Kyle Kaechele’s indigestion and acid reflux had been getting progressively worse, but he just kept buying over-the-counter antacids to keep going. Then, after a late business meeting, Kyle, the western director of field sales for Oracle Marketing Cloud,went back to his hotel room and ordered room service.
After eating two cheeseburgers and some fries “in record time”, he fell asleep—but not for long. He woke up in terrible pain. “My arms were numb. I couldn’t feel my whole chest. I thought, ‘Oh, my God, I’m dying. I’m having a heart attack.’”
He managed to call the American equivalent of 999 for help and when the paramedics came and checked him, they assured him it wasn’t a heart attack—just indigestion. As they packed up, they advised him to seek medical help for his condition.
His doctor prescribed a PPI, a proton-pump inhibitor, telling him the pills would be “life-changing”. They didn’t work—and small wonder. A recent study has shown that as much as 86 per cent of patients taking PPIs twice a day still experience both acid and non-acidic reflux.1
In Kyle’s case, the reflux got worse. He doubled the dose and the medication still didn’t help. Finally, after repeated changes in prescriptions, including one for the H2 receptor antagonist Zantac (ranitidine), after another three months of daily misery and pain, he decided he’d
“I realized you keep taking these pills, but all you’re doing is dealing with the short-term symptoms. You’ve really got to change your life.”
Gastro-oesophageal reflux disease
‘Gastro-oesophageal reflux disease’ (GORD), also known as ‘gastroesophageal reflux disease’ (GERD) in the US, is a condition where stomach acid and food particulates back up from the stomach, creating an extremely painful acidic burning in the oesophagus.
According to the NHS, one in five people in the UK, mostly adults over age 40, suffers from GORD, with one in 10 experiencing this painful event on a daily basis. Estimates for the US are higher, with as much as 60 per cent of the adult population experiencing some type of symptoms. GORD affects men and women equally and is not uncommon in children.
If left untreated, it can cause oesophagitis, or inflammation of the oesophagus, as well as narrowing of the oesophagus due to scar tissue forming because of the damage done over time by stomach acid. This creates difficulty in swallowing. Ulcers may form and bleed, while a precancerous change to the oesophagus called ‘Barrett’s oesophagus’ may also arise.
And then there’s the potential for oesophageal cancer. Described by The Telegraph as “one of the deadliest cancers in the UK”, the incidence of this cancer in the UK has almost doubled since 1985 in tandem with the dramatic increase in diagnosed cases of GORD.
So what’s behind GORD?
Traditionally the trouble is related to a weakening or malfunction of the lower oesophageal sphincter (LOS), the circular band of muscle surrounding the base of the oesophagus that opens to permit the passage of liquid and foods into the stomach, and then closes to keep the stomach contents separate. It’s also believed that increased intra-abdominal pressure causes bloating in the stomach that, in turn, forces the LOS open.
But what causes the increased intra-abdominal pressure in the first place?
Sadly, the causes of indigestion and GORD have not been rigorously studied and, historically, the focus has been on treatments for the painful symptoms instead.
Over-the-counter (OTC) antacids to neutralize stomach acid and relieve heartburn have been incredibly popular for over 50 years. Whether in chewable or liquid form, OTC antacids act by either neutralizing stomach acid or absorbing stomach acid. Bicarbonate of soda (baking soda) is an example of the former, and products that include calcium and magnesium salts fall into the latter category.
Although not recommended for use by children under 12 years of age, OTC antacids are regarded as not dangerous, with only minor side-effects like constipation, diarrhoea, thirst and stomach cramps being reported. According to an article in the pharmacists’ trade journal Drug Topics, OTC antacids comprised a $10 billion global market in 2008.
When OTC antacids don’t work for indigestion and GORD, people are told to seek medical help. At that point, what’s usually prescribed is an H2 blocker (also known as H2 receptor antagonists) or a proton-pump inhibitor (PPI). H2 blockers, which came on the market in 1976 under the trade name Tagamet, work by blocking the action of histamine on the epithelial cells that line the inside of the stomach, so reducing the amount of stomach acid produced. They are generally considered less effective than PPIs, and are available as both OTC and on prescription.
