Acid Reflux (GERD): Treating Symptoms vs Addressing Causes
- Aug 26, 2024
- 7 min read
Updated: 5 days ago
Paul A. Goldberg MPH, DC, DACBN, DCBCN
Founder and Consultant to The Goldberg Tener Clinic
Chronic Disease Reversal
Gastro-Esophageal Reflux Disease (GERD) is a long name for a very common set of symptoms afflicting over twenty million people in the United States and is a condition we commonly help patients overcome in our practice.
The way an individual is affected by GERD differs somewhat from person to person but in general there is a burning sensation, related to irritation by stomach acid referred to as “heartburn”, though the condition is not directly related to the heart.
Excessive stomach acid is often blamed as being the problem medically as if it were the cause of the patient's problem to be aggressively "treated". This is a serious distortion. Stomach acid is a highly valued and needed component for good health and in many ways should be considered liquid gold!
Stomach acid is comprised of Hydrochloric acid / HCL) which is produced and secreted by specialized cells in the stomach called parietal cells. HCL has critical functions including:
HCL begins the digestion of proteins on their ultimate pathway to become amino acids. Amino acids perform a myriad of essential functions including serving as structural components of connective tissues e.g. skin, muscles, ligament and tendons, constructing hormones and red blood cells, making cells for organs, creating neurotransmitters and other vital tasks. Without the production of HCL from parietal cells, proteins cannot be efficiently broken down into their constituent polypeptides and amino acids. This results in impaired metabolic function/digestive disorders. If dietary proteins are not broken down efficiently, they are acted upon by bacteria residing in the gut, leading to putrefaction and its byproducts e.g. ammonia, indican, cadaverine and putrescine. The byproducts of bacterial putrefaction are highly toxic, contributing to the development of impaired digestion, allergies, foul smelling methane gas, irritation of the intestinal lining and increased chances of developing a wide range of health issues including autoimmune disorders.
HCL is used by the body to administer an acid bath to food entering the stomach thereby eliminating invading bacteria, viruses and parasites thus preventing them from entering the small intestine to create illness. Insufficient stomach acid due to a variety of problems including general poor health, chronic fatigue, the use of acid reducing medications, overeating, poor diet, is a common cause of SIBO (Bacterial Overgrowth of the Small Intestine).
HCL makes minerals in our food e.g. calcium and magnesium more soluble so they can be effectively utilized by the body.
HCL, upon entering the duodenum (small intestine), triggers the release of sodium bicarbonate neutralizing the acid and activating pancreatic enzymes including amylase for the digestion of carbohydrates. Without HCL (acid), bicarbonate would not be released leading to turmoil in the digestive tract and a severe lack of digestive enzymes for the breakdown of food.
The Hazards of Acid Reducing Drugs
The acid reflux associated with GERD can lead to irritation of both the stomach and/or the lower esophagus and in severe cases can lead to gastric bleeding, ulcers and strictures. It is for these reasons that physicians commonly administer antacids, PPI’s (proton pump inhibitors) and H2 Blockers. Antacids neutralize the acid and H2 blockers (e.g.) Pepcid, Zantac, ranitidine) and PPI’s (e.g. Prilosec / omeprazole, Nexium, prevacid, protonix) inhibit acid secretion. In both cases, the availability of acid is reduced. This can lead in time to a wide range of health issues as detailed above resulting from the incomplete breakdown of proteins, minerals not being made soluble and bacteria / parasites not being destroyed due to the absence of HCL. The multitude of resulting health issues that can then evolve is significant.
Potential Side Effects of different types of Antacids
The side effects of over-the-counter antacids depend heavily on their active mineral components. [1, 2]
Aluminum-based antacids: Constipation, stomach cramps, and a loss of appetite. Chronic overuse can drain phosphate from the body, increasing the risk of bone-weakening osteopenia or osteoporosis.
Calcium-based antacids: Constipation, bloating, and gas. Excessive or prolonged intake can cause hypercalcemia (excess calcium in the blood), which manifests as muscle weakness, fatigue, and confusion and increases the risk of developing calcium kidney stones.
Magnesium-based antacids: Diarrhea, nausea, and abdominal cramping. Because the kidneys filter out magnesium, individuals with kidney disease are at a high risk of developing a toxic buildup of magnesium in the blood (hypermagnesemia).
Sodium bicarbonate-based antacids: High sodium content can lead to fluid retention putting people with high blood pressure, kidney disease, or heart conditions at particular risk. Overuse can disrupt the body's acid-base balance, leading to systemic alkalosis.
Rebound Acidity: Stopping daily or heavy antacid use abruptly can cause the stomach to temporarily overproduce acid, making heartburn symptoms feel worse than before.
