Chapter 1: Acid Reflux Nation
You Are Not Alone If you are suffering from heartburn
, you are not alone. In fact, you’ve got way too much company. In the United States, over 50 million Americans complain of acid reflux. That’s one-sixth of the entire population. Roughly 44 percent report an attack at least once a week. More than 23 million people experience episodes of heartburn daily. Even for a physician like me, who sees gastrointestinal patients regularly, the numbers appear staggering; but as a person who suffers (or I should say, has suffered) from acid reflux, it is reassuring to know that I am not alone.
What’s particularly sad is that this disease distorts one of life’s most primary pleasures: eating. Unlike other diseases, you cannot avoid food, one of the primary causes of heartburn. You have to eat—at least three times a day—so it’s not something you can ignore. I for one thought paying the price of heartburn after every meal was something I was going to have to do all my life. Happily, I was wrong. The Skinny on Acid Reflux
Acute acid reflux, as anyone who suffers from it knows, is a sudden burning surge of stomach acid that flares up into the throat, much like the lava of an erupting volcano. And like lava, it burns everything in its path. The stomach makes acid to help digest food that has recently been eaten. Ideally, that acid should stay in the stomach. But sometimes it shoots up into the esophagus. This is reflux. Reflux usually occurs about an hour after a meal, but it may affect you shortly after you eat. Or maybe it wakes you up suddenly at night hours after you’ve eaten. I have many patients who swear the accompanying chest pain is so severe they think they’re having a heart attack.
We doctors call this sudden, uncontrollable surge of stomach acid gastroesophageal reflux disease, or GERD. Because acid reflux is the primary symptom and major complaint of the disease, the term is often used as a stand-in for GERD. Another frequently used name for the same problem is heartburn, which is most descriptive. For simplicity’s sake, we will do the same. In The Acid Reflux Solution
, you’ll find these terms used synonymously along with GERD.
GERD can manifest itself in many ways. Reflux can be so painful that maybe you’re afraid to eat. And while obesity is, in fact, associated with GERD, some of my patients avoid food to such an extent that they lose way too much weight, and I worry about malnutrition and their susceptibility to infections. Others lie awake at night, losing valuable sleep time, fearfully waiting for an attack. Worse still, chronic acid reflux causes scarring that produces esophageal strictures, which can make it difficult or even impossible for food to get to the stomach. A further stage of chronic inflammation of the esophagus is a precancerous condition called Barrett’s esophagus, diagnosed by a serious change in the epithelial tissues. GERD is even associated with 60 percent of malignant esophageal adenocarcinomas that line the esophagus—the fastest growing cancer in America—that occurs in the area where the esophagus joins up with the stomach. Who Gets Acid Reflux?
Though it may seem improbable, GERD strikes people of all ages. Babies, especially those who are not breast-fed, often suffer from acid reflux. You’ve heard of a “colicky” baby? Well, that colic is regurgitation of undigested milk or formula mixed with stomach acid. The cranky, crying, fussy behavior too often attributed to a defect of personality is an expression of pain.
Young adults are also not immune. At an age when the tendency to overindulge is greatest, we tend to think we’re immortal, eating and drinking as if there were no tomorrow. Unfortunately, as anyone who has overindulged at a frat party knows, drinking too much does not come without consequences. How many people have not been woken up by a little bit of acid or bile in their mouth after a long night of celebration? Gross, indeed, but one of the body’s early warning signs. If occasional bouts of excess lead to heartburn or even acid reflux, it is usually transitory, and the occasional Alka-Seltzer tablet or swig of Pepto Bismol may be all that’s needed. But if drinking—and eating—to excess occurs frequently and continues long enough, heartburn and indigestion can become chronic problems. Symptoms of esophageal discomfort or pain that occur at least once a week can be symptomatic of more serious issues.
People over fifty, though, suffer the greatest frequency of GERD, which may be no surprise. As we age, our bodies lose the ability to compensate, as any middle-aged “weekend warrior” can attest to. The joints don’t work as well, and it should be no surprise that our digestive system also undergoes changes with age. Old bad habits, which we can often tolerate in younger years, begin to take their toll. And stress can cause more overeating and too much drinking. Another sad but true fact not to forget is that as we Americans get older, we are prone to getting heavier, and as I mentioned before, overweight and obesity are strongly associated with GERD, something we’ll discuss in depth later on.
Two major changes in the population have given rise to the high prevalence of acid reflux. One is the concurrent epidemic of obesity in America. We already know that as a country, we have an issue with food; we love it too much! Let’s face it, with 70 percent of the population overweight and one-third of those so obese it threatens not only their quality of life but also their life expectancy, we know something’s wrong with the way we eat.
