As February is Oesophageal Cancer Awareness Month I wanted to dispel some common myths around reflux and natural remedies and mention some that could be useful.
The Relationship Between Reflux and Stomach Acid
There is much debate whether reflux is the result of too much or too little stomach acid. The reality is that excess stomach acid production is quite rare. For most people it is more to do with the impact of stress and busy lifestyles on the digestive process meaning that digestion is compromised and food therefore stays in the stomach longer than it should, increasing the pressure in the stomach and relaxing the lower oesophageal sphincter allowing the stomach contents and stomach acid to leak back into the oesophagus.
Managing stress, eating at the dinner table and chewing your food properly can all help support the digestive process and reduce the pressure on the lower oesophageal sphincter and therefore reduce reflux episodes.
The Link with Bile Acids
Sometimes reflux can also be caused by bile acids entering the stomach known as bile acid reflux – this is often more severe than regular reflux and often doesn’t respond to PPI (proton pump inhibitor) medication – bile acid reflux is also common in silent reflux.
Bile that comes into the oesophagus often does more damage than hydrochloric acid and can increase the risk of Barrett’s Oesophagus and oesophageal cancer.
If you have severe or silent reflux and a PPI isn’t helping then ask your doctor to check your gallbladder for gallstones or bile sludge. If you have symptoms of bile sludge – pale, floaty, greasy stools, trapped wind/burping, pain around the ribs, nausea then sprinkling a little lecithin powder on to food can help to support this.
As well as reducing acid production PPIs also stimulate the production of mucin needed for mucosal repair which is one of the reasons they are recommended for Barrett’s.
The Use of Alginates
Another important treatment for bile acid or silent reflux is an alginate such as Gaviscon as this helps to plug the lower oesophageal sphincter and prevent the reflux from entering the oesophagus and therefore reducing the damage.
It is important to use an alginate medication before bed and also immediately after meals that are known to trigger your symptoms. It is better to take the alginate before the reflux occurs so taking immediately after your trigger meals is better than the ‘wait and see’ approach as once the reflux has occurred the benefit is somewhat lost.
Low Stomach Acid
As reflux is typically caused by low stomach acid, using a HCl (hydochloride) supplement, or Apple Cider Vinegar, can be helpful. However, it is important to note that both these products can cause damage to the digestive system and make the situation worse so they should be avoided if you suffer with Barrett’s Oesophagus, general oesophagitis and gastritis.
Supporting Your Digestive System
The digestive process can be supported by a bitter herb or chewing some bitter leaves 20 minutes before you eat. You can further support the digestive process with a digestive enzyme supplement taken as you eat your meal to help with the breakdown of food – however please note that this is not recommended if you have an ulcer or gastritis.
Slippery Elm can be an alternative to a PPI. Whilst slippery elm can help heal mucosal damage, patient’s with Barrett’s Oesophagus should also continue with their PPI and an alginate before bed. Slippery elm must be taken at least 2 hours away from medication.
A Reminder..
If you’re experiencing ongoing heartburn, acid reflux or indigestion – or noticing difficulty swallowing or food feeling like it’s sticking – don’t ignore it. These symptoms are not something you should have to live with. If they persist, change, or if your medication isn’t helping, it’s important to go back and see your GP and ask for further assessment. Trust your instincts, be persistent, and make sure your symptoms are properly checked – early action can make a real difference.
