This has been one of my biggest health issues for most of my life. Every visit to the doctor resulted in a prescription for antacid medication. Once I started looking deeper I found that there is actually an epidemic proportion of people now taking acid blockers or antacid tablets all over the world. I thought this can’t be right, I can’t believe there are billions of people out there with excessive stomach acid. So I dug deeper and discovered many causes and it all came back to the microbiome.
I have now mostly resolved the issues through educating myself and changing my diet. You can do the same by reading my articles on Gut Health and adapting changes in your lifestyle to improve your reflux.
What is Acid Reflux?
Acid Reflux, GERDS, Heartburn, call it what you like if you have experienced it, you will know that familiar burning sensation in your chest. Acid and/or contents of stomach are moved upwards through the sphincter (the valve that separates the esophagus and the stomach) into the esophagus causing various symptoms such as heartburn, sour taste in the throat, regurgitation without nausea along with atypical symptoms, feeling of a lump in their throat, asthma, hoarse voice. However, by far the most common symptom is heartburn.
We should not be aware of any stomach acid regardless of how much you have due to this protective lining. We make about 2L of SA a day. Without this mucus lining, the stomach itself can become inflamed and the neurological system of the stomach malfunctions and causing the stomach not to empty properly, the sphincter to malfunction ultimately resulting in reflux.
Some of this impact can manifest as a nutrient deficiency. Magnesium is a critical nutrient for part of the stimulatory effect of causing stomach acid to be released. Something as simple as a magnesium or zinc deficiency can have an impact on stomach acid production. Histamine is also involved with triggering stomach acid production so prolonged or overuse of Antihistamine medication can have an impact as well.
What causes acid reflux?
There is a debate on the causes of Acid Reflux. One of the hypothesis is “hypo functioning” where you are not digesting food well enough. If you are not digesting well because you lack digestion enzyme function or stomach acid HCL, the contents of your meal are going to push up, creating pressure on the sphincter and you will feel that burning sensation.
There can also be a lack of patency, meaning a flimsiness in the lower esophageal sphincter, it’s not strong enough to stay closed and therefore resist the flow of stomach contents coming back up the esophagus.
Another possible cause of reflux problems is a bacteria called H. Pylori. H. Pylori can burrow itself into the gastric lining causing irritation and inflammation of the gastric lining itself. This can result in heartburn, reflux and ulcers. H. Pylori is a very smart and adaptive microbe and has mechanisms within the bacteria to shut down stomach acid production so that it can increase its own survival. This can result in Hypochlorhydria (a deficiency of stomach acid), manifesting all the symptoms downstream from that – inability to digest protein, absorb minerals, release pancreatic enzymes, bile from the gallbladder and affecting the gut microbiome and more likelihood to develop SIBO because you don’t have enough acid to kill off the bacteria.
Are you constipated? This is a very under considered cause of reflux in my opinion. If you are constipated, this can have a huge knock on effect on your digestive system and cause no end of problems including acid reflux. You can read more about constipation here.
Stress & Reflux
As with most other things, stress plays a huge role in causing Acid Reflux. Stress can cause the stomach to stop digesting food properly leaving it to ferment and pushing up through the sphincter.
Stress also has an impact on the Vagus nerve. Anxiety affects Vagal Tone, the firing of the vagus nerve that controls a whole bunch of processes including stomach acid secretion. So when you are under high stress or anxious, you’re in a state which will deactivate that vagus nerve, leading to low secretion of stomach acid which you need in order to digest food.
There is a link between anxiety and reflux and it involves the parasympathetic and the sympathetic nervous systems. These are part of the autonomic or automatic nervous system. This nervous system that controls the different functions of our body that we never think about. We don’t think about peristalsis the movement of the muscles in our GI tract controlling the movement of food through our tract.
It turns out that our emotions are heavily linked to the neurological stimulation and function of our enteric nervous system. When you have a stress reaction (which is really what happens when you have chronic anxiety) there is an up regulation of the sympathetic part of the autonomic nervous system and this has an impact on how the GI tract is functioning by decreasing stomach emptying.
If you think of a situation where at any moment you might be attacked by a wild animal, the last thing your body needs is to focus on digestion. It is not the priority, in this situation the priority is survival – run or fight. So the body slows the motility of the stomach. This impacts the Migrating Motor Complex (MMC), not moving food through the GI tract, the stomach is not emptying properly, thus the sphincter muscle is more relaxed because you are not having the proper tone to the stomach. All these have an influence on gastric reflux. There are studies showing that the more anxiety we have the more reflux we have.
Finally, we can say that one cause of reflux is anxiety but also anxiety is caused by reflux. Ultimately, the root cause of this problem is connected to the damage to your gut microbiome and here we go full circle again!
Quite commonly in modern medicine this is all seen as the excess production of stomach acid and prescription of PPI (proton pump inhibitors) or other acid inhibitor medication are given. These work by shutting down the mechanism that produces stomach acid. They reduce approximately 95% of stomach acid production. As we have discussed previously, stomach acid is essential for overall health (especially killing unwanted bacteria that enters the body through the mouth). Other medications such as over the counter antacids are used all the time, we eat really large meals, plus foods that have a detrimental effect on the stomach and the GI tract which in turn compounds the problem of acid reflux.
Patients are often told to double the dose if symptoms persist and although these medications are extremely effective at reducing stomach acid production, it has no effect on the Lower Esophageal sphincter, even actually preventing it from closing. You will never get the benefit of stopping reflux with these drugs because it doesn’t change the reflux and its root cause. After stopping these drugs, the symptoms of reflux are often exacerbated.
Taking PPIs long term can have a devastating effect on the microbiome. People who have been taking PPIs for years show signs of osteoporosis, auto immune disease, chronic fatigue syndrome to name just a few. They also show signs of bacterial overgrowth which can perpetuate the problems of a dysfunctional small intestine.
Resolving acid reflux takes time. It’s never one size fits all. You need to establish your root cause and then make changes to your diet to improve the overall health of your digestive tract. Here are some tips:-
- Stopping caffeine and alcohol
- Taking a fiber supplement, better still moving to a plant based diet to get plant fiber.
- Changing to a mediterranean diet
- Sleep studies show that good sleep improves acid reflux
- Reduce stress levels
- Use bitters to fire up your digestion
- Help heal your gastric lining by using natural therapeutics like Bismuth, Aloe and Licorice Root
- Add fermented foods to your diet (very slowly, small amounts)
Once you have made changes then over a period of time you can start to reduce your antacid or PPI inhibitors very gradually, under the supervision of your Doctor (1).
(1) – Note I am not a doctor or any other medically trained person and you should never suddenly stop taking your medication without consulting your doctor. This information is purely for informational purposes based on my own experience with suffering from life long problems with GERDS.