The second major factor contributing to the huge number of people suffering from GERD is the aging of the population. As more and more baby boomers reach the age of sixty-five and the proportion of older adults nearly doubles by 2030 from what it was a decade ago, the proportion of people suffering from acid reflux is going nowhere but up. Signs and Symptoms of Acid Reflux
While many older adults suffer from GERD, their symptoms are sometimes less obvious and often more serious. They will attribute a sour taste in the mouth to a touch of indigestion or dismiss chronic dry cough to the air conditioning or allergies. (I know more than one person who went to the emergency room claiming they had a bad stomach flu only to find out their coronary arteries were completely clogged and they’d gotten there just in the nick of time.) Acid reflux can even cause tooth decay and mimic symptoms of ulcers (abdominal pain, nausea) and asthma (coughing, wheezing), causing misdiagnoses and years of unnecessary suffering.
Fully one-third of people who think they have asthma actually suffer from GERD. They develop the characteristic wheezing and difficulty breathing from aspirating acid. Remember that stomach acid we’ve sometimes tasted after too much partying? At times, the backflow slips down into the lungs, causing irritation that triggers bronchial spasms and other symptoms that are exactly the same as asthma. Once we treat the GERD, the asthma symptoms go away.
Just the other day I had a patient who is a doctor himself. He suffered from severe asthma for three years before his rheumatologist suggested he be tested for GERD. We attached a BRAVO chip (more on this in a minute) to his esophagus and determined that even though he was one of those people who doesn’t feel the acid, he was refluxing regularly and severely. In his case, medications did not help, and there was a physical repair needed. Once it was accomplished, his “asthma” disappeared. Amazing, but true.
So how do you know if you are suffering from GERD, or if you’re having a heart attack? How can you be sure it’s just heartburn?
Possible symptoms of GERD include:
• Frequent heartburn
• Hoarse or raspy voice
• Wheezing and shortness of breath
• Persistent dry cough
• Feeling like you have a lump in your throat or food stuck in your chest
• Difficulty swallowing
• Pitting or discoloration of the teeth
• Feeling full too soon
• Chronic sore throat
• Trouble getting a restful night’s sleep
Fewer than half of the more than 50 million people suffering from acid reflux actually seek medical help, usually those who cannot sleep at night. In fact, more than a quarter of all Americans self-medicate for symptoms of acid reflux more than two times a month. But the fact that acid reflux can disguise itself as other diseases is a really strong argument for not diagnosing it yourself. Self-diagnosis usually leads to lack of objectivity. We tend to downplay important symptoms or accentuate minor ones. Diagnosing yourself is a little like trying to fly. If you’re estimating the distance below you as only two feet and you’re correct, when you take off, you’re in the clear. If it’s a fifty-foot drop, you’re toast. Diagnosing GERD
How do you find out for sure if you are suffering from acid reflux? There’s a nifty new device called a BRAVO chip. It’s a tiny computer and transmitter designed to measure pH, or acid level, which is attached to a microscopic suction cup. The instrument is threaded down the throat of the patient, pressed onto the esophagus, and left in place. The device senses every change in esophageal pH and transmits this information in real time to a receiving monitor secured onto the patient’s belt, much like a pacemaker. Basically, it gives the doctor a chart of when and how often the “acid volcano” erupts. It also tells how far the acid travels. A physician like me can read the printout and see exactly if and when acid washes back up into the esophagus. The chip stays there for two days, so that a good picture is relayed of just what is going on during eating, sleeping, exercising, and other activities. After a couple of days, it simply slips off and is washed out to sea, as it were, with the next bowel movement. But by then, I’ve got all the information I need.
To be sure, not everyone needs a BRAVO chip to diagnose GERD. Quite simply, your physician may decide based on your symptoms alone that you have GERD. But you must be sure it is not a cardiovascular problem that is giving you that pain in your chest in the middle of the night and that you do need the medications you are taking while you are transitioning into your new healthy lifestyle.
Anyone popping even ordinary antacids, let alone powerful proton pump inhibitors, had better be sure they need them. A medical professional should also make sure those antacids are not interfering with other medications or contributing to chronic physiological problems. These pills, while effective, are not benign, and I believe strongly that airing the very real consequences of chronic use may help patients take a closer look at their treatment plan and consider some natural alternatives, such as the ones presented in The Acid Reflux Solution
Excerpted from The Acid Reflux Solution by Dr. Jorge E. Rodriguez with Susan Wyler, MPH, RD. Copyright © 2012 by Dr. Jorge E. Rodriguez with Susan Wyler. Excerpted by permission of Ten Speed Press, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.