Gastro-Esophageal Reflux, GER

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Gastro-esophageal reflux, abbreviated to GER in American English, or to GOR in British English (standing for gastro-oesophageal reflux), is considered a disease when it happens frequently (GERD). But is it really a disease per se, or often a symptom of something else?

Gastric reflux is when some of the acidic ‘gastric juice’ leaks from the stomach back up into the food-pipe. The acid causes a burning sensation – often called heartburn – accompanied by pain, often severe pain. The acid damage can also predispose to cancerous changes in the cells lining the pipe.

The oesophagus has a ring-shaped muscle at its lower end, which is supposed to seal the junction between it and the stomach and prevent stomach acid leaking out.

However, sometimes the ring muscle does not close tightly enough and acid comes back up into the oesophagus. What can cause this?

Some lifestyle causes of GER:

  • Alcohol, especially high-proof spirits.
  • Smoking or chewing tobacco.
  • Fried food, particularly food fried in processed vegetable oils.
  • Factory-made food flavour concentrates, like ‘meat’ or ‘chicken’ cubes, gravy mixes, fish extracts.
  • Eating too much or too often, on a regular basis. The occasional ‘buffet blow-out’ will make you wish you had made fewer trips to the food counters, but the discomfort is usually gone the next day.
  • Large waist circumference. A fat belly presses on the stomach, squeezing out some of its contents through the ring muscle into the oesophagus. This is especially noticeable when reclining, or at night in bed.
  • Prescription medicines sometimes cause stomach upset. Speak with your doctor about alternative preparations. Even better would be to discuss ways of resolving your health issues so you don’t need to take the medicines at all.
  • Getting older. As we age, the production of stomach acid declines.

Treatment of GER

Pharmaceuticals

Over-the-counter antacids, or prescription tablets from your doctor to stop or reduce acid production (like a proton pump inhibitor) will make you feel more comfortable. Unfortunately, it’s only short-lived relief because the effect wanes, and you’ll find you need to swallow more and more ‘medicine’ to get the same level of relief you had at the beginning.

Strong stomach acid is important because it signals the ring muscle that food is in the stomach being digested, stimulating the muscle to close tightly to prevent leakage, as shown in this study.

Using pharmaceuticals to get rid of what little stomach acid you have left will obviously reduce the signal strength even more, eventually making GER or heartburn worse.

And the drugs do nothing to rectify the cause. In addition, there will be a list of serious side-effects, especially with long-term use of the powerful proton pump inhibitors (often abbreviated to PPI’s).

Neurologist Dr David Perlmutter’s short video explains some of the dangers of acid-blocking drugs.

Protein digestion

Also worth factoring into your decision to try a natural alternative before taking an antacid or prescription drug, is why stomach acid is made in the first place.

Proteins in food are not straight chains; they’re convoluted and folded. The hydrochloric acid unravels the folds to make them easier to digest, and also stimulates the conversion of pepsinogen to the special protein-digesting enzyme, pepsin.

Pepsin acts on the unraveled protein and breaks it into its building blocks, called amino acids. The amino acids are used to build a plethora of tissues and important substances, like skin, bone, blood cells, hair, nails, muscle, collagen, keratin, hormones, enzymes, neurotransmitters, antibodies, and a host of other things. It’s a very long list!

Obviously, protein is vital for our function and structure, and we can’t live without it.

How much protein do you need?

Stomach acid is needed not only to digest protein, but also to signal the next section of the digestive tract that partly-digested food is on its way and that appropriate enzymes should be prepared for the next steps of the digestive processes.

Each section of gut works in harmony with the previous section, and with the next section. Inadequately prepared food leaving the stomach hinders the digestive processes in the small intestine, reducing the uptake of important minerals and vitamins.

Makes sense then, to try and improve GER and heartburn by natural means first, rather than destroying the rest of the stomach acid with pharmaceuticals, doesn’t it?

Here are some suggestions…

Alcohol and tobacco

Ideally, stop using alcohol and tobacco. I know this is easier to say than do, because I used to enjoy both. Thankfully, I managed to stop smoking years ago…but only after the ninth attempt. Sure did challenge my will-power!

Strangely enough, alcohol was easier. After reading so many articles about the detrimental effects of alcohol on liver and brain cell functions, I knew it would be better to abstain. But, what about the benefits of the antioxidant, resveratrol, in the red wine? Maybe just a small glass with the evening meal, I told myself.

Actually, I now know you’d have to drink several bottles of red wine to get a meaningful amount of resveratrol. Fortunately, there are plenty of food sources, like cocoa (and dark chocolate), the skins of red-skinned peanuts, and berries such as mulberries, raspberries, blueberries, and bilberries.

