Acid Reflux 

What is acid reflux?

Acid reflux is where the acidic contents of the stomach is brought back up into the mouth and throat, the acid can cause irritation to the lining of the oesophagus and become painful. It is also sometimes referred to as GERD (Gastrooesophagal reflux disease). GERD can cause heartburn, chest pain, difficulty swallowing and in some cases a chronic cough. 

What causes it?

Acid reflux is a symptom of a number of potential underlying conditions. There are a number of medical conditions which can cause acid reflux including a hiatus hernia, GERD, H.pylori bacteria or SIBO (small intestinal bacterial overgrowth). However, acid reflux can also be down to other factors, and addressing the root cause is often the most effective way in treating it. These can be down to gut function, hormonal imbalance, food intolerances and other lifestyle factors such as stress. 

Contrary to popular belief, acid reflux is often due to a lack of stomach acid (hydrochloric acid) rather than too much. Hydrochloric acid is responsible for breaking down food, as well as providing an inhospitable environment for viruses, bacteria and parasites (this includes hPylori which thrives in low acidic environments). 

Gut

There are a few dietary factors which can trigger acid reflux or worsen the condition, these include processed food, fried food, spicy food, caffeine, alcohol, sugar and tomato based food. Food intolerances including those to gluten, dairy or egg can also be a trigger. Healthy overall gut health is affected by a number of different issues including anxiety, stress and depression as well as hormonal imbalances. Research has confirmed the gut-brain connection and as such our emotional state can have a direct impact on gut health. 

Stress

Stress can be one of the predominant underlying causes of GERD. If the body is under stress, the adrenal glands release adrenaline in response and the sympathetic nervous system activates the fight or flight mode. When the body is in fight or flight mode, the body focuses its energy resources to preventing a life threatening situation or fleeing from an enemy. One of the ways in which this affects the body is the suppression of the digestive system; the muscles of the stomach wall are shut down and the stomach stops producing digestive enzymes.

Hormones

Studies have shown that oestrogen levels can play a role in symptoms of GERD. There are oestrogen receptors in the mucosal lining of the stomach, this acts as a protective barrier and helps to prevent injury and infection. this mucosal layer is more susceptible to damage due to decreased oestrogen in post menopausal women. This can lead to an increase in symptoms of GERD. It is not uncommon for patients with hormonal disorders such as PCOS and PMT to also have symptoms of acid reflux. 

Stress can also play a factor in hormonal balance, as during the body’s fight or flight response, cortisol levels are heightened and therefore this can reduce the amount of oestrogen or increase in progesterone. 

Treatment

As herbalists we always attempt to treat the root cause of the symptoms, and this can be down to a number of issues mentioned above such as stress and lifestyle factors. Herbal treatment can assist in reducing symptoms through the use of anti -inflammatory herbs as well as cholagogues which promote the flow of bile from the gall bladder into the duodenum. One of the symptoms associated with GERD is the relaxation of the lower oesophageal sphincter (LES) which usually only happens during swallowing however in GERD cases it can happen periodically. Cholagogues relax the smooth muscle in the gall bladder and research suggests they can also be effective in relaxing the smooth muscle in LES. The use of demulcent herbs can help to soothe and reduce inflammation. The use of anxiolytic herbs such as valerian stimulate the vagus nerve which acts on the parasympathetic nervous system to aid relaxation and restore normal digestive function.

The common medical treatment for reflux is a prescription of PPIs such as Lanzoprazole and Omeprazole. These act by reducing the production of stomach acid, which as mentioned above can  in fact be a causative factor of GERD symptoms. PPIs can also affect the bioavailability and absorption of vitamins and minerals, as stomach acid is needed to help with absorption of certain vitamins.  Studies have shown both short term and prolonged use of PPIs can resulting in B12, vitamin C, Calcium, Iron and Magnesium deficiencies which can have a more detrimental effect on overall health.

Herbal Treatment

Celandine (Chelidonium majus): Celandine is a cholagogue which helps to regulate the gall bladder, as well as tone the smooth muscle of the gall bladder and LES. Celandine must only be used under the supervision of a qualified medical herbalist. 

Belladonna (Atropa belladonna) : Belladonna contains the constituent Atropine which has been shown to reduce TLESR and improve symptoms of reflux. This herb should also only be prescribed by a qualified medical herbalist to ensure the correct dose. 

Marshmallow Root (Althea officinalis radix) : Marshmallow is a demulcent and therefore help to reduce inflammation associated with GERD, as well as having a soothing effect on the oesophagus if suffering from irritation. 

Liquorice Root (Glycyrrhiza glabra) : Liquorice is an anti-inflammatory and a demulcent so helps to soothe symptoms of acid reflux. It also acts on the adrenal glands to help reduce inflammation and stimulate hormone production. 

Meadowsweet (Filipendula ulmaria): Meadowsweet is a natural antacid as well as being an anti-inflammatory and is used to help soothe heartburn and acid reflux. The tannins also help to heal and protect the gut lining.