GERD is an extremely common problem in the U.S. 44% of Americans suffer from it at least once a month, and 20% suffer from it weekly. (1) Drug companies make $7 billion a year selling acid suppressing drugs – primarily proton pump inhibitors (PPIs) like Prilosec and Aciphex.
The popularity of these drugs is predicated on the idea that GERD is caused by stomach acid burning the esophagus. This is known as the “chemical burn” theory. It holds that GERD develops from caustic, chemical injury that starts at the surface layers of the esophagus and progresses through the tissue to the deeper layers (the lamina propia and submucosa). (2)
Early animal research seemed to support this. Studies showed large quantities of stomach acid with a pH of less than 2 does damage the esophagus. (3) However, the concentrations of acid used in these studies are much higher than those normally found in human episodes of reflux. In fact, the vast majority of human reflux episodes have a pH of more than 2 and are incapable of causing esophageal damage. (4)
What If GERD Is Not Caused by Acid Burning the Esophagus?
In a 2009 study Souza and colleagues connected the esophagus directly to the duodenum (the upper part of the small intestine) in a group of rats, thus permitting acid to reflux freely into the esophagus. (5) To their surprise, it took 3 weeks for damage to the esophagus to occur. Commenting on the results, senior author Stuart Spechler said:
That doesn’t make sense if GERD is really the result of an acid burn, as we were all taught in medical school. Chemical injuries develop immediately. If you spill battery acid on your hand, you don’t have to wait a month to see the damage.
If acid itself caused the damage, we’d expect to see the damage start at the superficial layers of the esophageal tissue, and then progressively deepen. Instead, this study found the opposite. 3 days after the initial acid exposure, there was no surface damage – but inflammation had already begun to develop at the deepest layer of the tissue. This inflammation didn’t rise to the surface layers until about 3 weeks after the initial acid exposure.
This Suggests That GERD Is an Autoimmune Disease
Acid refluxing into the esophagus doesn’t damage the mucosal lining. Instead, it causes the esophagus to release inflammatory cytokines that attract inflammatory cells like interleukin-8, interleukin-6, and others. It’s not the initial exposure to stomach acid that causes the tissue damage characteristic of GERD; it’s this inflammatory process, which is characteristic of autoimmunity.
Do You Have GERD – or NERD?
The theory that GERD is not caused by chemical injury is supported by the fact that 70% of westerners diagnosed with GERD have no visible tissue damage.
In fact, these people don’t have GERD at all. They have NERD, or Non-Erosive Reflux Disease. Tissue biopsy of their esophagus shows inflammation developing at the base layers of the esophagus like GERD sufferers, but no damage to the surface layers as the conventional theory would predict. It’s unclear at this point why the tissue injury progresses to the superficial layers in GERD – but not NERD – sufferers, but this study suggests that the answer may be an autoimmune mechanism.
So What Does This Mean for You? How Do You Avoid GERD and NERD in the First Place?
In an earlier series of articles I presented evidence that acid reflux is caused not by too much stomach acid, but by not enough. I argued that low stomach acid causes bacterial overgrowth in the gut, which in turn produces gas that puts pressure on the lower esophageal sphincter, causing it to open and inappropriately allow acid into the esophagus.
I also offered a simple, 3-step protocol for treating reflux and GERD without drugs that thousands of people have now successfully used (check out the 190 comments) – including people that had been on acid suppressing drugs for 20 years or more. This is important because acid-suppressing drugs have numerous side effects and complications.
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Why You Should Think Twice about Taking Acid-Suppressing Drugs.
Acid stopping drugs promote bacterial overgrowth, weaken our resistance to infection, reduce absorption of essential nutrients, and increase the likelihood of developing IBS, other digestive disorders, and cancer. The pharmaceutical companies have always been aware of these risks. When acid-stopping drugs were first introduced, it was recommended that they not be taken for more than six weeks. Clearly this prudent advice has been discarded, as it is not uncommon today to encounter people who have been on these drugs for decades – not weeks.
