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:
It also comes, free of charge, with impaired digestion and absorption of the following nutrients:
- Vitamin B12
- 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
- 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
- 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.