Why do some people suffer from acid reflux?
1) Too little stomach acid- AKA hypochlorhydria
Ironically, given the high use of heartburn medication that reduce stomach acid, one of the main causes of acid reflux is low stomach acid, called hypochlorhydria. When someone suffers from low stomach acid, a few things happen that can lead to acid reflux. Here is one example: stomach acid triggers the opening of the sphincter between the stomach and the small intestines. If there is not enough acid, the opening of the sphincter to the small intestine is delayed. This can lead to increased intrabdominal pressure and essentially create a small amount of backwash into the esophagus. There is still some acid present, so this will irritate the esophagus and cause the same amount of pain as acid reflux from a stomach with too much acid.
Symptoms of hypochlorhydria include feeling like eating meat makes you nauseous, ill, uncomfortable, or a feeling of heaviness in your stomach when you eat meat, high protein foods, or greasy foods. It feels like these foods just sit there and keep on fermenting in your stomach. Belching, flatulence, and bloating shortly after eating are also signs of hypochlorhydria, especially if the belching includes a foul odor or taste.
2)Gluten and other food sensitivities often lead to acid reflux. Some recent research linked peptic disease, including heartburn, GERD, and stomach ulcers to gluten exposure in people with a gluten sensitivity and/or Celiac disease. Scand J Gastroenterol. 2009;44(12):1424-8.
3) Poor diet, especially one high in caffeine and alcohol consumption.
Both caffeine and alcohol relax the sphincter between your esophagus and stomach, and can lead to acid backwashing into the esophagus.
4) Stress– especially paired with any of the above situations.
Stress will often trigger our bodies to go into the nervous system called the ‘fight or flight’ response. The sympathetic nervous system is actually responsible for this response and when triggered by stress or perceived stressors, your body will actively shunt blood away from the digestive system to your skeletal muscles to take on that angry bear or boss or help you rush to your next meeting. Your body needs time and blood flow to drive digestion. If you find yourself in a high stress environment most of your days, then chances are, your digestive system is challenged leading to acid reflux that does not necessarily relate to excess stomach acid.
Antacids and Proton Pump Inhibitors
When individuals use antacids and proton pump inhibitors to neutralize or block the production of stomach acid, it can become a problem if used for more than six months to a two years. If used long term, blocking or neutralizing stomach acid reduces the effectiveness of digestion and absorption of key nutrients throughout the entire digestive tract. Acid is a key player in trigger entire digestive tract to function properly.
What are the consequences?
Long-term reduction of stomach acid can increase the risk for:
- Infection from H. Pylori and other opportunistic bacteria. Long-term lack of acidity in the stomach may even increase your risk of developing a parasitic infection, since HCL can kill off some food borne parasites
- Osteoporosis and osteoporosis related fractures
- Vitamin and mineral deficiencies, such as vitamin A, calcium, iron, vitamin B12, zinc, and folic acid deficiencies
- Protein and fat malabsorption, and increased indigestion
What are the Consequences of these Deficiencies? (please note this is not an exhaustive list)
- Vitamin A – suppression of the immune system, skin inflammation, gastric inflammation, lung inflammation, acid reflux, and infertility
- Protein Deficiency – immune suppression, anemia, inability to heal, blood sugar abnormalities, fatigue, and possible weight gain
- Calcium Deficiency – bone loss, hormone disruption, blood clotting problems, muscle cramping, high blood pressure, gum disease,
- Iron Deficiency – anemia, increased risk for viral and bacterial infections, fatigue
- Vitamin B12 – nerve damage, fatigue, increased risk for cancer, heart disease, bone loss, anemia, and depression
- Folate (Folic Acid) – risk of intestinal cancer and polyps, mood disorders (depression, anxiety), fatigue, risk of other cancers, heart disease, bone loss, and anemia
- Zinc Deficiency – reduced immune function, slow healing, easy bruising, lowered antioxidant status, acidic pH, diabetes, and heart disease
What to do if you have acid reflux/GERD/heartburn?
As an acupuncturist and East Asian Medicine practitioner, my biggest take away point is to treat the real underlying cause of any ailment, especially acid reflux. Taking heartburn medication in the above situations is not treating the real cause of the problem, and may do more harm than good. It is important to find out if you have too little stomach acid, or if your diet and lifestyle are the true root of the problem. I would encourage you to find a medical professional that looks into hypochlorhydria, diet, lifestyle, food sensitivities, and stress as causes of acid reflux. Most acupuncturists and East Asian Medicine Practitioners are trained in treating the digestive system, since the digestive system is seen as the center pillar of health in East Asian medicine. I encourage you to work with someone to counsel you through your acid reflux, since the Internet has much conflicting and sometimes poor information out there. It is also far easier to work with a trained health care professional than to make yourself crazy with self-diagnosis.