The researchers took a group of people without any history of reflux and put them on PPIs for 8 weeks (where did they find these volunteers???) More than 40% of the healthy volunteers developed rebound acid-related symptoms like heartburn, acid regurgitation and dyspepsia once they stopped taking the drugs. (6) The authors of the study stated:
If rebound acid hypersecretion (RAHS) induces acid-related symptoms, this might lead to PPI dependency and thus have important implications.
I’d say!
If you suffer from acid reflux, make sure to read the entire series, and then follow the 3-step protocol I laid out. In a future article I’ll be covering some additional natural treatments that studies have shown to be just as effective as PPIs, with virtually no side effects or risks.
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I’ve had fairly bad GERD (though I didn’t know what it was at the time) over the past few years. It went away after cutting out nightshades as Robb Wolfe mentioned worked for him, especially tomato and eggplants. Perhaps nightshade sensitivity is more common than thought?
Hello Chris,
I suffer from heartburn all day and have gas on eating raw vegetables( especially capsicum).Milk upsets my stomach and so I cant drink milk.Even soymilk makes me feel bloated.I have had triple therapy for H pylori but it wasnt useful.
I have now read your article and it makes perfect sense..But one thing I cant understand in my case..When I havent eaten for 4-5 hours after lunch or when I am sleeping (early morning around 7) why do I still get heartburn…The bacteria shouldnt be producing gas because they dont have food to act on and acid shouldnt be pushed up..Is my heartburn happening because I am the minority of GERD sufferers who have high stomach acid and not low acid???
Many Thanks
Hi Chris,
Thanks for another great article. It took me several months getting rid of my reflux symptoms and discomfort. It was a long patient effort, not an over night cure. I just wanted to post this to tell everyone to not give up. Different things work for different people. For me, the HCl was the best thing, and I just had to keep at it. I had terrible rebound acid after PPI discontinuance. During that period, adding acid in the form of ACV worsened it. I guess that makes sense, in retrospect but I did not know then about the rebound effect. During the rebound period, I took a low dose of ranitidine only when so symptomatic that I could not function. But eventually that was no necessary.
I made some great strides in discovering that post dinner heartburn could be banished with Natural Calm!
Makes sense, since a lot of antacid products like Pepcid Complete contain magnesium. I also discovered that I absolutely cannot tolerate even the tiniest amount of coconut oil. I just dipped my finger in some and licked it, and it burned all the way down, and burned all the way back up. Probably the biggest help came from eating 5 hrs before bed. Any less time meant immediate reflux as soon as I laid down.
Interestingly, I had stopped taking Sam-e after running out. I initially was taking it for low back pain. My back pain came back, so I started up on the Sam-e again, and noticed a huge reduction in reflux.
As for diet, I eat a lacto-paleo format. Prior to the PPI drugs, I could control it by simply eliminating grains. Now, I have had to eliminate nightshades and most fruit as well. A lo carb paleo diet seems to work best for me.
