Heartburn, Helicobacter, Antacids and Salt
The current medical and nutritional literature suggests no cause
or cure for heartburn, also known as acid reflux, and as Gastro-Esophageal
Reflux Disease (GERD). Recent experiences of the writer
strongly suggest that GERD responds to salt supplementation if no antacids or
medications are taken. Both my case and the current literature indicate that the
bacterium helicobacter pylori is involved in GERD. Web research has allowed me
to piece together a coherent picture of GERD, with several component causes.
This picture differs from the currently fashionable explanation. The purpose of
this web site is to alert sufferers to this alternative view of their problem,
so that readers may be able to reverse their conditions as I and others have
done.
I strongly encourage patients with serious health problems to
seek medical care. The problems and histories of others may be quite different
from my own. I welcome information about the experiences of others, whether it
supports or casts doubt on the theory described here.
Summary in Q&A Form
What causes the pain?
There is no disagreement here. The pain of GERD is primarily the
result of stomach acid contacting tissues that are unable to withstand it, in
the esophagus, at the lower esophageal sphincter (LES), or in the stomach.
What change occurred to cause this condition?
GERD has much in common with the ulcer. To understand GERD,
research the current views on ulcers. It is now accepted that ulcers are caused
by an infection to the mucous lining of the upper GI tract by the helicobacter
pylori bacterium. This infection renders that mucous lining unable to protect
the underlying sensitive tissues from the acid contents of the stomach.
Then GERD is an infection?
Yes and no. The h. pylori bacterium is present in a large
percentage of the population, most of whom do not have GERD. This bacterium does
not thrive in a highly acidic environment, so a normal stomach is able to keep
the infection level low by maintaining strong hydrochloric acid (pH 1-2). Those
bacteria that remain live within the mucous lining, in reduced numbers.
Do I have too much acid or too little?
If you are a typical GERD sufferer, both. You have too much acid
for the underlying unprotected tissues, but too little to reduce the infection.
This is why antacids, acid blockers, and PPI's relieve the pain in the short
term, but make things worse over the longer term. It is a no-win situation. Is
it any wonder that so many people seem unable to escape the condition?
Compared with a normal person, a GERD sufferer has stomach
acid that is too weak.
How did I come to have too little acid?
Possibly through the use of antacids and acid blockers. Or
perhaps through the use of mineral supplements such as calcium carbonate or
magnesium oxide. These are bases that neutralize the hydrochloric acid of the
stomach. They should be strictly avoided. Check the ingredient list of any
mineral preparation for basic compounds, such as oxides, hydroxides, carbonates
or bicarbonates. Any supplement with these should not be used.
It has also been proposed that h. pylori itself can produce
enough base to reduce stomach acidity. Certainly it produces some base.
You mean that antacids cause heartburn?
Antacids cause the low stomach acidity that permits H. pylori to
thrive, thus indirectly causing GERD. So yes, antacids and acid blockers help to
cause the condition they are supposed to treat! As a result, sufferers often
behave like addicts, ceaselessly taking the very substances that keep them ill.
What sorts of mineral supplements are satisfactory?
The best are the chelated forms. But beware: some multi-minerals
contain both chelated and basic minerals.
Magnesium chloride solution may also be useful during recovery
from GERD.
Can GERD be reversed by avoiding antacids?
Many people, including the writer, have been able to reverse the
condition with "life style" changes. My changes included stopping all
medication and resuming a normal or greater than normal use of salt.
How did you cope with the pain without using medication?
Milk is a recognized alternative to antacids for treating
heartburn. I used milk, soy milk, yogurt, and small, frequent meals. This kept
the discomfort manageable. My full recovery took many months, however. Later, I
discovered that mastic gum capsules can also be a helpful aid during recovery.
What was the salt for?
Prolonged use of antacids, acid blockers or inhibitors causes a
persistently low level of hydrochloric acid in the stomach. So these medications
deplete the body's store of chloride. Salt, sodium chloride, and diet salt,
potassium chloride, are our only significant sources of chloride. Thus, it makes
sense to supplement one's normal use of salt to promote recovery.
Isn't salt bad for you?
