Reflux: Too Much or Not Enough Stomach Acid?

Misdiagnosed digestive issues can be treated—but not with commonly prescribed drugs

Many efforts to treat reflux do more harm than good because the root of the problem is misdiagnosed. CHAjAMP/Shutterstock

It used to be common knowledge that indigestion or heartburn was a sign of dietary indiscretion. Taking an antacid was the typical means of treatment. If the heartburn sufferer was ahead of the game, he or she would avoid suspect foods or take a natural remedy to improve digestive function.

Now, a pharmaceutical drug is prescribed to treat a full-blown disorder.

Gastroesophageal reflux disease (GERD) is a disorder of chronic heartburn. GERD may also be a silent cause of breathing issues if ascending stomach acid irritates the bronchioles. It’s thought to be caused by an overproduction of stomach acid that gets pushed up into the esophagus. Holistic medicine posits an opposing view of the underlying cause, with reflux occurring due to an impairment of proper digestive function.

Modern proton pump inhibitor drugs are designed to treat a limited presentation of patients with reflux—those who overproduce gastric acid. However, the majority of patients with reflux don’t produce too much stomach acid, but not enough. Let’s review the physiology of digestion:

Chewing and tasting food allows the tongue to signal the brain to prepare the stomach for digestion. The gut and brain together decide how much gastric acid is needed to further breakdown food. Parietal cells secrete gastric acid until the pH of the stomach gets to be 1 or 2 (very acidic), liquifying the stomach contents. When this occurs, the sphincter surrounding the duodenum opens up to allow the liquified contents to pass through to the small intestine. If this system works adequately, a moderate-sized meal should exit the stomach within two hours.

A pathology of the parietal cells can result in excess secretion of gastric acid. Stopping the hypersecretion of stomach acids is the rationale behind the development of proton pump inhibitor drugs such as Prilosec, Prevacid, and Nexium, all of which inhibit the release of stomach acid. Experiencing reflux on an empty stomach may be a sign of an overproduction of stomach acid.

More common is reflux after a meal, especially when laying down. This is typical of insufficient stomach acid slowing the digestive process and preventing the stomach from emptying in a timely fashion, known as gastroparesis. With less acid in the stomach, the signal to tightly close the hiatal sphincter is weak and the esophageal opening is compromised. Picture the stomach churning, trying to do more work with less acid.

This combination results in the pushing of stomach acid up the esophagus, causing reflux.

Here, the solution is to utilize remedies that improve digestive function and ensure proper stomach emptying. Taking a reflux drug will give symptomatic relief but it further blunts digestion. In turn, larger and larger food particles of poorly digested food pass into the small intestine. If enzymes, bile, and intestinal flora cannot complete the job started by the stomach, these larger food particles can act as irritants, trigger an immune response, and promote inflammation.

Another problem associated with decreasing stomach acid production is malnutrition. The parietal cells that produce gastric acid also release a compound called intrinsic factor into the stomach. This compound is necessary for the absorption of vitamin B12. Impairing the function of these cells can lead to a B12 deficiency, especially in susceptible populations such as the elderly

If reflux occurs after a meal, it’s possible the problem is gastroparesis due to insufficient gastric acid. You can test it yourself by seeing if a digestive aid improves the problem. Taking 1-2 tablespoons of raw, organic apple cider vinegar in a little water prior to a meal will likely improve reflux of this type by supplementing the gastric acid. Another traditional remedy is Swedish bitters, taken after a meal to encourage the parietal cells to excrete stomach acid by stimulating bitter receptors in the lining of the stomach. If either is helpful but reflux persists, betaine hydrochloride pills are a stronger option.

Healing from reflux also requires eliminating irritating foods. Processed and refined foods, sugar, spicy foods, and alcohol can all contribute to reflux. Eating too large a meal or drinking too much water with a meal (diluting stomach acid) can also weaken digestion. Consuming raw, fermented foods with meals, such as homemade sauerkraut, also strongly enhances digestion.

If you are suffering from reflux, don’t settle for a “band-aid” solution and get to the root of the problem. Proton pump inhibitor drugs are appropriate for those who genuinely overproduce gastric acid, but these drugs are meant for short-term use only. Taking them for years further degrades digestive vigor for someone not producing enough stomach acid. Clean up your diet and try one or more of these natural remedies to reclaim your digestive health and live free of the symptoms of reflux.

Brandon LaGreca is the founder and director of East Troy Acupuncture, an integrative medical clinic serving southeast Wisconsin, where he specializes in whole-food nutrition, ancestral health, and environmental medicine.