Gastroesophageal reflux disease (GERD) is a condition that is highly common in the United States. When one has this condition, the valve separating the esophagus from the stomach allows acid into the unprotected esophagus, often causing an unpleasant sensation.
Between 10-20% of people experience weekly symptoms, and $13 billion in prescription pharmaceuticals were spent treating this condition. The identification of the causes of GERD is a matter of some controversy right now which has significant implications in how the disease is treated.
Most people believe that GERD is caused by too much stomach acid. The vast majority of medicines that are given to people to treat GERD lower stomach acid.
While these are effective, there is a lot of evidence that the exact opposite scenario is true. Too little stomach acid could be causing GERD, and treating it with most prescription pharmaceuticals could make the condition worse in the long run.
The first thing someone should notice with regards to the too much stomach acid hypothesis is that most people experience dramatic drops in stomach acid when they age.
As a result, one would expect that GERD would become less and less of a problem if the high stomach acid cause hypothesis were correct. However, the exact opposite is observed. The incidence of GERD actually increases as one ages.
Why are young people not getting GERD in huge numbers given their large amounts of stomach acid? The main reason is that the valve separating the stomach from the esophagus normally works.
If it fails at all, then it does not matter if you have a little stomach acid or a lot. It is going to cause a problem. The reason why is the esophagus just is not protected against the corrosive effects of the acid.
This fact also explains why many people get systemic relief from pharmaceuticals. By dramatically decreasing the stomach acid that is flowing into the esophagus, one will get less symptoms. However, if the valve is not functioning well, there will always be small amounts of acid corroding the esophagus.
Recent evidence indicates that even silent GERD, that is when symptoms are not noticed, is dangerous and can even lead to a much greater risk of esophageal cancer.
The underlying dysfunction of the valve is believed to result from the unnatural expansion of pressure in the stomach, which pushes stomach juices out of the valve.
There appear to be two things that cause this increase in pressure. The first is an overgrowth of bacteria in the gut, and the second is the accumulation of improperly digested carbohydrates.
Both of these underlying issues actually can be the result of lower stomach acids. Bacteria cannot survive well in the stomach when the pH drops below 3. If one weakens the acid of the stomach, then this bacteria will overgrow causing increased stomach pressure.
The presence of undigested carbohydrates also helps to feed such bacteria. The reason that the carbohydrates are undigested also largely relates to the fact that the stomach acid is not powerful enough to quickly reduce them.
As a result, when people consume medicines such as proton pump inhibitors, they could be temporarily relieving their GERD symptoms while weakening their stomach acid, which is only making the underlying problem worse.
In contrast, many physicians have found that providing hydrochloric acid supplementation to boost the acid content of the stomach actually resolves the disease.
Thus, understanding the causes of GERD has very important implications towards changing our current treatment paradigm. If you currently suffer from GERD, you should seriously consider going off the prescription medications and taking actions to increase the acid content of your stomach.