GERD Symptoms:

• Heartburn (is a feeling of burning sensation in the chest area that usually gets worse at night)
• Chest pain
• Belching
• Regurgitation of food or liquid
• Regular throat clearing or coughing
• Excess mucus formation, post-nasal drip
• A sensation of a lump or "stuck" in your throat
• Hoarse voice
• Swallowing problems
• It can also lead to disrupted sleep. ⁽³⁾

There are valves on the top and bottom of the stomach. A circular band of muscle on the top of the stomach (the lower esophageal sphincter(LES)) typically prevents stomach acid and content from flowing up into the esophagus. When you swallow, this sphincter relaxes and allows food and liquid to enter your stomach, and then it closes again.

The problem starts when the sphincter functions abnormally or weakens, allowing the stomach content and acid to flow back up into your esophagus and causing irritation.

The lower valve of the stomach allows the content to move into the small intestines and prevents food from flowing back up into the stomach. ⁽⁴⁾

What causes GERD?

Stress

The autonomic nervous system controls the sphincters' function. When you are stressed, the sympathetic side of the autonomic nervous system gets activated, which is known as the fight-fright-freeze mode. ⁽⁵⁾ This state can lead to a dysfunctional sphincter. But there are other problems with stress that influence the whole digestive process.

When you are going through a stressful period, the blood will be pumped mainly to the muscles and other vital organs (away from the gut) to prepare the body to face the danger or run away from it. Digestion (immune function, reproduction, and many other bodily functions) is not essential in survival—the production of all digestive juices like stomach acid, pancreatic enzymes, bile flow decrease during stress.

Adequate stomach acid (HCl) is also required for proper sphincter function to stay closed and open only when needed. The sphincters have receptors that can detect hydrochloric acid (HCL). When stomach acid gets low, it can interfere with the signaling process to the sphincter, allowing it to be open longer or partially so that little acid and even remaining food content can come up to the esophagus causing all the uncomfortable symptoms.

Furthermore, less protective mucus is produced during stress, allowing stomach acid to cause damage to the gut's lining, leading to inflammation, even ulcers, and gastritis. ⁽⁶⁾

Low stomach acid

So in the previous section, you could discover how stress can lead to low stomach acid, but let's analyze it a bit further.

The digesting fluid secreted in the stomach is gastric acid (stomach acid), colorless, watery, and super acidic. It is one of the most crucial digestive juice secreted with numerous enzymes and intrinsic factors. It has (typically) a pH of 1 to 2. The higher the number goes, the more alkaline it becomes, which we don't want because an adequate level of acid is required for:

• Protein digestion
• Activating pepsin (enzyme)
• Proper sphincter function (so the valve stays close and food doesn't reflux back)
• Stimulating other digestive juices to be released further down your digestive tract
• Mineral absorption
• Killing unwanted bacteria, parasites in the food (preventing SIBO or food poisoning)
• Activating intrinsic factor that is needed for vitamin B12 absorption ⁽⁷⁾

The reality is that contrary to popular belief, heartburn symptom is mainly caused by low stomach acid and not high stomach acid.

Another factor that can cause lower stomach acid is Helicobacter pylori infection. This gram-negative bacteria can cause low-grade inflammation and damage to the stomach lining leading to ulcers, and it was even associated with gastric cancer. ⁽⁸⁾ Read more about Helicobacter pylori infection.

Stomach acid can be caused by chronic inflammation, autoimmune disorders, age (acid levels decrease as we get older). ⁽⁹⁾

What is the issue with stomach acid lowering drugs?

Proton pump inhibitors (PPIs), antacids, and other drugs are commonly prescribed or purchased medications used to lower stomach acid. While there are cases when they might be needed short-term, long-term usage has a negative impact on the whole digestive process and body functions.

Long-term usage has been associated with Clostridium difficile infection, vitamin B12 deficiency, decreased magnesium levels, elevated risk of bone fractures, kidney diseases, dementia, SIBO (Small Intestinal Bacterial Overgrowth). ⁽¹⁰⁾

These medications may mask the symptoms but won't resolve the underlying causes and predispose the individual to other health complications.

How can you improve stomach acid production?

Bitters are excellent to stimulate digestion. Bitter greens (kale, arugula, dandelion) or even digestive bitters (gentian) could be helpful.

Using diluted raw apple cider vinegar before meals can also help with digestion. Avoid if you have gastritis or histamine intolerance, and never use it undiluted because it can damage your teeth.

My favorite tip is eating slowly and chewing your food well. Digestion starts in the brain (yes! By looking at, smelling it, the brain gets the information that foods are coming in, so let's prepare for digestion!), but by chewing, you allow the enzymes in your saliva to start breaking down the food.

SIBO (Small Intestinal Bacterial Overgrowth)

SIBO stands for Small Intestinal Bacterial Overgrowth. It means an increase in the number of bacteria and/or changes in the types of bacteria present in the small intestine. SIBO is commonly caused by an overgrowth of various bacteria that should generally be found in the large intestine. ⁽¹¹⁾

SIBO can cause classic symptoms similar to IBS (Irritable Bowel Syndrome). These include abdominal pain, discomfort, cramping, gas, bloating, reflux, diarrhea, and/or constipation. According to studies, 84 % of IBS cases are caused by SIBO. ⁽¹²⁾ Read more about SIBO types.

One theory that Norman Robillard, Ph.D., suggested about SIBO causing GERD is that one of the leading symptoms of SIBO is usually bloating, and bacteria produce gas through carbohydrate (fiber) fermentation which can increase abdominal pressure pushing acid up to the esophagus. ⁽¹³⁾

The other link I briefly mentioned above is that many people were given Proton Pump Inhibitors (PPIs) or antacids to manage their heartburn symptoms. Since adequate stomach acid is required to prevent overgrowth, treatment with acid blockers, especially long-term usage (over 1 year), may lead to SIBO. ⁽¹⁴⁾

Other contributing factors of GERD:

• Dysbiosis in the colon ⁽¹⁵⁾
• Smoking ⁽¹⁶⁾
• Obesity ⁽¹⁶⁾
• Sedentary lifestyle
• Alcohol consumption ⁽¹⁷⁾
• Bad eating habits (eating too fast, overeating, drinking during meal times)
• Certain foods
• Lying down immediately after eating
• Hiatal hernia ⁽¹⁸⁾
• Pregnancy
• Certain medications
• Delayed stomach emptying (gastroparesis) ⁽¹⁹⁾