Causes of Acid Reflux – Low Stomach Acid

Causes of Acid Reflux – Low Stomach Acid

causes of acid refluxThis may sound completely counter intuitive, but there is a significant body of opinion, and a smaller body of hard research, which maintains that one of the causes of acid reflux is too little stomach acid, not too much. I’ll give a brief explanation of this here.

According to Chris Kresser (see reference below), low stomach acid causes acid reflux in two ways: firstly, by providing an environment for bacterial overgrowth, and secondly by leading to carbohydrates being poorly broken down and consequently not absorbed by the intestine. As a result, the gases produced by the bacteria in both cases leads to higher Intra-abdominal pressure (IAP), causing the Lower Esophogeal Sphincter (LES) to release acid into the esophagus. It’s widely believed that the LES releases stomach acid into the esophagus (and therefore causing acid reflux or heartburn) as a result of extra pressure from the stomach – this theory assumes this pressure is caused by internal factors – ie bacteria – or external factors, such as obesity, tight trousers etc.

Another theory is that acid reflux and heartburn are caused by the lower esophageal sphincter remaining open because the acid in the stomach is too weak to trigger its closure. Here’s a video explaining the phenomenon:

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If this is true – ie acid reflux is caused by low stomach acid – it means that the drugs which turn down the production of stomach acid – lanzaprozole, omeprazole, prilosec and other acid suppressing drugs – are in fact making the problem worse.

There is a small number of clinical trials backing up both parts of the theory, and there is support from the evidence showing that stomach acid production declines with age, but the incidence of gerd increases with age. My reading of it suggests to me that, yes, this could apply to certain individuals, but does that include me? The only way to to answer that question is to assume it’s true and give the suggested antidotes a try – to take acid supplements and/or reduce the bacteria overgrowth.

I’ll cover reducing the bacterial overgrowth in another post, but here I’ll describe taking acid supplements. I started taking apple cider vinegar (I, and quite a few others, recommend this brand: for the US –  here, for the UK – here – a widely recommended remedy for heartburn – with meals, as suggested, a tablespoon in a glass of water.

Unfortunately it seemed to worsen my symptoms in the long run; I tried on several occasions, but to no avail.

In spite of this lack of success, I began taking the HCL plus Pepsin, again recommended to increase the amount of acid in the stomach. I initially experienced a worsening of the burning sensation in my throat, but this improved, and overall it seemed to improve my symptoms.

I would recommend reading  Why Stomach Acid Is Good for You: Natural Relief from Heartburn, Indigestion, Reflux and GERD (UK  here),and Heartburn Cured: The Low Carb Miracle (UK here) by Dr. Norm Robillard .

For a more detailed explanation of the problems with low stomach acid, go read Chris Kresser, ref 1 below.

Have you taken acid supplements for your gerd? Give me your feedback, or let me have your comments below.

References: 1


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3 thoughts on “Causes of Acid Reflux – Low Stomach Acid

  1. Pingback: > Heartburn & Gerd / Gord News Roundup - Causes of Acid Reflux, Salt & Heartburn, New Surgical Technique - How To Get Rid of Acid Reflux

  2. Barbara

    My compliments on your website — well written, concise and concepts clearly yet simply explained!

    Over the past 3 years I have developed Ileocecal Valve Syndrome, then SIBO, IBS-C (methane tested very high on breath test), functional dyspepsia (which seems to be a milder version of full-blown gastroparesis) and most recently LPR (no more lemonade and kombucha tea for me ;-|).
    I’m modifying diet per Koufman / Aviv / Robillard.

    I am in the camp that believes low stomach (among other factors) causes LES to open when not supposed to, and is likely a contributing factor to stomach contents emptying too slowly through pyloric valve into small intestines.

    Digestively, I’m the perfect candidate to trial Betaine Hcl with Pepsin, BUT am afraid to take it, because I have [1] eosinophilic esophagitis and [2] two benign congenital esophageal strictures that narrow to 1/4 inch . One at very top of esophagus, the other at very bottom (picture a long thin balloon with knots at each end). I cannot swallow tabs or caps whole and mostly eat soft / pureed food. With capsule supplements, I pull apart and mix powder with food or drink.

    Having LPR with dietary acid being one of my worst triggers, I obviously dare not mix betaine Hcl with Pepsin with food! I take either DGL or digestive bitters before meals, chewable digestive enzymes (no pepsin) with meals, and Iberogast (herbal prokinetic to gently encourage faster stomach emptying) at the end of meals. In between meals I use ginger tea, alkaline water, Manuka honey (10+ or 15+).

    After a lot of searching, I have found a product that is Betaine Hcl WITHOUT Pepsin, but have not yet ordered it. Further research on Wikipedia shows Betaine Hcl / TMG has pH of 1.84, so I would clearly have to mix with quite a bit of food to avoid the direct acid hit.

    I have made such good progress the last 2 months healing LPR with low acid / lower fat diet and avoiding other dietary triggers that I don’t want to do anything to reactivate the pepsin.

    I understand the Betaine Hcl protocol and have my functional medicine practitioner’s blessing to try it.
    Any thoughts or insight on safely taking Betaine Hcl / TMG without triggering LPR symptoms would be kindly appreciated!

    1. Post author

      Hi Barbara
      Many thanks for your comments. I’m sorry to hear about your conditions. Unfortunately I’m unable to advise on specific situations. I suppose I’m lucky enough not to suffer from LPR, so I can’t even comment from my own point of view. Perhaps you could post a query on the Facebook and / or forum sites which abound. I suspect, though, that given the amount of research you’ve already undertaken, you’re already aware of these and have already tried that route?


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