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One of the many causes of Gastro Esophageal Reflux Disease appears to occur from lack of proper stomach acid production. I know that is opposite everything you have ever heard from mainstream medicine. Most people are told that they have too much stomach acid, which causes GERD. You see advertisements all the time on television for acid reducing medication like proton pump inhibitors.
The primary cause of GERD is not increased stomach acid but instead is from elevated gastric pressure. For GERD to occur, the LES has to be weakened, increased gastric pressure has to forces stomach acid and pepsin into the esophagus, and uncontrolled excessive inflammation to occurs. Generally, throughout the day people can reflux occasionally, from esophageal pressure changes, swallowing, and consumption of food. However, most people can easily handle these types of reflux episodes and inflammation. For others, they cannot, and they develop reflux conditions like GERD.
How Does Low Stomach Acid Production Cause GERD?
Lowered stomach acid production facilitates overgrowth of pathogens and protein fermentation and malabsorption, which increase gastric pressure and stomach distension. The increase in gastric pressure and stomach pressure eventually weakens the LES (Lower Esophageal Sphincter) and causes GERD. Stomach acid is produced by our stomach to help limit pathogen overgrowth, digest protein, activate digestive enzymes, signal an increase in mucin production in the stomach, and increase absorption of B12 later in the gastrointestinal tract (intrinsic factor). So without proper stomach acid production, what happens to our digestion?
Eventually, microorganism overgrowth occurs and leads to further digestive issues. Protein that is maldigested influences the microbiome, leading to overgrowth producing excessive amounts of hydrogen gas, causing distension, esophageal pressure changes, and LES weakness. Protein is broken down ineffectively from lack of stomach acid, causing excessive protein fermentation from overgrowth leading to increased hydrogen gas production and distension. Upper gut bacteria are also able to use glucose from our food as a source of fuel and increase hydrogen production leading to stomach distension. A hiatal hernia may eventually develop from worsening stomach distension increased further pressure on the LES and esophagus. The increased pressure would further weaken the LES and worsen GERD.
Overgrowth of bacteria in the stomach and esophagus may lead to reduced probiotic Akkermansia muciniphila colonization, in the upper gut, which combined with reduced stomach acid production results in a reduction of mucosal barrier health in the stomach and esophagus. Increased endotoxin production from gram-negative overgrowth can increase inflammation in the stomach, causing gastritis, and increase inflammation in the esophagus, causing the symptoms of GERD. The esophagus is also able to produced limited quantities of bicarbonate (using carbonic anhydrase) to protect itself from reflux, its capacity is reduced if repeated reflux events are occurring. The worsening combination of increased inflammation (endogenous cytokines and chemical injury) from constant refluxing (due to increased gastric pressure) into the esophagus, reduction of mucosal integrity, and endotoxin inflammation causes the symptoms of GERD from excessive esophageal inflammation.
A simple test to determine whether you have too little stomach acid is to take a tablespoon of Apple Cider Vinegar in one ounce of water…a shot glass to see if your symptoms improve.
If they do, it is a good bet that you have too little stomach acid. At that point, come in to see us or schedule a consultation as this is not something you should attempt to treat on your own,
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Taryn DeCicco, ND, LAc, LDN
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Taryn DeCicco ND, LAc, LDN of Apple A Day Clinic in Arlington Heights, IL has been specializing in Acne, Skin, and Digestive Disorders for over 16 years.