This is an extension to our previous article Weak stomach acid and the relationship with heartburn, acid reflux. Many people often blame stomach acid or gastric juice as high for acid reflux or heartburn. Actually its works in the opposite way. I searched for the answer for many years but hadn’t found earlier. One should know that high acid or strong acid environment in stomach is a rare case. People should understand that symptom is not the cause and treating symptoms will give only temporary relief, will not cure from the cause. With this article Weak stomach acid and the hidden cause of acid reflux and heartburn, we are trying to put an insight here along with other relevant health problems.
In our earlier article we mentioned that one cause of experiencing acid reflux and heartburn as entering stomach content to the esophagus through a gate called lower esophageal sphincter(LES). It opens when food comes from mouth through esophagus enters in the stomach and after entering in stomach it closes. The stomach is designed to take acid load but not the esophagus. When reflux occurs more frequently and with long lasting inflammation, damage to the esophagus occurs. And in future prolong such condition may require a surgical approach. The LES separates and protects the esophagus from acidic stomach content. A small amount of acid whether strong or weak entering in esophagus can result to burning effect of the esophagus. When it becomes chronic known as Gastroesophageal reflux disease or in short GERD. So why the reverse flows happens?
Weak stomach acid and the hidden cause of acid reflux and heartburn
Increased intra-abdominal pressure
When intra-abdominal pressure increases it pushes stomach content which also includes acid into the esophagus through the LES. A study published in The New England Journal of Medicine found that symptoms of gastroesophageal reflux occurred during an increase in intra-abdominal pressure. (1)Paper from Gastroenterology concluded the same as intra-abdominal pressure has causative mechanism of reflux disease.(2)
So what increases intra-abdominal pressure?
Weak stomach acid
Below the acidic measurement of stomach environment.
|Less than 3||Normal|
|3 to 5||Hypochlorhydria|
|Greater than 5||Achlorhydria|
Low ph indicates strong acidic environment and in the opposite, high ph indicates weak stomach acid or gastric juice.
In earlier article we mentioned that strong acidic stomach protects the body from bacterial overgrowth by killing bacteria, germs that comes with foods as well as aids digestion. However stomach acid becomes weak as people ages.
People begin to experience indigestion, acid reflux and heartburn with ages and acidic environment in stomach also decreases as people grow older.(3)
And continuous uses of antacid, proton pump inhibitor or other acid suppressor as over the counter drug make the situation worse by making stomach acid weak as well as impairing digestion process. These may give temporary relief but unable to approach to the cause. Treating gastroesophageal reflux disease with profound acid inhibition will never be ideal because acid secretion is not the primary underlying defect.(4)
Weak stomach acid impairs pancreatic secretion and results deconjugation of bile acids
Pancreatic enzymes help in breaking down of fats, carbohydrates and protein for further digestion and absorption in intestine. And bicarbonate ion in pancreatic juice also secreted in duodenum to neutralize acidic food content coming from stomach. Pancreatic enzymes play critical roles in digestion and absorption of foods including carbohydrates otherwise bacteria will do the taking process.
And presence of acid and digestive contents in chyme or partially processed food coming out from the stomach stimulates pancreas secretion. When low ph gastric secretion enters in duodenum, it stimulates both digestive enzyme and bicarbonate ion from the pancreas.(5)
These digestive enzymes further breakdown of foods and aids absorption in small intestine. And the bicarbonate secretion neutralizes acidic environment that comes from entering into small intestine. A good digestion needs right ph at right time at right place. And you need normal strong acidic environment to stimulate pancreatic juice.
Impaired gastric juice or stomach acid and pancreatic secretion significantly correlates with indigestion and malnutrition.(6)
Bile acid plays important role in fat digestion, cardiovascular health and prevention of gallstone. And weak stomach acid or suppressing stomach acid impairs this process. Suppressing stomach acid also results in gastric bacterial overgrowth and deconjugation of bile acids.(7,8)
Normal stomach acid destroys most of the bacteria attached with foods and prevent over colonization in wrong place such as duodenum and small intestine. Weak stomach acid can contribute to bacterial overgrowth in lower part of the stomach as well as small intestine. And acid suppression by weakening stomach acid leads to bacterial overgrowth.(7,8,9, 10, 11) And remember small intestine is not designed for over colonization of bacteria.
Overgrowth of bacteria releases lots of gasses and harmful toxins. They also steal nutrients for their own use. Such condition can lead to poor digestion as well as nutrition deficiency. This also relates with intra abdominal pressure.(12)
A study published in Scandinavian Journal of Gastroenterology suggests that inflammation or damage to esophagus is associated with small intestine bacterial overgrowth.(13)
Poor digestion of carbohydrates
As we mentioned normal stomach acid stimulates release of pancreatic enzymes in small intestine for digestion of foods including carbohydrates. Abnormal gastric ph or high ph gastric juice or weak stomach acid can’t stimulate pancreatic juice as it does in normal condition. When pancreatic enzyme secretion is interrupted, the absorption process of food in small intestine will also be impaired including carbohydrates.
Poor digestion of carbohydrates can cause fermentation and fermentation of food can cause bacterial growth. They happily grow with fermented carbohydrates and start over colonization in wrong places like small intestine. A study published in the journal of Gasteroenterology concluded that Colonic fermentation of indigestible carbohydrates increases acid reflux and symptoms of GERD. (14)
Putrefaction of protein
Proteins need acidic environment to process inside the body. If you have weak stomach acid in stomach, it impairs proteins digestion. And undigested protein rots in small intestine. Rotten proteins release large amount of nitrogen to the blood stream which further can affect organ like liver, kidney and brain. And bacteria and yeast eat the amino acids part of protein that the body suppose to use, once certain bacteria remove the nitrogen group. (15) Fueling food to bacteria fueling growth of bacteria.
