Still with the fluids ,my protein shakes i suffer daily with Gerd and i am miserable to say the least hoping to get help at some point .

    Tracy Quimby wrote on July 6th, 2015
  5. I used to take Pepcid AC two or three times a week. I would mainly get acid reflux when drinking gin and tonics. Eventually I lost my taste for tonic and I also started taking probiotics and digestive enzymes. Now I get heartburn or acid reflux about 2 or 3 times a year, at most. It only happens when I get out of the habit of taking probiotics.

    grisly atoms wrote on October 4th, 2015
  6. It’s interesting that you mention hormones playing a part when it comes to GERD.

    In my first pregnancy I had hyperemesis gravidarum (vomiting around the clock).
    Whilst bed bound and google symptom checking I noticed alot of my symptoms tied in with GERD.
    -Waterbrash (excess saliva I had to spit in cup)
    -Dry wretching
    -Trapped Air
    -Regurgitating bile
    All of this occurred on week 5 of pregnancy so I doubt it was due to pressure due to the growing baby and more to do with hormones. As soon as I gave birth everything went back to normal.
    Hyperemesis Gravidarum like GERD is also a scientific mystery and continually linked to h. Pylori bacteria in the gut.
    Could Hypermesis Gravidarum be an extreme form of GERD?
    Could the remedies suggested here benefit a HG sufferer? I and so many other women can only hope for a cure for Hypermesis Gravidarum.
    I’d suggest if you have GERD to go go 5o the doctors and checking that your hormones are in balance.

    Kina wrote on March 11th, 2016

Leave a Reply

If you'd like to add an avatar to all of your comments click here!

© 2016 Mark's Daily Apple

Subscribe to the Newsletter and Get a Free Copy
of Mark Sisson's Fitness eBook and more!