Monday, October 10, 2011

Why Stomach Acid Actually Prevents Heartburn

GERD (gastroesophageal reflux disease), or heartburn as it's commonly known, is the most common digestive disorder in the United States; approximately 10-20% of Americans experience symptoms at least once a week.  Conventional treatment is to take antacids.... chances are you've probably used these drugs at one time or another.  Tums, Zantac, Pepcid... ring any bells?  Or if you're really serious about your heartburn, maybe prescription Nexium?  Drug stores sell these things like candy.  Literally.  Tums is placed right next to the candy and gum in the checkout area, and for the first ten or so years of my life, I thought it was candy.  On the prescription side, Nexium was the number two best selling prescription drug on the market in 2006, just behind Lipitor (don't even get me started), bringing in $5.1 billion.  People generally find heartburn relief in these medications, so all is well right?  Not quite.

Although this topic may seem tame, there is more than you know going on behind the scenes.  I recently read a fantastic set of articles by Chris Kresser about the physiology and treatment of GERD that brought this to my attention.  It's a long six-part series, something I probably wouldn't have made time for if not for the combination of my iPhone and a boring afternoon class.  Since I will be summarizing a large amount of material here and simplifying some of the concepts, it would be unrealistic for me to cite all of my claims like Chris did.  So if you don't believe me, just refer to the link above.

For starters, let's talk about what exactly GERD is.  Out of Taber's Medical Dictionary, GERD is:  "A common condition in which acid from the stomach flows back into the esophagus, causing discomfort and, in some instances, damage to the esophageal lining."  You see, there is a one-way door between the esophagus and the stomach called the lower esophageal sphincter.  In digestion, food moves through this door to the stomach, and when everything is functioning correctly, nothing comes back up.  In GERD, small amounts of stomach acid are able to creep up into the esophagus, causing burning and damage to the wall of the esophagus, which can lead to a number of problems including esophageal cancer if left untreated.

That's all well and good.  But where we run into trouble is when we get into what causes this acid reflux.  There is a clear disparity here between what the research shows and what is believed by the general public.  Drugs that treat GERD, through a variety of mechanisms, attempt to reduce the amount of acid in the stomach.  This typically reduces heartburn.  Not coincidentally, if you ask your neighbor what causes heartburn, he or she will likely tell you "too much acid in the stomach".  You might even get the same answer from your doctor (I hope not).  But they'd be wrong.  In fact, nearly all patients with GERD have too little stomach acid.  That is not a typo.  I'd have to be a real loser to mistype my italics.  According to Jonathan Wright, MD of the Tahoma Clinic in Washington state, "When we carefully test people over age forty who’re having heartburn, indigestion and gas, over 90 percent of the time we find inadequate acid production by the stomach.  In 24 years of nutritionally oriented practice, I’ve worked with thousands of individuals who’ve found the cause of their heartburn and indigestion to be low stomach acidity. In nearly all these folks, symptoms have been relieved and digestion improved when they’ve taken supplemental hydrochloric acid (HCL, aka stomach acid) and pepsin capsules."  In reality, excess stomach acid is only found in a few rare conditions like Zollinger-Ellison syndrome; GERD is hardly ever associated with too much stomach acid.

I don't want to get too much into the mechanism by which low stomach acid causes GERD, because then this article will be way too long and nobody would read it.  So I'll try to make this as short as possible.  Prepare yourself for a wild ride...

Stomach acid (HCL) makes the pH of your stomach very low, ideally below 2.  At this level of acidity, it is near impossible for any bacteria to survive for more than 15 minutes, so the environment inside of the stomach is just about sterile.  When someone has low stomach acid, for whatever reason, the pH begins to increase.  This results in a stomach environment that is more tolerable for bacteria, allowing them to make it through to the small intestine where they can thrive.  Low stomach acid also means impaired carbohydrate digestion, which leads to increased intra-abdominal pressure due to bacterial fermentation of these undigested polysaccharides.  If this intra-abdominal pressure is high enough, it forces the contents of the stomach back up into the esophagus, leading to heartburn.  At this point, you probably go to the doctor for a Nexium prescription, intent on knocking out even more of that stomach acid.  Now your stomach pH rises even more, probably above 5, allowing even more bacteria to set up shop in there.  The first in line will be H. pylori, which, incidentally, suppresses stomach acid secretion, resulting in further impairment of digestion, which leads to more bacterial fermentation, which leads to more intra-abdominal pressure, which leads to more reflux... phew, that was tiring.  That's what you get for trying to make a complicated mechanism quick and easy.  So here is the summary of all that jibber-jabber:

