Some time back after a talk I did on digestive health at the International School Manila I was approached by a fellow mom who told me she had been suffering from acid reflux for over a year. Besides daily discomfort it was affecting her on several levels. She didn’t have much of an appetite, her energy levels were low and she wasn’t sleeping very well. After one year of trying everything possible, including over the counter antacids, essential oils, Proton Pump Inhibitors (more on those later) and homeopathic remedies she was clearly frustrated.
Eliminating some common acid reflux trigger foods from her diet, like coffee, citrus and chocolate as well as dairy and gluten, had helped a bit but despite all these interventions she had not been able to fully resolve her symptoms and she asked what I thought could be the underlying problem.
Acid reflux or indigestion is something almost everyone experiences from time to time. For most people it shows up as an occasional burning sensation also known as heartburn in the lower chest area or throat. The burning sensation, which can be accompanied by a sour or bitter taste in your mouth, is the result of acidic stomach contents that flow back up into the esophagus. Acid reflux can happen to anyone, often as a result of overeating but when you experience it frequently or more than twice a week it is considered Gastroesophageal reflux disease (GERD).
Imagine the discomfort of acidity and indigestion and experiencing it almost daily. And yet, it is one of the most common digestive disorders. In the U.S. it has been estimated to affect 20 – 30% of the population. Chronic and frequent reflux can, besides the discomfort, potentially cause whole host of additional issues such as persistent cough, disrupted sleep, nausea, throat problems, difficulty swallowing, chest pain, dental erosion and bad breath. Without treatment it can cause serious complications in the long run.
When it comes to the topic of chronic reflux and how it relates to stomach acid (aka hydrochloric acid or HCL), I have a thing or two to say. Partly because of personal experience but also because many years of studying the topic of digestive health has made it clear that the conventional way of treating persistent acid reflux is often misguided.
This is how I explained it to my client: the common explanation for acid reflux is that there is too much acid in the stomach. By taking an antacid or acid blocker medication to reduce the level of stomach acid you are usually able to temporarily resolve the discomfort, which may look like proof that indeed there was too much acid.
However, often the real problem is exactly the opposite: rather than too much, there is not enough acid production in the stomach. And if this sounds like a stretch, consider that studies have shown that stomach acid secretion goes down with age, yet the risk of GERD increases with age. Chris Kresser, M.S. L.Ac, globally recognized leader in the field of functional and integrative medicine says this: “If heartburn were caused by too much stomach acid, we’d have a bunch of teenagers popping Rolaids instead of elderly folks. But of course that is the opposite of what we see.”
What is often going on instead is that this low level of stomach acid causes the lower esophageal sphincter (LES), which is the “gate” between the esophagus and stomach to malfunction. The LES normally opens up only when food has to move down into the stomach or when gas has to find its way out, by way of burping. When the LES is malfunctioning and there is bloating in the stomach, the resulting increase in intra abdominal pressure can cause the stomach content including acid (even if it is of a lower level) to be pushed upwards into the esophagus. The bloating can be a result of maldigestion of carbohydrates, which I will explain later.
Suppressing stomach acid levels on an on-going basis does not deal with the underlying problem in this case. It actually makes it worse. *
In this editorial published in the journal Gastroenterology, the authors state the following: “Treating gastroesophageal reflux disease with profound acid inhibition will never be ideal because acid secretion is not the primary underlying defect. (…) The pathophysiology of acid reflux concerns the dysfunction of the gastroesophageal barrier and research needs to refocus on ways of restoring its competence rather than merely suppressing gastric acid secretion.”
Food for thought!
Stay tuned for part 2 of “Acid Reflux: A Root Cause Approach” where I will explain why low stomach acid can be the cause of many health and digestive issues, what causes low stomach acid levels and what to do about all of it.
Be well.
* Important note: My purpose is to educate and shed light on some common misconceptions regarding acid reflux and some of its underlying causes but please note that there are definitely situations where intervention with acid reducing or acid blocking medication is required. If you are on prescription medication or you are dealing with a medical diagnosis such as Zollinger-Ellison syndrome, peptic ulcers or esophagitis you need to consult with your doctor before making any changes in diet, medication or otherwise.
