What is Acid Reflux?
Acid reflux, medically known as gastroesophageal reflux (GER), is a condition in which the contents of the stomach retrograde through the esophageal sphincter back up into the esophagus. Along with food, the stomach contains enzymes and acids which cause a burning sensation in the esophageal walls.
Normally, a band of muscles at the bottom of the esophagus called the lower esophageal sphincter (LES) relaxes to let food and liquid pass through to the stomach. It then contracts and closes to ensure the contents of the stomach remain contained within the muscular bag. Sometimes, abnormal relaxation or weakening of the LES can allow regurgitation of stomach acids into the esophagus, causing inflammation and erosion of the esophageal lining. This is called acid reflux/GER and commonly feels like heartburn.
Many people experience mild acid reflux sometimes. However, if you experience it multiple times a week, you might have GERD. GER disease (GERD) is a long-lasting condition of acid reflux, producing frequent symptoms such as heartburn and regurgitation. GERD is one of the most commonly diagnosed GI disorders in the US, affecting approximately 20% of people in America. The risk for GERD increases with high alcohol consumption, lower socioeconomic status, age >50, and more importantly, type 2 diabetes.
Symptoms, Diagnosis, and Risk Factors
GERD can manifest as:
- Chest pain
- Regurgitation of sour liquid or food from the esophagus
- Disruption of sleep at night
If you experience these symptoms regularly, you should consult a doctor. Your doctor may be able to diagnose you through a description of your symptoms or an endoscopy. Self-medication through PPIs can lead to an increased risk of diabetes.
The following factors increase your risk for acid reflux:
- Hiatal hernia
- Consuming large meals at night
What is Diabetes?
Diabetes is extremely common in the developed world, with 1 in 10 people in the US diagnosed with the disease. Diabetes mellitus is a metabolic disorder that is characterized by high blood sugar. In type 2 diabetes, the cells of the body become resistant to insulin, a hormone that allows the uptake of glucose from the bloodstream into the cells for storage. Consequently, glucose circulates in the blood, and chronic high blood glucose level results in complications of the circulatory, nervous and immune systems.
For this discussion, the most important complications of diabetes mellitus are vascular damage and neuropathy (damage to nerves).
Symptoms, Diagnosis, and Risk Factors
The hallmark symptoms of diabetes are excessive urination, hunger, and thirst.
Other symptoms include:
- Weight loss
- Tingling of hands and feet
- Delayed healing
- Dry skin
If you experience these symptoms, consult a doctor for a timely diagnosis. A fasting blood sugar test is performed. A confirmed diagnosis of diabetes shows a fasting blood sugar exceeding 125 mg/dL on two separate tests.
Your risk for diabetes increases if you:
- Are overweight or obese,
- Maintain an inactive or sedentary lifestyle,
- Have a family history/genetic predisposition for the disease, or
- Are pregnant
How are Acid Reflux and Diabetes Linked?
An estimated one-fifth of the American population suffers from acid reflux, and the numbers are on the rise. GERD is an economic burden on the country, with the total cost for treatment exceeding $12 billion. With 10.5% of the US population also suffering from diabetes and a national cost of $327 billion, it is important to study the established relationship between the two disorders to further discuss the management and treatment options.
Acid reflux/GERD and diabetes are linked in a few ways.
Overweight individuals are 50% more likely to develop GERD. The abundance of fat in the abdominal area may inflict mechanical pressure on the stomach, causing it to reflux its contents into the esophagus. Obesity also increases the chances of hiatal hernia and an amplified gastroesophageal pressure gradient, providing the perfect scenario for acid reflux to occur.
We know that patients with diabetes tend to be overweight or obese. Thus, it makes sense for overweight diabetic patients to also frequently experience acid reflux.
The likelihood and coincidence of these disorders cannot just be attributed to obesity. According to a study published in the World Journal of Gastroenterology, individuals with diabetes mellitus are at greater risk of GERD than non-diabetic individuals. Some studies have also found that 40% of diabetic individuals also suffer from GERD, regardless of weight. This indicates a more direct connection between diabetes and acid reflux.
Studies suggest that diabetic neuropathy – nerve damage due to high blood sugar – accounts for GERD symptoms in diabetics. Although nerve damage commonly occurs in the legs and feet, it can also occur in the vagus nerve. The vagus nerve regulates many parasympathetic functions in your body – functions that you cannot consciously control. These include heart rate, digestion, and immunity, amongst others.
Damage to the vagus nerve impairs GI function, including esophageal, stomach, and intestinal actions. Abnormal relaxation and contraction of the LES can directly lead to acid reflux and symptoms of GERD. In addition, impairment of the pyloric sphincter (between the stomach and intestine) causes delayed gastric emptying (gastroparesis). Prolonged retention of gastric contents increases the likelihood of acid reflux. Barring acid reflux, gastroparesis produces other symptoms of GERD like heartburn, nausea, bloating, and early satiety.
GI Tissue Damage
High blood glucose is a silent killer, having several adverse effects on the body before diabetes is even diagnosed. Not only does high blood glucose damage nerves, but it can also damage the vascular tissue that it circulates in. This can lead to GI tissue damage, including the esophagus and LES, increasing chances for acid reflux and regurgitation.
Prescription of PPIs
Proton pump inhibitors (PPIs) are a class of antacids prescribed to treat acid reflux. The stomach releases acids to create a low pH for optimal activity of the digestive enzymes it releases. PPIs inhibit the release of excessive acid to curtail the consequent symptoms of GER. PPIs are amongst the top ten most used drugs in the world since they are used in the treatment of a wide array of GI issues such as acid reflux, peptic ulcers, and indigestion.
Although an effective drug for GER, studies have shown that prolonged use of PPIs increases the risk of type 2 diabetes by 24%. Thus, it is not recommended to unnecessarily prescribe PPIs, especially for long-term use. Based on these findings, doctors should also recommend users of PPIs regularly get screened for diabetes.
The Bottom Line
Although genetic predisposition plays a major role in our health, we can control the food we eat and the activities we partake in. Both diabetes and GERD have a high prevalence in the obese and sedentary population of the world. So, to prevent the unpleasant symptoms of acid reflux and the uncomfortable limitations of diabetes, you should maintain a healthy lifestyle. Half an hour of daily physical activity and a balanced diet saturated with natural and organic foodstuff will protect you from most modern diseases.
Studies have proven a distinct relationship between diabetes and acid reflux. If you regularly experience acid reflux and have been using PPIs for the past two years, you should get screened for diabetes immediately. Conversely, if you are a diagnosed patient with diabetes and experience regular GER symptoms, you should consult your doctor to rule out diabetic neuropathy.
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