(updated Nov. 2020)
Digestion and GI Disorders: Heartburn, Reflux, and GERD
I find that most of my patients who complain of GI problems are deficient in digestive enzymes. A deficiency in these enzymes prevents the body from breaking down and sufficiently absorbing food. Most digestion and absorption takes place in the small intestine and is regulated by pancreatic enzymes (digestive) and bile. The pancreas aids in digestion by releasing proteolytic enzymes, which help break down proteins into amino acids.
These enzymes break down food-stuff and allow the smaller molecules and nutrients to be absorbed into the bloodstream. The enzymes may become deficient for a variety of reasons, including advancing age, excess sugar, deficient essential fatty acids, excessive trans-fatty acids, and overeating. Eating processed food also depletes normal pancreatic enzymes.
Raw, unprocessed foods contain their own digestive enzymes. When we eat these foods, we help spare our own pancreatic enzymes. However, eating processed foods requires our body to secrete extra amounts of pancreatic enzymes. Over time, processed foods deplete a persons own pancreatic enzyme stores.
Proteolytic enzymes also help regulate inflammatory reactions by reducing the amount of kinins in the body. Kinin is a tissue hormone capable of causing severe and painful inflammatory reactions. It is triggered by allergic foods or chemicals and can cause inflammation anywhere in the body, including the brain.
Bloating, Gas, and Indigestion Protocol
Bloating, gas and indigestion may be signs of low stomach acid, deficient digestive enzymes (not able to break down and digest their food), bacterial or yeast overgrowth. Take a digestive enzyme with each meal. I recommend my patients use a potent pancreatic digestive enzyme formula that utilizes USP porcine-derived high-potency pancreatin for reliable and consistent enzyme activity.
If after one week you continue to have bloating gas or indigestion add 3 capsules of high dose probiotics (good bacteria, acidophilous, etc.). Probiotics should taken on an empty stomach. Usually one to two months of probiotic therapy is enough.
Heartburn, Reflux, and GERD
One estimate is that 40% of the US population has some degree of esophageal reflux, with 20% of adults complaining of weekly episodes of heartburn and 7–10% complaining of daily symptoms. Esophageal reflux occurs when the lower esophageal sphincter malfunctions, allowing the backward flow of acid, bile, and other contents from the stomach into the esophagus.
Gastritis (inflammation of the stomach itself), peptic or duodenal ulcers, and chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) can result in reflux. A hiatal hernia and can also result in esophageal reflux.
The most obvious symptom of esophageal reflux is heartburn. It occurs after eating and can last from a few minutes to a few hours. Heartburn feels like a burning sensation in the pit of the stomach. The pain may also move up into the chest and throat. GERD (gastroesophageal reflux disease) can cause esophageal scarring or Barrett’s syndrome, a chronic irritation from acid-bile reflux that causes the normal esophageal lining cells to be replaced by precancerous cells. These cells are associated with an increased risk for development of cancer.
DiagnosisAn endoscopy test is used for the diagnosis of GERD. This test involves examining the esophagus through a flexible viewing tube, which can also take a biopsy to correctly identify acid reflux.
Conventional Treatment of GERD
H2 antagonists (Tagament, Pepcid, Zantac, and Axid) and antacids (Tums, Maalox, etc.) are usually the first line of treatment. If these fail to work, then proton-pump inhibitor drugs (Nexium, Prevacid, or Prilosec) are initiated. However, many physicians now prescribe proton-pump inhibitor drugs as a first-line therapy. These medications block the absorption of zinc, folic acid, B12, calcium, and iron.
Long-term use of these medications can block all stomach acid (hydrochloric acid). The stomach needs hydrochloric acid to break down proteins for digestion. Failure to do this can lead to all sorts of problems, including intestinal permeability, anemia, fatigue, increased allergy disorders, depression, anxiety, and bacterial and yeast overgrowth.antacids
Are Antacids the Answer?
No! First, the esophageal sphincter is stimulated to close by the release of stomach acids. When there’s not enough stomach acid present—because antacids have neutralized them—the esophageal sphincter may not close properly. This allows acid to travel back up into the esophagus and cause heartburn, also called esophageal reflux or gastro-esophageal reflux disease—GERD. GERD is usually treated by antacids, but antacids could make the GERD worse.
Second, the stomach needs an acidic environment for hydrochloric acid to turn the enzyme pepsinogen into pepsin. No acid equals no pepsin, which is needed for digestion, especially protein. No protein digestion means no amino acids. No amino acids, no neurotansmitters (serotonin, dopamine, norepinephrine, etc.).
Last, an acidic environment is one of the body’s first lines of defense, destroying viruses, parasites, yeast, and bacteria.
Achlorhydria (Low Stomach Acid) Protocol
Numerous studies have shown that acid secretion declines with advancing age. It’s been estimated that 50% of Americans over the age of 60 suffer from achlorhydria, a deficiency in hydrochloric acid. The resulting rise in stomach pH can cause many of the symptoms associated with FMS and CFS.
