December 28, 2007:- It’s estimated that 40% of the US population has some degree of gatroesophageal reflux disease (GERD), with 20% of adults complaining of weekly episodes of heartburn and 7�?0% 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.

Stress is a major factor in reducing the flow of stomach acid. This is why it’s best to eat in a quiet, relaxing environment.

Age is another factor in acid production. It has been well documented that acid production decreases as we age. Some studies have shown that, on average, acid production is significantly decreased in about 50% of those over the age of 60. There are other factors that come in to play as well. Chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) can result in reflux. Infections will work to reduce the production of acid. Two common culprits are H. Pylori and Candida Albicans. Both of these organisms like an acid free environment and will work at shutting down stomach acid production.

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 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.

Diagnosis
An 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. Acid blocking drugs have potential side effects that include anxiety, depression, diarrhea, nausea, increased cough, muscle pain, and flu-like symptoms. These medications block the absorption of zinc, folic acid, B12, calcium, and iron. And studies show the risk of hip fracture (from calcium deficiency) is directly related to the duration of proton pump and antacid drugs, ranging from 22% for 1 year of use to 59% for 4 years of use, relative to nonuse.


If you’re taking antacid medications, please take a good multivitamin.


Are Antacids the Answer?
The answer is no! Acid receptors are found in the lower end of the stomach and they control the function of the Pyloric Sphincter. The Pyloric Sphincter controls how fast or slow the stomach empties. If the acid level in the stomach does not reach the right level, the Pyloric Sphincter will not open. The food is trapped in the stomach and will start to ferment. The fermentation causes gas and creates a different kind of acid that the acid receptors are not sensitive to, and the gas wants to go up. The stomach wants to empty, and the peristalsis (stomach contractions) will increase in an attempt to force the food out of the stomach. The sphincter at the top of the stomach is weaker then the Pyloric Sphincter and will give way first, letting the food and gas go up into the esophagus. This causes heartburn.

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.


Why Stomach Acid is Good For You
Stomach acid or hydrochloric acid (HCl), is a very powerful digestive agent, and much more important than you realize.

If you suspect you have low stomach acid and aren’t taking stomach acid blocking medications and aren’t already taking digestive enzymes, then you may want to try taking betaine HCL with pepsin capsules.

Questions

I have bloating and gas that seems to be worse when I eat certain foods. Will taking digestive enzymes help this? And which should I take betaine HCL with pepsin or pancreatic enzymes?

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. For recent onset of heartburn/reflux symptoms I typically recommend starting with betaine HCL with pepsin. For individuals who’ve been on prescription heartburn or reflux medications for more than one month, I recommend they take pancreatic digestive enzymes.

Why the difference?
Ideally everyone would take the betaine HCL with pepsin and increase their stomach acid levels. Betaine HCL supplementation helps close the esophageal sphincter and prevent acid from leaking back up into the esophagus. However, individuals with an irritated stomach lining may not be able to tolerate the increase in stomach acid (betaine HCL), it may actually make their condition worse. This is especially true for folks who’ve been on stomach acid blocking drugs for a while (one or more months). For individuals with heartburn or reflux who’ve been on stomach blocking drugs for less than a month, trying betaine HCL with pepsin and see if it helps reduce the symptoms. IF you find that betaine HCL with pepsin irritates your stomach (burning or flush feeling) then stop taking them and switch to pancreatic digestive enzymes. Pancreatic enzymes don’t have HCL acid so they won’t irritate the stomach. Pancreatic digestive enzymes work in the small intestine to help breakdown and absorb carbohydrates, proteins, fats, and their nutrients.

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 usually encourage my patients to try the digestive enzymes (with each meal) alone for a week or two and see if this alone prevents you from giving any reflux symptoms, often times it does. The longer you’ve been on prescription medications for reflux the harder it becomes to discontinue them. If you continue to have reflux while taking the digestive enzyme, then you’ll need to go back on the prescription medication. If so, keep taking the digestive enzyme with each meal along with your prescription ant-acid drug.

Can I take pancreatic digestive enzymes or Betaine HCL forever?
Yes, you can take them as long as needed to stop your heartburn or reflux.

Should I take pancreatic digestive enzymes or Betaine HCL even if I don’t have heartburn or reflux?
Stomach acid and absorption decreases as we age, therefore I encourage all of my patients over the age of 35 to take pancreatic digestive enzymes. This is especially true of anyone with bloating, gas or indigestion issues.

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
�?peppermint
�?chocolate
�?coffee
�?tea
�?alcohol
�?tomatoes
�?garlic
�?onions

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.

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