Acid Reflux, Heartburn & GERD

Acid reflux is the most common digestive disorder in the United States. The prevalence of Gastroesophageal Reflux Disease (GERD) is increasing steadily, but it is very likely underestimated because the availability of over-the-counter (OTC) antacids permits people to self-diagnose and self-medicate, without a doctor being aware of their condition.

The average person thinks, based on TV ads and their doctor, that heartburn, indigestion, acid reflux and GERD is caused by “too much stomach acid.” There’s a big problem with this theory.

Underlying Causes for GERD

Your symptoms are a warning sign that points to internal imbalance. Sluggish digestion, Candida overgrowth, toxin build-up and lifestyle factors such as poor diet, stress, inadequate sleep and obesity.

Low stomach acid permits small intestinal bacterial overgrowth (SIBO) and the incomplete digestion of carbohydrates increases intra-abdominal pressure (IAP - pressure in the stomach), causing the lower esophageal sphincter (LES) to malfunction, resulting in acid reflux, heartburn, indigestion and GERD. So lets look at each one of these factors individually.

Low stomach acid:
  • The incidence of heartburn, indigestion and GERD increases with age, but stomach acid production gradually declines with age. In fact, one third of the population past age 60 have atrophic gastritis, a condition marked by little to no acid secretion. By age 80, 40% of women produce no stomach acid at all. Age-related stomach acid decline is due to a loss of the cells that produce the acid.
  • When stomach acid is measured in people suffering from acid reflux, it is almost always low, not high. Very few people have excess stomach acid, except only a few rare conditions like Zollinger-Ellison syndrome. GERD is hardly ever associated with too much stomach acid. Clinicians have found that giving hydrochloric acid supplements to patients with heartburn, acid reflux, indigestion and GERD often cures their problem. If too much stomach acid was truly to blame, you would logically expect that taking more HCL would make it worse, but that isn’t the case.

SIBO: Stomach acid provides a two-way barrier that kills the harmful bacteria we consume and breathe, preventing live pathogens from entering the intestine, because most bacteria don’t survive a stomach pH of 2 or less. At the same time, stomach acid keeps intestinal bacteria from moving into the stomach and esophagus, where they can cause problems. It is a major defense mechanism of the body. When stomach acid is insufficient and pH rises above 3, bacteria are able to survive passage through the stomach, causing small intestinal bacterial overgrowth (SIBO), inflammation, and damage to the intestines. 71% of GERD patients test positive for IBS. The connection between GERD and IBS is bacterial overgrowth (SIBO) in the small intestine.
  • H. pylori is the most common chronic bacterial pathogen, occurring in more than 50% of the world population. Infection rates increase 1% with every year of life, so approximately 80% of 80 year olds are infected with H. pylori. H. pylori suppresses stomach acid secretion, which is how it survives the hostile acidic environment of the stomach that would ordinarily kill all bacteria. Eradicating H. pylori increases stomach acid secretion.

Fermented goat milk products like kefir and yogurt offer more benefits than beneficial bacteria alone, including minerals, vitamins, protein, amino acids, L-carnitine, fats, CLA, antimicrobial agents and assist in the eradication of H. pylori. Goat kefir and yogurt are therapeutic and may be well tolerated because goat milk is closest to human breast milk and therefore easier to digest, and the bacteria have already consumed and fermented the carbohydrates in the milk.

Carbohydrate malabsorption: When microbes in the intestines metabolize carbohydrates that haven’t been digested properly, the fermentation process produces gas. If 30g of carbohydrate escapes absorption in a day, it can produce more than 10 liters of hydrogen gas. To give you an idea how little that is, 4.2 g = 1 teaspoon. The gas increases intra-abdominal pressure, which is the driving force behind acid reflux and GERD.

Hydrogen gas is the preferred energy source for H. pylori and elevated levels of hydrogen gas are also associated with Salmonella, E. coli and Campylobacter jejuni, the leading cause of bacterial diarrhea illness in humans worldwide.

IAP: An increase in intra-abdominal pressure (IAP) triggers to GERD. Gastric distention (stomach bloating) pushes stomach contents, including acid, through the LES into the esophagus. Other things that can cause gastric distention include overeating, eating too fast, consuming complex combinations of foods, eating foods that are not biocompatible, posture and body position, spicy or fatty foods and obesity.

