rAcid reflux, heartburn, feeling a lump in your throat and disrupted sleep. Are you dealing with these symptoms on a daily basis? You may be dealing with gastroesophageal reflux disease (GERD) due to a backflow of stomach acid. Don’t worry, I’ve got you.
In a two-part series, I will be discussing everything you need to know about GERD and the importance of stomach acid. In this article (part 1), I will discuss the importance of stomach acid and the problem with low stomach acid. I will recommend a simple baking soda test to check for low stomach acid from the comfort of your home. You will understand what GERD is and its symptoms. I will go over the main underlying root causes of GERD we need to consider for successful treatment. In part 2, I will share my top recommendations to improve GERD naturally.
What Is Stomach Acid + Why Is It Important
Stomach acid is also known as gastric acid or gastric juice. It is made of hydrochloric acid (HCL), lipase, and pepsin. It is a digestive fluid that is released into your stomach from a gland in your stomach lining. The pH of stomach acid is very acidic, between 1 and 3. Your stomach acid plays an essential role in activating digestive enzymes and digesting proteins. It also helps to inactivate swallowed harmful microorganisms, thus protecting you from gastrointestinal infections (1, 2).
What Is Hypochlorydria? — The Problem with Low Stomach Acid
Though your stomach acid levels can fluctuate from time to time due to stress, diet, or certain medications, you want your stomach acid levels in a healthy range most of the time. Your stomach pH should be under 3. Hypochlorhydria is a condition characterized by chronically low stomach acid levels. If you have hypochlorhydria, your stomach pH is between 3 and 5. Stomach pH over 5 means you have achlorhydria, which means having almost no stomach acid.
If your body has low stomach acid, it will be unable to effectively break down protein. As a result, larger, undigested protein particles can get into your small intestine. This will force your pancreas to create more enzymes to metabolize these proteins. The high demand for these enzymes can put a lot of stress on your pancreas and eventually lead to gut irritation, poor absorption, and the underutilization of important amino acids. This may increase the risk of digestive symptoms, gut infections, leaky gut syndrome, and mineral deficiency (3).
Baking Soda Test for Low Stomach Acid
Trying a baking soda test is a simple way to see if you are dealing with stomach acid. All you need to do is mix ¼ teaspoon of baking soda with 4 – 6 oz of cold water. Drink this mixture in the morning before you eat or drink anything.
Drinking this baking soda mix should make you burp or belch. The question is how long it takes. Start your timer as soon as you drink the mix.
If it takes you 3 minutes or more to burp or you don’t burp at all, you are probably dealing with low stomach acid. If you burp very quickly after drinking the mix or several times, you may have too much stomach acid.
Small burps may simply mean that you swallowed air from drinking too quickly. To make sure you are not confusing air with burping from stomach acid, you may want to perform this several times throughout the week and check for an average result.
What Is GERD
Acid reflux happens if you have a backflow of stomach acid from your stomach. This can irritate the lining of your esophagus causing discomfort and a burning sensation called heartburn. Everyone experiences acid reflux from time to time after a spicy meal or drinking coffee. However, many people experience acid reflux and heartburn on a regular basis.
Gastroesophageal reflux disease (GERD) means that you are experiencing a backflow of stomach acid and related symptoms on a regular basis. If you have GERD, you may endure acid reflux and heartburn several times a week or even on a daily basis.
Symptoms of GERD
Symptoms of GERD may include:
- Heartburn, usually after eating and generally worse at night
- Difficulty swallowing
- Chest pain
- Regurgitating sour liquid or food after eating
- Feeling like you have a lump in your throat
- Feeling nauseous
- Disrupted sleep
- Chronic cough
- New symptoms of asthma or worsening symptoms of asthma
Underlying Issues Behind GERD
Before I can offer you some tips on how to improve GERD in part 2 of this series, it’s important that you understand some common underlying reasons behind GERD. Uncovering and understanding the root causes of your symptoms is important to address them effectively instead of just putting a bandaid over your symptoms.
Low Stomach Acid and GERD
One of the biggest misconceptions when it comes to GERD, heartburn, and acid reflux is that it’s caused by high stomach acid. In most cases, however, low stomach acid production is the actual culprit behind your GERD symptoms.
HCL in your stomach acid helps to change large solid meals into chyme, which is a semi-liquid soupy substance that can pass through the rest of the digestive process without an issue. If your body doesn’t produce enough HCL, it won’t be able to break down food properly. This may result in a backflow of acid and GERD.