One evening, a headache started soon after a few sips of a very nice Cabernet Sauvignon. I never have headaches, so maybe someone was trying to tell me something? I put the glass down, left it unfinished, and announced to Heide I wouldn’t drink alcohol ever again. That was over 15 years ago, and haven’t touched a drop since.

Back then I didn’t know that smoking, and swallowing alcohol, both attack the ring muscle that’s supposed to close tightly and prevent gastric juices from coming back out. I often had ‘heartburn’ or ‘indigestion’, and must have swallowed kilos of antacid tablets.

Fried food

In Malaysia, chicken rice – deep-fried chicken with boiled white rice – is a popular choice. Lately I’ve noticed French fries sometimes replace the rice, and the thin coating of traditional flour on the chicken has been replaced by what looks like processed cornflakes:

fried chicken and chips

The combination of fried protein and processed starch fried in processed vegetable oil is very effective for increasing inflammation in the body, so it’s no surprise foods like these are not well received by the digestive tract.

Inflammation is at the root of most of the so-called lifestyle diseases – another good reason to keep inflammation as low as possible.

Vegetable oils are easily oxidised, especially when they are heated, producing many disease-promoting free radicals and increasing inflammation, as I described in this post:

What’s the fat in our food?

If you can’t resist frying food, use the lowest heat possible, the shortest time possible, and a saturated fat like ghee, butter, tallow, or coconut oil.

If you want the best, use ghee, butter, or tallow from pastured, grass-fed cows rather than from cows fattened on corn and industrial wastes in confined feeding operations.

And choose cold-pressed, unfiltered, extra virgin coconut oil rather than the processed ‘coconut cooking oil’ available in some supermarkets.

Although cold-pressed extra virgin olive oil is a healthy choice, add it cold to prepared foods and salads and don’t fry with it. Heat damages the structure of the polyunsaturated and monounsaturated portions of the oil.

Palm oil is high in saturated fat, so in theory is stable at higher temperatures and could be used for frying. However, although Malaysia is a big producer of palm oil, I haven’t been able to find a cold-pressed palm oil. The only palm oil available in our local supermarkets is the highly-processed variety, which isn’t real food like the aforementioned choices, so we prefer to avoid it.

Red palm oil is high in health-promoting carotenoids and vitamin E. Unfortunately that’s not on the local shelves either. There is one red cooking oil that looks like red palm oil, but if you read the label on the side you’ll see it’s a blend of canola oil and red palm fruit oil. Unfortunately, it’s another not-found-in-nature concoction.

Gravy cubes, sauce concentrates

In England, many people like gravy on their food. I used to avoid it because it gave me heartburn. Or maybe it was the wine with my meal and the cigarette afterwards, rather than the gravy? Bisto gravy mix was popular, and so were Oxo cubes, both of which I found to ‘gnaw’ at my stomach.

In Asia many different sauce concentrates, like fish sauce, oyster sauce, soy sauce are used to get a bit of flavour into otherwise bland noodles. If you read the ingredients label you’ll often find several chemicals, including the synthetic flavour enhancer mono-sodium glutamate (msg). Many people think msg is sometimes described as ‘yeast extract’, which sounds like it’s a natural product, so be aware of possible marketing ploys.

Experiment by leaving off the gravies and sauces you use. Maybe one of them causes you to have heartburn or GER.

Just Eat Real Food (JERF)

JERF is a healthy maxim to have in mind when you’re shopping.¬†Real food is food that is as close to Nature as possible when you buy it.

That means buying from your local farm shops, markets, or vegetable sections of supermarkets, and cooking your purchases at home. That’s the only way you’ll know exactly what you’re eating.

Processed foods in packets, boxes, tins, bottles, or bags often contain chemicals such as flavours, colourants, consistency modifiers, and preservatives, all of which are an additional burden on your detox organs – your liver and kidneys – and much more likely to give you heartburn.

Fat tummy

If you look at your profile in a mirror and see you’re shaped like an apple, it’s time to lose some centimetres from your waist. Then you’ll be able to recline or lie down without your big tummy squashing your stomach and other internal organs.

There are several articles on weight loss on this website to help you, and in the right-hand column there’s also a link to our YouTube channel, where there is a selection of videos about how to lose weight and keep it off.

Please feel free to contact me via the comment box below, if you need some helpful suggestions for losing weight.

Supplements

Betaine hydrochloride increases stomach acid, but I’ve not been able to find it in the local pharmacies and therefore can’t test it. The stomach enzyme that digests protein (pepsin) is also available as a supplement in some countries, but I’ve not found it here either.

