We eat to live. Our bodies rely on nutrients from food to produce the energy needed to sustain life and good health. And let’s face it — for most people, eating is simply an enjoyable experience.
But what if eating is painful?
This is the reality for millions of Americans living with acid reflux or gastroesophageal reflux disease (GERD). Despite being one of the most common digestive disorders in the United States, acid reflux is often misunderstood.
In this article, we’ll discuss what acid reflux is, the prevailing theory behind its cause, and what you can do to manage it effectively.
What is Acid Reflux?
Acid reflux or gastroesophageal reflux (GER) is the regurgitation of stomach juices or contents into your esophagus. It can affect people of all ages, including infants.
Although many people use the terms acid reflux and GERD interchangeably, they refer to different – but closely related – conditions. Many people can experience occasional acid reflux and treat it with over-the-counter medications without a problem.
But acid reflux can sometimes progress to GERD, a chronic gastrointestinal (GI) disorder with more frequent and severe symptoms. Without treatment, GERD can lead to serious complications, including inflammation of the esophagus.1
According to one recent review, approximately 20% of American adults live with GERD.2 But the true prevalence could be much higher – many people have access to over-the-counter acid-reducing medications. This allows patients to self-medicate rather than report to a healthcare professional.
Common Symptoms of Acid Reflux
- Heartburn — a painful, burning feeling in the stomach or chest area. The sensation rises from your breastbone toward your throat.
- Regurgitation — a sense of stomach contents coming back up into your throat or mouth, often described as a sour taste in your mouth
- Chest pain
- Abdominal pain
- Problems swallowing or pain while swallowing
- Bloating, belching
- Chronic cough
- Sore throat or hoarseness
- Wheezing, especially at night
- Excess saliva
Before delving into the theories behind the causes of acid reflux and GERD, let’s briefly discuss the digestion process.
Your GI tract is essentially a long tube that begins at your mouth and ends at your anus. While it appears simple from the outside, digestion is a highly complex process that involves multiple organs, enzymes, nerves, and hormones. All of these players transform what you eat into fuel for your cells.
Your brain is much more than a silent observer – it can be argued that digestion starts here. Can you recall a time when just the thought of your favorite dessert caused your mouth to start watering? The sight, smell, or taste of food encourages salivation and gastric activity, gearing up the body to receive food. Experts call this the cephalic phase of digestion.5
Once food enters your mouth, it’s processed both chemically and mechanically. Your teeth break it down into smaller pieces, and enzymes in your saliva create a mixture that is easier for you to swallow called a bolus.6,7
At the end of your esophagus is the lower esophageal sphincter (LES), a bundle of muscles that relaxes to allow the bolus to pass through to your stomach. This valve protects your esophagus from your stomach acids and prevents your stomach’s contents from flowing back up.10,11
Once the bolus reaches your stomach, it mixes with the digestive juices. This is also where the chemical breakdown of proteins begins. Your stomach then empties its contents – called chyme – into your small intestine.12,13
Most of the nutrient absorption occurs in your small intestine. The digestive juices from your pancreas, liver, and intestine mix with the chyme for further breakdown. The nutrients are then absorbed through the walls of your small intestine and into your bloodstream.14,15
Undigested parts of food, fluid, and other waste products are moved into the large intestine. Your large intestine absorbs residual water, electrolytes, and vitamins. Other waste products are formed into feces, which are then propelled toward the rectum and eliminated from your body.16,17
The Importance of Stomach Acid
For your stomach acid – or gastric acid – to break down, digest, and absorb nutrients from food, it needs to be quite acidic.
The acidity of a liquid is measured using a pH scale. The range spans from 0 (most acidic) to 14 (most basic). For reference, water has a pH of 7.0, or neutral.
So how acidic is your stomach acid?
The pH of human stomach acid is 1.5 to 2.0, making it much lower than most animals.18 In other words, your stomach acid is highly acidic.
