Heart burn, acid reflux, GERD – what is the difference?

All of these conditions occur when acid from the stomach escapes into your oesophagus, via the sphincter at the top of the stomach, creating a burning sensation.

All of these painful digestive conditions are related and tend to cause similar symptoms, however, they usually develop in stages.

In the case of acid reflux, stomach acid leaks out of the stomach and into the oesophagus. When this progresses, it can be diagnosed as gastroesophageal reflux disease (GERD) which is considered to be more severe. Heartburn is also commonly called GERD.

The most common symptom of GERD is frequent pains in the chest and burning sensations hence the name “heartburn”. Other signs of GERD are difficulty swallowing or keeping down food and liquids, coughing, wheezing and chest pain. Often these symptoms occur or are much worse at night.

An alarming finding from one study conducted in Norway found that the incidence of acid reflux rose from around 11 percent of the population to over 17 percent over a period of 11 years. A similar rise is happening in other industrialised countries too.

It might not be the biggest deal to have acid reflux symptoms on occasion but research shows that people with long-standing, chronic heartburn are at greater risk for serious complications. These include stricture (narrowing) of the oesophagus and inflammation of the oesophagus or oesophagitis. Other developments can include chronic infections and there are concerns re fracture risk and pneumonia (linked to PPI medication).

If we have low stomach acid our food isn’t broken down as quickly or completely so proteins stay in the stomach longer than is normal. This means the acid also stays longer and this can cause digestive issues, especially when we start moving around following a meal. Slowing our digestion down is also a problem as it gives food time to ferment and putrification can occur. This means bacterial balance can become problematic as certain undesirable species thrive (pathogenic) and yeast and fungus can also start to proliferate. This in turn can lead to more serious problems from an unhealthy microbiome balance and conditions such as IBS and multiple digestive issues.

So we need our stomach acid but we need it in the right place.

Silent reflux - what is this?

Over 112 million people in Europe, about 20% of the population, are estimated to suffer with acid reflux. Acid reflux occurs when acid from the stomach flows back up into the tube running from the throat to the stomach (the oesophagus). This causes a burning sensation known as acid reflux or heart burn.

Silent reflux occurs during the night and is so named as people often don’t know it is happening. One of the most common symptoms is an unexplained need to cough frequently or clear your throat a lot. This is due to the erosion of the protective mucus which lines the oesophagus or irritation and damage to the cell membrane itself.

Both acid reflux and silent reflux are often treated with medication to reduce the level of acid in the stomach. Too much stomach acid is rarely the issue however, it’s more about stomach acid escaping from the stomach, where it belongs. In fact, both conditions often arise initially due to low levels of stomach acid and digestive enzymes, which frequently decline with age. As digestive function declines the bacteria in the gut (microbiome) can become imbalanced leading to dysbiosis, bloating and gas, or conditions such as small intestine bacterial overgrowth (SIBO). These issues increase the risk of bacterial fermentation, instead of digestion of food. Fermentation causes gas which can lead to a buildup of pressure in the gastrointestinal (GI) tract. If this causes the sphincter at the top of the stomach to open and the acid will reflux, causing burning.

My approach

I am always looking for the root cause of health problems and acid reflux is no exception. There are many steps which can be taken to improve digestion and acid reflux symptoms.

Acid suppression medication from your GP can help with immediate symptom relief and may be needed initially to protect the lining of the oesophagus. It is best not to rely on this long-term however, so we would look to investigate root causes. Is it poor digestive function, bacterial overgrowth or imbalance or are there any structural issues such as weak diaphragm muscles, weak sphincters, hernias, ulcers? Parasites or fungal and yeast infections also need to be ruled out.

Sometimes simple diet and lifestyle changes are all that is required. We will often work to take the pressure off your digestive system whilst starting to improve digestive capacity. There are also some key practical steps that can help such as losing weight, avoiding eating just before bed or avoiding key food triggers such as alcohol, caffeine, spices and chocolate.

Acid reflux symptoms

Common	Less common
Heartburn	Voice changes
Chest pain	Hoarseness
Dry cough	Sore throat
Nausea	Difficulty breathing – asthma symptoms
Thick and bubbly saliva	Teeth damage
Pain in the upper part of the abdomen	Damage to mucous membranes in the mouth

Get in touch

If you would like to get to the bottom of your acid reflux, please get in touch for a free initial chat on 07740 876233. I would love to help you.

References

Holzer, P. (2007) Acid sensing in the gastrointestinal tract; American Journal of Physiology Gastrointestinal and Liver Physiology 292(3): G699-G705 doi: 10.1152/ajpgi.00517.2006

Eom, C-S. et al. (2011) Use of acid-suppressive drugs and risk of pneumonia: a systematic review and meta-anlaysis. Canadian Medical Association Journal; 183(3) pp.310-319. doi: 10.1503/cmaj.092129

Acid reflux and the problem with PPI’s

Acid reflux is a common and distressing complaint that my clients often need help with. As many as 20 percent of Europe’s population is estimated to suffer from acid reflux – that is 112 million people in Europe alone. In 2019 over 60 million doses of the two most common drugs known as proton pump inhibitors (PPI’s) were prescribed.