LES: The only time this valve is supposed to open wide is to permit swallowed food and liquids to pass easily into the stomach. If the lower esophageal valve (LES) is functioning properly, it doesn’t matter how much acid is in the stomach, because the valve will stay closed and prevent it from going into the stomach. With GERD, the LES is malfunctioning, so acid from the stomach gets into the esophagus and causes pain. You don’t have to have excess acid in the stomach to have heartburn. Any amount of acid in the esophagus is going to cause problems because the delicate lining isn’t protected against acid the way the stomach lining is. The question shouldn’t be, “How to reduce stomach acid secretion,” but “What causes LES to malfunction?”

GERD


The mainstream medical approach

Treating acid reflux, heartburn and GERD involves taking acid stopping drugs for a long as symptoms are present. When antacids were first introduced, it was recommended that they not be taken for more than six weeks. Clearly that prudent advice has been discarded, because people are taking them for months, years and many continue for the rest of their lives.

Unfortunately, not only do these drugs fail to address the underlying causes, but they make it worse. This is a serious issue because antacid medications, acid stopping drugs and proton-pump inhibitors (PPIs)
  • increase the risk of cancer is by inducing hypergastrinemia, a condition of above-normal secretion of the hormone gastrin. Taking a standard 20 mg Prilosec daily typically increases gastrin levels fourfold and when heartburn fails to respond to the standard dose, long-term treatment of doses as high as 40 mg has produced gastrin levels up to tenfold above normal. In a healthy stomach, ascorbic acid (vitamin C) is dependent upon a stomach pH of less than 4 to remove nitrite from gastric juice by converting it to nitric oxide. Since most acid stopping medications have no trouble increasing pH to 5 or higher, the elevated concentration of nitrites in gastric fluid can predispose to stomach cancer. Therefore, acid stopping medications can increase the risk of stomach cancer by two distinct mechanisms.
  • decrease extracellular levels of adenosine, resulting in increased inflammation in the digestive tract, thus predisposing users to developing serious inflammatory bowel disorders. Adenosine is a key mediator of inflammation in the digestive tract. High extracellular levels of adenosine suppress and resolve chronic inflammation in both Crohn’s and Ulcerative colitis.
  • promote bacterial overgrowth. 9/10 people treated with Prilosec for at least 3 months, which reduces HCL secretion in the stomach to near zero, developed significant bacterial overgrowth. A stomach without much acid is a perfect environment to harbor pathogenic bacteria. It’s dark, warm, moist, and full of nutrients. Most of the time these bacteria won’t kill us right away, but some of them can. People who have a gastric pH high enough to promote bacterial overgrowth are more vulnerable to serious bacterial infections, like Salmonella, Campylobacter, Cholera, Listeria, Giardia, and C. Difficile, which cause disease. We can expect that acid reducing drugs would worsen H. pylori infection and increase gastritis (inflammation of the stomach) and epithelial lesions in the corpus of the stomach in people infected with H. pylori. H. pylori infection significantly increases the risk of stomach cancer. H. pylori is the cause of 90% of duodenal (intestinal) and 65% of gastric ulcers.
  • actually make the underlying condition (not enough stomach acid) worse, making the lifelong use of these medications necessary for anyone who takes them.

Low stomach acid is associated with a wide range of serious disorders that go beyond the stomach and esophagus. They include:
■ Allergies
■ Bronchial asthma
■ Depression, anxiety, mood disorders
■ Pernicious anemia
■ Skin diseases, including forms of acne, dermatitis, eczema, and urticaria
■ Stomach cancer
■ Gallbladder disease (gallstones)
■ Rheumatoid arthritis, Lupus and Graves disease
■ Irritable bowel syndrome (IBS), Crohn’s disease (CD), Ulcerative colitis (UC)
■ Chronic hepatitis
■ Osteoporosis
■ Diabetes

Hydrochloric acid is absolutely essential for the breakdown and absorption of nutrients which occurs within a narrow range of acidity in the stomach. As stomach acid declines and the pH of the stomach increases, the normal chemical reactions required to absorb nutrients is impaired. Decades of research have confirmed that low stomach acid – whether it occurs on its own or as a result of using drugs – reduces absorption of several key nutrients such as iron, B12, folate, calcium and zinc.

