Digestive symptoms rank amongst the most common of everyday ills. A significant proportion of the population suffers from symptoms such as indigestion and heartburn. Increasingly, doctors are diagnosing a condition known as gastro-oesophageal reflux disease (GORD) – a condition characterised by frequent attacks of heartburn. One of the most common theories about what causes GORD is air swallowing. However in a study published recently in the American Journal of Gastroenterology (1), it transpires that the gulping back of air is NOT at the root of a digestive strife seen in GORD.
I see a lot of people with GORD in my practice, and my experience is that the symptoms associated with it are almost always causes by problems with the digestion of food. While it is often assumed that once food is swallowed it will be effortlessly broken down and absorbed into the body, the reality is the process of digestion is a very active process that depends on a number of factors, including the thoroughness of chewing as well as levels of stomach acid and digestive enzymes. It’s not uncommon for individuals to overwhelm their digestive systems, and this is usually what is the true cause of upper digestive symptoms such as bloating, belching, heart burn ad reflux.
Below, I’ve added a piece which was originally published in Healthy magazine which explores the underlying cause, and cure, for GORD. Taking the advice contained within it is very likely to lead to relief from upper digestive symptoms.
What is GORD?
Key to understanding what GORD is, is a knowledge of the how the digestive system works in health. One of the key functions of the digestive tract is to break food down so that it can be absorbed through the gut wall into the bloodstream. Digestion of food starts in the mouth through the action of chewing. Once swallowed, food makes its way down a tube called the oesophagus (gullet) to the stomach where acid starts the digestion of protein based foods such as meat, fish and dairy products. Once food leaves the stomach, it passes into the small intestine. Here it is subjected to the action of digestive enzymes that continue the digestive process. Some of these are found in the wall of the gut itself, while some of these are secreted by a gland called the pancreas. Bile, secreted by the gallbladder, also works on the food and helps with the digestion of fat.
In between the oesophagus and the stomach is a ring or muscle known as the gastro-oesophageal sphincter. In health, this valve opens to let food through to the stomach after swallowing, and then shuts to ensure that the stomach contents do not flow back into the oesophagus. However, for a variety of reasons, the gastro-oesophageal sphincter may not work as it should, which may allow stomach contents to flow back into the oesophagus. Doctors call this gastro-oesophageal reflux, and this condition is a common cause of heartburn – a burning sensation felt behind the breastbone.
Many of us will have experienced heartburn at one time or another. However, in individuals who suffer from heartburn at least twice a week, doctors may diagnose GORD. During the course of a year, between one quarter and one third of adults have some symptoms suggestive of GORD such as heartburn and acid reflux.
The diagnosis of GORD is generally made through the symptoms. However, some doctors may recommend additional tests including endoscopy where the inside of the upper digestive tract is examined with a camera. This test can be helpful in diagnosing a variety of problems including inflammation in the oesophagus (oesophagitis) and ulceration or inflammation in the stomach or duodenum.
Conventional Treatment for GORD
Conventional treatment for GORD is based on drugs that reduce the secretion of acid in the stomach. These drugs fall into two main categories:
Proton pump inhibitors omeprazole (Losec), esomeprazole (Nexium), lansoprazole (Zoton), pantoprazole (Protium) and rabeprazole (Pariet)
H2 blockers – such as cimetidine (Tagamet) and ranitidine (Zantac) nizatidine (Axid) famotidine (Pepcid)
Rarely, surgery may be advised where drug treatment fails to control the condition.
So what really causes GORD?
Inadequate chewing is a common problem in poor digestion. Another potential issue is a lack of acid in the stomach. Symptoms that are suggestive of this include bloating, belching or burning immediately after meals. Other features of low stomach acid may include a feeling of food sticking in the upper abdomen, or that just a small quantity of food causes a feeling of fullness. Stomach acid isn’t just important for the digestion of food, but also plays a critical role in the absorption of certain nutrients including minerals such as iron and vitamins such as B12 and folic acid. All of these nutrients are essential for healthy red blood cell formation. As a result, long standing low acid secretion can lead to a problem with anaemia. Anaemia that tends not to respond to supplementation with iron or other nutrients is quite often related to low stomach acid.