In contrast, PPIs reduce stomach acid by inhibiting the enzymes in the stomach wall that produce the acid in the first place. Omeprazole (Prilosec) was first on the market in 1989, followed quickly by the intravenous drug pantoprazole (Protonix I.V.) and then esomeprazole (Nexium) in 2001.
A 1991 study examining low-dose maintenance prescriptions of H2 blockers for duodenal ulcers concluded that “these agents can be given safely for several years and probably much longer”.2 And as recently as 2002, PPIs were regarded as having “minimal side-effects and few significant drug interactions.” 3
As a result, prescriptions for GORD have grown exponentially in popularity—and profitability. In 2013, IMS Health, a global information services company, cited Nexium (esomeprazole; made by AstraZeneca) as the top prescription PPI and the number-two best-selling drug
on the global market, pulling in $6.1 billion in sales that year alone.
But as time goes by, the safety of H2 blockers and PPIs have come into question. In fact, recent studies are proving that these prescriptions—especially PPIs—are anything but safe.
Impaired cognitive function is the most frequently reported adverse effect of H2 blockers,4 mostly affecting the elderly population, and especially those with kidney and liver problems. Delirium, hallucinations, confusion, disorientation, hostility, psychosis and paranoia have also been reported, with symptoms usually presenting within the first two weeks of use.5
Gynecomastia, the enlargement of breast tissue in men, has been seen in patients taking the H2 blocker cimetidine.6 The Mayo Clinic in Rochester, Minnesota, cites a long list of possible adverse effects with H2 blockers, including abdominal pain, coughing and difficulty swallowing, fever and flu-like symptoms, irregular heart beats, painful joints and glands, wheezing and difficulty breathing.
And yet PPIs, while generally considered more effective for GORD than H2 blockers, carry a substantially meaner punch. One study matched more than 100,000 PPI users with the same number of non-users over a 120-day period and found that users had a 158 per cent greater risk of heart attack than non-users.7
Seven months later, a “data-mining study” examining 16 million clinical documents involving 2.9 million people was set in motion to determine the risk for cardiovascular problems associated with PPI use in the general population. The result? A 200 per cent increase in the risk of death due to myocardial infarction.8 No such increased cardiovascular risk was found with H2 blockers for GORD.
But the trouble with PPIs doesn’t stop there. Recent studies reveal that PPI use increases the risk of chronic kidney disease by as much as 50 per cent.9 One study from Canada showed that people aged 66 and older using PPIs have an increased risk of acute kidney injury and interstitial nephritis (where the tissues between the kidney tubules become inflamed and swollen).10 Last year, a study from State University of New York in Buffalo, New York, claimed that patients who developed chronic kidney disease have a “76 per cent increased risk of dying prematurely”.11
Another reported side-effect of long-term PPI use is the reduced vitamin and mineral uptake by the body. To be absorbed, iron must be processed by the acid released in the stomach. The same is true of calcium and magnesium. Low magnesium levels are related to heartbeat irregularities, palpitations, muscle spasms, restless legs syndrome, low blood pressure, insomnia and seizures. Indeed, chronic PPI use can leave the body incapable of properly absorbing magnesium even when supplements are taken.12
Equally insidious is the negative impact of both H2 blockers and PPIs on vitamin B12 levels, especially in the elderly.13 B12 helps the body make red blood cells, and maintains the nervous system and even DNA itself. A deficiency in the vitamin due to the use of H2 blockers and PPIs can result in less sound blood vessels, shortness of breath, dizziness, anaemia, fatigue, walking difficulties, balance issues, depression, memory loss and paranoia.