This high acidity is critically important for your health, accomplishing such stellar feats as:
- Protection against microorganisms: Harmful bacteria and yeast can enter your body through the food you eat. If they’re not destroyed, they may cause digestive upsets or disturb the balance of your gut microbiome. A review of 26 observational studies found that acid suppressants increased the risk of colonization in the intestines by multidrug-resistant microorganisms.19
- Absorption of vitamin B12: The acidity of your stomach acid promotes the extraction of vitamin B12 from food, which allows it to be absorbed. Vitamin B12 deficiency can result from stomach acid inhibitors, with symptoms like mouth ulcers, irritability, depression, and disturbed vision.20,21
- Absorption of certain minerals: In addition to vitamin B12, your stomach acid plays an important role in the absorption of iron, magnesium, and zinc.22,23 Long-term deficiency in these minerals can have a serious impact on your health.
- Regulation of pyloric sphincter activity: Hydrochloric acid, a component of your stomach acid, is largely responsible for the low pH. It also regulates the relaxation of your pyloric sphincter, a small band of muscles that allows the chyme to pass into your small intestine.24
- Activation of pepsin: The low pH of your stomach acid breaks down pepsinogen, a substance secreted by the cells of your stomach wall, into pepsin. This enzyme breaks down dietary proteins that reach your stomach into amino acids.25
In short, keeping your stomach acid pH at a low level is critical for optimal digestion and absorption of nutrients.
What Causes Acid Reflux?
A popular belief is that acid reflux is caused by too much stomach acid. According to this theory, the discomfort from excess stomach acid can be neutralized by antacids like Tums.
But there’s a problem. Stomach secretions decrease with age, but the incidence of acid reflux and GERD increase with age.26
In other words, the evidence shows the complete opposite.
Acid reflux isn’t caused by having too much stomach acid or having it be too acidic. Rather, acid reflux and GERD are caused by having acid in the wrong location.
So what contributes to acid reflux and GERD? Researchers so far have been unable to pinpoint an exact cause, but we do know that there are various mechanisms involved.
Lower Esophageal Sphincter Dysfunction
One potential cause of acid reflux is the dysfunction of LES, the ring of muscle that protects your esophagus from your stomach acid.
If your LES is working properly, the only time LES should relax is when food is passing through or when you belch.
Some studies indicate that patients with GERD have frequent LES relaxations that aren’t triggered by food passing through. This causes the pressure in your stomach to exceed that of your esophagus, and the contents of your stomach can flow back into your esophagus.27
Your esophagus isn’t designed to handle such acidic conditions. As a result, even small amounts of acid can cause discomfort.
So what would cause such frequent LES relaxation? A few known causes of LES dysfunction include:28
- Certain foods (ex: chocolate, coffee, mints, sugar, onion, etc.)
- Excess weight in middle section
- Many medications (ex: albuterol, calcium channel blockers, beta blockers, benzodiazepines, some narcotics)
- Increases in intra-abdominal pressure
- Gravity (lying down immediately after eating)
- Hiatal hernia
- Autonomic dysfunction mediated via the vagus nerve
Another factor that may contribute to acid reflux is achlorhydria. Achlorhydria is the scientific term for the inability to produce stomach acid.
Low stomach acid reduces your ability to inhibit bacterial overgrowth, leading to conditions that allow certain bacteria like Helicobacter pylori to thrive.29
Research has also shown that the use of antacids promote bacterial overgrowth. In one trial, 30 patients with GERD were treated with 40 mg of Prilosec (omeprazole) for at least 3 months. Eleven of the 30 patients had bacterial overgrowth compared to just one of the 10 control group patients.30
Reduced stomach acid also affects downstream nutrient breakdown and absorption. Hydrochloric acid triggers the release of cholecystokinin, which in turn stimulates pancreatic enzyme release into the small intestine.31 Some experts believe that the resulting poor digestion from the lack of digestive enzymes can lead to disturbances in gastric emptying and abdominal pain.32
Causes of achlorhydria include the following:33
- Autoimmune gastritis
- Medications (proton-pump inhibitors, acid blockers)
- Certain bacteria (ex: Helicobacter pylori)
- Severe iron deficiency
- Certain types of cancer
How do you know if you have low levels of stomach acid? In our clinic, we often see the following symptoms associated with achlorhydria:
- Depression or anxiety
- Brain fog
- GI distress with meals
- Brittle nails
- Hair loss
- Autoimmune issues
Testing for achlorhydria isn’t easy. Traditional methods are invasive and uncomfortable for the patient. But certain supplements may be able to help you determine if you have low stomach acid. We’ll discuss our recommended supplements below.