  • Zinc is one ingredient the body needs to make HCL. Zinc takes part in several metabolic processes related to keeping cell membranes stable, forming new bone, immune defense, night vision, and tissue growth. In a controlled study, Tagamet and Pepcid raised intragastric pH to over 5 and reduced zinc absorption by 50%.
  • Iron deficiency causes chronic anemia, which means that the body’s tissues are literally starving for oxygen. 80 percent with chronic iron deficiency anemia were found to have below normal acid secretion. Supplementing hydrochloric acid has improved iron absorption in patients with achlorydia (no stomach acid production). Iron-deficiency anemia is a well-known consequence of surgical procedures that remove the regions of the stomach where acid is produced.
  • Vitamin B12 (cobalamin) is needed for normal nerve activity and brain function. B12 enters the body bound to animal-derived proteins. In order for use to absorb it, the vitamin molecules must first be separated from these proteins with the help of – you guessed it – stomach acid. If stomach acid is low, B12 can’t be separated from its carrier proteins and thus won’t be absorbed. In one study of 359 people aged 70-80 years with serious atrophic gastritis, a disease characterized by low stomach acid, more than 50 percent had low vitamin B12 levels.
  • Among other things, folate (folic acid) is vital for keeping the cardiovascular system healthy and for preventing certain birth defects. Low stomach acid levels can interfere with folate absorption by raising the pH in the small intestine. At the same time, when folate is given to achlorydric patients (with no stomach acid) along with an HCL supplement, absorption of the vitamin increases 54%.
  • Calcium makes our bones and teeth strong and is responsible for thousands of other functions in our body. Stomach acid make calcium absorption possible. When HCL supplements are given, calcium absorption increases five-fold. I have experienced every bit of this and lived it out in my own body for more than a decade before I found the correct information (not misinformation), understood and applied it.
  • The absorption of any nutrient that is bound to protein will be inhibited, including vitamin A, vitamin E, thiamine (vitamin B1), riboflavin (vitamin B2), and niacin (vitamin B3).
  • Many essential amino acids (we cannot manufacture them in our bodies, so must get them from food) play a crucial role in mental and behavioral health.Stomach acid breaks protein down into individual amino acids, such as Tyrosine (and its precursor phenylalanine) which are precursors of the neurotransmitters dopamine, epinephrine and norepinephrine, and Tryptophan which is a precursor of the neurotransmitter serotonin. Low stomach acid causes mal-digestion of protein which leads impaired amino acid metabolism and deficiency of essential amino acids, resulting in chronic depression, anxiety, and insomnia. It is therefore understandable why acid suppressing drugs have mental health links to depression or mood disorders. At the same time, proteins that escape digestion by pepsin end up in the bloodstream and cause an immune reaction (food allergies). You can only be allergic to proteins that have not been completely broken down.
  • If the food leaving the stomach isn’t the correct pH, meaning not sufficiently acidified, it will not trigger the gallbladder to release bile. If bile is not properly secreted, it can build-up in the gallbladder and become more and more concentrated, increasing the risk of gallstones. A typical symptom of decreased bile excretion is difficulty digesting fats.

The chemistry of digestion: We can eat the most nutritious diet imaginable, packed with vitamins, minerals and other essential nutrients, but if we aren’t absorbing those nutrients we won’t benefit from them.

80% of carbohydrate digestion occurs in the mouth by the release of pancreatic enzymes being thoroughly mixed with the food while chewing. Carbohydrates (plant foods) require an alkaline environment to be properly digested. Protein (like animal meats) requires an acidic environment to completely break amino acid links. Alkaline and acid cannot coexist at the same time.

When receptors in the mouth detect the presence of protein, they inform the stomach to start making HCL. Stomach acid (HCL) triggers the production of pepsin, which is the enzyme required to digest protein. If HCL levels are depressed, so are pepsin levels. Low HCL and pepsin levels are not adequate to completely break down proteins into their component amino acids and peptides. Since this is not supposed to happen, the body reacts to these proteins as if they were foreign invaders, causing allergic and autoimmune responses.

Protein digestion takes precedence at a pH of 1.6. When alkaline foods are part of the mixture, it raises the pH above 2, so that neither gets broken down properly. When carbohydrate foods are consumed in excess and/or not completely digested, they become food for pathogenic microbes in the intestines. This is the cause of ‘food allergies’, it's not necessarily the food. You can only be allergic to incompletely digested / broken down proteins.

