Environmental Triggers, Symptoms, and Interventions for Acid Reflux
With 60% of Americans reportedly experiencing acid reflux once in a while and 20% experiencing reflux on a routine basis, it is safe to say that most people are familiar with the discomfort and pain this condition can bring. There are even another 50% of patients with diagnosable reflux that have no symptoms at all. Thus, the damage is occurring on a daily basis, but nothing is being done to alleviate or fix it.
As an ENT, I often have patients who come to see about acid-related throat symptoms. The main complaint is hoarseness or soreness in the throat, but sometimes symptoms are more magnified with the patient complaining that it feels like they are having a heart attack or that they are refluxing stomach acid from the throat into their sinuses when laying in bed at night. Most of the time, the patient thinks the issue is mainly gastrointestinal but doesn’t know the cause or why basic interventions like taking antacids or OTC acid reducers just haven’t seemed to help. Some patients have even altered their diets to exclude acidic foods or beverages in hopes of relief, but this doesn’t usually move the needle for them either. What most of these patients do not realize and what I would like to illuminate with this article is that many times, acid reflux often arises and persists because mold and mycotoxins have entered the picture and disrupted the immune system and acid balance in the body.
What is Acid Reflux?
Acid reflux is stomach acid or bile moving up from the stomach and into the esophagus. Reflux can occur at any distance from the lower esophagus and up into the larynx (vocal cords), into the lungs, and even into the nose, Eustachian Tubes to ears, and sinuses when lying down. Typical acid reflux is esophageal–gastroesophageal reflux disease (GERD). Laryngeal is Laryngopharyngeal reflux or LPR. Bile reflux does not show up on a 24-hour acid esophageal monitor test as it is more basic in pH but still causes damage.
Causes of Reflux
1. Mechanical issues that allow the free movement of stomach and bile acid into other areas of the body.
– Hiatal hernia (opening in the diaphragm)- when large enough, the stomach can enter into the chest cavity causing lung collapse and severe reflux symptoms.
– Valve obstruction in pylorus end of the stomach
– Narrowing of the esophagus or esophageal stricture
– Zenker’s diverticulum (A pouch in the throat esophagus that forms when the upper esophageal sphincter doesn’t open all the way, putting pressure on an area of the pharynx wall. This excess pressure gradually pushes the tissue outward, causing it to form the diverticulum or pouch.)
Any of the above conditions, if suspected, should be evaluated by an experienced laparoscopic general surgeon to determine if they require any endoscopic surgical intervention. If it is typical esophageal reflux requiring surgery the current procedure is called a LINX which is a small magnetic titanium bracelet that goes around the distal esophagus that is closed at rest and opens upon swallowing.
4. Decreased stomach acid and/or digestive enzymes
5. Environmental, airborne mold
6. Parasites – Parasites have been linked to reflux because of gastritis and the weakening of the esophageal-gastric sphincter. There are some reports of anti-parasitic drugs relieving GERD. Ivermectin and other anti-parasitics have been of benefit. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5787065/)
Mold and Reflux – What is the Link?
Reflux is a big problem for almost all toxic-mold-exposed patients. Additionally, patients who have mold and/or mycotoxin sensitivity tend to experience reflux, but most do not have a symptom. They are often the 50% I mentioned at the beginning of this article.
At this point, you are probably wondering, “Why would something like mold (inhaled mold) lead to reflux?”
Reflux is related to mold in 2 main ways:
1. An IgG allergy to Candida – Candida is a yeast that is present in everyone’s gut, but the IgG immune reaction to the fungus causes inflammation which leads to food allergies. Then, both the food allergies and the immune reaction to candida cause reflux separately or together.
2. The fungal load or concentration of mold in the environmental air – Fungi in the air go into the nose, sinuses, and lungs. All fungi have the same cell wall structure, a 1-3 Beta-glucan structure. When you breathe in mold, it causes a systemic immune reaction (in mold-sensitive people) that causes a cross-reaction to the gut Candida, present in all people, much like if you are sensitive to penicillin you also react to Amoxicillin because it’s the same chemical structure, so that now the Candida in the stomach causes inflammation which drives reflux. If a patient is constantly breathing in high levels of mold spores, you can see how this cycle then becomes never-ending and very problematic.
(As a quick clinical example, I had a patient with the GERD reaction to Yeast and the IgG allergy to both environmental mold and Candida in the gut. His testing results are illustrated above. So when he got his air fixed and had surgery, his GERD was resolved until he got off his anti-Candida diet. Candida sensitivity is permanent and must be managed with diet and natural antifungals and Probiotics for best long-term reflux resolution.)
3. Mycotoxins are neurotoxins – Mycotoxins can mess with the nervous system, thereby impairing muscle function in the gut. Peristalsis can then be impaired in the small and large bowel weakening the lower esophageal sphincter causing reflux and severe constipation.
