Low Stomach Acid and Reflux

If you google what causes GERD or heartburn, you will most likely find foods that cause too much acid such as tomatoes, chocolate, coffee and alcohol. However, low stomach acid may be to blame. 

GERD (gastroesophageal reflux disease) happens when ANY amount of stomach acid reaches the esophagus. This is due to an inappropriate opening of the LES (lower esophageal sphincter). So then the question is, what causes the LES to open? Newer research has pointed to an increase in intra-abdominal pressure and this may be due to low stomach acid.

Stomach acid is vital to breakdown food, absorb nutrients, and kill off pathogens that we ingest with food. As we age, we produce less stomach acid and this allows undigested food to sit in the gut and ferment, which can lead to an overgrowth of bacteria in the small intestine. This is known as SIBO (small intestinal bacterial overgrowth). Bacteria produce gasses as a waste product. This in turn creates an increase in abdominal pressure and causes the LES to open. 

Here is the problem; most people will take medicines such as PPIs and antacids chronically. These medications were initially intended for short term use. Overuse can lead to chronically low levels of stomach acid and worsen the problem over time. The antacids may alleviate the symptoms in the short term, but just exacerbate the problem long term. 

Low stomach acid may not be the only reason for reflux, but it is common. Luckily, it can easily be managed with some diet and lifestyle changes. Removing the foods that trigger reflux to start so that you can stop using medications like PPIs and antacids. Some may benefit from the use of digestive enzymes under the supervision of their healthcare provider.