Is Low Stomach Acid the True Cause of Heartburn and GERD?

Is Low Stomach Acid the True Cause of Heartburn and GERD?

The painful burning chest and sour throat of heartburn are a familiar after-dinner event for many women. Commonly understood triggers include medications, certain foods, obesity and bending over or laying down too soon after eating. When heartburn symptoms escalate and occur at least twice a week, a diagnosis of GERD (gastroesophageal reflux disease) may be made. For suffers of these frequent attacks, the pain is disruptive and distressing. Many turn to over-the-counter and perception medications for relief.

Millions of people worldwide use antacids and proton-pump inhibitors (Prilosec, Prevacid, Nexium) each year to control their GERD symptoms, but some experts believe that treating stomach acid as the enemy misses the true root cause of GERD. While acid-lowering medicines may offer relief from symptoms, like heartburn pain, the source of the problem is not addressed and may be worsened. There is

Low stomach acid reduces the stomach’s ability to break down carbohydrates by thwarting the release of pancreatic enzymes. Additionally, stomach acid functions to control bacteria. When acidity is too low, either naturally or due to acid reducing medications, bacteria can flourish. This is the argument of Chris Kresser , M.S., L.Ac and author of “The Paleo Cure.” Kresser points to low acid as the root cause of GERD. While it may seem counterintuitive, he argues that low stomach acid allows bacteria to overgrow in the stomach and intestinal tract, causing carbohydrate malabsorption, abdominal gas and pressure and ultimately the eruption of stomach acids past the valve into the esophagus. Kresser points the finger specifically at H. pylori bacteria, a common bacterial pathogen. H. pylori survives in the stomach by suppressing acid production. Heartburn/GERD, Kresser also advises sufferers to avoid high fiber foods, which can feed gut bacteria and produce gas. The use of hydrochloric acid supplements to raise stomach acid levels may seem extreme at first, but many sufferers have found relief with this method. Kresser recommends a Betaine HCl capsule with pepsin or acid stable protease. Betaine HCl is a form of Hydrocloric acid derived from beets. He warns that this method is not appropriate for those taking anti-inflammatory medications like NSAIDS, ibuprofen, aspirin, Indocin or corticosteroids, such as prednisone. These medications can cause damage to the lining of the digestive tract, causing potential bleeding and ulcers. Hydrochloric acid therapy could increase this risk. As always, it is best to consult your health care provider before beginning a new therapy.

Kresser recommends a slow start, to find your ideal dosage:

“To minimize side effects, start with one 650 mg capsule of HCL w/pepsin in the early part of each meal. If there are no problems after two or three days, increase the dose to two capsules at the beginning of meals. Then after another two days increase to three capsules. Increase the dose gradually in this stepwise fashion until you feel a mild burning sensation. At that point, reduce the dosage to the previous number of capsules you were taking before you experienced burning and stay at that dosage. Over time you may find that you can continue to reduce the dosage, or you may also find that you may need to increase the dosage.”

Eating raw fermented foods, such as pickles, sauerkraut, kimchi and kombucha (a fermented tea beverage) can help to balance the bacterial levels of the gut. Probiotic dairy (yogurt and kefir) is also a good choice, although Kresser cautions that the carbohydrates in dairy can feed bacterial overgrowth, so moderation is advised.

GERD is a painful condition that significantly impacts the lives of its sufferers. Quick relief from symptoms is a reasonable and understandable goal. But while proton pump inhibitors can offer relief, we owe it to our stomachs to explore the new thinking that reliance on acid reducing medications may not be the best for our long-term health.



Chris Kresser, “Heartburn/GERD”, /wp-content/uploads/membership-files/ebooks/Heartburn%20GERD.pdf. PDF e-book

Reimer, Christina et al., “Proton-Pump Inhibitor Therapy Induces Acid-Related Symptoms in Healthy Volunteers After Withdrawal of Therapy,” Gastroenterology , Volume 137 , Issue 1 , 80 – 87.e1

Mark Feldman, Byron Cryer, Edward Lee, “Effects of Helicobacter pylori gastritis on gastric secretion in healthy human beings.” American Journal of Physiology – Gastrointestinal and Liver Physiology Published 1 June 1998 Vol. 274 no. 6, G1011-G1017 DOI,

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