Acid Reflux: What Is it? Often experienced although not often clearly understood, acid reflux (AR), as well as gastroesophageal reflux (GERD—a more severe form of reflux) is an uncomfortable and potentially life-altering affliction when it’s not dealt with.
It may seem like a benign condition, but its debilitating symptoms can severely affect a person’s quality of life, especially when occurring on a daily basis. AR occurs when the Lower Esophageal Sphincter (LES) either doesn’t close properly or opens prematurely and allows digestive acids from the stomach to come up, so to speak.
Millions of people suffer from acid reflux in North America alone. According to the GI Society: Canadian Society of Intestinal Research, 24% of Canadians suffer from heartburn, which is the primary symptom associated with acid reflux (AR).
(1) Anyone who has experienced chronic AR knows how it can interfere with routine functions such as eating and sleeping.
Acid Reflux Symptoms
- Heartburn (most common)
- Trouble sleeping
- Sore throat
- Bloody stool
- Bloody vomit
- Feeling of food being stuck in the throat
Antacids, such as Tums, Maalox, Rolaids, and Pepto-Bismol, are the most common over-the-counter (OTC) medications people take for AR. They offer relief by neutralizing acid, although sometimes they can cause either constipation or diarrhea, even when taken as recommended.
When these are ineffective, doctors may prescribe histamine 2 receptor antagonists (H2RAs, or H2 blockers), or proton pump inhibitors (PPIs), which “prevent acid production in the stomach.” (2) Alarmingly, in a 2017 study, PPIs have been “linked to a more than doubling in the risk of developing stomach cancer.” (3)
These traditional approaches may be a contributing factor of AR, as well as other more serious conditions. An increased consumption of prescriptions and OTCs for the many ailments which plague North Americans can actually be compromising the stomach lining, causing hypochlorhydria (hydrochloric acid deficiency in the stomach).
(4) Hydrochloric acid is a vital component of healthy digestion. I taught injured workers for many years, and, without fail, all of my students who took pain medications regularly (which was nearly all of them) had stomach issues, not the least of which was heartburn.
Common Misunderstandings About Acid Reflux
I witnessed decreases in appetite and an inability to digest even the simplest of foods. As common as AR has become in modern society, assumptions are often made as to what the causes and best treatments for it are. Undoubtedly, some may be shocked to discover which of these assumptions are fact and which are myths.
MYTH: Spicy Foods Always Trigger Acid Reflux
Quite often, one of the first things patients are cautioned to avoid when complaining of AR is spicy food. Surprisingly, though, there is very little evidence to actually support the claim that spicy food causes AR. (5) While everyone is different and may have a reaction to particular foods based on their individual constitutions, spicy food has been demonized in this respect.
Many factors need to be considered when trying to surmise our triggers. In addition to eating spicy food, has there been on over-indulgence in quantity consumed? Over-eating can mean food stays in the stomach longer, which leads to an increased possibility of AR.
I always suggest keeping a food diary to track symptoms and patterns. Being our own investigators can often teach us so much more about our triggers and responses than strangers can.
FACT: Acid Reflux Affects Your Sleep
The reality is that LES is likelier when lying down. The gravitational flow of stomach contents and acid is unavoidable. As a result, doctors will often suggest “head of bed elevation” to assist with this issue. (6)
It’s sometimes even suggested to nap in an upright position when possible. Also, avoiding meals, especially heavy foods, 2 to 3 hours before bed can reduce the risk of nighttime sleep disruption.
MYTH: Mint and Milk Eases Symptoms
Mint has a reputation for aiding with digestion, and while this can be true in some circumstances, the mechanisms at work can have an opposite effect when taken for heartburn.
This is what happens when people clump all digestive ailments together. Mint increases the release of bile, which can aggravate AR. It also relaxes the LES, leading to that “coming back up” of stomach acid. (7)
Another misconception is that milk helps AR. The calcium and relatively higher pH (compared to stomach acid) of milk are reasons why it is thought to help, but excessive calcium has the potential to cause “acid rebound,” where the stomach, over time, responds to the reduction of acidity by producing more,(8) and this could possibly happen with milk.
A 1976 study of the effects of milk on acid secretion and pH levels was found to increase acid secretion in its subjects, which speaks again to short-term relief over prolonged negative effects. (9) (10)
One herb that can facilitate in proper relief of symptoms is licorice. Not the candy, of course, but real, DGL licorice. This aids in covering the esophageal lining with mucus, which benefits symptoms without the after effects of producing more acid, like milk does. (11)
FACT: Acid Reflux and IBS May Have Something in Common
This is a real possibility because the factors at play are both related to digestive ailments. From the moment food goes into our mouths, there is a link to all digestive pathways. Our digestive tract includes everything from point of entry to exit.
