Prone to Acid Reflux? You May Have an Underlying Condition

Acid reflux is a condition where stomach acid reverses into the oesophagus, causing uncomfortable and painful symptoms. The more severe version of this condition is gastroesophageal reflux disease or GERD, which about 9% of Malaysians experience. Hence it is crucial to address the root causes of chronic acid reflux to avoid more serious health issues down the road.

What is Acid Reflux, and How Does it Progress to GERD?

The oesophagus connects your throat to your stomach. Between the oesophagus and the stomach opening is a muscle flap called the lower oesophageal sphincter (LES). It functions to automatically open to let food in.

A weak LES allows the acid in your stomach to escape and flow back into your oesophagus (thus the “reflux”). That will result in burning your oesophageal lining. 

Symptoms of acid reflux include heartburn, chest pain, nausea, coughing, gagging, sore throat, difficulty swallowing, hoarseness and bad breath.

Experiencing these symptoms more than twice a week could lead to GERD, a risk factor for developing more serious conditions like esophagitis or inflamed lining.

That could also cause Barrett’s oesophagus (leading to oesophageal cancer) and a scarred, narrowed oesophagus. That can make eating and drinking considerably harder.

Underlying Factors in Chronic Acid Reflux or GERD

Several underlying factors lead to a weakened LES and, therefore, acid reflux.

• Structural: Being overweight exerts upward pressure on your stomach, causing tension on the LES. Being pregnant or having a hiatal hernia can have a similar effect. 
• Eating habits: Regularly eating spicy, fatty, and rich foods can over-stimulate acid and bile production. Meanwhile, skipping meals causes normal stomach acid that would have been used for digestion to aggravate your stomach lining instead.  
• Medication: Certain medications taken regularly or for a prolonged time can also upset your stomach acid. Non-steroidal anti-inflammatory drugs (NSAIDs), calcium channel blockers used to treat high blood pressure, certain asthma medication, and antidepressants are known to cause acid reflux as a side effect. 
• Cigarette smoke and alcohol: If you’re a smoker or live with one, you’re might experience frequent bouts of acid reflux.
• Stressful lifestyle: When you’re too stressed, you’re more likely to skip meals, have a poor diet, and give in to bad habits like smoking.

The TCM Perspective

Traditional Chinese Medicine (TCM) recognises that acid reflux involves things going in the wrong direction. 

“Acid reflux is caused by an ascending stomach qi (vital life energy). It’s the result of an imbalance in the stomach, and sometimes the liver system. The goal of a TCM acid reflux treatment would be to first stop the acid reflux, protect the stomach lining, and then strengthen the stomach to prevent future occurrence,” explains TCM Physician Ng Qing Xiang from Eu Yan Sang Clinic. 

TCM formulations that encourage a descending stomach qi include inula flower (Xuan Fu Hua, 旋覆花), cuttlefish bone (Hai Piao Xiao, 海螵蛸) and cockle shell (Wa Leng Zi, 瓦楞子). A common formula to strengthen stomach and spleen function is Si Jun Zi Tang (四君子汤). There are also health drinks with ingredients like potato juice and fennel juice that are soothing and can strengthen the stomach lining. 

Physician Ng also recommends complimenting herbal medication with acupuncture. The combination can help relieve acid reflux symptoms and strengthen the stomach and spleen systems. 

In the TCM framework, illnesses of the body are also evaluated through syndrome differentiation. That includes both physical and psychosocial symptoms.

Chu I Ta, Chief TCM Physician of Real Health Medical, shares that there are three categories of people who tend to have chronic acid reflux that can turn into GERD and his suggestions on addressing these syndromes.

Impatient personality

People in this group are high-stress multi-taskers and perfectionists. They carry a lot of nervous energy, which compromises their digestive system. This group has “stagnation of liver qi”, with the diagnosis of “liver-stomach disharmony and disorder in stomach qi circulation”. 

Find ways to reduce your stress levels. When you’re having a meal, enjoy it mindfully rather than mindlessly typing away at your computer or smartphone. After eating, have a rest or take a short walk.

Physician Chu recommends herbs that will regulate the liver qi and harmonise the stomach and liver, such as cockle shell (Wa Leng Zi, 瓦楞子), oyster shell (Mu Li, 牡蛎), finger citron fruit (Fo Shou, 佛手), corydalis (Yan Hu Suo, 延胡索), and chinaberry (Chuan Lian Zi, 川楝子).

Wrong food, wrong timing

Those in this category have their poor eating habits to blame. They lack a regular eating schedule and tend to eat high-fat, spicy, and sweet foods. That can stimulate an overproduction of stomach acids. Fatty foods can also trigger excessive bile secretion that can upset the digestive tract. TCM classifies this group as “irregular diet and food stagnation”, referring to the overburdening of the digestive system. 

To rebalance, take your time when eating, chew deliberately and slowly to signal the stomach to get ready for digestion. Avoid fruits such as grapefruit, pineapple, and tomatoes after a big meal, as they can irritate your stomach lining. 

Meanwhile, foods such as black fungus, lotus roots and Chinese yam are great for promoting gastrointestinal lining healing. Make sure your last meal is at least 2-3 hours before bedtime. 

Also, herbal remedies like medicated leaven (Shen Qu, 神曲), hawthorn berry (Shan Zha, 山楂), malt (Mai Ya, 麦芽) and chicken gizzard membrane (Ji Nei Jing, 鸡内金) can improve digestion and clear the stagnation.

Obesity and constipation

People in this group are severely overweight, with chronic constipation. “Our digestive tract is like the plumbing of a house. If the pipe has a blockage, waste cannot pass through, causing a backsplash. Similarly, when we are constipated, food is unable to move through smoothly, causing pressure in the stomach, leading to acid reflux,” Physician Chu elaborates. 

Exercise is key in promoting gastrointestinal motility to relieve constipation and help address obesity. Also, try to avoid sitting for a long time and avoid wearing tight clothes when you’re feeling uncomfortable. 

Which herbs to take will depend on the specific constipation syndrome. Those with “excessive” syndrome will do well with white peony root (Bai Shao, 白芍), bitter orange (Zhi Shi, 枳实), magnolia bark (Hou Po, 厚朴), and rhubarb root (Da Huang, 大黄). 

Meanwhile, the qi deficiency syndrome can be addressed with astragalus (Huang Qi, 黄芪), codonopsis root (Dang Shen, 党参), white atractylodis rhizome (Bai Zhu, 白术), and poria (Fu Ling, 茯苓). Finally, those with the blood deficiency syndrome or constipation can consider peach kernel (Tao Ren, 桃仁), Chinese angelica root (Dang Gui, 当归) and notopterygium root (Qiang Huo, 羌活).

However, both Physician Ng and Physician Chu advise us to work with a professional TCM physician to determine the right formulations for our body composition. 

Those with chronic acid reflux can take medications such as antacids, H2 blockers, and proton-pump inhibitors. In severe cases, you may also opt for surgery once you have consulted with your doctor.

However, rather than opting for short-term relief or waiting until it’s too late, identify the underlying factors and start making the necessary changes so that you can look forward to days, weeks, and months free from acid reflux.