What is reflux?

Acid reflux is when the contents of your stomach move upwards into your oesphagus (food pipe) and sometimes into the back of your throat.

Sometimes it can feel like you have ‘thrown up’ in your mouth.  Its technical term is gastroesophageal reflux disorder  (gastro is stomach, oesophageal is your food pipe and reflux is the movement upwards of the stomach acid).

Most people experience heartburn (that yukky burning pain in your chest) if this happens frequently and you have some of the symptoms below then it may be GERD (or GORD)

 

The main symptoms of reflux apart from the sour taste at the back of the mouth can be:

• Chest pain
• Burning feeling
• Nausea
• Vomiting
• Pain when swallowing
• Difficulty swallowing
• Sore throat
• Chronic cough
• Bad Breath
• Bloating (in the stomach just under the breastbone)

 

What causes it?

This is a good question.  There appears to be no single cause for it. It can be due to the following reasons: 

1. The lower oesophageal sphincter is a round band of muscle that links your stomach to your oesophagus. It usually relaxes and opens when you swallow and then tightens and closes once food is in the stomach to keep it there. When this sphincter doesn’t function properly by not closing then this allows stomach contents and the hydrochloric acid that you make to digest your protein rises up the oesophagus causing the burning discomfort and sour taste. 
2. Hiatus Hernia which can affect the function of the sphincter. 
3. Eating too much in one go can cause the stomach to distend and stop the sphincter closing properly.
4. Lying down too soon after large meals can create too little pressure on the sphincter so it doesn’t close properly.
5. Small Intestinal Bacteria Overgrowth (SIBO) can create pressure from bloating and distention in the small intestine which in turn puts pressure on the stomach causing the sphincter to not close properly. 
6. Hypochloridria  (not enough stomach acid). THIS IS IMPORTANT! Hydrochloric acid helps the body to break down and digest specific nutrients such as protein. Also important for the eventual absorption of B12 and calcium and magnesium. It is also a barrier to bacteria – killing off bacteria and viruses in the stomach (some of which if they end up in the intestines are linked to various cancers including pancreatic and colon). (1)  Low levels of stomach acid can impact your ability to absorb nutrients and can eventually damage the gut and cause chronic health conditions.  When we suppress our stomach acid unnecessarily that can actually cause bigger problems.  Don’t always assume it is because of high amounts of hydrochloric acid.  
7. Pregnancy – reflux is common due to the growing foetus putting pressure on the stomach. 

 

Risk factors include

1. Obesity (association)
2. Insulin resistance (association)
3. Age
4. Medications – relaxing the sphincter
5. Stress (due to parasympathetic nervous system being down regulated)
6. Low hydrochloric acid (stomach acid) – food sits in the stomach for longer unable to be broken down as efficiently, encourages the growth of H. pylori and also SIBO due to the higher pH. 
7. Diet – fatty foods, chocolate, coffee, alcohol, spicy foods, ‘acidic’ foods such as citrus and also fizzy drinks.  Can either affect the pH of the stomach acid or affects the pressure on the sphincter.  

 

Why does it need to be assessed and treated?

It can lead to chronic cough (reflux cough syndrome), asthma (reflux asthma syndrome) and reflux dental erosion syndrome.  It is also associated with pharyngitis, sinusitis,  recurrent otitis media (ear infections) and also fibrosis of the lungs. If the constant movement of acid up the oesophagus isn’t stopped then eventually the oesophagus gets eroded and ulcerated  and can lead to what is known as Barrett’s oesophagus  which can then lead to cancer of the oesophagus. Reflux therefore is more than just an irritant!

 

Current Treatments

• Antacids – if you are taking these everyday then you need to get a proper assessment.
• H2 blockers – these lower the acid in your stomach (some of the ingredients in these medications e.g. N-Nitrosodimethylamine (NDMA), are known to cause cancer and have been banned by the FDA in America. (2)
• Proton Pump Inhibitors – these also lower the amount of acid the stomach makes

Surgery may be possible if the sphincter between the stomach and the oesophagus is not functioning properly and that is the reason for the acid splashing up the oesophagus. This surgery is known as a fundoplication.  There is however a time limit to how long this procedure can last for (10-15 years). It may be that if the sphincter loosens again, medication may be the only option.  

