What is reflux:

Reflux is the backward flow of stomach acid and other contents from your gut into your esophagus (the tube that connects your throat and stomach), and it’s a sign of gut problems. It can cause chronic symptoms and damage to the delicate mucosal tissue of your esophagus.

Reflux symptoms are one of the most common complaints to primary care doctors in Western countries, and reflux is a risk factor for erosive esophagitis, and Barrett’s esophagus (which is associated with an increased risk for esophageal cancer).

Acid blocking and acid reducing medications:

Because reflux is so common, its treatment has been the target of aggressive pharmaceutical marketing to healthcare professionals and consumers. You’re likely familiar with acid blocking and acid reducing medications like Zantac, Prilosec, Tagamet, and Pepcid (PPIs and H2 blockers).

Medications that block and lower stomach acid are often considered a first line of defense against reflux symptoms. These medications however do not address the root cause of the reflux, leaving it unchecked and able to continue to cause damage.

Long term use of acid blocking and reducing medications, and low stomach acid levels impairs gut health and your ability to digest and absorb nutrients from foods you eat.

Use of these medications is associated with osteoporosis, depression, deficiencies of vitamin B12 and a variety of minerals, small intestinal bacterial overgrowth (SIBO), irritable bowel syndrome (IBS), pneumonia, and an increased risk of a variety of gut pathogens.

Reflux is often due to low stomach acid rather than high, and the symptoms are similar. Lowering acid levels further with medications makes the problem worse, and increases your risk for additional health problems.

You need stomach acid:

Without adequate stomach acid you can’t digest and absorb nutrients from foods you eat. Amino acids from proteins, vitamin B12, iron and zinc are examples of important nutrients you can become deficient in with low stomach acid levels.

Amino acids are the building blocks for everything in your body, down to the intracellular level. Even your DNA.

Vitamin B12 deficiency can result in irreversible nerve damage.

You need adequate iron levels to help your blood cells carry oxygen to all the tissues in your body.

Zinc is necessary for wound healing, the production of hormones, and for a strong immune system.

Your body runs off of nutrients from foods you eat. They are your fuel. When they are missing, imbalances develop and symptoms and health problems follow. Gut problems and low stomach acid can cause nutrient insufficiency and deficiency, because if you can’t digest, and absorb nutrients from foods you eat, no nutrition plan will help meet your body’s need for fuel. The fact is, you aren’t what you eat, you are what your body can do with what you eat.

Respiratory reflux:

Respiratory reflux occurs when contents from your gut irritate respiratory structures and cause symptoms like chronic coughing, feeling like something is stuck in your throat, frequent throat clearing, a bitter taste in the back of your throat, and difficulty swallowing. You may have symptoms like these, and not make the connection to reflux and your gut health, because you aren’t experiencing typical reflux symptoms.

Respiratory reflux symptoms can be caused by refluxed acid, and also by nonacid contents like pepsin that come up with the acid. If you suffer from symptoms like these and find that acid reducing and acid blocking medications and the typical reflux treatments don't help much, it might be that the nonacid contents are causing the symptoms you’re experiencing.

Natural approach:

You can address reflux naturally with diet, lifestyle, and other nutritional interventions that identify root causes of the problem, and restore your gut health.

Diet:

Diet changes can be helpful for managing symptoms. Common reflux trigger foods:

Caffeine
Alcohol
Chocolate
Garlic
Onions
Mint
Spicy foods
Fried foods
Fatty foods
Citrus
Tomato based products
Highly processed foods
Junk food
Carbonated beverages including fizzy water

A diet of whole, real foods, rich in plant foods and high in fiber often can resolve the problem. If you need guidance on what to eat, my nutrition recommendations can help.

Specific foods that may help with symptoms:

Bananas
Oatmeal
Leafy greens
Yogurt
Ginger

Food sensitivities:

Keep in mind that food sensitivities are not the root cause of your symptoms and health problems. They are a symptom of gut problems. Continuing to remove foods from your diet can lead to nutrient insufficiency and deficiency over time. Your body runs off of nutrients from foods you eat, and when they are missing because they are not being included in your diet, imbalances will develop and symptoms and health problems follow. Elimination diets, and ‘healthy’ diets that remove foods, food groups and categories of foods may be guilty of robbing your body of the fuel it needs to function.

Lifestyle interventions:

Maintain a healthy weight
Stop smoking
Don’t lie down after a meal, wait at least 3 hours

Eat slowly and chew thoroughly
Avoid tight fitting clothing, which may put pressure on your abdomen and LES (lower esophageal sphincter)

Elevate the head of your bed when sleeping by 6 to 9 inches, a mattress elevator can be helpful:

‘Cooling’ may help, in particular a cooling pillow for sleeping:

Stress:

Stress management is important when it comes to reflux and gut health. Stress can cause reflux, the severity of reflux correlates with the degree of stress, and stress causes changes in stomach acid secretion (can increase it or lower it, depending on the individual).

Stress can lead to leaky gut, and nutrient insufficiency and deficiency. Chronic physical, chemical, and emotional stress burns through nutrients and steals them from other needs your body has.

Other medications:

There are many medications that can worsen reflux symptoms by altering gut motility, contributing to dysbiosis (abnormal gut bacteria, overgrowths, undergrowths and infections in the gut), and reducing LES tone (the valve that stops gastric contents from coming back up into the esophagus becomes weak).

Medications that make reflux worse:

Antibiotics like tetracycline and clindamycin
Anticholinergics
Sedative/hypnotics (benzodiazepines)
Tricyclic antidepressants
Theophylline
Prostaglandins
Calcium channel blockers
Alpha adrenergic blockers
Beta adrenergic blockers
Nitrates
Progesterone
Steroids
Aspirin
NSAIDs
Sustained release potassium
Bisphosphonates
Iron and potassium supplements

If you are on medications that you suspect are worsening your symptoms, talk to your doctor.

Gut problems:

H. pylori (a normal bacterial inhabitant in your gut) has been identified as a cause of stomach ulcers, but also is linked to reflux. H. pylori can be benign, but it can overgrow and cause symptomatic infection. Infection with H. pylori can lead to chronic gastritis, which can progress to stomach cancer.

Dysbiosis can be caused by a variety of factors. Low stomach acid levels is a common one. It allows gut flora to become imbalanced, overgrown, and infected. This causes inflammation in your gut, which increases permeability of your gut lining leading to leaky gut. Leaky gut causes food sensitivities, digestive symptoms, skin rashes, chronic fatigue, autoimmune disease, and a variety of chronic symptoms and health problems. This scenario also can cause, and aggravate reflux.

Restore your gut health:

Restoring normal gut function is a cornerstone of overall health and wellness. Eighty percent of your immune system is located in your gut microbiome, so when your gut health is impaired it can negatively impact your entire body, and cause symptoms and health problems like those mentioned, including others that don’t seem to involve your gut at all.

If you struggle with reflux and haven’t been able to get relief, get professional guidance.