About 80% of my clients report symptoms of acid reflux. It might not be the main reason they've come to see me, but it's often a contributor to some of their symptoms. Let me explain....
For some, this burning, belchy, seeing-my- food-again feeling can happen every single day. For others, it is less frequent and is triggered by particular foods, situations or changing hormones (oh hello perimenopause, another symptom you say? You shouldn't have....).
Some clients have suffered with this for years. Many have been put on PPIs (proton-pump inhibitors) by their GP’s, originally for a short period of time, but if they stop taking them the acid reflux returns with a vengeance.
So what exactly is acid reflux?
Also referred to as heartburn, acid reflux typically occurs when some of the contents of your stomach make their way back up your oesophagus.
You may remember from GCSE biology that one of the ways in which our stomach breaks down our food is using hydrochloric acid (Hcl). We make this ourselves in glands in our stomach.
This acid is crucial for breaking down our food and helping us extract the nutrients we need from our food. However, it’s not so clever when it somehow escapes from the stomach and travels upwards towards our throat.
It’s acid – it hurts. It gets sore and irritated. It’s not good for our long-term health.
Our stomachs have a specially designed lining to cope with the acidity. Our oesophagus does not.
As well as that burning feeling you may also experience excessive belching, coughs or hiccups that keep returning, a hoarse voice, not so pleasant breath, bloating and nausea.
What causes acid reflux?
There are numerous causes. I find getting to the root of each individual case to be crucial in solving the symptoms.
I’ve listed the main reasons here, some of which feature more highly for some people than others.
Too much stomach acid
Sometimes the body’s mechanisms that control how much of this we need go a bit haywire. Some medication increases our natural production while hormonal imbalance and nutrient deficiencies can also play a part. Smoking increases stomach acid production.
Too little stomach acid
Perhaps surprisingly, sometimes acid reflux is caused by too little stomach acid being produced. At the top of our stomach we have a ‘gate’ called the lower oesophageal sphincter (LOS). This gate opens to let our food in but promptly shuts behind it.
However, this gate is operated by a very sensitive sensor system. It needs to sense that there is sufficient acidity in our stomach or it has a tendency to stay open just a fraction - letting things go back up that should stay down.
Causes of low stomach acid include persistent stress, nutrient deficiencies (particularly B6 and zinc), dehydration and PPIs such as Omeprazole and Lansoprazole.
Sometimes our LOS can become a bit lazy. The presence of hernia’s may also contribute. Previous irritation and damage to the oesophagus can leave the lining very sensitive to even the smallest amount of reflux.
What can I do about it?
Understanding what is driving your own individual symptoms is crucial. Rarely do I see acid reflux as a stand-alone digestive challenge. Often implications of it in the long term are also seen further down the digestive ‘domino’ (from your mouth to the loo).
However, there are some important things to consider:
Simply - we need water to make stomach acid and keep it balanced at the levels it should be.
Reduce stress and slow down
Easier said than done, but stress has a huge impact on your whole digestive function. If we eat in a rush or we are not in a relaxed state our natural digestive processes can not operate at their best.
Digestion starts when we start to think about the food we are going to eat, let alone start cooking it. Sight, smell and thoughts of food trigger initial production of around 20% of our total stomach acid.
In addition, our nervous system is responsible for moving our food through our bodies and signalling ‘ready’ to our digestive enzymes – if we are tense, this is negatively impacted tenfold.
Consider nutrient depletions, particularly B6 and Zinc
Unfortunately, many medications, including the oral contraceptive pill, deplete key nutrients needed for stomach acid production. Increasing foods rich in these nutrients and sometimes supplementing for a short period of time can be helpful.
Chew bitter foods such as rocket and watercress as you prepare your meals
These help stimulate all of the gastric function to switch to ‘food incoming – go go go’ mode. It’s also a great way to sneak in some more leafy greens that most of us don’t eat enough of.
Eat smaller, more frequent meals
This reduces the pressure on the sphincter and helps prevent the valve opening at the wrong time. However, this isn’t so good for your blood sugar balance, so may not be appropriate if you suffer from pre-diabetes or blood sugar control challenges.
Limit fatty foods & other trigger foods
High fat meals relax the sphincter and slow the rate at which the food leaves the stomach to go to your small intestine. Certain foods such as peppermint tea, chocolate, spicy foods and tomatoes can also influence acid reflux.
In particular, peppermint tea relaxes the LOS and just taking this out of your daily habits can reduce acid reflux dramatically.
Stay upright after a meal
Have your dinner 2-3 hours before bed to give your stomach chance to empty before you lie down and reduce the chances of the LOS opening up.
So what about PPIs?
Our stomach acid is made by ‘proton-pumps’ in cells in our stomach. As the name suggests, proton-pump inhibitors work by stopping these pumps from working.
For acute episodes of gastritis or when taking other medications that may interfere with digestive function PPIs can be very much needed.
The problem is that over time if used on a more long-term basis they can contribute to the very problem they are there to solve.
Ironically, they deplete many nutrients, including B6 and zinc needed to make stomach acid.
Having chronically low stomach acid for long periods of time decreases our ability to absorb all nutrients, such as B12 and magnesium, and can have a very detrimental effect on areas such as our energy levels, brain health, cardiovascular health, bone health and hormone health.
In addition, as our stomach is at the beginning of our ‘digestive domino’, low stomach acid can lead to problems ‘downstream’ such as IBS, constipation, diarrhoea, bloating and cramps.
The problem is that coming off PPI’s once you’ve been on them for a while can be challenging. This is because you may experience something known as ‘rebound heartburn’ and promptly give up.
This happens because the body’s internal signals have been used to the stomach acid being suppressed – they’ve constantly been telling the stomach cells to make more acid, but then the PPI has stopped this production.
When you take the PPI out, the body takes a while to normalise its own signals and to stop shouting loudly ‘more acid please’.
Coming off PPI’s needs to be managed carefully and with the support of a nutritional professional and your GP. It’s absolutely possible to do, but crucial to do it with support, the right foods and supplements and a long-term view to minimise symptoms and never need a PPI again.
There are other types of reflux too! Bile acid reflux comes from further down the digestive domino.
Silent reflux happens at night. You don’t necessarily have typical reflux symptoms, but you might feel like you constantly have a lump in your throat during the day that won’t clear.
I’ll cover more on these topics in the future.
AND watch this space for a group programme on all of this later in the year.
If you’d like to chat about anything I’ve covered in this post and see if I can help get rid of your digestive symptoms FOR GOOD please do get in touch.