 

Traditional remedies to help

Milk – this can help temporarily due to milk being alkaline and thereby neutralizing the acid, however in some people it can eventually make the reflux worse once the fat is digested (in some people fat can cause the reflux). 

Baking soda (added to water) – this is the same as milk in that it is alkaline and so some people can gain temporary relief by it. It is considered to be safe if taken in small doses now and again. But should not be taken over a long duration or in high amounts due to the sodium content which can cause high blood pressure amongst other side effects. 

Ginger – whilst some people can benefit from chewing ginger or drinking ginger tea it can also exacerbate reflux in some people. GInger is a digestive enhancer and is excellent for nausea and vomiting. (3) 

Chewing gum – a very small study back in 2005 showed that chewing sugar-free gum for half an hour after a meal can reduce reflux. This study only had 31 participants so isn’t large enough to recommend this as a great intervention. (4) 

 

My Top Tips:

1. If you have had chronic reflux and have been living on antacids PLEASE make an appointment to see your GP.  If you have pain or difficulty swallowing then this MUST be assessed by a GP immediately. 
2. Maintain a healthy weight 
3. Reduce or quit smoking –  NOTHING good will come from smoking
4. Consider reducing alcohol or at least don’t drink alcohol on an empty stomach. Alcohol can increase inflammation in the mouth, throat and oesophagus, impair motility and clearance of food in the stomach. (5)
5. Reduce spicy or fatty foods if these exacerbate reflux (it might be worth tracking your diet with your symptoms and see if certain foods are causing it). 
6. Consider reducing coffee (I know I know trust me I would not say this if it didn’t make a difference – coffee is acidic and can exacerbate reflux – this was a ‘game changer’ for my husband. 
7. It may be worth increasing your protein intake or considering a collagen supplement especially if the issue is with the sphincter itself- amino acids and collagen ,may help to strengthen the connective tissue. 
8. If your hydrochloric acid is too high then apple cider vinegar may be helpful at reducing the acid – 1 tsp of apple cider vinegar to a glass of water before meals, over time you can increase to 1 tbsp.  Try this before using antacids or other medications. 
9. Increase fruit and vegetables slowly to ensure that you have nutrients that are both anti-inflammatory and antioxidant. Low intake of fruit and vegetables are associated with an increased risk of reflux, Barrett’s and oesophageal cancer.  Ensuring a good amount of fibre (fruit, veggies and complex carbohydrates) has also been shown to reduce the risk. (6, 7)
10. Have a larger breakfast and lunch and a small dinner (which is actually how we are designed to eat)
11. Make sure there is at least 3 hours between dinner and bed. Lying down can exacerbate reflux.  You may need to elevate your head during sleep if its worse at night (I remember those pregnancy days). 
12. If the reflux is due to low stomach acid then you may not be consuming enough zinc or b vitamins which are required for its production. Stress, smoking and alcohol use can deplete stomach acid. H. Pylori infection if unresolved can also lead to low stomach acid so make sure you rule that out too. 
13. Bitters, betaine HCL (must be alongside protein and build up slowly)
14. Herbs – marshmallow, liquorice, slippery elm, hoheria, chamomile, Iberogast.

Make sure you speak to a herbalist or naturopath if you are taking any medications before trying herbs as they can interact with medication. 

If you have any questions or would like to book a free call to discuss your own symptoms and get some guidance then contact me using the links below. 

References

1. https://sarah-brenchley.com/why-your-mouth-is-the-driver-of-both-health-and-disease/
2. https://www.fda.gov/news-events/press-announcements/fda-requests-removal-all-ranitidine-products-zantac-market
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019938/
4. https://www.researchgate.net/publication/7519637_The_Effect_of_Chewing_Sugar-free_Gum_on_Gastro-esophageal_Reflux
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2880354/
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2735568/
7. https://pubmed.ncbi.nlm.nih.gov/15591498/

Email me at sarah@sarah-brenchley.com or book a free discovery call to discuss how I can help you and go to https://sarah-brenchley.com/links for free resources and join the best Facebook Group ever  – Women’s WellBeing Circle. 

Go to my You Tube channel to watch the video versions of these blogs: https://www.youtube.com/channel/UCmS_kdkO4JsbqyhvfLwOPtA