HEARTBURN FOR THE HOLIDAYS

I can't believe I ate the whole thing...

Are you someone who dreads all the deliciousness of the holidays?  Someone for whom the food feels good going down, but not so much when it comes back up? Do you get phlegm or a drippy nose after eating?  Do you run for an antacid or a TUMS?  This is the blog for you!
    One thing that does not make logical sense to people is that the symptoms of low stomach acid and high stomach acid are basically the same.  When tested, 95% of people reporting acid reflux actually have LOW stomach acid, especially elders.  For some reason, this seems to be missing information in MD schools so your MD will cleverly prescribe (or you will cleverly go down to the drug store and buy) ANTACIDs or ACID-BLOCKERS.    
    The symptom is regurgitation of acid from the stomach into the esophagus.  We have a system in place to prevent that - it is a sphincter at the bottom of the esophagus, called the Lower Esophageal Sphincter (LES).  It is given the signal to close by a certain level of stomach acid - so if you don't have that level, it doesn't close, and any acid you do make backs up into your esophagus, causing that burning pain.  The drippy nose and phlegm are because your body is desperately trying to make mucous to protect those tissues.  Long term exposure to this acid can cause mucous forming cells to form in the esophagus, and these tissue  changes are called "Barrett's esophagus"  and are pre-cancerous.  So, we definitely want to avoid this, and that is the rationale for acid blockers, which fix the symptom and protect against Barrett's, but at a fairly high cost - and the problem hasn't been fixed, only the symptom.
    Another contributor can be a hiatal hernia, when your stomach pushes up through the hole in your diaphragm designed for your esophagus and major arteries to pass through.  Then, when you breathe or use your diaphragm, the stomach gets strangulated and squeezes the acid up into the esophagus.   Hiatal hernias are caused by things that put pressure on your abdomen with no other place for the pressure to be relieved - straining at stool, picking things up while holding your breath, violent coughing or vomiting, tight waistbands, excess weight.
    Antacids work,  but only because they keep your stomach from making any acid at all.  So, what are the functions of stomach acid - oh, nothing important.  Let's see - protein digestion, for one - can't break proteins down for the next step of digestion without stomach acid.  Mineral absorption, including iron.  B12 absorption.  Killing parasites and bacteria.  Also, low stomach acid contributes to constipation.  
    Safety studies on antacids were done for 4-6 weeks.  That is the length of time they are approved for - but I have patients who come in and have been on them for decades. 
    Side effects: loss of bone density, osteoporosis (due to lack of mineral absorption).  Constipation.  Dementia (yep, it's right there in the literature). Nerve pain/neuralgia (due to low B12).  Anemia (due to poor iron absorption).   Dysbiosis (because bad bacteria aren't killed and overgrow). Parasites (ditto, not killed).    *Dysbiosis leads to inflammation and inflammation is the cause of almost every chronic disease.  And so on.
    Now, anyone who has been on acid blockers can tell you that when they go off of them, it HURTS.  And this convinces them to go back on.   Well, it hurts because your body has a feedback system - you have low stomach acid, you make more.  If you have none because you've been on acid blockers (which basically turn off the system) and then you stop - well the body goes "oh my god, there's no acid here, we've got to make a whole bunch".   And thus this rebound symptom. 
    I have successfully helped many people get off of antacids and become symptom free after years of chronic reflux - it isn't that hard.  Basically, they need demulcents to protect their esophagus from the acid as they stop the acid blockers, they need some way to INCREASE their stomach acid, and sometimes they also need an herbal formula to tighten up their lower esophageal sphincter. Many also need to have their hiatal hernia reduced,  which can be done with a fairly simple visceral manipulation (which sometimes needs to be repeated a few times before it holds) and education about reducing actions which push the stomach up through the diaphragm.  Also, avoiding trigger foods is important - soda, tomatoes, chocolate, coffee and mint seem to be almost universal, but specific food allergens can also trigger reflux. 
    Eating late at night is a problem because the stomach is full, and gravity is now against you. If you have a hiatal hernia or poor LES tone or stomach acid that is not strong enough to create the pH that triggers the LES to close, your stomach acid will spill up into the esophagus. Many people with bad gastric reflux will prop themselves up on pillows or elevate the head of the bed. 
    I took the time to write this up because it is a huge problem, acid blockers are one of the highest selling drugs, prescription or OTC, and they cause a lot of problematic side effects and may even set the stage for long term chronic disease.   And because the average sensible person (and the average sensible MD) will think "symptoms of too much acid?  What we need is an acid blocker"  when actually the case is just the reverse.
    Kind of like the thinking that eating fat makes you fat - makes sense, but isn't the least bit true.  

Here's to ENJOYING your holiday meals!

In health,

Dr. Anne