One gastroenterologist from the Chronic Abdominal Pain Center at the Cleveland Clinic in Ohio says, “Is there a link between IBS and GERD? Absolutely…I see it all the time in our clinic. If you combine the results of all the studies, GERD is probably about four times more common in people with IBS.”
Although the exact connection has yet to be determined, one study’s conclusion is that there is evidence enough “suggesting common underlying dysfunction.” (12)
MYTH: Acid Reflux is Always Due to Excessive Acid Production
This may be the biggest myth in need of clarifying. As mentioned earlier, AR can often occur because of too little acid being produced. If there isn’t enough acid to aid digestion, then contents come back up, accompanied by what little acid there is, and causes heartburn.
Stomach acid production reduces as we age, so we often see AR incidents in people over 40 rather than teenagers. (13)
FACT: Acid Reflux May Lead to Cancer
About 10% of the population who suffer from GERD can develop Barrett’s esophagus, a condition that turns the esophageal lining into tissue that resembles intestinal lining. Although one does not definitively lead to the other, there is about a 1% chance that those suffering from Barrett’s esophagus can develop esophageal cancer. (14)
The good news is that there are safe and natural ways to combat some symptoms of AR, such as weight loss (if overweight), and head-of-bed elevation. I often recommend that people have one or two ounces of apple cider vinegar before meals in order to aid with digestion pre-emptively.
Also, adding foods like kimchi or kombucha can be beneficial for reconstituting some of the good bacteria into the gut for healthier digestion. It’s important to discuss all options with your health care practitioner and to, ultimately, be an active participant in recognizing your body’s reactions to triggers, whatever they may be.
- Gastrointestinal Society. (2018). Report Card: Acid Reflux & GERD in Canada |Gastrointestinal Society. [online] Available at: https://www.badgut.org/about us/newsroom/report-cards/gerd-report-card/
- Natural and Over-the-Counter Heartburn Treatments | Gastrointestinal Society.Gastrointestinal Society. https://www.badgut.org/information-centre/a-z-digestive-topics/natural-counter-heartburn-treatments/. Published 2018.
- Ka Shing Cheung, Esther W Chan, Angel Y S Wong, Lijia Chen, Ian C K Wong, Wai Keung Leung. Long-term proton pump inhibitors and risk of gastric cancer development after treatment forHelicobacter pylori: a population-based study. Gut, 2017; gutjnl-2017-314605 DOI: 10.1136/gutjnl-2017-314605
- Hypochlorhydria (Low Stomach Acid): Causes, Treatment, and More. Healthline. https://www.healthline.com/health/hypochlorhydria. Published 2018
- Kaltenbach T, e. (2006). Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. – PubMed – NCBI. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pubmed/16682569
Lacy B, Everhart K, Crowell M. Functional Dyspepsia Is Associated With Sleep Disorders. Clinical Gastroenterology and Hepatology. 2011;9(5):410-414. doi:10.1016/j.cgh. 2011.02.010
Jarosz M, Taraszewska A. Risk factors for gastroesophageal reflux disease: the role of diet. Przegla̜d Gastroenterologiczn y. 2014;9(5):297-301. doi:10.5114/pg.2014.46166.
Hammond, C. (2018). Does milk settle an upset stomach?. [online] Bbc.com. Available at: http://www.bbc.com/future/story/20130904-does-milk-calm-an-upset-stomach
Publishing H. What you need to know about calcium – Harvard Health. Harvard Health. https://www.health.harvard.edu/staying-healthy/what-you-need-to-know about-calcium. Published 2018.
Ippoliti AF e. (1976) The effect of various forms of milk on gastric-acid secretion. Studies in patients with duodenal ulcer and normal subjects. – PubMed – NCBI. Ncbi.nlm.nih.gov. https://www.ncbi.nlm.nih.gov/pubmed/946584.
What to Drink for Acid Reflux: Teas and Nonacidic Juices. Healthline. https://www.healthline.com/health/gerd/beverages. Published 2018.
Chris Iliades M. Living With IBS and GERD. EverydayHealth.com. https://www.everydayhealth.com/ibs/living-with-ibs-and-gerd.aspx. Published 2018.
Rémond D, Shahar D, Gille D et al. Understanding the gastrointestinal tract of the elderly to develop dietary solutions that prevent malnutrition.
Cold F, Health E, Disease H et al. Barrett’s Esophagus: Symptoms, Causes, andTreatments. WebMD. https://www.webmd.com/heartburn-gerd/guide/barretts-esophagus-symptoms-causes-and-treatments#1. Published 2018.
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