GERD is caused by stomach acid or bile refluxing or backing up into the esophagus. The lower esophageal sphincter (LES) should normally close and prevent acid from backing up into the esophagus. While the idea that acid reflux is caused by too much stomach acid is still popular, anyone familiar with current scientific literature is aware GERD is not a disease of excess stomach acid. In fact, if the LES is working properly, it would not matter how much acid is in the stomach.
While suppressing acid will reduce the symptoms of GERD, it does nothing to address the underlying problem. Therefore, it makes sense to focus on the underlying cause and avoid the host of side effects associated with chronic acid suppression. (More on the side effects of acid suppression in another article).
It is now well accepted that GERD (and failure of the LES to close properly) is caused by increased intra-abdominal pressure. Acid reflux occurs when pressure causes gastric distention, or stomach bloating, to push the stomach contents, including acid, through the LES and into the esophagus. This is what leads to recommendations regarding overeating, obesity, bending over or lying down after eating, consuming spicy or fatty foods and alcohol come in, as they all relax or put pressure on the LES.
There can be a number of causes of increased intra-abdominal pressure. One major cause is carbohydrate malabsorption, leading to bacterial overgrowth, which ultimately causes fermentation of foods in the intestines resulting in gas and increased intra-abdominal pressure. Other causes of poor digestion or malabsorption, which can produce the same results include:
- Enzyme deficiencies
- Nutrient deficiencies
- SIBO (small intestine bacterial overgrowth)
- Too little stomach acid
Finally, other and somewhat related causes of GERD include:
- Food allergies
- Pylori infection
- Candida overgrowth
- Stress (which can cause improper digestion)
As you can see, there are many potential causes of GERD. Unfortunately, while the chronic use of acid suppressing drugs may relieve symptoms, they do nothing to resolve the underlying cause. In fact, they contribute to poor digestion and bacterial overgrowth, again contributing to increased intra-abdominal pressure. And worse they lead to a host of other long term side effects including nutrient depletions, leaky gut syndrome and potentially auto-immune disorders.
Since GERD and the use of acid suppressing medications is so prevalent in our society we will cover much more on this topic, including how to identify the cause and steps to healing in a future article.