There were some questions above about whether PPIs prevent cancer or may be indicated for people with Barrett’s esophagus. I’ve done a lot of research on this topic as I have Barrett’s esophagus. In my opinion, PPIs do NOT prevent cancer in people with BE. Here’s why:
1. The incidence of esophageal adenocarcinoma (EAC) has increased nearly 1000% in the past 5 decades, with the rate of increase barely slowing, if at all, after H2 blockers and PPIs were introduced. Note also that smoking rates dropped dramatically during this period too and smoking increases the risk of EAC. (see http://cebp.aacrjournals.org/content/early/2010/12/01/1055-9965.EPI-10-0802.abstract)
2. PPIs do not prevent EAC in animal models of EAC. These models clearly show that it is not the acid in reflux that causes cancer, but rather the bile and food-derived oxidative and nitrosative compounds in the refluxate. (http://www.ncbi.nlm.nih.gov/pubmed/10389684; http://www.wjgnet.com/1007-9327/full/v17/i25/3060.htm; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1235382/)
3. The human evidence is all epidemiological, a type of evidence which is susceptible to many errors, and is not even uniform in showing any preventative effect. In fact, there is a major study that shows that the risk of esophageal adenocarcinoma was 3 time HIGHER among patients who used medication for symptoms of reflux compared to those who did not use any antireflux medication (2.9 times higher when controlled for reflux severity). (http://www.ncbi.nlm.nih.gov/pubmed/10080844). More importantly, the studies most often cited for the proposition that PPIs may lower the rate of EAC incorporate a major error that, to my knowledge, I am the first to point out. In particular, it has been known for 25 years that patients with Barrett’s esophagus are, on average, LESS sensitive to pain than patients with a comparable amount of (measured) reflux but without Barrett’s esophagus. There are dozens of changes that mark the progression of normal squamous tissue to metaplasia, dysplasia, and ultimately neoplasia (and they may occur in no particular order). It seems loss of pain sensitivity is one of those changes. The reason this is HUGELY significant is because the studies showing that PPIs are protective generally involve comparing patients with Barrett’s esophagus who were taking a PPI upon diagnosis (or within the first x years of diagnosis) to those that don’t (i.e., these were not controlled trials but, rather, compared people who chose to take a PPI to those that didn’t). Unfortunately, these studies have FAILED to consider why these BE patients might not be taking a PPI. The answer is, no doubt, that these are generally the patients that have lost pain sensitivity!! If you fix for any one event in the progression to EAC (e.g., p53 silencing to name another one) and compare those BE patients who have already experienced that event to those that haven’t, you will likely find that the ones that have are at much higher risk for cancer than those that haven’t. (These studies also incorporate the “adhere effect” blogged about why Dr. Eades, likely further confounding their results.) (Supporting studies: http://ukpmc.ac.uk/abstract/MED/3559107; http://ukpmc.ac.uk/abstract/MED/3559107; http://www.ncbi.nlm.nih.gov/pubmed/21768433
Lastly, PPIs are capable of harm, potentially increasing the rates (and delaying the detection) of esophageal, gastric and colon cancer, causing nutrient malabsorption (with all its attendant consequences, including bone loss), and increasing the risk of food poisoning and pneumonia. Since there is no good evidence that they prevent cancer, I would strongly recommend avoiding acid suppression, unless indicated for short term emergency use (e.g., in case of an ulcer). Following Chris’s suggestions will make it possible.
Thanks so much for this info. It is the biggest concern of my clients on giving up PPI’s.
Thank you, Dan for this information and for taking the time to post the links to your resources. I’ve recently been diagnosed with precancerous Barrett’s esophagus. I’m a bit baffled by the diagnosis (via endoscopy biopsy) as I have nothad pain atatypical to acid reflux or GERD. The pain I’m experiencing is at the base of my ribs on the sides of my abdomen (sometimes the right side, sometimes the left and sometimes both)and comes and goes at varoius times…no correlation to food…and is a stabbing pain that only last seconds I was prescribedDexilant of which I took for a few days and experienced tightness in my chest. I had a test that showed I have low stomach acid. Needless to say I dont think thePPI helped but rather hindered.
Would you share what things you have found to help you? I have been following a paleo diet for over ten years now. Curious as to why I’m all of a sudden experiencing this.
Hi Dan and mom2one,
I just learned about Barrett’s from your posts here. It seems to me that if the body is increasing its amount of small intestines, it is looking for some kind of nutrition it is not getting. Do you know if there have been studies on controlling Barrett’s with supplements?
I’m finding this discussion very interesting as I have a 6 year old son who has had reflux since birth and we still don’t know how to stop it. In the process of going back to food sensitivity tests and eliminating gluten, dairy, eggs and beef to see if that helps.
