Causes of Acid Reflux – Low Stomach Acid
This 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:
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.
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