Poor digestion can be caused by eating too fast, not being present with the food, eating foods that are not biocompatible and/or consuming complex combinations of foods, as described above.

Cure

Temporary relief from symptoms doesn’t imply that the underlying causes of the problem have been addressed or that healing is taking place. Western medicine focuses on suppressing symptoms without giving attention to the cause. Curing disease means eliminating the cause. When a disease is cured, the symptoms don’t return once treatment is discontinued. Curing isn’t profitable for drug companies, so they create lifelong customers.

The damage from poor stomach function and GERD not only extends upward to the sensitive esophageal lining, but also downward through the digestive tract, contributing to other digestive disorders, malnutrition, disease conditions and cancer. The pharmaceutical companies have always been aware of these risks. The last thing they want is for doctors and their patients to learn how to treat acid reflux, heartburn, indigestion and GERD without drugs. Acid suppressing drugs perpetuate and exacerbate these conditions which creates a vicious cycle. There is something very wrong with a healthcare system that administers medications which actually contribute to the conditions they’re supposed to relieve. What is especially disturbing about this is that these symptoms are easily prevented and cured by making simple dietary and lifestyle changes.

The best treatment for acid reflux is NO treatment. When foods are consumed in a way that works with the
chemistry of digestion so that proteins are completely digested and assimilated, and carbohydrates are properly broken down into glucose and rapidly absorbed in the small intestine before they can be fermented by microbes, and the gut micro-biome is restored to a healthy balance, then the root cause has been addressed and symptoms stop.

In summary

Low stomach acid contributes to bacterial overgrowth in the bowel and the incomplete digestion of carbohydrates caused by overconsumption, pancreatic insufficiency and/or improper food combining, feeds microbes in the gut which increases intra-abdominal pressure (pressure in the stomach), causing the lower LES to malfunction, resulting in acid reflux, heartburn, indigestion and GERD. So you can clearly see that reducing stomach acid is not the answer.

My personal experience has proven this to be true also. Due to severe nutritional deficiencies and the resulting rapidly declining health, I stopped making HCL in my mid-30’s. I never had heartburn before that! I’ve been taking hydrochloric acid with protein meals ever since, and have not had it recur since. In my private practice, every client with acid reflux has been initially doubtful, but responded well to HCL supplementation. The opposite would be expected if the true cause of these conditions was too much stomach acid.

Other things that produce the symptoms associated with GERD
Some medications irritate the esophagus directly and produce pain similar to heartburn.
Iron supplements and antibiotics, such as tetracycline, are known for being hard on the stomach.
Pain relievers like aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve) are hard on the esophagus and stomach.
Bisphosphonates, such as alendronate (Fosamax), ibandronate (Boniva) and risedronate (Actonel), can upset the stomach and cause esophageal erosions.
Potassium supplements for blood pressure regulation can irritate the esophagus.
Some medications relax the LES valve allowing reflux to occur.
Blood pressure drugs like calcium channel blockers and beta blockers work by relaxing the blood vessels, but also relax LES.
Sleeping pills and sedatives (benzodiazepines such as diazepam (Valium) and temazepam (Restoril)) help you relax, but also relax the LES.
Asthma medications, such as theophylline (Elixophyllin, Theochron), work by relaxing the muscles of the airway, but they can also relax the LES.
Narcotics (such as morphine and oxycontin).
Certain antidepressants (such as imipramine or amitriptyline) act as muscle relaxants and can delay gastric emptying.
Anticholinergics, such as oxybutynin (Ditropan) and promethazine (Phenergan), are prescribed for nausea, overactive bladder, and irritable bowel syndrome.

Various foods and beverages that increase gastric acidity are said to increase acid reflux, but we have already seen how too much acid is not the problem. It is very likely that the foods blamed for increasing acid reflux may be bio-incompatible and the inflammation they create is causing increased gastric pressure. However, caffeine, alcohol, eating large meals, anything that slows gastric emptying, resulting in increased gastric pressure. Certain probiotics have been said to make GERD worse.

I hope this article has been helpful to you. If you need more information or have questions, please don't hesitate to email johnna@wholefamilyhealthandnutrition.com to schedule your free introductory consultation. I look forward to meeting you!