I have an 8 yr old with similar history. Turns out he is mildly allergic to wheat, eggs, and oats. I also started using HCL supplement and it has been the most helpful thing I have done. I also use two kinds of probiotics. But the HCL worked the first time. Its not too expensive and it is easy to tell whether or not it works right away…
I have a recurring pain in the left side of my chest that I have seen associated with GERD. The left side of my chest gets a tingling sensation and I can’t lie down flat at night because of a pressure that makes it impossible to sleep. I thought I was having a heart attack but after a stress test *and* an angiogram, they found no blockage.
On some Paleo boards others commented that I was experiencing GERD. Does that sound right to people here? Has anyone else felt similar pains? I was on the SAD for years and just started Paleo a month ago. The symptoms are a little less but they are still there. Its very demoralizing.
I had severe chest pains so intense that I thought I was having a heart attack. One time the pain was so bad that I passed out (face first in my cat’s wet cat food, lol). It was that episode that started me searching for answers and got me on a paleo diet. I thought all was going well with that, but after a couple of months, my gerd returned. Although the attacks were milder, they became more frequent. I read on one of the paleo sites that food allergies could be a contributor. In my effort to find paleo friendly proteins that I could afford, I started to eat a lot of eggs. I began to notice that most of my attacks occured after eating eggs. It turns out that eggs are a common allergen. I tried just eating the yolk, as some people recommended, but that didn’t help. Also, oddly enough, pastured eggs ($7.50/doz @ my farmers market!!!!) made the gerd attacks worse than eating the free range/grain fed, non organic (cheaper) eggs I bought at my neighborhood grocery. I discovered all this by keeping a food diary; you might want to try keeping track of what you eat before gerd attacks to see if it’s a food sensitivity. Although there can be delayed reactions, over time a food diary can give you some common denominators. For me, triggers were not just the grains, but also pastured eggs, omega 3 fish oil supplements (but I can eat fish) and dehydration. To be honest, keeping a food diary doesn’t really appeal to me. I don’t want to be obsessed with what I’m eating and write it all down. But it has been a big help in eliminating my gerd triggers and the associated intense pain.
My gastro recommends rubbing your sternum if it relieves the heartburn you know it’s gerd and not a heart attack.
Do you recommend stopping the PPI medication prior to starting the 3-step treatment you recommend to eliminate acid reflux?
I can’t make medication recommendations. That’s something to discuss with your doctor, but if you check the comments you’ll see that many people who’ve done this protocol have been able to get off their meds.
I guess I’m just wondering if it’s safe to start the HCl protocol while still taking PPI?
Yes, but if you experience an increase in burning/distress, you should seek help.
Your comments about GERD being an autoimmune disease are very noteworthy in light of Dr. William Davis’ recent book, “Wheat Belly” in which he makes a very compelling case for wheat gluten being the primary culprit in GERD. Quoting Dr. Davis in Wheat Belly, “I have personally witnessed complete or partial relief from symptoms of IBS and acid reflux with gluten removal from the diet many hundreds of times, whether or not celiac markers are abnormal.”
Personally, I fought with PPIs for more than 12 years, dealing with rebound each time I tried to quit, and then discovered, mostly by accident, that eliminating wheat cured my GERD within a few weeks.
“The drugs, called proton-pump inhibitors, have become widely used to treat crying in babies just a few weeks old”
http://www.theaustralian.com.au/news/health-science/crying-foul-on-drugs-to-calm-bawling-babies/story-e6frg8y6-1226246820491
Shocking.
Some of my clients are afraid to get off PPI’s due to Barrett’s. They are being told by their MDs that the PPI’s are cancer preventative?
That’s what I was told when I was recently diagnosed with BE! I took Dexilant for a few days only to have the worst chest pain (not where the original painhas been)! I’ve been eating a paleo diet for over ten years and now I’m considering an AIP diet. I have not had symptoms as everyone here describes. I would love to find a nutritionist to work with to see if I’m having food sensitivities/intolerances. I already know I’m allergic to wheat, rye, barley, oats, rice, soy, hence the paleo diet. My symptoms did not begin until last summer when my dr prescribed new supplements. I noticed I was sometimes having trouble swallowing the capsules and they would get lodged in my throat. Sometimes I would regurgitate them. I recently requested a powder form, so we’ll see if that helps.