Excessive use of salt may raise your blood pressure on a
short-term basis. To reverse such increases one may reduce the salt or mix some
diet salt, potassium chloride, with one's salt. [Added 9-30-2010: Mixing these salts was suggested in
an Adele Davis book. I am now unsure how effective this is. It may be that the effect of salt on blood pressure
is more due to the chloride than to the sodium. I have found that taking chelated potassium
can lower my blood pressure, but this may work by eliminating chloride from the body.]
Rather than use diet salt one might also eat sufficient fruit
and vegetables to supply potassium to balance the salt.
Salt consists of sodium and chloride. Both of these minerals
are essential to life.
It is helpful to have a means to check your own blood
pressure, so that you can check it between visits to a doctor.
How much salt is safe?
Many web sites recommend a maximum of six grams per day. That is
about one teaspoon. I believe that one can recover from GERD with substantially
less. The most important step is to stop all medication. Use frequent meals and
milk or milk-like products to reduce the acidity. This allows the chloride
volume to increase even while the acid strength is kept low.
The helicobacter
bacterium lives in the mucous lining of the stomach wall, of the duodenum
wall, and of the esophagus wall. There it damages the protection that the mucous
lining supplies to the wall of the digestive tract against the hydrochloric acid
of the stomach. This damage leads to pain, sometimes called dyspepsia,
and to ulcers.
Since the mid-1980's when the bacterial cause of gastric and
duodenal ulcers was announced,
the use of surgery to treat these ulcers has fallen off markedly. Instead,
antibiotics and often bismuth are used. Some medical web sites state that the
esophagus has no mucous lining, thus perhaps trying to justify a different
approach to disease there. Other sites, and Gray's Anatomy, state that there is
a mucous lining also in the esophagus. In particular, there must a lining in the
valve, the LES, between the stomach and the esophagus. No doubt the LES lining
can become infected in the same way as the rest of the stomach lining. This
valve is located at the site of the pain experienced by many GERD sufferers.
The site Introduction
to GERD lists "impaired tissue resistance" as one of the possible
causes of GERD.
The First Chloride Connection: Weak Acid
Helicobacter can thrive better in a weakly acidic environment
than in a strongly acidic one. "Predisposing
factors for the H. pylori infection are low gastric output..." When the
acidity is greater than about pH 4.3 (lower pH), helicobacter
can no longer reproduce.
Hypochlorhydria, meaning weak stomach acid, has been
associated with GERD by some doctors.
More mainstream
medical accounts associate hypochlorhydria with chronic gastritis.
Other consequences of hypochlorhydria
besides H. pylori infection include poor digestion of proteins and poor
absorption of various nutrients, including vitamin B12 and certain minerals.
Many nutritional web sites point out that salt contains the
chloride needed for hydrochloric acid. Medical web sites seem to miss this; but one
site goes so far as to suggest that a nutritional deficiency may be a
"root cause" of hypochlorhydria, though the writer can't guess which
nutrient might be involved!
The chloride in salt is an essential nutrient, as is the
sodium. One cannot live without these minerals. A sufficiently severe deficiency
of either will produce disease, or death.
What does it mean for the stomach acid to be weak? It means
that the level of H+ ions is low. But this level is equal to the level of Cl- or
chloride ions, since the HCl in the stomach has equal numbers of H+ and Cl-
ions. Most of the body's chloride is contained either in the blood, the
interstitial fluid such as lymph which mimics the blood in mineral composition,
or in the stomach, while there is relatively little chloride within the body's
cells. The chloride level in the extra-cellular fluids is maintained by the body
to tight tolerances, so it is reasonable to describe hypochlorhydria as a type
of chloride deficiency.
The Second Chloride Connection: Nutrition and Medication
For our hypothesis that GERD is associated with chloride
deficiency to have merit, we would expect that a heartburn sufferer would be
someone who eats little salt. We might also look for some other behavior that
tends to eliminate chloride from the body.
The suspicious behavior is this: Taking mineral bases orally
that cause chloride to be eliminated from the body, or taking medication that
inhibits the production of stomach acid.
