<aside> <img src="/icons/mathematics_blue.svg" alt="/icons/mathematics_blue.svg" width="40px" /> Summary

1. Low stomach acid contributes to bacterial overgrowth in the bowel
2. This leads to carbohydrate malabsorption (due to decreased pancreatic enzyme secretion)
3. Bacteria feed on malabsorbed carbohydrates and produce gas
4. Gas increases intra-abdominal pressure and causes reflux and G.E.R.D. related symptoms </aside>

From the top…

<aside> <img src="/icons/circle_blue.svg" alt="/icons/circle_blue.svg" width="40px" /> Reflux is caused by too little stomach acid, not than too much

Jonathan Wright, MD of the Tahoma Clinic in Washington state: when stomach acid is measured in people suffering from heartburn and GERD it is almost always low, not high“

Acid secretion declines with age, GERD symptoms increase: “When we carefully test people over age forty who’re having heartburn, indigestion and gas, over 90 percent of the time we find inadequate acid production by the stomach.”

“In nearly all these folks, symptoms have been relieved and digestion improved when they’ve taken supplemental hydrochloric acid and pepsin capsules.”

Any amount of acid in the esophagus is going to cause problems. That’s because its delicate lining isn’t protected against acid like the stomach lining is.

i.e. It’s not a case of “too much” acid, rather acid in the wrong place

Why?

Low stomach acid contributes to carbohydrate malabsorption (because stomach acid, HCL, stimulates release of pancreatic enzymes).

If pH too high (alkaline) pancreatic enzymes won’t secrete and carbohydrates won’t be broken down properly.

In his excellent book, Heartburn Cured, microbiologist Dr. Norm Robillard argues that carbohydrate malabsorption leads to bacterial overgrowth, resulting in IAP which drives reflux.

This pressure causes gastric distention (stomach bloating) that pushes the stomach contents, including acid, through into the oesophagus.

Meaning reflux is also be caused by a dysfunction of the muscular valve (sphincter) that separates the lower end of the oesophagus and the stomach.

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<aside> <img src="/icons/circle_blue.svg" alt="/icons/circle_blue.svg" width="40px" /> What promotes low stomach acid?

• Acid suppressing drugs

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  ⇒ There are three primary consequences of acid stopping drugs:

  1. Increased bacterial overgrowth
  2. Impaired nutrient absorption
  3. Decreased resistance to infection

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• H. pylori infection:

  H.pylori suppresses stomach acid secretion to survive (treating it with antibiotics increases stomach acid).

• When both are combined: Acid suppressing drugs increase H. Pylori risk

  H. pylori → low stomach acid → heartburn → acid suppressing drugs → worse H. pylori infection → further reduction of stomach acid → chronic heartburn & GERD

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