As a dietitian, I have talked to SO many people who have experienced acid reflux among other chronic nutrition symptoms like bloating, gas, and fatigue. While it may seem daunting, low stomach acid is something that can be corrected. That means that some GI (gastrointestinal) issues may be easier to resolve than you realize! Beyond easing GI problems, sufficient levels of stomach acid can also result in clearer thinking, improved mood, better bowel movements, and increased energy. Let’s dive in!
The real deal about acid reflux
Excess stomach acid is often blamed for being the cause of acid reflux. However, in about 90% of cases, the actual cause of acid reflux is low stomach acid. When the stomach isn’t acidic enough, the lower esophageal sphincter (LES) is not signaled to close properly and remains partially open. This then allows acid to go back up into the esophagus, causing reflux symptoms. Low stomach acid can create imbalances in the microbiome called dysbiosis, where unfavorable bacteria live in the gut and cause issues.
If you have low stomach acid, you may experience some of the following symptoms: bloating, belching, burning, flatulence immediately after meals, indigestion, food allergies, nausea after supplements, stomach pain, undigested food in stool, and extreme fullness after eating. Prolonged low stomach acid can contribute to allergies, asthma, skin disorders, rheumatoid arthritis, insomnia, osteoporosis, GI infection, and depression. It can also cause malabsorption of different vitamins, minerals, and proteins which can lead to leg cramps, cracking/peeling/chipping fingernails, neurological issues, or hair loss.
What causes low stomach acid?
Chronic stress, aging, poor diet, infection, and improper medication use can all cause low stomach acid. Stress and eating a diet high in refined sugars and oils impair digestion. It leads to a decreased production of stomach acid due to nutrient deficiencies. Drinking and smoking may also result in nutritional deficiencies of B vitamins, zinc, or both. We also need healthy stomach acid to provide a barrier as the immune system’s first line of defense against foreign invaders. When our stomach acid levels are low, it increases our chances of other infections and conditions that can harm our guts and bodies.
So – how do we reverse acid reflux?
- Heal your gut through foods
- Look to supplements
- Talk to your provider about taking PPIs
If you go to the doctor for heartburn or GERD, the standard treatment is a prescription for a PPI medication (proton pump inhibitor) like Prilosec, Nexium, Zantac, or Pepcid. Oftentimes, this treatment can act more as a bandaid for symptoms and, in some situations, can make symptoms worse. When these acid reflux medications are used, they lessen or completely eliminate stomach acid, making us more vulnerable to worsening GI issues.
One study looked at the microbiome of 1,815 people and found that proton pump inhibitor users had a less healthy gut, which may explain their increased risk of stomach infections. A recent cohort study concluded that those who took PPIs for more than one year had an associated 17% increased risk of death. These medications were not designed to be used for more than 6-8 weeks but are often taken for years. While the medications do provide welcome symptom relief, they can lead to osteoporosis, nutrition deficiencies, and heart disease, each of which can contribute to a higher risk of death.
Food triggers and how to manage them
It’s important to focus on how you are eating so you can avoid your food triggers and help your gut heal. There are several common food triggers for acid reflux. Some of the most common triggers include tomatoes, onions, garlic, chocolate, coffee, alcohol, fried foods, spicy foods, citrus, dairy, soda, and carbonated beverages. Everyone will have different triggers and symptoms, so be mindful that the journey to reverse acid reflux will not be the same for everyone. If you aren’t sure what foods are a trigger, consider the following:
- Try completing a food journal to pick up on any habits or patterns to see how you can better improve your symptoms.
- Slow down, be mindful, and enjoy your meals. Be sure to chew your food thoroughly.
- Be aware of meal size and when you eat.
- Try reducing foods that cause the opening of the esophagus to weaken. These may include alcohol, processed foods, fried foods, caffeinated beverages, and soda.
- Try reducing foods that may be irritating to your esophagus. These may include citrus fruits, juices, tomato-based foods, spicy foods, pepper, coffee, and carbonated beverages.
Tips for a healthy gut
- Add apple cider vinegar before meals. Apple cider vinegar is a great natural remedy because it has a very low pH in balance with your stomach. You can mix 1 tbsp in a glass of water.
- Cook with cruciferous vegetables. Cruciferous vegetables have been proven to reduce inflammation and reduce the risk of colon, liver, and stomach cancer. These veggies are also high in fiber, which makes them the perfect food for your body and gut bacteria! The most common cruciferous vegetables are broccoli, kale, cabbage, and cauliflower.
- Sip on stock. Bone broth can help heal the small intestines from any damage caused by low stomach acid. It contains collagen, a protein that nourishes the intestinal lining and reduces inflammation.
- Play with peppermint. Peppermint has antibacterial and gastric acid-promoting effects. It can help increase the flow of bile and digest fat. It is most commonly taken through capsules, essential oils, or teas.
- Pick your prebiotics and probiotics. Taking pre- and probiotics is a great way to encourage a balanced, healthy gut. You can incorporate these in the form of food or supplements. Sources of prebiotics include artichokes, apples, nuts, oatmeal, rice, and sweet potatoes. Probiotics include Greek yogurt, kimchi, sauerkraut, kefir, and miso.
If you have been taking PPIs for years and are considering going off of them, talk to your healthcare provider. If you are interested in supplements, some of the following have been studied to help bridge the gap:
- Ginger can reduce inflammation and soothe irritation in the gut lining.
- Deglycyrrhizinated Licorice (DGL) has been used in ancient Chinese medicine to heal and soothe the gut lining. It has anti-ulcer and anti-inflammatory properties that can help heal the gastric mucosa to create a barrier that may protect the esophagus.
- Studies show that melatonin can protect the esophagus against acute reflux esophagitis, as well as the chronic inflammation that leads to GERD and Barrett’s esophagus. Melatonin can protect the esophagus against potentially damaging factors including acidic stomach enzymes as well as alcohol, non-steroidal anti-inflammatory drugs (NSAIDs), and stress.
Other ways to support healthy stomach acid
- Eat protein-rich foods at the beginning of your meal to stimulate the digestive enzymes necessary for digesting protein.
- Chew thoroughly. This is one of the most important steps of digestion. Food proteins need to be broken down to be properly digested.
- Limit liquid intake during meals until at least 30 minutes after a meal to allow for proper stomach acid production and the breakdown and use of proteins.
- Stay hydrated between meals to support healthy movement of the gut; this way, intestinal contents leave the body instead of flowing back into the stomach.
If you’re interested in adjusting your diet, the YMCA Nutrition Counseling Program helps adults find a healthier way of eating that’s right for them with the help of our Registered Dietitian. Learn more »
–Mattie Lefever, LDN, RDN
