A Burning Issue

Most people have, at some time or another, experienced acid reflux, or ‘heartburn’ as it is more commonly known. For many people this is just an occasional discomfort, caused by eating too much rich food. However, for individuals who suffer from Gastro-Esophageal Reflux Disease, or ‘GERD’, acid reflux is a constant problem which can cause a great deal of pain and distress.
When we eat, the stomach secretes acid, enzymes and other substances, which help to break down food. The lining of the stomach is uniquely designed to resist the corrosive nature of these substances. Under normal circumstances, a band of muscle at the top of the stomach, known as a ‘sphincter’, prevents reflux of stomach contents into the esophagus (the tube connecting the throat to the stomach). However, in some people, this sphincter becomes weak, and the stomach contents flow back up into the esophagus. This often affects babies due to an under-developed digestive system, and pregnant women due to hormone changes that affect muscle tone. Obesity and structural abnormalities of the gastrointestinal tract such as hiatus hernia can also contribute to acid reflux.

Reflux of stomach acid into the esophagus leads to symptoms such as a burning sensation in the chest which is usually worse when bending or lying down; pain or difficulty swallowing; chronic hoarseness or cough; a sour taste in the mouth; bad breath; and excess production of saliva (waterbrash).

The lining of the esophagus is not designed to resist the acid contents of the stomach, and repeated exposure can therefore cause inflammation (esophagitis). In severe cases, erosion of the esophageal lining by stomach acid may lead to the development of an ulcer. In some people a tightened or narrowed area of the esophagus (known as a stricture) may develop which can lead to pain and difficulty in swallowing.  Chronic inflammation due to acid reflux may also trigger the cells lining the esophagus (which are not designed to resist acid) to mutate and become more like acid-resistant stomach cells. This condition is known as Barrett’s Esophagus, which may lead to the development of cancerous cells.  It is therefore extremely important for anyone who regularly suffers from heartburn or any of the other symptoms of GERD to consult a medical herbalist or GP.

Orthodox treatment for GERD usually consists of a type of medication known as a   proton pump inhibitor (e.g. omeprazole) to reduce the production of stomach acid. This is usually effective in controlling the symptoms and reducing the incidence of inflammation and other complications. However, the problem with GERD is not one of too much acid, but rather the presence of acid in the wrong place.

Acid is required in the stomach for proper digestion of food and to control harmful bacteria. Long-term use of medication to reduce the production of stomach acid does not cure the underlying disorder, and may lead to a disturbance in the microflora of the digestive system, and decreased absorption of a variety of vitamins, minerals and other important nutrients, such as Vitamin B12, Vitamin C, Calcium, Magnesium and Iron. This can lead to an increased risk of serious infections, such as pneumonia and Clostridium difficile, and increased risk of osteoporosis and bone fractures. Recent studies have also shown that long term use of proton pump inhibitors is also associated with an increased risk of Alzheimer’s disease and heart attacks.

Fortunately there are more natural ways of treating GERD, which are both safe and effective. First of all it is important to avoid any foods that trigger the problem. These vary from person to person, but common culprits include acidic foods such as oranges and tomatoes, fatty foods, onions, chocolate, coffee and alcohol. Gluten intolerance is also a major cause of GERD and I have had many patients who were able to come off long-term medication and remain symptom-free after switching to a gluten-free diet.

Avoid eating very large meals, which increase the pressure in the stomach, and opt for smaller, more frequent meals instead. Try to sit upright after meals until the food is digested and avoid slouching on the sofa, or eating a large meal at bed time. Likewise, bending and lifting may lead to worsening of symptoms and should be avoided after eating. It may be helpful to raise the head of the bed so that the esophagus is higher than the stomach.

Herbal treatment of GERD usually includes demulcent herbs such as marshmallow root, which helps to soothe and protect the lining of the oesophagus. Liquorice root is another soothing herb, which helps to reduce inflammation and promotes the release of substances that protect the tissues of the gastrointestinal tract. Calamus root helps to increase the tone of the oesophageal sphincter, and thus prevents reflux; while meadowsweet is a natural antacid, which also helps to protect the lining of the oesophagus, reduce inflammation, and prevent cell mutation.