Reflux.....that horrible burning sensation you feel when you regurgitate the acid from your stomach up into your esophagus. Not only is it painful, but if it becomes a long term issue, it can create much bigger problems for your health.
So, what actually causes reflux? Glad you asked!!
The conventional thinking around reflux is that it occurs because the stomach is producing too much stomach acid (hydrochoric acid), and that's why it's being regurgitated back into the esophagus. While this can be a cause of reflux, it isn't the whole story.
But first, let's look at some basics...
When you eat, the chewed food passes from your mouth to your stomach via a muscular tube called the esophagus. At the bottom end of your esophagus is a one-way valve, also known as a sphincter, called the lower-esophageal sphincter, or LES for short. The function of the LES is to allow your food to pass through into your stomach, while simultaneously keeping the contents of your stomach from travelling back up into your esophagus.
Why is this important?
Well, because the contents of your stomach are very acidic, if they are allowed to backwash into your esophagus, the delicate cells which are similar to the ones inside your mouth, can be damaged by the burning acid. When this process takes place over a long period of time, the consequences can be serious.
Symptoms of reflux (otherwise known as GERD - gastro-esophageal reflux disease), range anywhere from mild to severe. Mild symptoms can include a morning cough that fades away through the day, or a slightly sore throat in the morning upon waking, which again, disappears as the morning progresses. A severe episode occurs when enough acid is regurgitated to make it up through the esophagus into the mouth and throat, leaving the sufferer coughing, gasping for breath, and reaching for the nearest glass of water to calm the fire in their digestive tract. Whether the symptoms are mild or severe, they indicate that something is out of balance and needs sorting out.
The National Institute of Health states that, when the lower esophageal sphincter (or LES) becomes weak or relaxes when it shouldn't, the result is gastroesophageal reflux, where the stomach contents rise up into the esophagus.
So according to the NIH, reflux occurs because of a weak lower esophageal sphincter. But why would the LES be weak? What causes it to relax at the wrong time?
Stay with me for a bit more sciency stuff!
The LES is activated automatically by your nervous system when the acid in your stomach is increased. As your stomach acid rises, the pressure on the LES to close, increases. However, if the right levels of acidity in your stomach aren't reached, the LES doesn't close properly, and you find yourself with that burning feeling of reflux.
Also, there is another valve called the pyloric sphincter (so many of them!!), which is at the other end of your stomach, and this valve holds the digested food in your stomach until it's ready to be moved into your intestines. Now, here's the tricky bit.... This valve works in an opposite way to the LES. It won't open to let the contents out of your stomach until the acidity reaches enough of a high level. So, if the food sits in your stomach for too long, this can lead to bloating, indigestion, and reflux. And just to add the icing on the cake, so to speak, as we get older, we tend to produce less stomach acid, which is why reflux can seem to come out of nowhere as we age.
So this explains why the LES may be malfunctioning - insufficient amounts of stomach acid.
But there may be other reasons reflux may be plaguing your life, and one of these could be because of bacterial overgrowth in the small intestines.
We all have different types and amounts of bacteria living in the small intestine that gain their nourishment from the food that you eat. If you eat mostly fats and proteins, the types of bacteria that grow are not huge gas producers. However, if you eat lots of carbs, the bacteria have a virtual party down there, and they multiply rapidly, as well as ferment the carbohydrates, causing, you guessed it, gas! When there is an overgrowth of these types of bacteria in your small intestine, then you get lots of gas, causing an increase of pressure in your bowel. This increased pressure can have the effect of forcing the gas and stomach contents upward, through the weak or relaxed LES, and into the esophagus, resulting in the familiar feeling of heartburn or reflux.
So the next question to ask is, "why is there bacterial overgrowth in the gut?" Refer back to the prior reason....low stomach acid!
Stomach acid is there first of all, to digest your food...proteins mostly. Secondly, and just as importantly, stomach acid helps to kill off anything that you may accidentally ingest that isn't good for your health....bacteria that are the bad type. When your stomach acid is at the correct levels, with a pH of 3, these bad bacteria can't survive, but if you have insufficient acid or the stomach pH rises above 5, the bacteria will begin to multiply too much and you will have an overgrowth problem.
Stomach acid helps with the digestion of carbohydrates by promoting the release into the small intestine, of pancreatic enzymes. If there isn't enough stomach acid, causing an abnormally high pH, the release of pancreatic enzymes will be inhibited, and the carbohydrates won't be sufficiently broken down.
To sum things up, there are a couple of important take away points:
low stomach acid has a big part to play in reflux
carbohydrates contribute to reflux when they aren't completely digested
the LES doesn't operate properly when there is incorrect amounts of stomach acid
What can you do if you suffer from reflux?
Eating more of a low-carbohydrate style of diet is the easiest thing that you can do right now at home. Minimising your intake of carbohydrates will help quite quickly with symptom relief. While this will help with reducing symptoms, it won't deal with the underlying reason of your low stomach acid or bacterial overgrowth. These need to be investigated by someone who can organise specific testing and look at your overall health picture, so that all the pieces can be put together. It's not advisable to try correcting low stomach acid without professional help.
And, let me be very clear here.....if you are taking medication for GERD, DO NOT STOP TAKING IT. You must always consult with your doctor if you want to come off any medications. Going 'cold turkey' with acid lowering medication can leave you with a much worse problem.
In the next blog, I'm going to look a little more at low stomach acid and some of the reasons behind why you may be experiencing it.
Enjoy your journey to health and wellness.