Sara Canner Nutrition

Eating a meal and feeling normal afterwards is something we take for granted. That is until the digestive process goes wrong, and the afterglow of enjoying food is ruined by reflux and indigestion.

What is gastrointestinal reflux disease (GERD)?

Heartburn is a symptom of acid reflux, known as gastrointestinal reflux disease (GERD).  The problem arises when acid leaks backwards from the stomach and into the oesophagus, or food pipe.

Here it irritates the delicate inner lining that doesn’t have the natural protection to cope with the harsh acidity of our stomach contents. The result is a burning sensation or pain in the chest that has you reaching out for over-the-counter antacids.

What is silent reflux?

Another common type of reflux is called Silent Reflux, or laryngopharyngeal reflux disease (LPR).  It’s known as silent, because a sufferer may not feel traditional heartburn lower down, but is constantly clearing their throat from irritation higher up. Extra mucous and the feeling of a lump in the throat are other symptoms of LPR.

The importance of stomach acid

Stomach acid itself is not the bad guy here and low stomach acid can be just as problematic as high stomach acid.  We need the right levels of it to extract the most nourishment from our food. 

Signals sent from the brain when you eat, or even smell or think about food, tell the stomach to start producing stomach acid and other gastric juices. These substances chemically break down protein, fats and carbohydrates into their smallest particles, before it goes on its way through the digestive tract to be absorbed. 

Backflow of acid is usually prevented by a ring of muscle called the Lower Esophageal Sphincter (LES) at the bottom of the oesophagus that connects to the top of the stomach.  This muscular ring should only open to allow food in and then close. However, a number of reasons can cause the muscle to slacken and allow acid to creep back up.

Why might acid flow back up?

Stress and hormones

Stress hormones that are released when we’re feeling anxious can alter the nerve signals that affect the way the LES works.  The reproductive hormones oestrogen and progesterone, and HRT, can do this too.  

Stress puts the brakes on the whole digestive process and stops production of gastric juices. The result? Unbroken down food sits in the stomach for longer causing a build-up of pressure that opens the sphincter. 

Eating too fast

Eating in a hurry is another factor that plays havoc with the digestive function.  During what’s known as the cephalic stage, the stomach needs time to catch up with our eyes, smell and sense of anticipation that get the stomach ready to receive food. 

That’s why it’s so important to enjoy the aromas while cooking. You can also chew on some bitter salad leaves like Rocket during the food prep. When it comes to the meal, sit down to eat, try to relax and remember to chew each mouthful thoroughly. Avoid teatime arguments, ruminating over work problems, reading emails or replying to texts.

How to improve acid reflux symptoms

For some sufferers, simple steps like relaxing before meals and eating mindfully may be all that’s needed stop heartburn in its tracks.

For others, a deep dive with a nutritionist or medical team into other digestive issues at play will be necessary.  Hernias, gallbladder and bile issues, gastritis, H.Pylori infections, SIBO and gastroparesis are just a few examples of conditions that may be linked to reflux.

The role of acid-lowering PPI medications

Proton Pump Inhibitors are prescribed for people who suffer from stomach acid backing up into the oesophagus.  As well as the misery of heartburn, prolonged exposure of the delicate cells in the oesophageal lining to stomach acid is damaging and a cancer risk.

For this reason, those with a diagnosis such as Barretts Oesophagus, where inflammation is seen on an endoscopy camera, PPIs such as Omeprazole are sensible and non-negotiable.

PPIs are also used to protect and heal the stomach lining in cases of gastritis, ulcers and H. Pylori infection. They are also used to protect the digestive tract lining when patients are on non-steroidal anti-inflammatory drugs. 

Where PPIs are necessary, nutrition and lifestyle advice can offer strategies to support digestion, reduce side effects of the medications such as bloating and make up for nutritional deficiencies caused by acid-lowering medications, such as B12 malabsorption. 

Coming off of PPI medications

The NHS guidance for medical professionals states they should be prescribed for the shortest time and lowest effective dose. They must also be reviewed regularly.

While acid-lowering medication can bring some relief, it isn’t always the answer. In some cases, it is possible to reduce and then stop a PPI. In line with NICE guidelines, a nutritional therapist with extra training in reflux management, like myself, can work with patients and their medical team to support the withdrawal process. Part of this is managing rebound heartburn and ensuring better outcomes.

My training in reflux management

My extensive training is with Digestion With Confidence, founded by pharmacist and nutritional therapist Debbie Grayson. Debbie is an expert in reflux management who advises health professionals. She also set up the directory of accredited practitioners to support people with or without PPIs. 

The process starts with a six-week programme of steps to relearn the art of eating. This includes key supplements if appropriate to support the digestive process. The programme also covers practical tips and lifestyle coaching to get digestion working again. Importantly, this is tailored to the root cause of the reflux or other digestive issue.

Rebound heartburn is very common when people first come off their PPI. It’s often a reason why many feel the need to jump back on their medication.  But this is a normal phase of stomach acid over-producing then recalibrating before levels settle down to a new normal.  So, strategies to deal with rebound heartburn and how to increase chances of staying symptom-free in future is part of the Digestion with Confidence approach.