When one ingests a basic compound such as calcium carbonate,
magnesium oxide or magnesium hydroxide, they neutralize hydrochloric acid in the
stomach, producing a salt, such as calcium chloride or magnesium chloride. This
salt (not table salt) proceeds further down the digestive tract where some
portion of it is reabsorbed into the blood stream, whence the chloride
originated. But while in the digestive tract the chloride is part of a salt with
calcium or magnesium, so its rate of absorption is greatly reduced: calcium and
magnesium are rather poorly absorbed in digestion. The absorption rate depends
on the body's need for the mineral, on the presence of vitamin D (in the case of
calcium), on stomach acid, and on other factors. The absorption rate for calcium
has been put at 40% or less, and much less when stomach acidity is low (reference,
reference2).
The result is that most of the magnesium or calcium chloride is excreted in the
stool, never re-entering the bloodstream. Thus, the body has lost some chloride.
If this is done habitually, and the chloride lost exceeds the amount consumed in
salt, then over time a chloride deficiency will result.
The story with an acid inhibitor is somewhat different. If the
stomach is not allowed to secrete acid, then the chloride and acid level in the
GI tract will drop radically, but the blood level may be normal. Blood
hypochlorhydria may be avoided, but the GI tract may still be easily colonized
by undesirable bacteria.
Once the level of chloride in the stomach is reduced, so is
its acidity, so that h. pylori can thrive.
Why Are Antacids Taken, and Why Are They Addictive?
Bases are found in many mineral supplements, in over-the-counter
antacids, and even in some breakfast cereals and toothpastes. The most common
multi-vitamin/mineral preparations contain calcium carbonate and/or magnesium
oxide, which are bases. Mineral supplements are taken for months or years, so
that there is plenty of time for a chloride deficiency to develop.
Antacids are taken by people who are already suffering from
heartburn or GERD. They give prompt relief from acid burning unprotected tissue.
But since these medications cause chloride loss, they aggravate in the long run
the very condition they alleviate in the short run. This produces a vicious
circle of dependency, that is, an addiction. So a chloride deficiency has plenty
of time to develop, and to become progressively worse.
Expert Mischief
For a number of years the public has been advised to eat a low
salt diet, due to the fear that excessive salt intake may cause high blood
pressure. But the advice is often followed by people who have no reason to think
that their salt intake is excessive or that their blood pressure is elevated. As
a result, one factor in our deficiency scenario, a low salt diet, is currently
very common.
The usual prescription for heartburn is an antacid or acid
inhibitor. TV commercials promote them endlessly. Medical "experts"
also often recommend calcium supplements, more often than not as calcium
carbonate, a base.
The Usual Explanation of GERD
Acid reflux is usually described as a failure of the LES, the
valve between the esophagus and stomach. The claim is that the valve allows acid
from the stomach into the esophagus, which cannot withstand it, and which then
becomes diseased. To make sense, this account requires that the esophagus have
no mucous lining to defend against stomach acid. Several web sites dispute this;
for example Gray's Anatomy.
Everyday Evidence Concerning the Usual Explanation
Heartburn sufferers report a wide variety of symptoms, some far
removed from the esophagus. Tingling fingers, odd sensations in the ears have
been reported. Many also experience heart irregularities. It is hard to see how
acid in the esophagus could produce such wide-ranging sensations. Examples.
It is easier to see how chloride deficiency or other electrolyte imbalances
could have such effects. Chloride
deficiency is known to produce abnormalities in the maintenance of proper
osmotic pressure within cells, and proper pH values both inside cells and in
body fluids. There may be other visible symptoms, such as loss of hair or teeth.
Such effects are far removed from the LES.
Secondly, most of us have at some time experienced burping up
stomach contents into the mouth. If heartburn is not present, this may produce
burning in the mouth, but not in the esophagus. That is, a normal esophagus
seems to be able to resist the effects of stomach acid without pain. This is
offered as everyday evidence for the existence of a mucous layer in the normal
esophagus. Since my recovery I have been able to drink several ounces of pure
lemon juice without any discomfort.
Thirdly, nearly all heartburn web sites note that heartburn
sufferers are unable to eat many foods, particularly if they are spicy or
acidic. This too is more consistent with our theory in which the GERD sufferer's
esophagus has a faulty protective lining than with the defective valve theory.