Mom,
Go to an endocrinologist and have your thyroid checked fir starters. Then, ask your other doctor why he has you on ANY kind of antacid at all when your acid is low (previous post). Third, try Bragg’s Apple Cider Vinegar in warm water with some honey 2-3 times a day. If you are afraid for your tooth enamel, swish out with some baking soda and water right after.
Do you have any advice for breastfeed infants?
Several years ago before I was tuned into a lot of this paleo/primal/wapf thinking my son, who was born 4 weeks early had GERD. He was about 95% breastfeed for the 1st year of his life with the balance coming from traditional formula. Since he was an infant he was put on cimetidine to combat the constant vomiting. However he still had GERD until he was about 2yo and I started getting a clue about proper nutrition. I convinced my wife to stop giving him ‘high calorie’ pediasure (since he was ‘underweight’) and also greatly reduce his sugar consumption. Since then he has been off the medication with very little GERD.
Now I have a 1 month old daughter who was born full term and she too has GERD. She was given about 3-5 feedings on formula due to my wife worrying about her milk supply not coming in soon enough (my daughter lost 14oz by her 2 day checkup). Other than that she has been 100% breastfeed. It seems logical that it is potentially something(s) my wife is eating. While she isn’t onboard with my dietary changes she does eat whatever I cook so most mornings she gets a few eggs, bacon/sausage, and the occasional hash browns and most evenings we’ll have a pretty ‘primal’ meal.
So would you happen to have any suggestions on breastfeed infant GERD?
Very interesting article. But so many people in the nutrition community talk about GERD as being a digestive/chemical problem. I have suffered from mild to moderate daily reflux for about four years and I have been a very healthy low carb paleo eater for 10 years. I have supplemented with enzymes, betaine, probitics and tried elimination diets. I had a sphincter manomentry test done and it showed low LES pressure, and for folks like myself, I don’t really know what the answer is – no matter what I eat, I get reflux simply because my LES is incompetent. On an empty stomach laying down, bending over etc I always have relux. I would love to hear if there are any ‘natural’ remedies out there for someone like myself, because PPI dependence or surgery is not great.
Thanks!
Exactly… I am a practicing physician who embraces paleo; however still believe in medicine when needed, and no i have no pharmaceutical ties a work for a state funded hospital. this article fails to explain/address the primary causes of GERD – LES dysfunction. From an immune standpoint Chris is right in saying that acid may not be the initial insult, like specifically in the case of scleroderm; however the acid does elicit inflammatory changes and this IS corrected by PPI, to a degree. Surgical correction can also sometimes fix faulty lower sphincters. The main point I am trying to make is by mediatig acid production we do damage control until the initial cause I.e. LES problems, diet, hiatal hernia can be addressed
Dr Mike
In terms of my patient population I have a very hard time believing that the primary cause of GERD is an LES dysfunction. Yes they exist in some folks, such as Dwayne, but I cannot fathom from my patient population that they are the primary cause. If they are then why can I clear up easily 7 out of every 10 that come to me on PPI or H2 antags within weeks.(as can other folks too, I’m nothing special, just making a point that the majority in my population is not LES dysfunction)
Although you do not believe this study was valid because of the design I have many patients that report a burning in the esophagus immediately after eating. I ask them if they feel something coming up. They say “no, just a burn” This is clearly a peripheral immunocyte response b/c of a loss or oral tolerance to very likely food antigens. You get them off the offending food and symptoms clear more times than not. I think I see too many folks unnecessarily on H2 antagonists and PPIs. The clear deleterious data of people stuck on these drugs for more than a year should warrant enough concern that the adage ‘first do no harm’ is not adhered by prescribing physicians.
I appreciate the dialog.
