The Root of Acid Reflux

Acid Reflux. GERD. Heartburn…

It’s the burning in your chest after you eat or as you’re laying in bed at night. In many cases, acid reflux is treated with antacids or proton pump inhibitors (PPIs). These lower the acid in your stomach, but too much acid production isn’t the root cause for most acid reflux. Reflux comes from relaxation of the muscle between the stomach and esophagus (the lower esophageal sphincter, aka the LES). This relaxation can result from extra abdominal pressure or too little stomach acid (which is linked with inflammation).¹ The burning your feel is stomach acid escaping up into your esophagus. The esophagus isn’t as protected against acid as the stomach, so the acid creates the feeling of ‘heartburn.’ 

The Usual Treatment

The most common acid reflux medications are over the counter antacids or prescribed PPIs, which lower acid levels. Reflux symptoms decrease because less acid in your stomach means there’s less acid that can escape into your esophagus. Over time though, PPIs can cause low calcium and magnesium levels because mineral absorption depends on stomach acid. They have also been linked with dementia² and infection by Salmonella, C. difficile (C-diff), and Campyobacter jejuni.³  Over time, PPIs can decrease your natural acid secretion, which is why your acid reflux flares up even worse if you don’t take your medication.⁴  Once you start taking them, you often have to keep taking them to control acid reflux symptoms. That said, if reflux isn’t treated, the acid damages the esophagus and increases risk of esophageal cancer.

So is there something else that can be done about acid reflux?

Sure. But first we have to look at the root cause for reflux. Reflux usually results from a lack of tone in the lower esophageal sphincter (the muscle just above your stomach) which happens for a couple of reasons.⁵ Here are the different factors contribute to your heartburn:

• Foods:

  What you eat can induce acid reflux symptoms. There’s a few types of food that fall under this category.

  • Sweets and wheats: High levels of refined carbohydrates (sweet treats especially) can aggravate reflux.⁶ Patients don’t always notice aggravation of their symptoms after eating sweets, but one study found that a low-carb, high-fat diet resulted in resolution of acid reflux symptoms for all participants within 10 weeks, even after stopping medications.⁷ 
  • Food allergens: Reflux symptoms can be worse eating certain foods. While you shouldn’t have to avoid a whole variety foods, if you eliminate gluten,⁸ dairy,⁹ or another common food allergen and notice your reflux getting better, that may be the trigger for your reflux.
  • Maybe or Maybe Not Fats: Sometimes fats aggravate acid reflux, but there’s more to it than just fat in your food. The kind of fat you eat is more important for controlling symptoms than the amount of fats.¹⁰  Not to mention that the type of fats you’re eating can affect more than just your digestion. On top of that, if fats are an issue for you, this is less an issue of the stomach than a lack of bile from the gallbladder. Stomach acid is one of the things that makes bile flow, and bile helps digest fats. Insufficient bile means fats aren’t fully digested, and this causes digestive problems. Using a cholagogue (something that stimulates bile flow) can help lower inflammation, infection and improve stomach function.

• Infection:

  If you have dysbiosis (an imbalance of microbes in your gut) in the upper GI, this is associated with acid reflux type symptoms.¹¹ This is could be due to the microbes themselves or because of the changes in the stomach environment produced by the bugs.¹²  Infection changes the environment, and the environment changes the tone of the sphincter.

  Cleaning up an infection means identifying the type of microbe (whether bacterial, viral, fungus, etc) and using the appropriate antimicrobial to battle the bugs. This can look like a targeted antibiotic, anti-fungal, or an antimicrobial herb (generally depending on your practitioner’s preference).

• Hormones.

  Multiple studies have come out linking hormone levels with acid reflux, especially high estrogen. Female patients that are pregnant, on hormone replacement therapy, or taking oral contraceptives are more likely to have acid reflux symptoms.¹³

• Extra Pressure on the Stomach…or maybe inflammation and hormones.

  Obesity has long since been linked to acid reflux. This is probably from the increased mechanical pressure, but there may be other contributing factors like inflammatory molecules from the fat tissue.¹⁴  Similarly, in pregnancy reflux symptoms can increase, which could be from increased pressure from beneath the stomach, or from hormones. Suffice to say, we don’t know the why, but extra weight makes reflux worse. That said, sometimes addressing the other factors listed can reduce or eliminate reflux symptoms even without lessening the weight. 

• Medications.

  Some medications induce acid reflux by changing how the sphincter fires. This includes asthma and allergy medications (anti-histamines), high blood pressure meds (calcium channel blockers), pain killers, sedatives, and anti-depressants.¹⁵ If you’re using these medications and finding they worsen your heartburn, it’s worth investigating other treatment options.

• Smoking.

  If you’re lighting up, that can cause acid reflux.¹⁶  Plus about a million other health problems. You already know it’s bad for you, so I’m not spending a whole lot of time on this one…

So what can I do?

Look back up at the list of causes and figure out which ones are relevant to you.

Cleaning up the diet can be a good place to start. Drop your carb levels, eat better fats, and avoid any food sensitivities.

Many people find that taking Betaine HCl will reduce their symptoms by returning stomach acid to normal levels. This can be helpful in the short term because it helps the lower esophageal sphincter tighten down some. That said, if your body isn’t performing the way it should, my opinion is that it’s best to figure out why that’s the case.

Over time, the esophagus gets inflamed by the acid from the stomach and may not work the way it should.¹⁷ I’d advise working with a healthcare practitioner sooner rather than later to address your heartburn and avoid long-term complications. By changing lifestyle factors and addressing triggers like food allergies, inflammation or infection, you can get long-term relief from your acid reflux.

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On March 30, 2018   /   Chronic Conditions, Uncategorized   /   Leave a comment