Apart from indigestion, other symptoms which suggest low acid secretion include weak nails and/or poor hair quality. Nails which are brittle or tend to flake and peel is quite a common symptoms in women with low stomach acid. Men, even though their stomach acid secretion is low, tend not to suffer from weak nails. Another common symptom in women is hair that is thin, brittle and tends not to grow well.
Another potential cause of poor digestion and food sensitivity is a lack of the digestive enzymes normally present in the small intestine. Some of these enzymes are naturally present in the lining of the digestive tract, but most are secreted by the pancreas and enter the small intestine via a small tube known as the pancreatic duct. Low levels of digestive enzymes can also provoke feelings of fullness after meals, and also symptoms such as indigestion, bloating, belching and wind. However, whereas individuals with low stomach acidity tend to get their symptoms immediately after meals, individuals with an enzyme problem will only normally start to get symptoms 1 ” 3 hours after the meal.
A simple home test for low stomach acid
While the test described above can be a very good way to diagnose a low acid problem, a simple home test can help to identify this condition. A level teaspoon of bicarbonate of soda should be dissolved in some water and drunk on an empty stomach. If sufficient quantities of acid are present in the stomach, bicarbonate of soda is converted into gas, producing significant bloating and belching within 5 or 10 minutes of drinking the mix. Little or no belching is suspicious for low stomach acid.
Natural methods for combating GORD
A few simple strategies can be very effective in improving digestion if there seems to be a problem here. These include:
1. Chew food thoroughly
Proper chewing is essential for proper digestion. As mentioned earlier in this chapter, chewing stimulates the secretion of acid and digestive enzymes. Chewing also mixes food with saliva which contains an enzyme which itself starts the digestion of starchy foods such as bread, potatoes, rice and pasta. And perhaps most importantly of all, chewing breaks food up, massively increasing the surface area available for contact with the digestive juices. This increases the efficiency of digestion by giving digestive enzymes the opportunity to penetrate the food and do the digestive work. Each mouthful should be chewed to a cream before swallowing.
2. Avoid big meals
The larger the meal, the larger the load on the digestive system. Small, frequent meals ease the burden on the digestive system and increase the likelihood of full and complete digestion.
3. Avoid drinking with meals
Some people tend to drink quite a lot of fluid with meals and believe that this can only help to ‘wash food down’. The reality is quite the reverse. Drinking with meals dilutes the acid and enzymes which do the digestive work, and does nothing to help the process of digestion. In the main part, drinking should be done between meals, not at meal time.
4. Consider food combining
Foods are made up of several chemical constituents including proteins, starches, fats, vitamins, minerals, fibre and water. The common proteins in the diet can be found in animal products such as meat, fish, dairy products and eggs. The common starches in the diet are bread, rice, pasta, cereals and potatoes. Proteins and starches are very different chemically, and are digested by different enzymes in the gut. In addition, proteins are initially digested in acid, while starches are digested in alkali (quite the opposite). Some individual’s digestive systems are unable to cope with protein/starch combinations, and this can lead to impaired digestion.
The principle of food combining theory is to avoid mixing protein (e.g. meat, fish, eggs) and starch (e.g. bread, potatoes, rice, pasta) at the same meal. This means eating either protein or starch, and combining it with a food which is classified as ‘neutral’ (e.g. non-starchy vegetables).
Supplements for overcoming GORD
Supplements of hydrochloric acid (HCl) taken in capsule form can certainly assist in the digestive process in individuals who have low or no stomach acid. Part of the action of hydrochloric acid is to convert an inactive substance called pepsinogen, into an active enzyme called pepsin. The function of pepsin is to start the digestion of protein food molecules. Acid supplements are therefore best combined with pepsin for maximum potency. Acid supplements should be taken before meals. Because acid supplements may worsen or possible even cause inflammation or ulcers in the stomach, they should only be used under the instruction of a suitably qualified doctor, nutritionist or naturopath.
A good alternative to acid capsules are supplements of digestive enzymes. A good digestive enzyme supplement will normally contain a range of enzymes each of which is responsible for digesting a certain food type.