Respectfully
George
I am speaking on PPI / H2 refractory cases. I’m a firm believer in PPIs and histamine blockers
And I understand where you’re coming from – I’d say with confidence human physiology is still largely unsolved, my point is simply the study shows what happens when you basically do a gastric bypass, the duodenum has no where near the acid producing capabilities of the stomach therefore you aren’t really exposing the esophagus to any “real” harm… furthermore by doing so you’ve removed the pyloric valve as a barrier and allowed pancreatic enzymes to violate the esophageal mucosa
The only logical thing to do is to heal the sphincter valve, and in order to do that I’ve seen aloe gel or juice work very well. 2-4 oz any time of the day you remember to do it because the aloe should be kept in the fridge. I prefer the gel (and use it for other reasons – it’s a wonderful internal healer which helps the external healing) because it coats the throat and just feels like it’s doing more good. But it would be a personal choice. I use Lily of the Desert brand because it’s pure aloe.
I have Sjogren’s Syndrome and scleroderma but most of the time you’d never know it. I do get a dry mouth but the aloe helps. It also helps tremendously with boils and cysts (because it’s a blood cleanser + much more). I use a little aloe mixed with vegetable glycerine to help with dry mouth. Amazingly, it works pretty good for quite a long time and I kinda discovered it by accident!
Try the aloe.
Dwayne, there are actually some fairly simple manual adjustments that can be done to the esophageal sphincter that are really effective (I learned them from an chiropractor). As an acupuncturist, I follow the adjustments with an acupuncture treatment. My experience has been that 2-3 sessions “fixes” the problem. Elderly patients often need a tune-up every few months.
While these aren’t DIY, they are effective and don’t require extensive supplementation or surgery. Good luck!
Hi Doug. I have a sensitive GI tract (always been that way). I was diagnosed with IBS when I was 13, and unfortunately I am a major food lover with a big appetite. As such, I am quite familiar with the difference between me having ‘digestive’ upset that causes heartburn/reflux from eating too much of the wrong foods, and simply having reflux from low sphincter pressure.
I have also had back issues in my life from sports injuries and the main trouble spots, confirmed by my chiropractor and on xray is around t-11, the very same area the the nerves enervating the epigastric region originate from on the spinal cord. I sought my Chiropractor out in hopes that working on that area would help. He also does some diaphramatic release stuff. While I haven’t noticed any distinct effect yet (it’s been about a year) I am sold on it because everything else feels great since I’ve been going!
I have also started going to acupuncture treatments ( just 2 so far) and they were very painful. The doctor said blocked energy was the reason it was so painful. Perhaps it’s a bit of a diagnosis and a treatment, as though the pain is an indicator that something is quite wrong with my system.
Dwayne- I’ve been going to acupuncture for mny, many years. its helps SO many heath issues. He also gave me some herbs for IBS (B4 i had GERD) and IBS totally went away!! of course he does needles for digestion too. the needles DONT hurt! the treatment shouldnt hurt as much as you desrcibed! you may want to see someone else of it continues to be painful! Good luck, valerie
I’ve had acupuncture for many years. Sometimes, at first, the needles CAN be very painful. This is when there is a lot of blockage. After a few sessions the pain should subside. Back when I first started, the needles were almost excruciating! I was so drained after the treatments. Now they are just a minor twinge. But believe me, it worked.
That is my thinking. Dr.Li said the reason is was so painful was blocked energy. I’m hoping as sessions go on it will be less painful.
I have had chinese acupuncture which didn’t cause pain and in fact almost immediately loosened muscles in my back from a car accident.
What are these manual adjustments Doug, please?
GERD is common in people with Scleroderma (autoimmune). It is my understanding that the disease damages the sphincter, then people develop GERD. If not treated GERD may eventually cause Barrett’s esophagus or lung fibrosis (from aspirating small amounts of stomach acid). I would love to wean off PPI’s, but if the sphinter is damaged, I don’t know if it is possible.