Low stomach acid >>> heartburn >>> acid suppressing drugs >>> H. pylori infection >>> further reduction of stomach acid >>> chronic heartburn & GERD

Your new found high stomach pH also comes with increased risk for the following bacterial infections, since there's no acid left in your stomach to keep them out:
  • Salmonella
  • Campylobacter
  • Cholera
  • Listeria
  • Giardia
  • Pneumonia
  • Tuberculosis
  • Typhoid
  • Dysentery

It also comes, free of charge, with impaired digestion and absorption of the following nutrients:
  • Protein
  • Carbohydrates
  • Fat
  • Iron
  • Vitamin B12
  • Folate
  • Calcium
  • Zinc
  • Likely other vitamins and minerals that haven't been specifically studied

Yup, that's just about EVERYTHING YOU EAT!  I'll let you figure out the implications of never having enough of any of these nutrients.
And low stomach acid is also associated with the following conditions:
  • Stomach cancer
  • Allergies
  • Bronchial asthma
  • Depression, anxiety, mood disorders
  • Pernicious anemia
  • Skin diseases, including forms of acne, dermatitis, eczema, and urticaria
  • Gall bladder disease (gallstones)
  • Autoimmune diseases, such as Rheumatoid arthritis and Graves' disease
  • Irritable Bowel Syndrome (IBS), Crohn's Disease (CD), Ulcerative Colitis (UC)
  • Chronic hepatitis
  • Osteoporosis
  • Type 1 Diabetes

Looks like you've opened the flood gates of disease.

Or... if you'd like, you can try giving your body exactly what it needs and take HCL and pepsin supplements, which can potentially alleviate your GERD with no side effects.  You'll increase your ability to digest and absorb nutrients, and increase your resistance to these nasty, disease-causing bacteria.  You can also try a low-carb diet, which has been proven here and here to have a nearly 100% success rate of curing GERD, probably because the problem-causing bacteria in your digestive tract can't survive without maldigested carbohydrates for them to ferment.

So if you have GERD, you have two choices.  Take the conventional route, spoon-feed the drug industry with your hard-earned cash for the rest of your life, and ruin your body's ability to digest food and protect itself from bacterial infections.  Or, you can get to the root cause of the problem.  Begin by adopting a low-carb diet to take care of the bacterial overgrowth problem.  Then restore your stomach acid by taking HCL and pepsin supplements.  For a complete set of guidelines on how to go about treating this naturally, without drugs, refer to this article: Get Rid of GERD and Heartburn Forever in Three Simple Steps.  Whatever you choose to do, just remember... stomach acid is there for a reason.  It protects you from bacterial infection and breaks down the food you eat; without it, you might as well kiss health goodbye.

Incidentally, my Krause's Food and Nutrition Therapy textbook mentions nothing about any of this in its nutritional treatment for GERD... way to go Krause.


  1. Fantastic article. I am forwarding the link to Olivia - she should definitely enjoy the read.

    Also interesting is the gastroenterologist visit she had. According to the "doctor," she has IBS and was prescribed Nexium. She took it for a couple days and felt like hell. So I gave her the betaine HCl and within a few days she had more energy and didn't have nearly as many stomach pains. Upon a followup visit with her doctor, I accompanied her. She told him that she stopped the nexium and started the hcl. She said she felt better, was more energetic, and feeling happier. Aside from the fact that he through me out of the office for god know what reason, he yelled at her, saying she was doing something wrong. How can it be that she's doing something wrong if she feels better taking the HCl? Needless to say, the nexium is in the garbage and no more visits to that idiot

  2. This is so good!! That's exactly what Matthew told me to do about my stomach problems. You explained it so well. I am so tempted to forward this to everyone I know...

  3. Will taking HCL and pepsin supplements help your stomach in general even if you don't have GERD? It seems like low stomach acid causes a lot of problems someone might not even be aware is related to that...

    1. It could help. As a general rule, take one HCl pill with a meal. If you don't feel a burning sensation in your stomach, try taking another one, and keep increasing by one until you feel a burning. If you can take more than 1 or 2 without feeling the burn, then you probably have low stomach acid

  4. How could this be applied to a 3 month old strictly breastfed infant who was diagnosed shortly after birth with severe reflux and who is on a high dose of Zantac (and consequently now weighs in the 10th growth percentile)?

  5. Once you have experience high acidity it is hard to remove it anymore.