And as if all this weren’t enough, the University of Michigan Health System released a report in November 2015 stating that 90 per cent of hospital inpatients prescribed PPIs for the first time in hospital have a higher risk of dying because the reduced stomach acid increases their risk of infection—most notoriously, by hospital-acquired pneumonia and Clostridium difficile.14 There is also a greater risk of community-acquired pneumonia (CAP) when taking PPIs.12
Fighting the wrong enemy
The ‘burning sensation’ of indigestion and the need to obtain relief from GORD is big business. In the drive for symptom relief, stomach acid has been turned into the enemy by doctors and pharmaceutical companies alike. But is stomach acid really the problem, or is something else going on?
Mr Majid Hashemi, consultant surgeon at the University College London NHS Hospitals, and a specialist in stomach and oesophageal cancers, laparoscopic surgery, obesity surgery and reflux disease, and honorary senior lecturer in Surgery at the Royal Free and University College London Medical School, states the situation plainly.
“GORD is not due to excess acidity,” says Hashemi. “In fact, non-acidic GORD causes symptoms of other conditions resulting from GORD as well. PPI and H2 blocker use is a simple method to set aside the symptoms. They do not address the cause of GORD or provide a cure.”
Worse, says Dr Wayne Andersen, former open-heart and critical care surgeon at Grandview Health Care Center in Kansas City, by absorbing stomach acid and lowering the pH in the stomach, and blocking the production of hydrochloric acid (HCl), taking antacids, PPIs and H2 blockers actually creates the conditions for further indigestion and GORD by impeding digestion, creating a cycle of ever-lower levels of stomach acid, leading to more indigestion and more reflux.
Instead of less acid, GORD sufferers actually need more acid in their stomachs—which is why the old home remedies of drinking lemon water or mixing apple cider vinegar with water and drinking it are so effective for both indigestion and GORD symptoms.
“It’s so counterintuitive,” says Andersen. “There are three reasons you make HCl, and the most important one is it helps break down the food in your stomach. It also helps when we eat stuff that has bacteria in the food. Hydrochloric acid kills external bacteria that can cause bloating and harm that can actually affect the duodenum, and your ileum and your small intestine.”
Surgeon-turned-diet-guru and author of The New York Times bestselling book Discover Your Optimal Health, Andersen says that, when we knock down acid production, we slow gastric-emptying and, most importantly, allow the wrong kinds of bacteria—such a H. pylori—to start growing in the gut. Once that happens, inflammation in the gut triggers increases in intra-abdominal pressure and pressure on the oesophageal junction itself.
Once irritated and under pressure, the LOS doesn’t close as well as it should. It doesn’t have the same capacity to “seal” correctly.
The result? GORD.
“The irony,” he says, “is that acid can improve it.”
Of course, it’s precisely the loss of stomach acid and lowered gastric pH that cause the dangerous lack of absorption of nutrients, vitamins and minerals that PPI and H2 blocker users are subject to as well—along with all the disturbing side-effects these deficiencies create.
If ever there was an example of how potentially dangerous it is to just attack symptoms with medication instead of seeking a cure for the actual problem that triggers the symptoms in the first place—in this case, indigestion—then PPIs, H2 blockers and GORD are it.
Getting to the root of GORD
Indigestion and gastro-oesophageal reflux can be triggered by all sorts of things— unhealthy bacterial overgrowth in the gut, obesity, overeating, eating too fast, stress, anger, spicy foods, alcohol, caffeine, even wearing clothes that are too tight around the middle.
According to Dr Deborah Gordon, a general practitioner in Ashland, Oregon, after age 50, our digestive mechanisms slow down. The pyloric sphincter, which empties the stomach, gets a little slower, so when we eat, the volume of what’s in the stomach fills up faster, so creating more pressure and more potential food to reflux. Yet our eating habits tend to remain the same as when we were young.
We still eat as much of all the wrong things as we used to when our bodies could handle it better. Only now we’re older and under greater stress in the workplace and in our home life.
Other contributing factors to GORD are drinking water and other beverages with meals, which slow stomach acid production. Poor food combining also affects acid production, as well as not getting enough rest and being exposed to heavy antibiotic use.
In Andersen’s experience the main things that help heal GORD are losing weight, stopping or decreasing the use of alcohol, caffeine and carbonated drinks, eliminating fatty, fried and spicy foods, and changing to a low-carbohydrate diet.
