The real causes of GERD (heartburn)

Everyone knows that our stomachs produce gastric acid. But many people associate this acid with the bothersome sensations of heartburn or acid reflux disease. No wonder that so many of us are eager to neutralize our stomach contents with medications. But can it really be done? Can we "turn off" gastric acid production and magically get rid of heartburn?

Our stomachs naturally produce a hydrochloric acid. If we don't make enough of this acid, a dangerous and potentially pre-cancerous condition called hypotrophic gastritis can develop.

Gastric acid is essential for normal digestion. It helps process and neutralize meat, so that it can then be digested by enzymes. Hydrochloric acid also signals the gastric glands to produce important digestive enzymes, which break down complex protein molecules into simpler and easier-to-digest substances, such as peptides, peptones and so on.

But even these smaller substances are still too large to be assimilated by our bodies. They need to be even further broken down by the enzymes of the small intestine and pancreas into amino acids. Unlike large molecules, amino acids can be used by our bodies for tissue regeneration. Unfortunately, without gastric acid, our bodies can't fully process protein. As a result, nutritional deficiencies can develop. Even worse, molecules that haven't been properly broken down can enter the bloodstream. Since they're too large to be used by our bodies, they can actually become allergenic or cause headaches and inflammation of the joints.

What does "too much acid" mean?

Like other bodily functions, there can be too much or too little gastric acid. Acidity is typically measured by pH. Neutral pH is 7.3. Anything above 7.3 is alkaline and anything below is acidic. The higher the pH number - the more alkaline; the lower - the more acidic.

So what's the normal pH for gastric acid? 1 - 3. That's a very acidic environment - similar in its strength to the acidity of a car battery. So where does the concept of "too much acid" come from? It doesn't appear to make physiological sense. Only 0 is less than 1. In the case of "high acidity of stomach fluids," our stomachs make more hydrochloric than necessary for the digestion of the particular foods we're eating (the acid pH may still be higher than 3).

Still, heartburn is indisputably a real and uncomfortable occurrence. But treating it has to begin with a good understanding of its true causes.

Causes of heartburn

The sensation of heartburn - burning in the esophagus - is the result of stomach juices flowing backwards (reflux). The pH doesn't matter - it can be 2 or 8. The esophagus lacks the same protective coating the stomach has. Any gastric juices - whether acidic or alkaline - can cause a strong irritation in the esophagus. This gastroduodenal reflux - or flow backwards - is what's commonly called "heartburn" or "acid reflux."

So why does reflux occur? There can be many reasons. Overeating can cause the stomach to stretch, causing the air trapped in the stomach to rise into the esophagus together with some gastric fluids. Eating too many sweets can also be a factor. Sweets stimulate the production of gastric acid, but unlike other foods, they don't neutralize these secretions. Ironically, lower hydrochloric acid production can actually contribute to heartburn. Without enough hydrochloric acid, meat proteins can't be properly digested, which stresses the entire digestive system. Yet another factor is dyskinesia (improper movement) of bile ducts, which can cause bile to be transported to the stomach, and later, the esophagus.

Heartburn can also be the result of something as simple as swallowing too much air while eating and talking - known medically as aerophagia. Another more serious cause could be a hiatal hernia, which can loosen the muscles of the esophageal sphincter, normally responsible for keeping the entrance to the stomach closed. In this case, gases and drops of digestive fluids can make their way inside the esophagus.

Dangers of low gastric acid

Clearly, simply taking an acid reflux medication won't solve most cases of heartburn. Instead, medications can actually mask the real problem and can even worsen digestion. For example, if your stomach has a normal pH (1 - 3), the pH of your intestines will be almost neutral (pH 5-7). If you eat too much of an alkaline product, such as meat, or if your hydrochloric acid secretion is lowered, your intestines can quickly become too alkaline. This over-alkaline state can last for a while, since your normal intestinal functioning will be weakened.

An intestinal pH of more than 8 signals your intestines to "rest" and stop contracting. Since your intestines are already full of alkaline food, they don't receive a signal to start working again, so they can continue to be filled with more food. This can lead to serious and painful constipation.

When gastic acid is lowered, certain digestive enzymes, such as pepsin and trypsin, can't be synthesized. As a result, proteins move into intestines before they're properly digested. Once in the intestines, the food starts to rot, which begins a "poisoning" process. One of the functions of gastric acid is to neutralize bacteria digested with food. If this didn't occur, the food reaches the intestines together with various bacteria. Inside, the bad bacteria starts to multiply rapidly, damaging the normal intestinal flora. The bacterial rotting process can lead to the secretion of active toxic substances, such as methane, hydrogen sulphide and so on. This can result in localized problems, such as colitis, hemorrhoids, polyps and even cancer.When the same rotten products seep into the bloodstream, they move quickly, poisoning the main organ systems: endocrine, immune, cardiovascular and so on. They are most harmful, however, to the nervous system - particularly the human brain.

In addition to everything else, lowering the production of gastric acid changes our vitamin profile and acid-alkaline balance. This can lead to numerous problems outside the digestive system, including allergies, memory difficulties, hypertension, sleep disturbances, arthritis and so on. The synthesis of the intrinsic factor responsible for assimilation of vitamin B12 stops together with the production of hydrochloric acid. When our body doesn't get enough B12, numerous problems can arise, including anemia, irreversible nerve damage and increased levels of homocysteine - a risk factor for heart attacks.

Instead of continuing to mask the cause of your heartburn, it makes more sense to find out where the problem is coming from and how it can be treated.

How we can help: Our first goal is to figure out what's causing your acid reflux. Dr. Koles is an experienced diagnostician who can direct your search for the real cause. Once the cause has been established, we can devise an individualized diet and supplementation program. Please note that we strongly caution our patients against stopping your acid reflux medications without consulting with a physician. An abrupt change can lead to a "rebound effect," where your stomach over-produces hydrochloric acid. Any change in medication should always be supervised by a doctor.