Decomposition of protein in intestine releases harmful by-products such as ammonia, hydrogen sulphide, amine and some others. As example amine involves in DNA damage and tumorigenesis of gastric and colon cancer. N-nitroso compounds produced through nitrosation of amines posses carcinogenic or cancer forming effects. (16)
And overall such condition also induces inflammation. If you are continuously weakening your natural stomach acid your body will not process not only carbohydrates, proteins and fats but also some other vitamins including minerals. And you will start developing diseases.
Take home message
Physician may sometime prescribe acid suppressor under certain condition. However if you are using acid suppressor continuously as over the counter, you are welcoming numbers disorders. You should know that and for that reason, you should not use as over the counter.
One thing you should know, weak stomach is not the single cause of acid reflux and heartburn. We are summarizing other causes in our coming article. We are covering one by one. If you have not read our previous article Weak stomach acid and the relationship with heartburn, acid reflux and restoration of stomach acid and remedies you should read. However people may have stomach infection or ulcer in stomach. For such case stomach acid should be restored only after healing from stomach ulcer or infection. It is safer to test with a smaller dose.
You should avoid allergic as well as inflammatory foods and any other food that is hard to digest including cow milk. Caffeine, alcohol and nicotine can cause inflammation inside the stomach. Other foods including hard digesting carbohydrates, sugar also fueling bacterial growth.
We hope this article Weak stomach acid and the hidden cause of acid reflux and heartburn will give an insight here. And I request you to put your input or update here.
Disclaimer: Information provided here are generalized information for
entertainment purpose only, not intended to provide one to one health
consultation or replace practice of a qualified practitioner. Different
people may have different health condition and may have different reaction
to the same food. Hence it has been advised to consult with health care
provider before application of any of above information
Source and references: 1.Mechanisms of gastroesophageal reflux in patients with reflux esophagitis,Dodds WJ, Dent J, Hogan WJ,Helm JF, Hauser R, Patel GK, Egide MS.,N Engl J Med. 1982 Dec 16;307(25):1547-52 2.Increased Intra-abdominal Pressure and GERD/Barrett’s Esophagus,Harvey J. Sugarman, Gastroenterology,December 2007,Volume 133, Issue 6, Page 2075 3.Fundic atrophic gastritis in an elderly population. Effect on hemoglobin and several serum nutritionalindicators,Krasinski SD, Russell RM, Samloff IM, Jacob RA, Dallal GE, McGandy RB, Hartz SC.,J Am Geriatr Soc. 1986 Nov;34(11):800-6 4.Evidence That Proton-Pump Inhibitor Therapy Induces the Symptoms it Is Used to Treat EDITORIAL,Kenneth E.L. McColl, Derek Gillen,Division of Cardiovascular & Medical Sciences, University of Glasgow, Gardiner Institute, Glasgow, UK,Gastroenterology, published online 01 June 2009 5.The Exocrine Pancreas,Pandol SJ.,San Rafael (CA): Morgan & Claypool Life Sciences; 2010 6.Impaired gastric acid and pancreatic enzyme secretion in patients with Crohn's disease may be a consequenece of a poor nutritional state,Winter TA, O'keefe SJ, Callanan M, Marks T.,Inflamm Bowel Dis. 2004 Sep;10(5):618- 25 7.Depressing acid, deconjugating bile,G M MURPHY,BMJ Journal 8.Suppression of gastric acid secretion in patients with gastroesophageal reflux disease results in gastric bacterial overgrowth and deconjugation of bile acids,Jörg Theisen,Dhiren Nehra,Diane Citron Jan Johansson,Jeffrey A. Hagen,Peter F. Crookes,Steven R. DeMeester,Cedric G. Bremner,Tom R. DeMeester, Jeffrey H. Peters,Journal of Gastrointestinal Surgery,, Volume 4, Issue 1, pp 50–54 9.Treatment of irritable bowel syndrome with probiotics. An etiopathogenic approach at last?, Bixquert Jiménez M.,Rev Esp Enferm Dig. 2009 Aug;101(8):553-64 10.Ardatskaia MD, Loginov VA, Minushkin ON,[Syndrome of bacterial overgrowth in patients with the reduced stomach acid secretion: some aspects of the diagnosis], Eksp Klin Gastroenterol. 2014;(12):30-6. 11.Su T, Lai S, Lee A, He X, Chen S,Meta-analysis: proton pump inhibitors moderately increase the risk of small intestinal bacterial overgrowth, J Gastroenterol. 2018 Jan;53(1):27-36. doi: 10.1007/s00535-017-1371-9. Epub 2017 Aug 2. 12.Effect of erythromycin on postprandial gastroesophageal reflux in reflux esophagitis.,Pehl C, Pfeiffer A,Wendl B, Stellwag B, Kaess H.,Dis Esophagus. 1997 Jan;10(1):34-7 13.Erosive esophagitis may be related to small intestinal bacterial overgrowth.,Kim KM, Kim BT, Lee DJ, Park SB,Joo NS, Kim YS, Kim KN.,Scand J Gastroenterol. 2012 May;47(5):493-8 14.Colonic fermentation influences lower esophageal sphincter function in gastroesophageal reflux disease, Piche T, des Varannes SB, Sacher-Huvelin S, Holst JJ, Cuber JC, Galmiche JP.,Gastroenterology. 2003 Apr;124(4):894- 902 15.http://sibotesting.com/what-causes-sibo-stomach-acid/ 16.Kaur H, Das C and Mande SS (2017) In Silico Analysis of Putrefaction Pathways in Bacteria and Its Implication in Colorectal Cancer. Front. Microbiol. 8:2166.