Soon enough, quarantine will be lifted. That means millions of Americans will be rushing back to bars and restaurants, inhaling more pizza, wings, burgers, and beers than oxygen. With the massive influx of fatty acidic foods, there will be REFLUX…. gastroesophageal reflux!
Most people get heartburn or gastroesophageal reflux occasionally, after a fatty meal or overindulging. They take a Tums or other antacid or pop a Pepcid or Zantac and the symptoms resolve. But for some with heartburn symptoms at least twice a week every week, a diagnosis of Gastroesophageal Reflux Disease (GERD) is warranted and requires further investigation into the cause of the chronic heartburn. In many of these patients, the lower esophageal sphincter is losing tone. The valve between the esophagus and the stomach is “leaky” or isn’t closing as tight and stomach acid is pushing back up into the esophagus after a meal. Chronic stomach acid contact in the esophagus can also lead to cancerous cell changes in the esophagus so, these patients may need to be on GERD medications long-term which can have some nasty side effects like impaired digestion and nutrient deficiencies, which can lead to other problems as a result.
So the question of many doctors is, is there an effective treatment to prevent chronic GERD symptoms that doesn’t require drugs? The most accepted and effective method is simply diet modification. Eating less acidic more alkaline foods, watery foods, and high fiber foods can help reduce the amount of stomach acid being produced and even neutralize some of the acid. For some, even this is not enough. New research is showing there may be another home remedy as well, one that only requires a patient to do one thing… breathe deep!
The esophagus passes through a small hole in the diaphragm before joining the stomach. The diaphragm hugs the esophagus just above the stomach and the lower esophageal sphincter (the “valve” between the esophagus and the stomach). When we breathe in, the diaphragm contracts and drops down, compressing the air and contents of the abdomen and produces an increase in Intra-abdominal Pressure (IAP). This contraction of the diaphragm also tugs and squeezes on the esophagus slightly, increasing the pressure in the esophagus just above the stomach.
This proper activation of the diaphragm is key for producing IAP which helps support the lumbar spine and pelvis during movement and preventing overcompensation of muscles in the low back and pelvis. It’s also very important in GERD patients to INCREASE intra-esophageal pressure to prevent the backflow of stomach acid. Physics dictates that HIGH pressure moves towards LOW pressure. That’s why on movies when you see an airplane or space ship window break, things are getting sucked out the windows. The high pressure inside is rapidly moving out towards the low pressure. If there is a lack of proper pressure inside the lower esophageal sphincter due to neurological inactivation of the smooth muscle and lack of diaphragm activated “squeeze” on the esophagus, the pressure inside the stomach can increase to slightly higher than that of the esophagus, and acid can begin to push through the leaky valve. Add in the extra pressure from the stomach contracting and producing more stomach acid after a large meal or acidic foods, and even more acid can force its way into the esophagus. Too much stomach pressure and not enough diaphragm push back can even lead to the stomach pushing its way through the hole in the diaphragm, or what’s known as a Hiatal Hernia. Once this happens, there is stomach tissue ABOVE the diaphragm, and nothing can stop it from producing acid directly into the esophagus. But there are ways to counter this stuff. Enter diaphragmatic breathing exercises!
By retraining the patient to activate the diaphragm properly during respiration, we can significantly reduce the symptoms of GERD or an occasional “heartburn” flare-up and prevent possible future attacks by “closing off” the leaky valve in the esophagus using the diaphragm. We increase the pressure in the lower esophageal sphincter and esophagus, essentially blocking the flow of acid back into the esophagus. If heartburn symptoms are already occurring, performing diaphragmatic breathing/activation exercises can help push the acid back down through the sphincter into the stomach again, providing relief. I have personally experimented with this treatment on a few patients, as well as myself during a recent bout of heartburn with surprisingly fast and effective results! We can use the principles and positions Dynamic Neuromuscular Stabilization (DNS) to teach proper diaphragm activation strategies and how to create IAP.
GERD patients commonly report the symptoms increase while lying on their back and decrease when sitting up or leaning forward. While learning to diaphragmatic breathe and create IAP is harder while sitting upright, this is a case where I may encourage a patient having symptoms to try the exercise sitting first to provide quicker relief and slowly build up to lying on their back as more and more activation is achieved.
So, the next time you're pounding down tacos and margs and you feel the familiar tightness and burning in your stomach and chest, before opening the medicine cabinet, quite literally take a deep breath. Consult your friendly neighborhood chiropractor, physical therapist, exercise trainer, or other professional trained in DNS principles to turn on that diaphragm again. Better yet, learn the exercises and perform them DAILY to prevent future occurrences as well as provide you low back and pelvis some support, and adapt some new dietary guidelines so you don’t have to deal with it anymore!
Dr. Gary Cervone