What’s the best way to get to the root cause of GERD? I’m currently on a proton pump inhibitor and I’m still having the “egg in the throat” feeling. Once I was diagnosed with Celiac I tried coming off the PPI and suffered greatly. I don’t want to harm my body further, as I’m aware of the side effects of PPIs. Your advice will be greatly appreciated.
Dr. Aaron Root’s Answer:
I’d definitely agree with you about the PPI’s long-term effects – not the best thing, and certainly, a more corrective strategy might actually give you relief, if not resolve the issue.
As you know, there are many possible causes for the symptoms of GERD. I’m assuming that the usual structural causes have already been ruled-out (if not, it would be a good idea to do that). In cases where there is a functional (versus a structural) “hiatal hernia”, there are manual therapy techniques that are very effective for restoring the integrity of the opening in the diaphragm (the “hiatus”) where the end of the esophagus is situated. Essentially, these are stretch techniques done by a practitioner directed toward the diaphragm, to “re-set” its resting muscle tone. I’ve even demonstrated it to spouses or partners of my patients so that they can do it at home. Sometimes these work nicely for actual, structural hiatal hernias that can even be visualized on imaging. Most of them, however, are functional, and involve an impaired coordination and feedback of the muscular activity of the diaphragm and/or the stomach and esophagus opening.
The paradoxical problem with many GERD conditions is really a LOW stomach acid production – not necessarily a high acid issue. I’ll explain this a little later. So, PPI’s will reduce the acid production (among other stomach functions) and may offer temporary, symptomatic relief, but will cause secondary problems related to low acid in the stomach; like osteoporosis, poor protein digestion (proteins are necessary to make all enzymes involved in all cellular machinery), and impaired absorption of certain minerals and vitamin B12. The stomach is supposed to make a rather strong acid – in fact, the specialized lining of the stomach will withstand an acid strong enough to burn the skin on your hands. This acid is necessary to initiate the digestion and assimilation of proteins and certain minerals, among other macro and micro nutrients essential for maintenance of life and health. It is also necessary to neutralize harmful microbes. In conditions where the stomach acid is low, it is usually because the overall maintenance and output of the stomach and its specialized lining are impaired, so that the integrity of the lining is diminished, and the little acid that is actually secreted will be sufficient to burn the stomach, causing pain and discomfort. The reduced motility of the stomach will give you that “egg in the throat” feeling. Sometimes, the muscular activity of the stomach gets impaired, like a muscle spasm in your foot, when there is a persistent irritant, or insufficient digestive activity, in the stomach.
In addition to hydrochloric acid production, the stomach also generates some important hormones, like “intrinsic factor” and “gastrin”. PPI’s and similar Rx’s tend to reduce the output of ALL stomach hormones and chemistry. Intrinsic factor is necessary to absorb and utilize vitamin B12. Gastrin is necessary to make the stomach (it’s a muscle) contract and move, and to stimulate the output of acid. If you haven’t already checked for an overgrowth of H. pylori bacteria, I would recommend doing that. The only reliable, non-invasive test is a “urea breath test” that most regular labs have available, and they all use the same outsourced lab kit by Metabolic Solutions. Basically, you exhale into a specialized bag, and send it off to the lab, and they measure the gasses that the bacteria make. H.pylori thrives in a low-acid stomach, and causes a host of problems in some people. It is also a cause of impaired stomach function in many cases.
If there is an H.pylori overgrowth, I’d recommend treating that – many botanical formulations that are designed for this are excellent. This will allow the stomach to begin to restore the integrity of its lining and acid output. Eventually, using a “betaine hydrochloride” (hydrochloric acid) supplement will be necessary, to “re-educate” the “proton pumps” of the stomach to generate acid, for a few weeks. I usually recommend this only AFTER a few weeks of natural astringent and protectant formulas that contain pomegranate, licorice, aloe. You could even drink a mixture of pomegranate juice and aloe vera juice 2 – 3 x day for a couple of weeks, then start introducing the acid supplementation later. You could also test your tolerance to acid by drinking a tbsp. of apple cider vinegar in a glass of water. There is a good chance that this will actually feel good, which will suggest that you can incrementally increase the vinegar concentration until you start introducing the betaine hydrochloride tablets.
A selection of yoga stretches with breathing are also a good way to “re-educate” the feedback and resting tone of the muscles surrounding the esophagus, because they directly involve the solar plexus region of the chest wall. These are movements that involve opening the front of the body, like “upward dog”, “cobra”, “bow”, “wheel”, “bridge”, and “upward bow”, to name a few. Usually, structure and function are paired, so a combined approach involving both of these strategies should offer a better chance at resolving the GERD issue.
Dr. Aaron Root,
11120 Wurzbach Road