Conventional Treatments for Acid Reflux
Conventional treatments for acid reflux do nothing to fix the root cause of the problem and can even be harmful to your digestion. Yet Americans spend billions of dollars on these over-the-counter medications.
Many of those drugs act by neutralizing excess hydrochloric acid in your stomach juice and blocking pepsin activity. Studies have shown that antacids can increase your stomach pH from 1.5 to 3.5. Such an increase can reduce the concentration of stomach acid by 100-fold.34 This is not a good thing as proper digestion depends on an adequate amount of stomach acid to break down your food.
These drugs also don’t do anything to prevent stomach acid from being regurgitated into your esophagus. And their long-term use can increase your risk of certain diseases, such as esophageal cancer.35
The MaxWell Approach to Treating Acid Reflux
At MaxWell Clinic, we take a holistic approach to treating acid reflux. Your clinician will get to know you, your symptoms, and your history before prescribing a treatment plan for you. Here are a few tips we often recommend to our patients to support natural stomach acidity.
- Eat smaller portions. Instead of eating 3 large meals a day, try to eat five or six smaller meals.
- Take time to eat your meal, chewing it well before swallowing. Wolfing down your food puts more pressure on the LES.
- Remain upright after eating. Lying down right after a meal puts pressure on your abdomen, causing your stomach acid to rise into your esophagus.
- Avoid or reduce foods that relax LES. These include alcohol, coffee, mint, garlic, onions, and fatty or spicy foods.
- Stop smoking. A study of 141 patients with GERD found that those who quit smoking reported improvements in their symptoms.36
- Lose weight. Weight gain is an important risk factor for GERD. In a study of 332 adults with GERD, weight loss was found to be correlated with a significant reduction in symptoms.37
- Elevate the head of your bed. Sleeping with your head elevated can help keep your stomach acid from entering your esophagus. Some studies show reductions in GERD symptoms using this method.38
- Slow down. Remember to pause, relax, and breathe before eating your meal. Try to remove yourself from any potential stressors, like work activities.
These simple lifestyle changes can help manage your acid reflux symptoms. Beyond these tips, supplements can be helpful in supporting your digestion. However, we highly recommend working with your MaxWell practitioner to ensure your success.
Our supplement recommendations for acid reflux often include:
- TumEZ: A zinc-carnosine complex that safely and effectively supports your stomach’s natural self-protective mechanisms without interfering with the digestive process.
- LicoCool: A blend of four specialized ingredients for enhanced gastrointestinal support. It contains a concentrated extract of licorice, which has a laxative and soothing effect.
- GastrAcid: This formula is our preferred method of assessing whether you have low levels of stomach acid. It provides hydrochloric acid and other factors to help maintain gastric pH and promote healthy digestion. If low stomach acid production is suspected, this is a non-invasive way to replace what you may be missing.
- Digestive NRG: A broad-spectrum digestive enzyme formula designed to support the digestion of fat, protein, carbohydrate, fiber, and lactose. This supplement works in a wide pH range unlike many other digestive enzyme supplements on the market.
Nashville Functional Medicine for Acid Reflux
Eating shouldn’t be painful. Our team at MaxWell Clinic can help you start to address the root cause of your acid reflux.
If you’re in the Nashville area and would like to learn more about becoming a patient, click here to schedule a free 20-minute discovery call with our New Patient Coordinator. We look forward to helping you.