One of the common conditions I encounter among my patients is the hiatal hernia. Patients often refer to it by the most common symptom it produces, reflux, or heartburn. Both terms are descriptively correct. Stomach contents flow backward up into the esophagus food tube from the mouth. Since the stomach fluids are usually very acidic, they burn the esophageal food tube tissues creating a burning sensation in the heart area. It is fairly obvious that this is not supposed to happen. The valve at the top of the stomach (the cardiac sphincter) is supposed to stay closed to prevent this from happening, and only open for a second or two at a time to let food down into the stomach. With heartburn/reflux this valve is not working properly. The question is why?
Since reflux medications are the most popular drugs on the market, this problem is clearly everywhere. Unfortunately, the medical drug approach does not address the problem at all. It merely addresses the symptom of acid stomach juice causing burning of throat tissues. The main drugs do this by turning off the acid production in the stomach. Stomach acid is not optional. Stomach acid is your main line of defense against bacteria, fungi, and viruses carried in our food supply. Stomach acid is vital as the first stage of digestion. It breaks down proteins and changes minerals into forms we can digest. Without this protein breakdown, undigested proteins make it down into the colon where unhealthy inflammatory gut bacteria feed on it. This turns your internal gut microbiome into a ghetto which sets you up for all sorts of other systemic diseases and psychological issues. Inflammatory metabolites from these bad bacteria travel directly to the brain affecting mood, concentration, memory, and motor function. The problems with mineral absorption created by low stomach acid set you up for early osteoporosis. These various problems are why the small print in the directions that come with these drugs says they are not to be used for more than two weeks. Most folks I know taking these meds are on them for years.
But the reflux itself is not a benign problem. The acid burns in the esophagus eventually turn the area above the valve into scar tissue that can actually shrink the opening to the stomach so much that only liquids can pass through. Over enough time the chronic irritation can eventually turn the area cancerous. So we can’t ignore the problem either. What can we do? What is the actual cause and can we address that? The answer to this is one of medicines’ biggest failures. So much of what goes on inside the body is controlled by the two halves of the unconscious nervous system – the sympathetic and the parasympathetic systems. Medical schools spend about 20 minutes teaching about these systems and then ignores them because they don’t have any good ways to control these systems. Yet your health is all about these two systems. Chiropractic, on the other hand, is founded on influencing these systems through spinal neurological adjustments. What is the key to reflux? Reflux comes from too much sympathetic and not enough parasympathetic nerve activity. Put in simple terms, reflux comes from stress most of the time. There are a few cases caused by blunt force trauma to the abdominal muscles, and a few other cases due to birth defects. But by and large, the basic issue is stress.
When you go into a stress stance, two relevant things happen to the area in question. First, going into stress triggers your sympathetic fight/flight/freeze response and shuts down your relax and digest parasympathetic nerve activity. It is this relaxed and digest nerve flow that causes the esophagus to produce the rhythmic flowing pulsing of the throat muscles that move swallowed food down to the stomach. Instead, the stress response causes these muscles to tighten up and contractually shorten the esophagus. This pulls the food tube and stomach up. This is produced by shutting down the nerve flow from the Vagus nerve. This is the nerve that controls almost all your internal organs.
The second thing that happens is the Phrenic nerve from the middle vertebra in your neck triggers the diaphragm muscle to contract to increase the pressure in your abdomen and strengthen your “core” muscles to prepare you to fight or run. When this muscle tightens, the small opening in the muscle the esophagus passes through to get to your stomach (called a hiatus) gets pulled and stretched larger. With this larger opening, when the esophagus contracts it pulls the stomach up into the chest cavity forming what is called a hiatal hernia. From this position, the cardiac sphincter valve at the top of the stomach does not work properly and now acid from the stomach can wash up into the esophagus.
In acute stress reactions where we run or fight, this usually is not a problem, because all the acid production has been shut off. But in chronic stress situations, the acid production comes partially back on, because remember I told you that shutting off stomach acid is not an option long term. So with chronic stress, the stomach is pulled up, the valve is partially open, and stomach acid is being produced. Hence you get heartburn. Can you see the medical doctor’s problem here? He knows that stress is the real problem, but what good does it do to simply tell the patient to stop being stressed? No good at all. This is why the second most common class of drugs prescribed are drugs for stress management. They don’t work. They don’t stop the stress response in the body and don’t stop reflux problems. But patients demand the doctor give them something for their symptoms, so they get prescriptions for acid blockers and feeling moderators.
A couple of months ago I came across a new device for treating patients with chronic hiccups. I bought one because the research I read on the product said that it worked by stimulating both the Vagus and the phrenic nerves. I immediately saw the potential for using this device for all my hiatal hernia patients. The device was basically a highly flow restricted drinking straw. The action of having to suck very hard while also trying to swallow activated these two nerves simultaneously. I tried out the device on several patients with good success. I tried to contact the company to see if I could get a quantity for the office for my patients. I guess I was too small time for them to respond to me. Well, not to let that slow me down, I figured out a way to reproduce the same effect using tiny cocktail straws that I would collapse by instructing the patient to partially pinch the straw in the middle while trying to suck up water from a cup.
I have tried this technique on about a dozen patients and have been completely successful in relieving the diaphragm spasm and hiatal hernia issue at the moment. Obviously, this is not a fix for the patient’s stressful life, but it is a neurological way to relieve the negative symptoms without drugs by returning the area back to normal physiologic functioning. The patient may have to repeat this process several times a day if they keep stepping into stress, but it is something. On another level, with the patient now empowered to do something about the symptom, they are motivated to pay attention to when their stomach knots up and they can’t get a deep breath. This will help them notice what events in their daily life need to be changed (if possible.) If the circumstances can’t be changed, then the challenge becomes how do we change our relationship to those circumstances so that they don’t bother us so much. This is more of a challenge, but the first step is just becoming aware of what is going on and the effect it is having on us. So much of the time we feel helpless, so our primary defense is to deny and ignore what is going on and how we feel in response. Unfortunately, these feelings don’t go away. They go underground and re-manifest as bodily symptoms. It sounds amazing, but it is now estimated that 80% of doctor visits by patients are for stress-related illnesses.
While it is not the solution to global warming, if sucking through a cocktail straw can reset your neurologic balance for 30 to 40 minutes and lift the stress load a bit, it will have an impact on the quality of your life. I have a bunch of those straws at the office which you can have just for the asking.
Take care,
David