What we're told about reflux vs. reality
07-16-2024
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Almost 50% of the population reports experiencing reflux regularly. Yet most of what we’re told about reflux and what to do about it is wrong. Most traditional healthcare professionals will tell you that it is caused by too much stomach acid without doing any digging into your situation to confirm that. They’ll probably prescribe you a proton pump inhibitor (PPI) and send you on your way. But this theory that reflux is always caused by too much stomach acid doesn't hold up in reality. I have worked with dozens of clients who were dealing with reflux, read countless stories from people who had reflux, I've read through studies on reflux and studied it pretty extensively for years. None of the people I've worked with directly were dealing with reflux because of too much stomach acid. Very few of the anecdotal cases I've read about online from people who dealt with it themselves or from other practitioners who helped patients with reflux determined that it was caused by too much stomach acid. Why would we be lied to about this? Well with almost half the population struggling with this, the pharmaceutical industry makes over $14 billion annually from PPIs that are prescribed in nearly every situation where a patient tells their doctor they have reflux. Since PPIs in most cases do nothing to resolve the real issues (more on that below), they have customers for life. There are many factors that can cause or contribute to reflux. Misinterpreting it can lead to some serious issues depending on the factors involved. From my experience, the most common factors contributing to reflux are:
Muscle Function Muscle function is a key factor with reflux. Particularly with the diaphragm & lower esophageal sphincter (LES). The diaphragm is a huge muscle between the chest & abdominal cavities. The LES is a muscle at the connection of the esophagus & stomach. The esophagus passes through the diaphragm via the esophageal hiatus. The contraction of the diaphragm as you breathe helps maintain the integrity / function of the esophageal hiatus & LES. This prevents acid from going from the stomach to the esophagus. There are several issues that I've seen cause disruptions in muscle function and contribute to reflux. A hiatal hernia, for example, is when a portion of the stomach protrudes through the diaphragm into the chest. This weakens the LES allowing stomach contents to enter the esophagus causing reflux. LES dysfunction is another factor to consider. Things like smoking, inflammation, medications, nutrient deficiencies and posture can disrupt LES function resulting in stomach acid & other contents leaking into the esophagus (reflux). Some things that can help with hiatal hernia or LES dysfunction include deep breathing exercises, intentionally chewing (slowly, mixing food with saliva, chewing thoroughly), walking after meals, stretching/yoga, parasympathetic stimulation, managing stress, no liquids with meals and addressing causes of inflammation. Pressure Pressure build up in the gastrointestinal tract is a common contributor to reflux too. Slowed motility, stress, smoking, lower stomach acid and pathogen overgrowth are some examples of what I've seen cause this build up. Pressure build up in the GI tract can compress the stomach pushing acid & other contents towards the esophagus while also weakening the LES. This can lead to acid entering the esophagus and the feeling of reflux regardless of how much acid there is to begin with. A common contributor to this is H. pylori, a pathogenic bacteria that often infect the gut. The overgrowth of this bacteria itself can cause a pressure build up. But it can also lower stomach acid, create inflammation and is linked to Barrett's esophagus. Almost every person I've worked with who had H. pylori overgrowth was experiencing reflux. Another factor I've often seen is diet. If someone is dealing with poor digestion or microbiome imbalances & also consuming a ton of fiber, this can build up pressure since the body can’t digest fiber and instead ferments it. This fermentation creates gases, which can build up pressure (a big reason why people on plant-based diets fart so much). Maintaining a healthy balances in the microbiome is important to avoid this build up of pressure. Eating healthy foods, keeping the microbiome in balance, managing stress, getting movement daily, prioritizing circadian health, etc. Also, addressing acute issues quickly/effectively when they arise. Acid Stomach acid plays an important role in gut health. From digesting food to fighting off pathogens, having proper acid levels is key. Having too much acid can be problematic and can contribute to reflux. I've seen this happen from things like pathogen overgrowth, kidney dysfunction, hormonal imbalances & abruptly stopping PPIs. But it is far from a common cause of reflux in my experience. From my experience, when high stomach acid levels are a factor, it's also generally in combination with pressure build up or muscular dysfunction. A common mistake that can lead to too much stomach acid is how people stop PPIs. After relying heavily on them, if someone immediately stops without easing off it can cause an overcorrection of acid production levels. What I've seen more often when it comes to stomach acid levels contributing to reflux is people having low acid levels. Stomach acid is one of the defenses our bodies have against pathogens in the digestive tract. Not having enough of it can increase our susceptibility to overgrowth, which as discussed above, can lead to reflux through a build up of pressure. Stomach acid also plays an important role in our digestion. When there is insufficient amounts of stomach acid and we do not digest foods as well, it can slow down the digestive process and lead to stagnation, which can create an environment where pathogens thrive and microbiome imbalances occur. Reflux is a common issue that many people with disrupted digestion deal with today. Yet the approach that 90% of health practitioners take to address it is ineffective. Actually, it makes things worse in many cases. Too much acid can cause reflux, but it’s not the most common cause. If you're dealing with reflux due to other factors like pathogen overgrowth, inflammation or stomach acid deficiencies and you take a PPI, you could potentially be worsening the issue. Yes, they may improve symptoms. At the end of the day, regardless of what's causing it, acid reflux occurs when stomach acid enters the esophagus. So, if you continuously suppress stomach acid production, it will reduce the amount of the acid available to flow into the esophagus. But at the end of the day, if the real problem is that there is already a deficiency in stomach acid that's allowing the overgrowth of pathogens or if there's inflammation that's disrupting muscle function, suppressing acid production might help with symptoms at the same time that it worsens the true cause of the symptoms. Stomach acid plays important roles in our digestive health. Continuously suppressing it can seriously backfire in many ways. PPIs are a $14 billion industry supplying a band aid solution to people's symptoms. This ultimately results in them becoming customers for life since the product doesn't resolve the real issue in most cases, so if they stop, their symptoms come back. Its important to also mention the side effects that can come with using PPIs. Use of PPIs over extended periods is linked to issues like nutrient deficiencies, pathogen overgrowth or microbiome imbalances, bone fractures, kidney dysfunction and even dementia. I've helped many clients get rid of their reflux. Not a single person used PPIs to do it. Also, none of them were dealing with reflux because they had too much acid. Actually, most of them had the opposite issue, which was being worsened by their doctor's previous recommendations to use PPIs. We resolved it by looking into issues like the ones discussed above and addressing them the right way. - Nick PS - if you're dealing with reflux and want to work with me to resolve the issue(s), reply here and let me know. I've helped many clients understand why they were dealing with reflux and eliminate the root causes of it. Would love to help you do the same. |