I see acid reflux rather frequently. It’s usually for a number of reasons and can be a symptom that may end up being more of a problem than anticipated. It’s not a nice thing for doggos to experience and is often telling you something is not quite right and finding out what that is, is paramount. So read on my lovely peeps, resolve your doggo’s blessed reflux.
What is acid reflux
Acid reflux in dogs, also known as gastroesophageal reflux, occurs when the acid (chime: mix of acid, salts and bile) from the stomach moves into the oesophagus. It can obviously cause some discomfort and although a symptom in itself (that is not deemed dangerous), it can lead to other issues. Reflux can cause irritation, inflammation and wear on the lining of the oesophagus, leading to possible ulcers. If left for long enough, this can cause narrowing, thinning, or necrosis of the oesophagus. Also a constant regurgitation (a common symptom of acid reflux) can cause vomit to enter a dogs’ lungs and lead to further damage or aspiration pneumonia.
Symptoms may be as follows:
· Bad breath
· Constipation, diarrhoea and bloating
· Burping, gagging, or minimal vomiting/regurgitation after a meal
· Dry cough
· Pain after eating, such as restlessness and hunching over
· Inactivity or lethargy after meal
· Loss of appetite
· Weight loss
There are many factors that may cause GERD, and these should be systematically evaluated when creating a treatment plan, aiming to address the reason as opposed to the disease itself.
What role does acid play in the gut?
Appropriate acid levels in the gut are paramount. HCL is also responsible for breaking down dietary proteins aiding in the absorption of nutrients. Healthy levels of acid (HCL) eliminates bacteria and viruses and prevents the overgrowth of pathogens in the upper GI tract, so hypochlorhydria (low HCL) can be a risk factor for SIBO (small intestinal bacterial overgrowth), fungal overgrowth, intestinal permeability and possible sensitivities and allergies.
Acid in the stomach can be too high but most commonly, is presents as too low, incapable of fully digesting and emptying food into the small intestines, allowing chime to sit in the stomach and allowing regurgitation. There is often the misconception that it's often too high and therefore must be suppressed by drugs.
Research has proven that a lack or suppression of gastric acid (HCL), has been associated with an increase in bone fractures, possible autoimmune disease, impaired absorption of B12, iron and magnesium.
Poor gut health and reflux can be linked to allergies, arthritis, autoimmune disease, itching and rashes, fatigue, anxiety, cancer, and so much more. In short, if the gut isn’t functioning at full capacity, then neither is your pet’s health.
Why is your dog experiencing acid reflux?
· Stress is often a low grade release of cortisol that can slow down digestion, creating a bolus of food in the stomach, that can sit around, coming up as regurgitation, rather than emptying into the small intestines in a timely fashion.
· Poor gut motility sometimes linked to poor food (dry food) or neurological dysfunction.
· Structural issues can be the cause such as obstruction, a loose dysfunctional lower oesophageal sphincter, hiatal hernia or inflammation caused from disease such as megaesophagus.
· Food intolerances, sensitivity and allergies can create immune dysfunction and a less hospitable digestive environment.
· Poor gut microbiota, yeast overgrowth, bacterial overgrowth, SIBO (small intestinal overgrowth), sometimes from antibiotic use.
· Poor immunity and gut immunity (integrity of the ‘one cell epithelial of the gut’), can cause inflammation and a lower level of acid which can slow down protein digestion and cause regurgitation.
· Disease such as a liver disease, pancreatitis, IBD (inflammatory bowel disease).
· Nutritional deficiencies.
· Being overweight.
Conventional Veterinary Approach to Acid Reflux
Vet’s often used drugs as an intervention and whilst it might alleviate initial symptoms, it is not a long term solution and implicates longer term issues.
Proton pump inhibitors (PPIs), inhibit the gastric acid production and are amongst the top 10 most commonly prescribed drugs in the world for humans and pets.
Pro-kinetic medication is sometimes used to help move food through the digestive system and strengthen the oesophageal sphincter muscles.
The above aren’t really successful options long term and most certainly do not address the cause. Whilst inhibitors may give short term relief, a more holistic approach is far more successful than unnaturally suppressing HCL levels.
The conventional approach generally believes that acid is overproduced. Whilst this is possible, it is deemed to be the reverse in many circumstances.