A 1986 study published in the Journal of the American Geriatric Society has found that 31.5% of the 359 participants between ages 60 and 99 had atrophic gastritis (4). People with atrophic gastritis have no stomach acid production. This may not be surprising considering that stomach acid production seems to decrease with age according to a 2004 review published in the American Journal of Medicine (5). On the other hand, the risk of GERD and other reflux disorders tends to increase with age. These results suggest a possible connection between low stomach acid and reflux disorders.
Yet, we are still treating acid reflux and heartburn with antacids as if high stomach acid was an issue. Hyperchlorhydria, which is a condition characterized by high stomach acid, is actually a very rare condition, while reflux issues are rather common. If high stomach acid was the issue, we wouldn’t be seeing so many middle-aged and older people who generally have lower stomach acid levels, but younger people and teenagers instead.
Taking Antacids and PPIs for GERD
Even though high stomach acid is generally not the true problem, pushing antacids and proton pump inhibitors (PPIs) are a common strategy for symptoms of GERD. These medications may cover up symptoms in the short term, but over time they can make your symptoms worse by reducing acidity. They may put further stress on your digestive system and the enzymatic processes of your pancreas. They may also deplete your body of B vitamins and trace minerals (6, 7). Now, if the regurgitation of stomach contents is chronic and the esophagus (the feeding tube leading to the stomach) is habitually irritated, its lining can become damaged and a precancerous condition may develop (named Barrett’s esophagus). This rare situation would require a PPI, but for the most part PPI’s are overprescribed, and for far too long a duration.
H Pylori and GERD
Helicobacter pylori or H pylori is a bacteria that can survive in your stomach’s acidic environment. H pylori overgrowth is a common issue that at least 50% of the population around the world is experiencing, often without knowing it (8, 9). It is a common underlying issue behind ulcers and other gut health problems.
H pylori is responsible for making the enzyme urease which allows the breakdown of urea in your stomach into carbon dioxide and ammonia. This process may result in bad breath and burping, two common signs of GERD.
As you already know, HCL is an acid necessary for protein digestion, metabolizing fats, stimulating bile, ionizing minerals, and other digestive processes. When your body is not making and releasing enough HCL, it can compromise protein absorption, digestion, and nutrient absorption. H pylori overgrowth can interfere with HCL production and digestive processes causing GERD and other gut health symptoms.
A 1997 study published in Gastroenterology has found that H pylori overgrowth may lead to reduced secretion of stomach acid (10). More recent research, including a 2008 study published in Helicobacter has also found that H pylori may play a role in GERD (11). On the other hand, a 1998 study published in the American Journal of Physiology, eliminating H pylori overgrowth may help to improve stomach acidity and reduce symptoms (12). A 2020 review published in Digestive Diseases has also found that eradicating H pylori infections may help to improve GERD (13).
Gut Dysbiosis and GERD
Another major underlying factor that may play a role in the development of GERD is gut dysbiosis. Gut microbiome balance is necessary for healthy digestion. Gut dysbiosis is the opposite of a healthy gut microbiome. It is characterized by too many harmful microorganisms and too few beneficial bacteria. Gut dysbiosis can increase chronic inflammation, infections, digestive symptoms, and chronic health concerns, including GERD (14).
According to a 2019 study published in the Journal of Thoracic Diseases, there may be a link between esophageal disease and your gut microbiome health (15). Small intestinal bacterial overgrowth (SIBO) is a gut health issue characterized by bacterial overgrowth in your small intestine. SIBO can result in belching, which is also a sign of acid reflux. SIBO can quickly lead to SIBO-related acid reflux and GERD.
According to a 2014 study published in Experimental and Clinical Gastroenterology, 57.5% of participants with GERD also had SIBO (16). Researchers found that 61.6% of GERD patients who received PPI treatment for over 12 months had SIBO, whereas those who were treated with PPI for 6–12 months had a 21.7% risk of SIBO, and in those who took PPIs for less than 6 months SIBO was detected in only 8.3%.
According to a 2015 paper published in the World Journal of Gastroenterology, SIBO is more common in patients who have been treated with PPIs than in those who were not (17). If you have SIBO and GERD, it is critical that you are not treated with PPIs as they may worsen your symptoms. If PPIs are making your GERD symptoms worse, it may be a hint that SIBO is behind your reflux issues.
To learn more about managing GERD, look for Part 2 of this GERD series. If you are looking for personalized tips and dietary recommendations for GERD or want to improve your health, wellness, and mental well-being, I welcome you to start a personalized functional medicine consultation with me for customized guidance to improve your health. You may book your consultation here.