Low stomach may also cause the very same symptoms associated with GERD. Unless you’ve had an upper GI endoscopy, biopsy, or blood test that shows a definitive case of GERD or H.pylori, then you may be causing more problems be usibg antacid medications. For example, one study found that 34% of those with low stomach acid reported indigestion and excessive gas. Forty percent complained of fatigue. We need gastric acid and pepsin for optimal digestion of food, absorption of nutrients, and release of pancreatic enzymes. A hydrochloric-acid deficiency triggers a chain reaction of digestive disorders, including malabsorption. Foods may be incompletely digested and subsequently absorbed into the bloodstream, where they can lead to food allergies, triggering pain and inflammation throughout the body.
Some symptoms associated with achlorhydria:
• distention after eating
• hair loss in women
• parasitic infections
• rectal itching
• multiple food allergies
• nausea after taking supplements
• restless legs
• sore or burning tongue
• dry mouth
Other associated signs
• abnormal intestinal flora
• chronic Candidiasis
• chronic intestinal parasites
• dilated capillaries in the cheeks and nose (in non-alcoholics)
• iron deficiency
• post-adolescent acne
• undigested food in the stool
• fingernails that are weak, peeling, and cracked
Diseases linked to low gastric acidity:
• vitiligo (skin disorder of milky white patches)
• urticaria (itching)
• Celiac disease
• Addison’s disease
• chronic autoimmune disorders
• pernicious anemia
• food allergies
• diabetes mellitus
If you’re suffering from heartburn, try the solutions below rather than antacids.
1. Take a pancreatic digestive enzyme with each meal. If you’ve been taking Nexium, Prevacid, Pepcid, Prevpac, Prilosec, Propulsid, Reglan, or Zantac for over three months, then you may have to stay on the medications along with taking digestive enzymes. Many of my patients have found that they don’t need these prescription medications once they start taking a good high potency digestive enzyme like the one I use in my practice.
2. If you continue to have problems with reflux even after taking digestive enzymes, then try taking Betaine with pepsin. See the information below.
Supplementing With Hydrochloric Acid
Adequate protein intake and a relaxed emotional state can help increase stomach acidity, but supplementation might also be necessary. Have your patients follow the guidelines below. I don’t recommend HCL for a patient who has been diagnosed with a peptic ulcer, because HCL can irritate sensitive tissue. It can also corrode teeth. Capsules should not be emptied into food or beverages. I recommend taking pancreatic enzymes along with HCL.
1. Take one capsule containing 600–650 mg. of hydrochloric acid, along with 100–200 mg. of pepsin, at the beginning of your meal. Continue taking one capsule with each meal for the next five days.
2. After five days, increase your dose to two capsules with each meal. Continue this dose for five days.
3. If you are experiencing no side effects (such as warmth, fullness, or other odd sensation in your stomach), increase your dose by one capsule each day until you do. Then reduce your dose by one capsule at your next meal.
4. Once you’ve established a comfortable per-meal dose (five capsules or fewer), continue at that level. As your stomach regains the ability to produce an adequate concentration of HCL, you will probably require fewer capsules. Listen to your body and reduce your dose as necessary. You may wish to reduce your number of capsules at smaller meals.
5. Be consistent. Individuals with low HCL and pepsin typically don’t respond as well to botanicals and supplements, so to maximize the benefits, keep up supplementation as directed.
I have bloating and gas that seems to be worse when I eat certain foods. Will taking digestive enzymes help this?
Digestive enzymes help you digest and utilize proteins, fats, and carbohydrates. You should notice that your bloating and gas are eliminated once you start taking digestive enzymes.
I’ve been diagnosed with GERD and have been taking Nexium (Prevacid, Zantac, Prilosec, etc.) for several months. Can I stop taking this medication and just take the digestive enzymes you recommend?
I would encourage you to try the digestive enzymes (with each meal) for a week or two and see if this alone prevents you from giving any reflux symptoms. The longer you’ve been on prescription medications for reflux the harder it becomes to discontinue them. However, you may find you don’t need the prescription medication once you start taking a digestive enzyme. If you continue to have reflux while taking the digestive enzyme, then try adding the betaine HCL with pepsin (see achlorhydria protocol) and probiotics (see below). If you continue to have a problem then you’ll need to go back on the prescription medication. If so then discontinue the betaine HCL with pepsin, but keep taking the digestive enzyme with each meal.
Treating with Diet and Eating Habits
Certain foods relax the esophageal sphincter and can make heartburn, reflux, and GERD worse. These foods include:
• fried, spicy, or fatty foods
• carbonated drinks
• citrus fruits
You should also avoid lying down within three hours of eating and should eat smaller meals more frequently (perhaps four or five daily). You can also elevate the head of your bed about six inches (to facilitate keeping gastric contents in the stomach) and try sleeping on your side, which would remove pressure from the esophageal sphincter, helping to keep gastric contents from backing up. If you continue to have problems even after trying the recommendations then you should be tested for GERD and H. Pylori. Please ask your doctor if you’ve been tested for either of these conditions. If not I recommend you be tested.