The study does not emulate GERD conditions, by attaching esophagus to the duodenum you bypass stomach and parietal cells, while I don’t dismiss inappropriate autoimmune response contribute, this study does not support that cause. Gut flora can’t colonize the stomach and the presence of the pyloric valve inhibits gas from backing in to the stomach from the intestines. Autoimmune may play more of a role in LES sclerosis and malfunction but the proposed mechanism is just highly unlikely considering our anatomy and physiology
OOPS sorry for my terse post…I need to add what a brilliant practitioner you obviously are…thank you for a great service to both your patients and me.
–george
Chris! Thank you SO SO SO much for this article on “GERD.” Per your advice a year ago, I have been MEDICATION FREE! I was on acid-reducing drugs for almost 10 years; I will spare you the gritty details concerning the horrible side effects these drugs caused. …$7 billion dollars to give people IBS, osteoporosis and cancer? That’s just plain ol’ disgusting. Thank you, again, for sharing your knowledge; you saved my life!
You’re welcome, Barbara. I’m so happy to hear it!
Hello Chris,
I am not clear on how you are stating that GERD is an autoimmune disease. I must be missing something.
That study from 2009 clearly showed that many so called “GERD” symptoms are a release of chemical mediators directly damaging the esophagus. That is why I always ask patients that supposedly have GERD if they ‘feels something coming up’. or if it is ‘just a burning feeling’ after eating foods. So many times that is a burning feeling and clearly a mediator release.
However I am not clear on how you qualify a mediator release as an autoimmune condition. It is an inflammatory response, often caused by a loss of oral tolerance that is easily rectified. Please clarify.
George Mandler LDN LicAc
An autoimmune disease is an inappropriate immune response against substances and tissues normally present in the body. It is not unusual for some acid to reflux into the esophagus. And 70% of episodes of acid reflux do not cause tissue damage (these are classified as NERD, as I pointed out). This suggests there may be some hyperactive immune response or other type of immune dysregulation in patients with GERD, since in their case stomach acid causes an immune response (inflammation) in the esophageal tissue, starting from the base layers and moving upward.
Chris,
Thank you for your reply.
Maybe I don’t understand what NERD is then or maybe our definition of autoimmune is different. I understand NERD as an inflammation of the esophageal tissue. The study is saying Cytokines are acting as messengers to attract prostaglandins and leukotrienes and I assume other mediators to the site. No where does it say there are antibodies that are made that attack the esophageal tissue. Maybe I missed where it considers a T or B cell response which is what is needed for an autoimmune condition as the body is mounting an attack on self. Inflammation and destruction of tissue caused by mediators alone is not autoimmune. There is no attacking of tissue cells that the immune system is identifying as non-self. It is simply an inflammatory response of the Innate immune system. This NERD mechanism is not autoimmune.
There is nothing that shows it is B or T cell driven which is what is needed for autoimmunity. Just because there is an inflammatory response and destruction to cells does not mean it is autoimmune.
George Mandler LDN LicAc
And no you are right, antibodies need to be produced against self epitopes to have true autoimmunity
Patients with NERD have the symptoms of GERD but endoscopic findings reveal normal esophageal mucosa. The fact that some patients with acid reflux develop cytokine-mediated esophageal injury and others do not suggests an inappropriate immunological response in the former case. There was a significant increase in the migration of neutrophils and T cells in the study, recruited primarily by IL-8.
Technically, “cytokine-mediated immune dysregulation” would probably be a more accurate term than “autoimmune”, but that would be an awkward headline. 🙂
Chris
I agree with you and would like to point out that the definition of auto-immune as defined by Witebsky’s postulates includes three categories
1-direct evidence of Tcell
2-Indirect evidence by replication of autoimmunity in animals
3-circumstantial evidence from clinical clues
many definitive antibodies have simply not yet been identified – that does not mean that auto-immunity does not exist in that case
Chris- Often when i eat-no matter what it is I’m eating- I start coughing, sometimes have post nasal drip, runny nose or just a dry cough. It could even start as soon as I have 1 bite of food. sometimes it happens when i have supplements and water – which I have 30 min after meal. does this sound like an autoimmune issue or something else?
