Keeping stomach acid in the stomach
The root cause of GERD is actually a malfunctioning LES, not an excess of stomach acid (5).
By now, we’ve established that any amount of acid making its way up to the esophagus is bad. Unlike the stomach, the lining of the esophagus has no protection against acid.
If the LES is working properly, keeping acid in the stomach (and out of the esophagus), then digestion proceeds as normal. But if the doorway that separates the stomach from the sensitive esophagus—the LES—is malfunctioning, acid from the stomach gets back into the esophagus and damages its delicate lining.
So what causes the LES to malfunction? Let’s look at a few theories.
Bacterial overgrowth causes bloating & puts pressure on the LES
Low stomach acid (as seen in many adults with acid reflux) creates the perfect conditions for bacterial overgrowth.
Normally, stomach acid effectively inhibits bacterial overgrowth. The stomach has a pH of about 3 or less, making it quite acidic such that most bacteria can’t survive for more than several minutes. But when stomach acid is decreased, the overall pH of the stomach rises, and bacteria begin to proliferate.
Bacterial overgrowth as a result of low stomach acid then does two things:
- Restricts carbohydrate breakdown and absorption
- Creates a build up of gas
The resulting gas increases pressure against the LES which is the driving force behind acid reflux and GERD.
Increased pressure in the stomach causes LES malfunction and GERD
One review determined that bloating in the stomach, referred to as intra-abdominal pressure, is the primary mechanism responsible for GERD (6).
Other things can cause acid reflux stemming from bloating within the stomach, pushing gastric contents (including acid) past the LES and into the esophagus:
- Hiatal hernia
- Reclining after eating
- Eating spicy or fried (fatty) foods.
Newer studies also show that the damage from bacterial overgrowth and GERD overlaps with other digestive problems, like irritable bowel syndrome (IBS) (7).
Working on making diet changes but can’t quite reach your goals? Work with a qualified specialist for nutrition counseling.
Low stomach acid, bacterial infections, and GERD
Insufficient stomach acid also creates a host of problematic conditions, including fostering the exact environment necessary for bacterial infections, such as H. pylori, to take hold.
- pylori is the most common chronic bacterial pathogen in humans, and its prevalence rises with age, suppressing stomach acid secretion even further. In fact, this is how it survives in the stomach’s hostile acidic environment, which would normally kill all bacteria.
Researchers believe that initial infection with H. pylori can take place when the acidity level in the stomach is decreased, even if only temporarily.
All roads lead to GERD
To sum up, declining stomach acid initially causes heartburn symptoms, for which most people begin antacid medications, whether prescribed or over-the-counter. Further reducing stomach acid sets up conditions for bacterial overgrowth and H. pylori infection, which then causes chronic acid reflux and GERD.
Treating acid reflux and GERD with integrative medicine
Each person’s digestive function and microbiome are unique. Because of this, if you have chronic heartburn or acid reflux symptoms, it’s best to work with an integrative physician who can tailor functional solutions to your specific needs.
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In general, here are some guidelines to restore healthy acid levels in the stomach:
Reduce factors that decrease stomach acid and promote bacterial overgrowth
Limit certain carbohydrates such as FODMAPs, and high-fiber foods that can increase abdominal bloating. You may also want to avoid probiotic use for the time being.
Replenish enzymes that aid digestion and prompt gastric secretions
Your doctor can help you test your stomach acid levels, and provide guidance for supplements that can restore healthy gastric acid secretions, such as HCL with pepsin.
Re-establish beneficial bacteria and a healthy intestinal lining
Once stomach acid levels are on the rise, you can re-inoculate your digestive system with healthy bacteria from probiotic foods (or supplements), and prebiotic fiber. Bone broth, DGL, or glutamine supplements are also helpful to heal an inflamed intestinal lining.
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While antacids may provide temporary relief for acid reflux, they do nothing to address the root of the problem—which is often insufficient gastric acid. If you’re looking for a long-term solution to your heartburn and acid reflux woes, restoring healthy levels of stomach acid is key. There are a number of ways to do this, from dietary changes to supplements. We’ve outlined some simple tips that can help get your stomach acid levels back on track and banish those pesky heartburn symptoms.
If you find yourself needing extra support, don’t hesitate to reach out to a patient care coordinator so we can help you reach the optimal digestive health you deserve.