What Is Usually Done to Treat Reflux?
The common first-line reflux treatments are as follows:
– Diet changes–no coffee, chocolate, spicy foods, tomatoes, etc.–all of which cause reflux.
– Elevating the head of the bed up to 20-45 degrees.
– Antacid meds, typically Nexium, Prilosec, Zantac, Dexilant, Prevacid, Protonix, Aciphex, and Carafate which is a suspension that heals the esophageal mucosa. These drugs are fine for the healing of acute or chronic esophagitis but over the long term, they can cause problems as they decrease stomach acid and therefore digestion which can cause more reflux but with less acid. There have also been reports of dementia from long-term use of some of these drugs. One 2016 Harvard study stated, “The most common PPIs in use were omeprazole (Prilosec), pantoprazole (Protonix), and esomeprazole (Nexium). All participants were free of dementia at the study’s beginning. Yet, after the eight-year follow-up, chronic PPI users had a 44% increased risk of dementia compared with those who did not take any medication.”
Reflux Interventions That Work Best for Mold Patients
At bedtime, I recommend first and most importantly, no eating 4 hours before bedtime. I also recommend elevating the head of the bed 20-45 degrees depending on the severity of symptoms. When the body is inclined, blood and lymph will continue to circulate more, allowing more blood and oxygen to move around the body and keeping the lymph flowing more freely. Keeping blood and lymph flowing is a help to the body’s nighttime tasks of repair and toxin removal.
An additional intervention that helps is to take 1/2 teaspoon of sodium bicarbonate in 3 ounces of organic aloe vera juice and a digestive enzyme, 1-2 after each meal and at bedtime. A short-acting antacid product like Pepcid and calcium Magnesium capsule (open and dissolved in 3 ounces of water) can also help. Aloe Vera soothes stomach inflammation and both the sodium bicarbonate and the Calcium/Magnesium neutralize stomach acid to allow healing. Digestive enzymes digest food and move stomach contents to the small bowel. The Pepcid decreases more stomach acid production during sleep.
Addressing Fungus Helps Resolve the Cause and Symptoms of Reflux
Often when reflux is chronic, more than one underlying cause should be addressed for maximum results. Mold/yeast almost always accompanies mechanical causes of reflux and should always be considered, even when surgery is the best route for the patient.
Here is an example: In the patient, GERD was caused by both a mechanical hiatal hernia and yeast. After esophageal surgery, his GERD was under control, but he got off his anti-yeast diet. Then reflux recurred until yeast was under control with both diet and meds. These pictures illustrate this case:
Top left: Yeast and Stomach contents at base of the tongue before the patient was treated for yeast/Candida.
Top right: Light pink is acid burned mucosa. The mucosa has been bleached out with acid. The dark pink is indicative of current acid burn.
Bottom left: The red is acid burn on epiglottis but Candida is gone.
Bottom right: Both yeast/Candida and GERD are gone because the patient had surgery and was addressing the yeast/Candida with diet and meds.
Why is Low Stomach Acid Something You Should Address?
Low stomach acid can cause more reflux because of less digestion taking place. With mold, the body is in a state of chronic inflammation. Many bodily functions are halted or slowed, like digestion, so that all resources may go to thwarting the toxic attack from the mold. Some patients with low acid must take Betaine which is Hydrochloric acid. The dose is specific for each person and a diagnosis and proper dosing after food should be done by a healthcare provider.
Other Supplements and Nutraceuticals That Can be Helpful
Besides the above, other supplements that may help are digestive bitters–I like “Better Bitters” by Herb Pharm. In short, they support digestive function by stimulating the bitter receptors on the tongue, stomach, gallbladder, and pancreas. This promotes stomach acid, bile, and enzymes to break down our food and helps us gain the maximum absorption of nutrients from what we’re eating. Drinking diluted, organic apple cider vinegar to help block the absorption of starch that promotes yeast overgrowth. Adding fennel seeds and soothing herbs, like ginger to the diet can also be helpful. Additionally, regular use of Sinus Defense can help to dampen the extreme immune response to mold which causes the reflux issues in the first place. CitriDrops Dietary Supplement also can be used as it has a bitter taste effect as well as the ability to kill both yeast and parasites. CitriDrops should be distilled in spring water–4-8 drops per 4 ounces of water–before drinking. I also have seen wonderful results for patients using a prescription, high-potency probiotic like VSL #3 or Extra Strength Visbiome. These replenish critical gut flora that maintains immune and digestive function.
What if Symptom Persist?
If your symptoms persist, work the list above and consult a good general laparoscopic surgeon who specializes in esophageal issues who does use the LINX surgery. Be sure to get a good esophageal endoscopic exam, or consult a skilled Gastroenterologist doctor who does functional medicine.
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