Sometimes I take unflavored Slippery Elm lozenges which help stop the coughing. they do have stevia and fructose. I’m guessing this is the kind of fructose you rec. not having. I take 3 of these a day at the most. Do you think the lozenges actually help or are just a band aid?
Excellent article Chris.
I know for me, after reading that rebound hyperacidity study, it clicked as to why it’s so hard to get off PPIs.
Here are a couple more studies that support the GERD and AI view. Well over my head I’m afraid, but you might find them interesting if you haven’t seen them already:
Inflammatory mediators in gastroesophageal reflux disease: impact on esophageal motility, fibrosis, and carcinogenesis.
http://www.ncbi.nlm.nih.gov/pubmed/20299604
Gastrointestinal manifestations in systemic autoimmune diseases.
http://www.ncbi.nlm.nih.gov/pubmed/21977190
From your previous series on GERD it seems like H Pylori is a very common major culprit. I’d love to read up a bit more on H Pylori, could you recommend any articles? Specifically on the Australian scientist who swallowed some to prove that stomach ulcers were caused by it and not stress. (That was hilarious, I heard about that in one of your podcasts).
With regards to your future article on natural treatments, if you are talking about de Souza’s Melatonin study, I’m a bit confused as to how he got a 100% success rate. It didn’t work for me and from my wanderings on the internet I’ve run across other people for whom it also didn’t work. My personal feeling after taking it for several months is that it does lower the amount of TLESRs to some extent but I haven’t noticed it having any effect on the acidity of the stomach (despite all the mechanisms they give).
Lastly, I was wondering what you think of the new TLESR inhibiting drug Lesogaberan?
Thanks again for taking the time to write these series, it is good to see someone writing intelligently on the subject rather than just spouting the same old stuff that doesn’t work.
Thanks, James. I had seen the first one, but not the second. Thanks for the link!
Did you do the melatonin alone or did you also do all of the methylation factors, i.e. TMG, folate, Sam-e, methylcobalamin, etc.? It is not meant to significantly lower the acidity of the stomach (which is not, in my view, a major factor in most cases of GERD/NERD), but melatonin and serotonin both play a number of important roles in the gut and I suspect when it does work it involves those mechanisms rather than a direct effect on acid production.
Here’s a brief description of Marshall’s discovery: http://www.hardydiagnostics.com/articles/Barry-Marshall-H.pylori2.pdf
Thanks for the link Chris.
I tried a few different variations but none with TMG, Sam-e. Which one is that?
de Souza developed Protexid with Dr Eades I believe, which is the formula used in the study, and the one I tried:
Which is the best choice for gastroesophageal disorders: Melatonin or proton pump inhibitors?
de Oliveira Torres JD, de Souza Pereira R.
http://www.ncbi.nlm.nih.gov/pubmed/21577303
Vit B6 (25mg) , B12 (50mcg), Folic acid (10mg), Triparadol 406mcg (blend of Melatonin, Trypophan, Methionine, Betaine).
I think a later version had less B6 and B12, switched to Folate and included Zinc, Calcium, Magnesium, Phosphorus. I can’t be certain though as I can’t read Portuguese.
I also tried variations of between 3-12mg of Melatonin, straight and time-release.
Hi
Please send me the link. I can read portuguese.
thanks
http://imageshack.us/photo/my-images/521/21012012125.jpg/
It’s a later version of: http://www.proteinpower.com/drmike/supplements/protexid-and-protexid-nd-and-adventures-in-dr/
Hi James,
I stumbled on a good account recently about Barry Marshall, the Australian scientist you mention, and others changing beliefs about ulcers and H Pylori. It is in chapter 9 of the book Vitamin D and Cholesterol: The Importance of the Sun
By Dr David Grimes, starting on page 67. This is in the preview in google books.
Enjoy!
Thanks Anne, I’ll check it out.
Do you have a link or source for the last study about the ppi’s? I’m very interested. Thanks!
Sure. I added it to the article. Not sure how that one slipped through the cracks, but thanks for catching it!
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