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Acid reflux (heartburn) affects more than 20% of the adult US population and costs billions of dollars in healthcare visits, prescriptions and hospitalizations. Acid Reflux (or GERD, when it becomes chronic) is more than just a simple heartburn. The condition can be a bearer of bad news for overall health of the body. The worst part is that conventional acid-suppressing medication does little to cure the condition. In fact, antacids do more harm than good and simply add fuel to the already burning (pun unintended!) issue, leading to unwanted complications. Constipation is one such complication of acid reflux. Let’s understand the connection between constipation and acid reflux and how to get relief naturally.
GERD, or gastro-esophageal reflux disease, is the result of stomach contents refluxing (sloshing) back into the esophagus. This occurs because of a dysfunctional lower esophageal sphincter, a muscular valve at the end of the esophagus that guards the opening into the stomach. The sphincter opens in the wrong direction (upwards) due to pressure inside the abdomen. This pressure, called intra-abdominal pressure, is caused by bacterial overgrowth (especially that of H. pylori) and inefficient digestion of carbohydrates leading to formation of gas that exerts pressure on the sphincter.
Acid suppressing medications (antacids) lower the acidity of the stomach, making conditions favorable for bacterial overgrowth. Low acid also does not activate the pancreas enough to release digestive enzymes leading to improper digestion of carbohydrates. So we know now that antacids make the condition even worse. But not only do they make your acid reflux worse, they do something more damaging.
Antacids (not to be confused with gastric acid inhibitors like cimetidine, ranitidine, pantoprazole, omeprazole, etc.) either chemically neutralize the acid in the stomach or bind to it physically to put it out of play. They usually show their effects immediately and the relief lasts for a short time. The most common types of antacids contain aluminum hydroxide. In a study done to evaluate the risk factors for chronic constipation, aluminum-based antacids featured prominently in the list. Aluminum inhibits the motor activity of the stomach (regular, rhythmic, muscular contractions that allow food to move forward while digestion) and intestines, thereby causing constipation.
Normal bowel movements occur as a result of motility of small intestines and colon (large intestine). This results in defecation, or passing of stools. The small intestine shows bursts of motility as a result of mixing of food with digestive enzymes. This motility helps in mixing and digestion of food contents. Once food is digested, the remainder passes into the colon through rhythmic motion called “peristalsis.” The undigested food moves slowly through the colon and can remain for 2 to 3 days in normal individuals.
Motor activity (peristaltic motion) in the colon shows two peak bursts – one in the morning, after waking up and having breakfast and the other after lunch (mid-afternoon). If this motor activity is inhibited, the contents will remain in the colon for an extended period and give rise to constipation.
Constipation can occur due to three main reasons – primary, secondary and iatrogenic. Primary reasons for constipation are reduced fluid and fiber intake, decreased activity and lack of privacy. Secondary reasons include tumor, partial obstruction of the intestines and certain metabolic effects. Iatrogenic reasons are due to pharmaceutical drugs, one of which is aluminum antacids.
A person is said to suffer from constipation if he or she passes stools less than 3 times a week, has to strain hard to pass stools, has lumpy or hard stools, or has a feeling of blockage in the rectum that prevents bowel movements.
Chronic constipation can cause many complications such as:
Apart from the direct correlation of aluminum antacids on gut movement and resulting constipation, there has been damning research about many other health complications of aluminum antacids. Patients who take aluminum hydroxide for a long duration may suffer from hypophosphatemia (decrease in blood phosphate concentrations). This may lead to muscle weakness and encephalopathy (disease of the brain), among others. Hypophosphatemia also results in softening of bones (osteomalacia) due to impaired bone remineralization (a natural process of minerals getting added to bones to keep them stronger). This can greatly increase the risks of fractures and other injuries.
If patients with kidney problems rely on aluminum antacids for long, they may suffer from aluminum toxicity due to accumulation of aluminum in their blood
Another study showed that patients who were on aluminum antacid therapy from three weeks to three months developed aluminum-induced encephalopathy. It was characterized by speech disorders, seizures, coma and even death.
The definition of constipation differs from individual to individual and from culture to culture. While many people in the eastern countries “go” at least once a day, many westerners relieve themselves maybe thrice every week. But since both are apparently healthy, it really comes down to personal preferences and individual needs of the body.
More than trying medication immediately when you experience constipation, you need to set your daily routine so that you never suffer from constipation in the first place. Getting physical exercise for around 20 minutes every day is a good start.
You also need to drink enough fluids to keep your food moving along the way and help stools stay smooth. Dietary fibers help bulk up the stool and make their passage easy. Also the way you sit to pass stools matter. It is advisable to squat rather than sit. Unfortunately, the western commode design does not allow you to squat. But if you must use it, we advise that you place your feet on a low stool, or squatting platform to change the angle of your body. This puts pressure on your abdomen resulting in easy passage of stools.
Supplements can also help in providing relief from constipation.
The connection between acid reflux and constipation tells us that every unit and process in our body is intricately linked with another. The doctrine of Western medicine that believes in treating every ailment as unique and disjointed can sometimes create more problems than it tries to solve. Antacids trying to relieve you of heartburn but causing constipation is an example of this kind of approach.
We’ve already talked about how the conventional notion of too much acid causing heartburn and GERD is utterly false. Only by regulating and balancing your gut microflora and healthy eating can you solve your acid reflux problem. This will remove the need for conventional acid-suppressing therapy. This in turn won’t cause constipation or any other health complication for that matter. True bodily balance comes from a healthy gut. If your tummy is happy, your body will rejoice.