Contrary to what most people have been lead to believe, acid reflux is a result of too little stomach acid, not too much. Let me explain…Your stomach produces a few different digestive juices, one of the main ones being hydrochloric acid (which I will refer to as stomach acid). This acid is required to break down proteins and to absorb many minerals (e.g. magnesium, iron) and other nutrients. We often like to say that we are what we eat. But that’s actually not true. We are what we digest and absorb and if we can’t absorb nutrients, even the healthiest diet in the world won’t do us any good.
Stomach acid also provides our first defense against food poisoning, H. pylori, Candida, parasitic and other gut infections. Without adequate acid, we leave ourselves open to decreased immune resistance.
As we age, our internal production of stomach acid declines (half of people over the age of 60 and 80% of people over 85 have hypochlorhydria, or low stomach acid). Low stomach acid can cause:
- Poor protein digestion and absorption
- Nutrient deficiencies – including magnesium, iron, zinc, calcium, Vitamin B12, etc.
- Discomfort, bloating, and belching
- Acid reflux.
If our supply of stomach acid is low and can’t digest proteins properly, food can hang around in your stomach longer than it should and ferment. Gas builds up, causing belching and bloating, and blows open your esophageal sphincter. This in turn causes your digestive juices to bubble up into your esophagus, giving you acid reflux.
In the center of your chest, there is a small, muscular tunnel that separates the end of your esophagus from your stomach. It’s called your lower esophageal sphincter (LES). When you’re eating, the sphincter should be open and loose, so food can travel to your stomach. But at all other times, the sphincter should be tightly closed. This prevents all food and digestive fluids from traveling upward. Acid reflux is just having a loose sphincter when it should be tight. It does not mean that there is too much acid. It means that the acid is in the wrong place – in your esophagus. Unlike your stomach, the lining of your esophagus is not coated with mucus to protect it from digestive juices, so when the LES is loose and these juices bubble upward, it hurts.
In addition to low stomach acid, there may be many causes of acid reflux, including magnesium deficiency, eating in a rushed or stressed state, drinking too much liquid during meals, etc.
Here are some of my go to solutions for acid reflux:
1) Slow Down and Chew. The average American chews each bite of food only a few times before swallowing it down hard, often with a gulp of water as a chaser. Try to chew your food until it’s liquid. This significantly reduces the work of your stomach. I know this seems simple, but sometimes the simplest remedies have the most profound effects. Just by chewing your food 20-30 times per bite and not drinking much liquid with meals (see below), you may resolve your acid reflux.
2) Drink as little liquid as possible with your meals. Ingrained in our dining culture is the practice of drinking beverages with our meals. But this habit is actually causing us harm. When we drink a lot of water or other beverages during meals, we are diluting our stomach acid. This makes it less potent, leading to belching, bloating, and acid reflux. Ideally we should hydrate 20 – 30 minutes before a meal and wait 1 ½ to 2 hours after a meal to drink. In between meals is by far the best time to hydrate. Have only a small glass handy during meals to help clear your palate (e.g. 4 oz).
3) Eat less at one time. Sometimes our LES gets blown open by the sheer volume of food we try to cram into our bellies. This is especially true when we eat at restaurants. Yes, the stomach will stretch, but only so far. Try to stop eating when you are 80% full. You have to leave room (literally) for digestion to take place.
4) Fix magnesium deficiency. This is a widespread issue in the US. The USDA estimates up to 90% of Americans don’t get enough magnesium. Low magnesium can cause your muscles to be too tight or to spasm erratically. This includes the LES. If you also struggle with any regular constipation, headaches, irritability, or tight muscles, try taking a magnesium supplement (start with 400mg magnesium citrate).
5) Stop eating foods that cause your LES to spasm. So here’s the solution to acid reflux that you didn’t want to hear. Unfortunately, we tend to love the foods that are most irritating to the LES. I know it’s hard to give up some of the foods we love, but continuing to eat them and just pop a pill to ignore the pain is likely to turn into a serious illness or disease some day. The most powerful food triggers include: cooked tomato sauce, citrus juices, coffee, soda, alcohol (especially wine), peppery or spicy foods, fried food, chocolate, and things with mint in them (e.g. gum, mints, toothpaste, tea).
6) Don’t eat or drink anything 2-3 hours before bedtime. Reflux can often be worst at night. This is when all of our muscles relax at least a little bit, including our LES. If you put food in your stomach and then go to bed before it’s fully digested, reflux is much more likely. The goal is to eat throughout the day such that you just go to bed with an empty stomach – but not hungry. Not eating a full 3 hours before bed is also an excellent way to improve the quality of your sleep.
7) Experiment with acid replacement. If you suspect that low stomach acid is the cause of your reflux, try taking 2 teaspoons of apple cider vinegar in the middle of a meal (mixed in 1 -2 oz. of water). The idea is to put something more acidic into the stomach at the right time.
And finally, a few words about acid reflux medications. Antacid medications such as Tums are only treating the symptoms – they do nothing to remedy the root cause. And long-term use makes acid reflux worse. If you’re taking a Proton Pump Inhibitor (PPI) such as Prilosec or Nexium for your acid reflux, it’s important for you to be aware that long-term use of PPI medications (more than a couple of months at the most) is dangerous! PPIs act by reducing the body’s production of acid (remember acid reflux is often a result of too little stomach acid, not too much!). PPIs prevent the absorption of critical protein and minerals that, over years, can be the true root cause of ailments such as osteoporosis, arthritis, depression, heart disease, and diabetes. If you are taking a PPI and want to stop, do not stop cold turkey; that can actually do more harm than good. Slowly wean off the medication over a month’s time.