Stomach acid has gotten a bad rap over the years. Walk through any drug store and you will see rows of medications that block stomach acid. Commercials and ads in various media outlets promise relief of occasional acid reflux. Is there truly a deficit of acid blocking substances in your digestive tract that cause a need for these medications? Or is it something else that lends to reflux of stomach acid? Diet and lifestyle factors play marked roles in how your body manages stomach acid.
Prevalent Use of Acid Management Medications
Nearly forty years ago, marketing surveys showed that 1 out of 2 individuals periodically used acid-blocking drugs. Recent market reports show a growth rate of antacid use about 3% every year with chronic antacid use in 65% of the senior population. Millions of healthy individuals young and old use these medications. Often these drugs are used long-term without thought of consequences or how to address underlying concerns.
Common acid neutralizers, acid suppressors, or acid blockers include Tums, Rolaids, Maalox, Alka Seltzer, Gaviscon, Mylanta, magnesium oxide, calcium carbonate, Pepcid, Tagamet, Zantac, Nexiumm, Prilosec, Prevacid, Protonix, and many others.
Very little stomach acid/hydrochloric acid (HCl) is present in the stomach between meals, but in a healthy system, an acid pH of 1.5-3.5 is usually maintained. As soon as you see, smell, taste, or even think about food, neurotransmitters and hormones signal an increase in acid production. This occurs because food pH is generally more alkaline, usually a pH of 6-8, and must be exposed to acid to start digestion. After food is ingested, the system will balance out again back to a pH of 1.5 to 3.5. This process of pH management sets off a series of reactions further down the digestive tract that complete the digestion process.
Stomach acid is produced by three substances – acetylcholine, gastrin, and histamine. Acetylcholine is the compound that talks to your brain and stomach that starts acid production at the thought, smell, or taste of food. Gastrin and histamine also trigger stomach acid production as well as multiple feedback mechanisms, motility and rate of digestion, absorption of nutrients, and more.
Lower Esophageal Sphincter
There is a sphincter, or muscular valve, located at the junction between the esophagus and stomach, called the lower esophageal sphincter (LES). This valve opens in response to eating and drinking foods and beverages. It closes after food has passed. It normally does not open at any other time except for belching and to vomit. This valve keeps stomach acid in the stomach.
If the sphincter becomes lazy or relaxes, acid can reflux upward into the esophagus. When that happens repeatedly, then the esophagus becomes sore and sensitive from bits of acid moving upwards. Chronic relaxation of this valve and reflux of acid may lead to chronic hoarseness or cough, throat clearing, feeling like there a lump in the throat, heart burn, and other concerns. As long as this valve stays closed, acid remains in the stomach. It doesn’t matter how much stomach acid is present.
Antacids Fail to Address Underlying Issue
Acid neutralizers, suppressors, or blockers affect levels of acetylcholine, gastrin, and histamine and the mechanisms and compounds produced by them. The effect is a lowering of stomach acid production to protect the delicate tissues of the esophagus. These medications reduce the acidity in the stomach, but they fail to address the underlying issue that allows acid to reflux upwards, that is - relaxation of the lower esophageal sphincter (LES).
Things that Relax the LES Sphincter
Irregular dietary habits and other factors adversely affect relaxation and tone of lower esophageal sphincter or make the valve relaxed. This affects the risk and severity of acid reflux (individual responses vary). These include:
• eating late at night with less than 3 hours between dinner and bedtime
• skipping breakfast
• eating quickly
• eating very hot foods
• alcohol consumption
• stress/poor mental health
• raw, cold or spicy food like onions
• fat and high calorie foods
• food allergies
• increased abdominal pressure/bending over with a full stomach
Medications can also weaken the valve. Some of them include bronchodilators like albuterol, NSAIDs (aspirin, ibuprofen, etc.), calcium channel blockers (Cardizem, etc), beta-blockers (Inderal), tranquilizers (Valium/diazepam), and nitrates/Nitroglyercin.
Additional Factors for LES and Acid Management
Grazing and frequent snacks also contribute to relaxation of the sphincter and triggering of acid reflux. Grazing throughout the day alters the timing of the digestive processes. It does not allow enough time for stomach contents to be digested and move down the tract. Repetitive release of stomach acid from grazing and snacking perpetuates imbalances that lead to relaxation of the esophageal sphincter. Many individuals are now told to eat frequent small meals because of blood sugar dysregulation. You must ask yourself, does this contribute to your acid reflux?