How Diet and Supplements can Help
The gut is the epicentre of immunity and health. If your dog’s digestive system is not working correctly, then nothing else will be. A symptom of acid reflux is telling you there is a dis-ease in the body and something needs to change to rectify it. Determining the reasons why are key. Is the food suitable for your dog? Are you feeding a commercial dry food? Are there nutritional deficiencies? Is there stress? Is the gut functioning properly?
Looking at suitable diets and food for your pet is essential. A fresh and balanced diet rich in easily digestible proteins, good fats and vegetables (fibre) can help support gut microbiota and stomach acid levels. Home made cooked or raw food are often best in this instance.
Processed foods and sugars can cause inflammation in your dog’s stomach, decrease acid levels, triggering acid reflux symptoms.
Certain foods can often be an aggravator of reflux, so understanding what might be bothering your dog is essential. If feeding a fresh diet has not worked and you are at a loss. Doing a food sensitivity test can help in removing the culprits.
An elimination diet is the best way forward as intolerance and allergy testing can be inconclusive.
Low dietary fibre intake is associated with decreased stomach and gut motility and delayed gastric emptying. Low fibre findings are mostly found in humans, but our counterparts experience the same pathogenesis in acid reflux and adding insoluble fibre, may help.
Checking for nutritional deficiencies is always a good start and something we offer here at MPN. There is a large correlation between low vitamin D levels and GERD in humans. I often find our pets can experience the same thing. Although a vitamin or mineral deficiency isn't usually the soul reason for acid relax, it is good to check this out. Low levels of acid may also indicate deficiency in B12, iron, magnesium and calcium.
Asking your vet to test for vitamin levels is a good start.
Zinc deficiency is correlated to and regarded as a potential in protecting gastro lining. The research is based on its anti-secretory properties and regulation of gastric levels. Many foods can be deficient in zinc and a common mineral when looking at deficiencies.
Such a beautiful and useful part of a diet regime is to looking at supplements. They can help to reduce symptoms of reflux rather successfully. These are mostly looking at how to support digestive function but also to consider other things that effect digestion such as stress.
Ashwaganda; this native Ayurvedic herb is one I always wax lyrical about. It has adaptogenic abilities when it comes to stress. It modulates cortisol levels (our stress hormones). If your dog is experiencing consistent stress, cortisol shuts down the digestive system and this has been shown to increase acid levels in the gut.
Slippery elm; such a beautiful insoluble fibre that tends to help regardless of the cause. It has mucilage properties where it creates a film, soothes, protects and helps to heal the entire gastric system, modulating acid levels in the gut. It’s a wonder herb for the cupboard.
Deglycyrrhised licorice; this botanical and functional herb is a demulcent (or mucilaginous, the same as slippery elm). It enhances oesophageal and digestive mucosal protection and in powder or liquid form, can help soothe the oesophaegal and digestive lining. According to a 2014 study, DGL was shown to create extra mucus, acting as a barrier to acid in the stomach and oesophagus. This barrier may allow the damaged tissue to heal and prevent future occurrences of acid reflux. A 2018 study i humans, found it was more effective than acid-suppressive drugs used.
Probiotics; gut microbiota allows for a healthy ecology and functioning of the gut. We know from studies that good bacteria protects the gut mucosa, helps support immunity, aids the digestion of food and prevents bad bacteria and yeast (linked to reflux), in growing out of control. Although research doesn't show a direct correlation with supporting stomach acid, it does support general digestion and health.
Enzymes; can be a great addition to help reduce acid reflux symptoms, especially if there are food intolerances and allergies. Best used in conjunction with slippery elm and probiotics to cover all digestive bases.
Glutamine; maintaining the gut membrane integrity has shown in animal and clinical studies that glutamine deprivation leads to atrophy, mucosal ulcerations and possible disruption of acid production.
Magnesium: hypo motility (slow motility of the gut) can be caused by a nutritional deficiency of magnesium. Whilst this has only been studied in humans and sheep, I have found the same to be true for dogs (especially if they have anal gland issues and anxiety also). However, magnesium is also a muscle relaxant so giving to a dog who has a dysfunctional (relaxed) oesophageal sphincter can be counter productive. Caution should be taken.
In conclusion, a lot can be achieved naturally by addressing stress, looking at diet and considering supplements to help modulate acid production.
I hope this helped and please know we are here to help. If you are concerned or at a loss as to what to do, check out our consultation services.