Finally, suppose that the usual explanation contains some
truth, that the LES in GERD does function abnormally. If the LES has a defective
mucous lining, then could it not become so inflamed by the acid as to affect its
ability to function? Alternatively, could not a chloride deficiency
produce a weak LES? Muscle weakness is a known symptom of chloride deficiency.
In either case, wouldn't it make sense to restore the mucous lining and cure the
inflamation, and cure any chloride deficiency, before resorting to surgery?
The usual explanation may be more a half-truth than a
falsehood.
Lack of Warning about the Danger of Bases
Warnings about the dietary intake of bases can easily be found if
you look for them*, but I
have never seen a warning that gave as a reason that bases may produce a mineral
deficiency. Often the warnings are given merely to promote the use of
proprietary drugs.
For its part, the Food and Drug Administration rates bases
such as calcium carbonate and magnesium oxide as GRAS, meaning 'generally
regarded as safe'. This allows their unrestricted use as food supplements
without any warning on the label. This might not matter if doctors warned
against their use, but in fact many doctors themselves prescribe calcium
carbonate to be used for extended periods.
Acid blockers usually carry notices that they only known to be
safe only when used for a short period of time, but these warnings are generally
ignored by both doctors and patients.
Click on the link above to see details concerning my own
experience. To summarize briefly, the start of my problem coincided in time with
the appearance of a sore on the gum over an abscessed tooth, which later
produced a positive blood test result for helicobacter. After root canal work, I
found that the taking of alkaline antacids made my GERD worse, while eliminating
bases from my diet and taking supplementary salt eliminated the GERD over a two
to six month period. That is, the severe pain I had experienced while running
for exercise disappeared in two months, and after four to six months very few
symptoms of any kind remained.
Safety of My Treatment
There is absolutely no danger in avoiding bases. Other options
are available. Chelated minerals are not basic. Other GERD medications may be
avoided as well so long as one eats small frequent meals. I used milk, or a
mixture of milk and soy milk to relieve gastric discomfort when symptoms of GERD
were present between meals. This advice came from Adele Davis' book "Let's
Get Well". Other high protein snacks such as nuts or sunflower seeds may be
useful as well.
How safe is it to increase one's salt intake? Several sources
suggest six grams (one teaspoon) as the maximum amount of salt that should be
consumed in a single day. Since sodium, chloride, and potassium must all be in
balance in the body, I take salt with a high potassium food, such as brewer's
yeast, or milk. Fruit or fruit juice should also serve the purpose. If all else
fails, a mixture of salt and diet salt may be used to keep sodium and potassium
in balance. Usually I prefer to use high potassium foods rather than the
potassium chloride found in diet salt, but I have also tried a mixture of salt
and diet salt in the ratio of 3:1 with good results.
What Compounds and Antacids Are Bases?
Some common basic (alkaline) ingredients in mineral supplements
and in over-the-counter antacids are carbonates, bicarbonates, oxides or
hydroxides of calcium, magnesium, sodium, or aluminum.
Particular brand names are given here.
Let's Hear From You
If you are able to lessen or clear up your GERD problem by
increasing your salt intake and avoiding bases and medication, please let me
know. You may e-mail me at Bob
Cotton. If your GERD does not improve with this change in diet, I would like
to know that too. If you have GERD, have you had a blood test or other test for
helicobacter? Do you use antacids? Do you eat little salt?
Suggestions regarding this site are welcome.
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Footnote: "H. pylori is
highly motile because of its spiral shape and multiple unipolar flagella
(mutants without flagella do not colonize). Flagella may also sense pH. The
organism colonizes the interface of the mucous/bicarbonate layer and the surface
epithelial cell where the pH is 6 or 7, although it can replicate at pH 4.3 and
survive at pH 2.3. It does not grow well at pH greater than 7."
From
The role of Helicobacter pylori in pathogenesis: the spectrum of
clinical outcomes. Scandinavian Journal of Gastroenterology..
1996;31[Suppl. 220]:3-9. [Review article]
First posted January 21, 2000
Revised September 30, 2010