Potential Side Effects of H2 Blockers
H2 blockers (such as famotidine, cimetidine, and nizatidine) decrease acid production. Their side effects are typically mild but can become more pronounced with extended use.
Short-term effects: Headaches, dizziness, diarrhea, constipation, and fatigue.
Nutrient deficiencies: Prolonged use reduces the stomach acid needed to absorb vital nutrients leading to vitamin B12 deficiency, iron-deficiency anemia, and low magnesium levels.
Bone fractures: Long-term reduction of stomach acid impairs calcium absorption, leading to poorer bone mineralization and a higher risk of bone fractures.
Central nervous system effects: Confusion, agitation, or hallucinations particularly in the elderly or those with kidney disease.
Increased risk of infections: Lower stomach acid removes a primary defense mechanism against ingested pathogens, raising the risk of community-acquired pneumonia and intestinal infections like C. difficile.
Medication-specific effects: Cimetidine can block androgen receptors, occasionally leading to gynecomastia (breast development in males) and erectile dysfunction.
Both H2 blockers and antacids alter stomach chemistry and can severely disrupt how your body absorbs prescriptions drugs. Antacids can deactivate certain antibiotics (like tetracyclines and fluoroquinolones). H2 blockers e.g. cimetidine, can interfere with liver enzymes and elevate blood levels of blood thinners, blood pressure medications, and anti-seizure drugs. Long term use of both classes of drugs can contribute to SIBO, allergies, autoimmune disorders, rheumatological / joint issues, eczema, psoriasis and other chronic skin issues, headaches, chronic fatigue etc. and, according to some studies, bone fractures, myocardial infarction and dementia.
In the video shown below, Scott, a recent patient that came to see us with chronic acid reflux (GERD), discusses the complications (neurological symptoms) he experienced after his medical physician prescribed Omeprazole (Prilosec) to treat his symptoms. Today, Scott no longer experiences reflux and is no longer taking Omeprazole. Click here to read the full case summary.
While pharmaceuticals, over the counter or prescription, are the most common way GERD is addressed, surgical options are employed as well.
In none of these scenarios is the cause of the problem addressed and therefore resolution of the problem is far from guaranteed.
What Causes GERD?
The first task to address regarding each patient with GERD is why is it occurring? GERD is not the cause of itself. This is a more effective and rational approach than to immediately “treat” GERD with drugs, usually on an ongoing basis, leaving the patient open to a lifetime of disabling side effects. Identification and addressing the cause(s) and improving the patient’s overall health is always the best route to take and in most cases the problem, with the right detective work completed and health building measures taken, can be resolved.
Common contributing causal factors in GERD include:
Overeating
Emotional stress (worry and anxiety)
Abnormal gastrointestinal bacteria
Environmental exposures/toxicities
Poor dietary
Food and inhalant allergies
Pharmaceutical agents
The use of coffee
The use of tobacco
Alcohol usage
Obesity
Lack of stomach acid
Sleep deprivation
An elevated level of stomach acid alone is rarely the cause of GERD as the areas where stomach acid is supposed to contact the GI tract are well protected. When stomach acid, however, encounters tissues not protected by mucus secreting goblet cells, damage can occur. The stomach has many goblet cells and if acid remains in the stomach and the first portion of the duodenum (where it is neutralized by bicarbonate) problems are unlikely to manifest. When the acid is displaced usually due to one or more of the causal items listed above, then damage to tissues, particularly in the esophagus, can occur.
We also find in some patients that it is not an excess of stomach acid causing the patient’s problems, but a lack of stomach acid, which in turn causes indigestion and the misplacement of the HCL present to contact the esophageal tissues. Low stomach acid becomes more prevalent as we get older. We often find patients who have been on antacids, PPI’s or H2 blockers for years, suffering from a multitude of issues not only from the GERD but from the effects of drugs which inhibit the amount of HCL the patient is able to produce. Identifying causal issues and restoring good health to the GI tract allows normalcy to return and with causes gone so are the symptoms.
Below is an interview with a recent patient from our clinic that suffered from chronic reflux, irritable bowel, high blood sugar and high cholesterol. His case illustrates the positive outcome possible when taking a causal based approach to the problem. The patient is no longer taking any form of medication for GERD.
Identifying causal factors in GERD and applying the appropriate health building measures takes work on the part of both the doctor and the patient. Taking a causal based approach as we have done since 1976, can often prevent the ongoing nightmare of drugs and their side effects associated with GERD. Stomach acid is an important component of good health. Interfering with the normal physiology of the GI tract with drugs to treat problems that should be addressed by causal identification and health building measures, can turn into a lifelong nightmare for patients that does not have to occur.
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