He cited a recent study by the Cleveland Clinic corroborating his own findings that if an overweight or obese person achieves a healthy weight, the decrease in GORD episodes is 72 to 98 per cent.
Formal studies have also shown that dietary changes, especially a shift to a low-carb diet, are very effective for reducing reflux. A 2006 study, from the University of North Carolina in Chapel Hill, revealed that “a very low-carbohydrate diet in obese individuals with GERD significantly reduces distal esophageal acid exposure and improves symptoms.”15
The GORD sufferers interviewed for this article agree: weight loss and diet are key. Kyle Kaechele, for example, despite his self-admitted tendencies to still
“see anything I want to eat and just eat it”, is completely off his PPIs and H2 blockers, and now manages his GORD through diet alone.
Natural ways to eliminate GORD
As Dr Mosaraf Ali, head of the Integrated Medical Centre in London, puts it, “Digestive problems are caused by Hurry, Worry and Curry. Everything has to be in moderation.”
An expert in Ayurvedic medicine and naturopathy, Ali’s approach to GORD is similar to those of Drs Hashemi, Gordon and Andersen: diet and stress reduction. Here’s a list of some common-sense general things you can do to eliminate GORD and heartburn; it combines advice from all the physicians interviewed for this article.
In urgent situations
1) Go for a walk to stimulate peristalsis (the wavelike motion in the gut that moves its contents along)
2) Drink water; you can also drink lemon water or water cut with some unfiltered organic apple cider vinegar to boost acid levels
3) Stimulate peristalsis and elimination with a magnesium supplement
4) Chew gum; this stimulates saliva production, and saliva contains natural compounds that protect the oesophagus
5) Take ‘digestive bitters’ (found at healthfood shops and online), which stimulate the body’s own digestive juices and acid production
6) Try supplementing with betaine HCl to increase stomach acid. DO NOT USE if taking anti-inflammatory medications like corticosteroids or NSAIDs (aspirin, ibuprofen, Advil, etc.), as this increases the risk of gastrointestinal bleeding
7) Relax. Breathing exercises for conscious relaxation can significantly improve GORD symptoms.1
Eating tips to get over GORD
1) Never eat when you’re emotionally upset and don’t eat on the run
2) Eat sitting down in a relaxed manner
3) Never eat and work at the same time: eating at our desks keeps us in fight-or-flight mode, so chronically stimulating the sympathetic nervous system, which means we’re producing less stomach acid to digest our food
4) Chew and chew and chew your food: digestion begins in the mouth with the production of saliva; aim for 20–30 chews per bite
5) If possible, take a walk after eating to aid digestion
General dietary recommendations
Things to get rid of
1) If you’re overweight, shed those extra pounds; excess visceral fat (the fat around your organs) creates increased intra-abdominal pressure and tight waistlines in clothes—both contribute heavily to GORD
2) Carbs from grains and root vegetables
3) Excess salt intakes
4) All fried and fatty foods
5) All processed foods
6) Commercial plant oils like canola, rapeseed, peanut oil
7) Products involving GMOs (genetically modified organisms)
8) Spicy foods
9) Carbonated drinks
10) Coffee and other caffeinated beverages
12) Tomato products and citrus fruits
14) Sugar and artificial sweeteners
15) Any foods linked with sensitivities (dairy, nuts, corn, soy, nightshades)
16) Be sparing with raw foods (salads, oranges, tomatoes)
Things to include in your diet
1) Bone broth (easy on the gut and highly nutritious)
2) Nutrient-dense veg and steamed leafy greens
3) Healthy organic proteins, lean meats and poultry
4) Fermented foods like sauerkraut and, if not sensitive to dairy, kefir and yoghurt (but not commercially processed or sweetened ones)
5) Lightly cooked, rather than raw, foods
Probiotics: to promote healthy intestinal flora
Deglycyrrhizinated licorice root (DGL): two tablets 20 minutes before a meal and/or before bedtime
d-Limonene extract (of citrus peel):
1 g 30 minutes before meals
Melatonin: in one study,
6 mg of melatonin taken with 5-hydroxytryptophan 100 mg,
d,l-methionine 500 mg, betaine
100 mg, l-taurine 50 mg, riboflavin
1.7 mg, vitamin B6 0.8 mg, folic acid 400 mcg, and calcium 50 mg worked better than the PPI omeprazole.1
A dietary solution: Sandy’s story
In the summer of 2010, Sandy Mason was 46 years old and her heartburn was “relentless”. She went to see a gastroenterologist, and endoscopy revealed a hiatal hernia (a painful condition where the stomach pushes up through a hole in the diaphragm and gets pinched), as well as gastritis and oesophagitis.