Instead, I use apple cider vinegar. I believe it not only helps me with protein digestion, but also has other health benefits.

Apple cider vinegar (ACV)

There are several different vinegars in our local pharmacies, but I prefer the one by Radiant. It’s made in New Zealand from organic red apples, is unfiltered, unheated, and contains the beneficial ‘mother’, which you’ll see as a sediment at the bottom of the bottle. It has a nice reddish tinge to it from the red apples, which could give an added antioxidant benefit, too.

Radiant organic apple cider vinegar on thrivelowcarb.com

Some people like balsamic vinegar, but to be frank, I don’t like the taste or smell of acetic acid and avoid using it on my salads.

To get the apple cider vinegar down the hatch I put two tablespoonsful in a small glass, squeeze the juice from a small lime into it, fill with water, take a deep breath, and knock it back. Then I swish my mouth with some of the green tea or water that accompanies our meals, and start enjoying the food.

Tip: Adding a few drops of lemon or lime juice to your water/ACV mix will give you some added benefits, as shown in this study. I find the citrus juice also makes the vinegar much better tasting.

Thinking of taste, on the shelf next to the Radiant bottles, there is an apple cider vinegar made locally, mixed with honey.

Although the label on the front of the honey version reads apple cider vinegar with honey, the label on the back tells a different story. Ingredients are listed as:

‘Water, Natural Honey, Apple Concentrate Juice and Vinegar. Contains permitted flavouring’

And the nutrition panel lists carbohydrate as 34.5g per 100ml. That’s about 7 teaspoons of sugar!

Nowadays, you can’t trust the front label: you have to read the ingredients and nutrition panels.

As you can see at this Wikipedia page, honey is over 80% sugars. And apple juice is high in fructose.

Unless you want to ramp up your blood sugar and insulin levels, increasing the risk of metabolic syndrome, it’s best to choose the real food version without the honey, apple juice, and flavouring.

Medical considerations and precautions

Teeth

Vinegar is acidic and it will attack your teeth if you leave it on them.

Best to swallow it before you start your meal, then after eating, wait 30 minutes before brushing. This gives your teeth a chance to replace any minerals from your saliva, that they may have lost.

Sucking the vinegar/water/lime or lemon mix through a straw would also by-pass many of your teeth, so you may like to try that.

Acid burn

Vinegar can burn the sensitive membranes of your mouth and throat, so be very careful and always dilute it with water first.

Diabetes

Apple cider vinegar is said to somewhat delay stomach emptying. This could be helpful in the control of diabetes because if it takes longer for the stomach to complete its digestive job,
there’s less likelihood of a sudden rise in blood sugar and consequent insulin spike.

How to control diabetes naturally

However, many type 1 diabetics experience a very marked delay in stomach emptying, called gastroparesis. If you suffer from this, or suspect you do, please see your doctor before using apple cider vinegar.

Heliobacter pylori

Infection of the stomach with the very commonly-occurring bacterium Heliobacter pylori can cause indigestion, bloating, acid reflux, as well as stomach ulcers. In Malaysia, part of our routine annual blood tests show if H. pylori antibodies are present.

A low value, indicating a low rate of infection, you may consider leaving and re-checking at your next blood test if you’re not having any symptoms.

However, if the value is high, and you’ve been having problems with reflux, speak with your doctor about treatment using an antibiotic cocktail.

As you may know, resistance to antibiotics is a huge problem in medicine. Apart from the risk of resistance, the antibiotics will ruin your gut microbiome and you’ll need to take probiotics afterwards to restore your gut health. Two good reasons to try apple cider vinegar before antibiotics.

Heliobacter pylori can’t survive in an acid environment, so increasing your stomach acid with a tablespoon of vinegar in a glass of water with a little lime or lemon juice before meals may help get rid of the bugs.

Important medical advice

If you have a condition for which you have been prescribed medicine, it is important to check with your doctor or pharmacist for any adverse reactions apple cider vinegar may have with your particular medications, before using it.

Also check with your physician before making any changes to your usual eating or exercise routines.

If you lower your blood sugar, or reduce your blood pressure through dietary changes to lose weight, but continue to take the same amount of medicine you were prescribed before the changes, your blood sugar level and blood pressure may go far too low.

If your doctor knows what you are doing he/she can keep an eye on your progress and lower your medications accordingly.

Want to know more?

If you’d like to read more about apple cider vinegar, this article is very informative and succinctly describes six evidence-based benefits.

And Dr Darren Schmidt talks about various benefits in his short YouTube video.

Comments? Suggestions? Experiences?

Please consider sharing your experiences of using apple cider vinegar in the comment box, below. Other people will find it helpful, for sure. Thanks.

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