Reflux 101

Nutrition | | August 31, 2009 at 8:21 pm
Photo by the half blood prince.

Photo by the half blood prince.

Antacids may be hurting you more than you think.

Heartburn, Reflux, GERD, dyspepsia. It’s a common symptom but a poorly understood process. With products like Tums at our disposal (which work by masking what is really happening) it is no wonder this simple information isn’t more widespread.

When most people think reflux the first thing that comes to mind is acid.  Stomach acid, or HCl (hydrochloric acid) is truly caustic stuff with a pH of around 2.  Most peoples’ solution to heartburn is to take Tums, or worse, strong proton pump inhibitors (such as prilosec) which only shuts down the digestive system even further. But there is a lot more to this equation than heart burn + tums = relief.

The first misunderstanding is that the main cause for reflux is an overabundance of stomach acid.  Understand that having adequate stomach acid in the first place is one of the foundational components of good digestion. It is not strictly the quantity of acid which contributes to reflux.

In fact, adequate acid levels are what keeps the LES (lower esophageal sphincter, also called cardiac sphincter) taut thus preventing the acid reflux, while lower acid levels make the LES loose, hence more of the acid reflux.  The reality is that the majority of people have low stomach acid, and prilosec and other antacids are over-prescribed which only further lowers acid that is already too low.  An unfortunate vicious cycle.

I am going to touch on the concept of cause vs symptom here because it is very relevant in this case.  The symptom under investigation is the simple but terrible burning you feel in your chest.  The cause is a complicated beast.  To understand the cause we need to look at several variables.  There are three  mains components as follows:

  • The LES, which is supposed to keep the contents of your stomach in place, is weakened.  The LES works as a one way valve allowing food into your stomach.  During digestion the valve should be shut, keeping the stomach contents and acid in place.  This is the primary physiology of reflux, NOT an overabundance of stomach acid.  How does the LES weaken? Read on.
  • Weak LES function can be due to sluggish digestion, being overweight or pregnancy.  One component of sluggish digestion is that the pH of the stomach can change to 3-4.  This is a huge difference from a pH of 2 (due to complex logarithmic math) and is absolutely not ideal for digestion.
    • An acid of pH 3-4 will still burn like fire to your esophagus.  It is very important that you understand this because a sluggish digestion is one of the causes of reflux which is characterized by low pH HCl.
    • When you body is not in digestion mode, the LES relaxes, and this low pH stomach acid creeps up giving you heart burn.
  • Weak LES function can also be linked to a lack of parasympathetic (feed and breed) nervous tone during eating.  This can be due to eating on the go, chronic stress and the ensuing weak adrenal system
  • Avoid the following foods because a weakened LES will be more likely to react to the following irritating foods
    • Caffeine
    • Nicotine
    • Alcohol
    • Chocolate
    • Citrus fruits
    • Fatty or fried foods
    • Garlic
    • Onions
    • Mint flavorings
    • Spicy foods
    • Tomato based foods

If you have been with me so far you’ll understand the problem is not the quantity of acid itself, but the system within which it is functioning.  The lower esophageal sphincter is the problem here which you now know is linked to the process of digestion.  The treatment then has to focus not on the symptom of heart burn, but on the multifactorial reasons contributing to it. Elementary, my dear Watson.

What can you do? Try these basic food eating principles:

NishantDr. Nishant Rao is a co-founder of He is a well-traveled naturopathic doctor and new father, practicing an integrative approach to create wellness in and around Los Angeles. Become a patient or discover his practice.

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  1. I would recommend two things – often times people can drink some vinegar and the heartburn will cease – proving that it’s not too much acid but rather a lack mostly due the the “antacids” they’re taking.
    One of the m ost effective remedies is Aloe. Aloe heals the body from the inside out. There are Aloe products on the market but one must drink one that has mostly aloe and little water.

    • Dear Karen,

      Thanks for your comments. Yes, most people do not actually have enough stomach acid, and the antacids are certainly over-prescribed in most cases. Of course, there are ways to measure actual stomach acid levels and ideally ought to be done prior to any prescription. Not any vinegar, specifically apple cider vinegar can be helpful, the physiological mechanism behind this phenomenon is that it helps to increase acid levels in the stomach in order to help with the process of digestion. Lastly, as you suggested, aloe can be helpful in some instances but it is mostly a mucilagenous plant, meaning that it helps coat and heal the digestive tract, yet it still does not address the underlying issue of why the reflux is there in the first place.

      Yours in health,
      Dr. Igor Schwartzman

  2. Great article on pH, as I have always been a big supporter of try a little vinegar first approach.

    Another common problem that people don’t recognize is a lack of nervous function in the body. I have seen individuals needing less and less prilosect after correcting a misalignment in the upper cervical spine (what we in the Upper Cervical world call a subluxation), and the symptoms decrease. One individual I was seeing was able to decrease his prilosect from daily to once every couple of months as needed. And to be honest, he was in the middle of a move to a city 2 hours away, so I think he was eating a lot of fast food at the time!

    • Dear Fredrick,

      Thank you for sharing your experience with your patients. As you point out in your example, it is always essential to look at the underlying issue of reflux, and of course any health concern for that matter.

      Yours in health,
      Dr. Igor Schwartzman