Digestive enzyme use should be avoided in cases of gastritis (inflammation of the stomach lining) and/or ulceration, but otherwise seem quite safe to use. 1 or 2 capsules should be taken after each main meal.
1. Bredenoord A J, et al. Air Swallowing, Belching, and Reflux in Patients with Gastroesophageal Reflux Disease Am J Gastroenterol 2006;101:1721″1726
Great information! Since I hit 40 (a while ago), my “iron gut” (I could eat anything and in large amounts) has disappeared. I do have the bad habit of eating too fast, but it wasn’t until I started adding digestive enzymes with my meals that I found relief.
I am going to try your simple stomach acid test too!
Your information was more confidence-inspiring than some of the other advice I have come across on the web. I would be interested to know if you have also looked at the role of H pylori (if any). I have just been diagnosed with GORD and there is a lot to understand. Thanks.
This is one of the best articles on the subject that I’ve come across so far. I am a new sufferer. I was prescribed acid-suppressing medication for ‘silent gord’, but it made things worse – then when I stopped I experienced acid rebound (apparently common, I now know). I’d never had heartburn until then – now I seem to get it more.
Tony above asks about H pylori, I’ve read of a number of other possible causes of these symptoms, including other parasites and ovarian cancer! I would like to know, if one tried hydrochloric acid supplements, could it damage the GI tract when it has been irritated by ‘acid rebound’?
I’m seeing a GP and a naturopath, but my GP seems a bit puzzled by my reaction to the drugs, and quite skeptical, and I’m not completely confident in the approach of the naturopath. Hence, researching as one must.
I am so confused….I had major digestion issues…I did the ‘at home’ stomach pH test with the bicarb in water, no burp, took the betaine HCL, no warming or heartburn etc so assumed low stomach acid. Took one tab of betaine HCL for about two months, then the acidy feeling got worse and worse and I ended up at the doctors with granulomas on the larynx – and left with a script for Nexium whcih I am still on a month later.
What I hate is this business you read on the web: “Doctors are all the puppets of big pharma and prescribe PPIs when all you need is a glass of apple cider vinegar for your reflux!!” I feel ill and acidy, no matter what I do – supplement or suppress, its bad for me, feel like I have a stomach full of acid and bile all the time. 40 years old, female, no other health issues, 50 kgs so not over weight. Help!
At 43 have been diagnosed with GORD and placed on Nexium. Symptoms include voice loss, bloating, dizziness &/or headache after eating, burning etc.
Have had endoscopy, gastroscopy, ultrasounds etc. For women displaying these symptoms have you checked out your Gallbladder??
Anyways I found this article very interesting and the not drinking while eating is definately beneficial for me.
I too am not overweight (62kg) but do guts down my food. Find that avoiding anything with caffeine in it helps, chewing better (as above), having Yakult daily, and I now have a planned weekly low GI diet which consists of 6 small meals a day..
Anyways know how you all feel so stick in there!!
I am looking for a doctor, perhaps a gastroenterologist, who understands this information on food combinations and practices in my area. I live in Allentown, Pennsylvania. I told my GP and also a nutritionist, that I was having some success in alleviating gas and bloating by following this diet. Both had never heard of it but wanted to copy the information I had found. I don’t get it- this sounds like basic biology to me. Why would this be unknown to them, and to most people? And why are some people symptomatic when most are not? The results I have achieved are very good, but I still have some trouble. I could use more advice by a medical practitioner who understands this. How do I find one?
I found this article interesting but confused a bit because I thought GORD was about too much acid causing reflux. I am on Lazarazopole which certainly helps but I recently found that Manuka Honey 10+ has wonderful natural healing so I am combining the two for now. I would like to think that the honey may be the answer to a natural remedy. I also feel that some medications can cause problems with digestion and my inflamed gullet but then I am not a doctor.
Thanks for the advice on gord. I have ceoliac disease and seem to have started with this complaint for about 2 months. my doctotor has done blood tests and I am waiting for the results. Also I have been experiencing not being able to breath and my doctor just felt my stomach and gave me anti depressants because she said i was anxious.