Not surprisingly, the doctor put her on the proton-pump inhibitor (PPI) Nexium (esomeprazole), plus an over-the-counter antacid containing sodium bicarbonate. He also told her she needed to lose weight.
She ignored the weight advice and embraced the PPIs. But they didn’t give her the relief she was looking for, so the doctor kept prescribing stronger and stronger PPIs. “I tried everything,” she says. “But it seemed like, whatever I did, my symptoms just got worse.”
Over the years, she switched doctors and kept switching prescriptions, but the heartburn and GORD never stopped. Eventually, she decided to quit the PPIs and go the natural route. “I chewed gum. I drank lemon water in the morning and put apple cider vinegar in my water at night, and I used baking soda and aloe vera juice. And it seemed to help. But after a while, the pain came back.”
By January 2015, she was in constant pain, and she had reached 194 pounds (88 kg)—a lot of weight for her 5’4” (162.5 cm) frame. At that point, she decided enough was enough. A friend, who was a nurse and health coach, told her about a weight-loss programme that balances carbohydrate and protein intake called Take Shape for Life (which, interestingly enough, was created by Dr Wayne Andersen).
Sandy jumped on the diet and experienced almost immediate relief from her symptoms. She learned to enjoy oatmeal and eggs, broiled meats and salads.
Between January and mid-July 2015, she lost 68 pounds (31 kg). Her blood sugar stabilized, and her heartburn and GORD completely disappeared.
Today she’s so enthusiastic about her newfound health and pain-free life that she’s become a health and weight-loss coach so that she can
“So many of us are addicted to medications,” she says. “And it’s literally killing us. If people can get their bodies back in balance and start getting the proper nutrients, it makes all the difference in the world.”
Sandy’s diet programme
“The more I study the subject,” says Sandy, ”the more I am coming to believe that many who suffer from GORD could eliminate or reduce symptoms with the proper balance of macronutrients.”
Overconsumption of carbohydrates seems to cause the most problems for GORD sufferers, she says. As a result, in her health-coaching practice, she recommends the following daily diet, taken in six meals spaced every 2–3 hours throughout the day.
Proteins: 100+g per/day. This amounts to 10–15 g at each of the five small meals and around 40 g at the larger, sixth meal.
Carbohydrates: 80–100g per day. While trying to lose weight and/or eliminate GORD symptoms, cut out all grains and starchy root vegetables from the diet. When counting carbs, subtract any fibre from the total to get the net carbs.
For example, one stalk of broccoli contains 10 g of carbohydrates, 3.9 per cent of which is dietary fibre, leaving
6.1 g of carbs. Allow around 13–15 g of carbs at each of the five small meals,
with the remainder taken at the larger, sixth meal.
Fats: 25–30 g per day, derived from healthy sources like avocados, nuts, olive oil, olives and low-carbohydrate salad dressings.
Sweeteners and all processed foods, of course, should be eliminated or kept to a bare minimum. GORD sufferers should also try to identify common trigger foods like citrus, tomato, onion, garlic and caffeine.
Once the symptoms are gone and a healthy weight has been established, grains and root vegetables like potatoes can be gradually reintroduced into the diet. In general, though, the best, healthiest source of carbs is fresh or fresh-frozen vegetables.