Individuals who consume high fat, low-protein, high-sugar, acidic foods and beverages (Western diet) have a greater incidence of acid reflux. Studies show if you drink 10 ounces or more at one time of soda pop or alcohol, you are more likely to experience acid reflux. Carbonated beverages reduce the strength of the lower esophageal sphincter. Drinking water does not. Extensive meta-analysis studies show mixed effects with coffee and tea on the LES tone and acid reflux. If you know that it bothers you, limit or avoid intake.
Lower bowel fermentation from certain carbohydrates like fructans or fructo-oligosaccharides (FOS) and germ overgrowth can increase relaxation of the sphincter. FOS is normally helpful and used as prebiotic. Rich sources of FOS include agave and agave syrup, Jerusalem artichoke, yacon, wheat, barley, bananas, onions, chicory root, garlic, asparagus, jicama, leeks, and other sources. If these foods are bothersome, you may need to address underlying germ overgrowth in the digestive tract. Lactose found in dairy is another carbohydrate that can affect the LES valve.
Athletic activity affects the tone of the sphincter that can lead to an increase in acid reflux. A small group of healthy athletes were evaluated on the effects of running on the lower esophageal sphincter and acid reflux. Participants ate a meal followed by a rest period then ran on a treadmill for 30 minutes at 60 percent maximum heart rate. They took another short rest break and ran for an additional 20 minutes at 85 percent maximum heart rate.
Results showed significant relaxation of the lower esophageal sphincter in all runners and almost all experienced an episode of acid reflux. Half of the participants were also found to have a functional hiatal hernia seen during running, but disappeared upon rest.
Lying down on your back with a hiatal hernia no matter what the size, adversely affects the lower esophageal sphincter and increase likelihood of acid reflux.
Many of the factors listed above that challenge the LES are things that can be changed by you making different choices rather than reaching for powerful medications. At the core of a healthy lifestyle is the simplicity of The Five Rules of The Leptin Diet. It allows adequate time between meals and other tips that impact digestion, LES function, as well as helping healthy weight management. Weight loss helps lessen the strain on the valve.
Make sure you take time to chew well and enjoy your meal in a relaxed manner as this helps your autonomic nervous system with digestion and movement of foods down the digestive tract. It allows for healthy management and support for the LES valve. Choose a variety of whole foods. If you indulge periodically in sugary treats or engage in some of the other risks listed above, scale down. You can change!
Avoid heavy lifting or exercise right after a meal. This helps reduce the intra-abdominal pressure that affects the valve. Wear clothing that is comfortable around the waist to not increase abdominal pressure.
Other Beneficial Tools
A clinical trial published in the 2018 World Journal of Gastroenterology demonstrated the benefits of high fiber diet on acid reflux management. Dietary intake of fiber in participants prior to the trial was less than 20 grams per day. Participants then added 5 grams of psyllium three times per day for an additional 15 grams to their daily diet. Results showed significant improvement overall with improved LES tone and function and decreased number of acid reflux episodes and frequency per week. Individuals who consume the Standard American Diet/Western Diet often lack daily adequate fiber and consume only 10-15 grams of fiber per day. Adults need at least 25-35 grams/day.
Nutrients like glutamine, N-acetyl-d-glucosamine, DGL licorice, and slippery elm help protect and support the mucosal tissues and lining of the esophagus and stomach. D-Limonene is also helpful and creates downward motility in the gut. This helps alleviate pressure on the sphincter. Calcium helps the muscle tone of the lower esophageal valve.
Studies show that melatonin, the “sleep hormone” affects many factors related with the valve and gut motility. Substantial amounts of melatonin are released in several areas of your digestive tract. Melatonin increases release of gastrin, which helps the valve squeeze or contract. This helps keep the acid from refluxing upwards.
Plant-based enzymes can also aid in digestion. They don’t provide stomach acid, but they help break down proteins, fats, and carbohydrates. A small amount of bitter herbs with your meal can be helpful for stimulating normal digestive mechanisms. Apple cider vinegar, lemon juice, and betaine HCl support stomach acid production and lower the pH in the stomach. These are often very helpful for healthy individuals.
In the last few years, Zantac and ranitidine, popular acid reducing medications were pulled from the market because unacceptable levels of NMDA were found in the product. NMDA is a probable carcinogen.These are serious issues. Millions of healthy individuals use acid management drugs long-term without education or concern for these underlying issues and long-term consequences. Many dietary and lifestyle factors that affect digestion and the tone of the lower esophageal sphincter can be corrected with self-care and some work to improve health.