What is acid reflux ?

Acid reflux occurs when the muscle at the bottom of the oesophagus is weakened and acid from the stomach leaks into the oesophagus. This often causes a burning sensation known as acid reflux or heart burn. Overtime this can lead to erosion of the mucus membranes lining the oesophagus. This is often indicated by a ‘lump in the throat’ sensation and accompanied by a frequent need to cough. Left to progress this can develop into the more serious conditions such as gastro-oesophageal reflux disease (GORD) or Barrett’s oesophagus where the lining of the oesophagus is damaged. Asymptomatic reflux can also occur during the night. Where damage is caused during sleep this is known as ‘silent reflux’ and if this travels as far as the throat or voice box it can develops into laryngopharyngeal reflux.

Acid reflux symptoms

Medication

PPI medication also known as antacids such as omeprazole and iansoprazole reduce the acidity of the stomach by up to 90%. This helps to reduce the damage caused by the stomach acid leaking into inappropriate areas and can ease uncomfortable symptoms.

The problem with this option is the medications have long-term health implications and are only intended for temporary use. Unfortunately patients rarely understand this and most are unlikely to discontinue or reduce their dosage.

Why we need stomach acid

Stomach acid performs a vital role in the digestive process. It activates pepsin for protein digestion and intrinsic factor for B12 absorption. It is responsible for closing the lower oesophageal sphincter (LES) and preventing the backflow of stomach acid into the oesophagus. The stomach is supposed to have a pH of 1.5 and this acidity sterilises our food destroying various bacteria and pathogens. It also triggers the pyloric sphincter at the bottom of the stomach to open for the next stage of our digestion.

Without this acidity we can get an overgrowth of harmful bacteria. The alteration in pH reduces stimulation of bile and digestive enzymes which can lead to nutrient depletion especially B12 and magnesium. In addition the presence of bacteria in the wrong location can cause gas to build up. This can exert pressure on the LES which can open at unwanted times causing acid leakage into unprotected areas which then develop tissue damage.

Problems with medication and low levels of stomach acid

Acid suppression can help with immediate symptom relief but the effects on slowing digestion can cause many undesirable side effects such as: nausea; vomiting; diarrhoea or constipation; abdominal pain; bloating; headaches and fatigue. Low acidity can induce dysbiosis and small intestine bacterial overgrowth (SIBO) largely due to diminished digestion and delayed emptying of the stomach. This bacteria can also colonise and translocate to the lungs via aspiration hence the risk of pneumonia rises with PPI use. There is also an increased risk of gastric infection and fracture risk. The mechanism for the latter isn’t confirmed but is thought to involve malabsorption of nutrients.

The solution

Sometimes simple diet and lifestyle changes are all that is required. These might include losing weight, avoiding eating just before sleep or avoiding key food triggers such as alcohol, caffeine, spices and chocolate. However the picture can become quite complicated as it often involves weak diaphragm muscles and hiatus hernia complications.

My approach

In functional medicine and nutrition we are always looking for the root cause of health problems and acid reflux is no exception. There are many steps which can be taken to improve digestion and alleviate symptoms of acid reflux.

Often clients require extra nutritional support and specific supplements as well as guidance to re-establish good digestion before they reduce their medication under medical supervision. Breathwork and certain exercises can help to retrain and strengthen the diaphragm. It is difficult to exercise the diaphragm without specialist guidance as this muscle only kicks in during anaerobic exercise which can’t be sustained for long. Breathwork has the added advantage of improving vagal tone which strengthens the rest and digest or parasympathetic branch of the autonomic nervous system (PNS). Our busy modern lives have taken a significant toll on our PNS with ‘grab and go’ lunches and chronic high stress levels.

So if you would like some nutrition and lifestyle support to help get to the bottom of your acid reflux, or to discuss working with me on any other issue please get in touch for a free discovery call 07740 876233. I would love to help you.

References

Holzer, P. (2007) Acid sensing in the gastrointestinal tract; American Journal of Physiology Gastrointestinal and Liver Physiology 292(3): G699-G705 doi: 10.1152/ajpgi.00517.2006

Eom, C-S. et al. (2011) Use of acid-suppressive drugs and risk of pneumonia: a systematic review and meta-anlaysis. Canadian Medical Association Journal; 183(3) pp.310-319. doi: 10.1503/cmaj.092129

Cai, D., Feng, W. and Jiang, Q. (2015) Acid-suppressive medications and risk of fracture: an updated meta-analysis. International Journal of Clinical Experimental Medicine; 8(6); pp. 8893-8904. PMID: 26309543