This site hosts articles and information aimed at the holistic treatment of GERD based on a significant research effort into the root cause of the disease and a dietary approach to treat it. The first book to come out of this research effort is Heartburn Cured by Norm Robillard, Ph.D. The dietary approach was inspired by his son, John Robillard.

John, pictured here, is an athletic trainer in Watertown Mass with many years of experience (Call him at 623-687-5254 if you would like to schedule a training session in the Boston Area)

It seems rather unreal that after all these years, the cause of GERD is has eluded medical science. While there is clearly some good information on GERD and a variety of treatment options, there remains a significant amount of misinformation as well. The problem stems from a misunderstanding on what causes GERD. Unfortunately, there is less interest in understanding the underlying cause of GERD than there should be. Perhaps it has something to do with the billion dollar business around selling Nexium, Prilosec and other similar drugs, known collectively as Proton Pump Inhibitors or PPIs. While some of these drugs offer a good short term treatment option, they were never mean to be taken on a permanent basis. Yet, this is exactly what has happened, despite the may side effects and health issues including increased risk of osteoporosis, pneumonia and malabsorption, and in some cases, gastric tumors and even cancer associated with these drugs.

So Many New Drugs

With so many new drugs being prescribed ever more frequently, I got a kick out of a comedy piece by the very funny comedian Mike Anderson that goes like this:

"I found out I have acid reflux so they got me on Nexium, it's the purple pill, it works great, but it has a side effect. It gives me diarrhea. For that I take Zelnor, but that makes me depressed, so I take Zoloft and that has a sexual side effect so I take Viagra, which works great but it gives me acid reflux"

 

Mild and occasional heartburn is fairly common, but more frequent heartburn or more severe symptoms generally result in a diagnosis of Gastroesophageal Reflux Disease or GERD. GERD is a serious medical condition that results when stomach contents including acid, bile and enzymes regularly escape into the esophagus (the tube that connects the mouth to the stomach). Because the esophagus does not have the protective mucous lining that the stomach has, it is "burned" by the stomach acid and that's what we recognize as "heartburn".

Under normal circumstances, food is kept in the stomach by the lower esophageal sphincter (LES), a group of several muscles that encircle the esophagus above the stomach that open or relax as food approaches and then reseal. Heartburn results when the LES is unable to prevent the contents of the stomach including hydrochloric acid (HCL), digestive enzymes and bile from escaping into the esophagus. The reason that heartburn hurts is because the esophagus does not have the same protective mucous that the stomach has. The acid, and likely stomach enzymes and bile “burn” the unprotected tissue.

The leading theory on the cause of GERD is that lower esophageal sphincter muscles (that normally provide a barrier between your stomach and esophagus) are weaker in GERD patients and that these muscles relax spontaneously in GERD patients allowing stomach contents to escape into the esophagus. The phenomenon has been termed “transient relaxation of the lower esophageal sphincter” or TRLES. This theory is generally accepted as the underlying cause of GERD by most doctors. But why in the world would these muscles just relax spontaneously? Heartburn Cured documents a new research-based theory that proposes that the root cause of GERD is carbohydrate malabsorption leading to the overgrowth of bacterial in the small intestine. The bacteria produce large amounts of gas and it's the gas that drives acid reflux. The solution is a diet that ensures that carbohydrates are either fully absorbed, or not likely to feed small intestinal bacteria.

 

Complications of GERD

Scarring and Dysphagia

In addition to the primary symptoms of GERD, there are many secondary complications associated with GERD, some of which are extreme and even life threatening. Repeated GER episodes can result in permanent injury to the esophagus. This scarring can lead to a narrowing of the esophagus referred to as a stricture. This narrowing results in a condition called dysphagia, where swallowing is affected. Dysphagia, can be described as the sensation of food getting stuck in the esophagus after swallowing and often indicates an advanced stage of esophageal damage.

Barrett's syndrome

Over time, untreated reflux esophagitis may lead to the development of Barrett's esophagus. Barrett's esophagus is a metaplastic (precancerous condition that begins in an area where cells have changed into another cell type) process that typically involves the lower esophagus. In trying to repair the damage from acid reflux induced esophageal damage, the esophagus heals in an unusual way. In this case, some of the cells of the esophagus (called squamous cells) are changing to resemble a cell type of the stomach. Barrett's esophagus can, in rare cases, progress to adenocarcinoma (cancer that develops in the lining or inner surface of an organ).

Lung Injury

Gastroesophageal reflux can lead to chronic, severe lung damage and recurrent infections. This GER induced lung injury is caused by the reflux of acid and other intestinal juices into the lungs. Aspiration of gastric juice into the lungs can also lead to what is called pulmonary fibrosis. This is a medical term that means scarring of the lungs. This is a serious condition that can actually require lung transplantation. On a related note, a recent study found that an increased risk of pneumonia was associated with the treatment of GERD with acid reducing medicines. This is covered in chapter three of the book Heartburn Cured.

Why Do So Many Cystic Fibrosis Patients Suffer From GERD?

One of the things a new theory is great for is testing the hypothesis in the real world. The new theory in Heartburn Cured links carbohydrate malabsorption and bacterial overgrowth to acid reflux. The theory proposes that small intestinal bacterial overgrowth (SIBO) fueled by carbohydrate malabsorption results in excess microbial gas production that could drives the reflux of stomach and intestinal contents into the esophagus.