5 surprising causes of acid reflux

Following the stress of this last year and a half, we’ve seen a huge influx of reflux clients in our clinic.

What treatment is available for reflux?

Currently, other than managing the symptoms with acid-suppressing medication (proton pump inhibitors - PPIs), there is little treatment available. People are often put on medication long-term (with associated potential increased risk of further gut problems such as SIBO and even Clostridium difficile infection), and often without help ‘coming off them’.

Stopping the medication will give ‘rebound reflux’ which can be quite severe, and not everyone is managed through or even told about this, which can lead to failure of stopping taking them.

It is preferable, of course, to try and avoid the need for medication, and this is where we try and help, using diet, lifestyle factors and by working on the microbiome. 

What are the underlying factors of acid reflux?

1. Stress

We all know about this one: reflux has a huge endocrine (hormonal) factor. Stress hormones impact digestive processes and stomach acid significantly.

Many lack the tools to counteract stress, however, and we recommend specific (but very simple) breathing exercises, mindful eating and chewing. This has to be approached before even attempting to wean off PPIs and to achieve any real results in addressing the symptoms for most.

2. Menopause

We find an increased incidence of reflux in our clients after periods stop, and there has been an associated link with HRT in research. This is best managed with an added focus on sex hormones.

3. Motility

This is an interesting one, and very relevant to reflux. Traditional thinking is that there is simply too much acid in reflux, but this is not always our clinical experience. More often, we find that it’s more a regulation problem, where the stomach’s management of the release of stomach acid becomes imbalanced and chaotic.

But this can be complex and this remains under-studied. The microbiome appears to play a significant part, but generally, we go by observation and experience when we approach this, as we simply know too little via research.

4. Incompetence of the stomach valve

This is common in reflux, leading to leaking of the stomach content into the throat/oesophagus (sore throat/clearing of throat). Other than the structural problems, we do not have a great understanding of why this occurs.

Being overweight (in particular around the middle) does increase the risk for sure, but generally, we find that a variety of seemingly associated factors such as microbiome or constipation play a part, but how they do exactly, that we don’t yet understand fully. We tend to see this quite often together with SIBO or even gallbladder issues - potentially due to upward pressure from the intestine.

5. Eating too many carbohydrates!

This might be a surprising one - but actually, something that we see quite a bit! Carbs are simply too cheap, too easy and too available in our diets. Sometimes people develop reflux a few months after they turn vegan for example (increased grain intake).

This isn’t a factor for everyone and does appear to be more relevant in simple heartburn - but certainly, it’s worth thinking about. If you consume a lot of grains or a lot of bread or pasta, try switching half of it to vegetables for a couple of weeks. Vegetables have the added effect of being alkaline and bitter, both of which tend to help soothe reflux greatly.

If however, you have SIBO/irritable bowel syndrome, this may actually flare symptoms, and this is when you likely need a nutritionist to help you navigate through the complexity of which order to do what.

6. A thinning gut/stomach mucosa?

This is currently just a theory - but it makes a lot of sense. Poor-fibre diets (rife in the UK) have been shown to thin the gut mucosal lining (not necessarily the stomach, but further down in the GI tract) - and this, together with say insufficient protein intake or a problem digesting proteins (looking at you PPIs), can contribute.

If you think of the mucosa being what stops the stomach acid from digesting the stomach itself, this irritation and gastritis could send SOS or confused signals to the brain and digestive processes perhaps creating dysfunction in stomach acid release. Certainly no harm in considering this for certain people, and we tend to have good results with mucosa-boosting type interventions.

What you can do yourself

So, understanding a little bit more about the disease process, helps us understand more about what might be going on for that specific individual - as not everyone will have the same causes.

Diet

Working on the diet is something you can do yourself: Not only cutting out acidic foods, which you have no doubt done already along with coffee and alcohol (a must), but also considering things like excessive fruit overall, refined carbohydrates (has to go) and excessive carbohydrates. A three-week elimination trial can be helpful, wheat and dairy can aggravate symptoms for some.

Interventions

Drinking very strong chamomile tea, sipping slippery elm (powder, mixed into a drink with hot water) before meals/before bed can be very helpful - it tends to work better in this form than capsules. Liquorice can also be very helpful (not if you have high blood pressure, or use Deglycyrrhizinated liquorice).

Avoid excess water with meals, but equally don’t not drink any water. Just sip a little, then continue to drink post-meal, again sipping away. Ideally, drink the majority of your water between meals or half an hour before.

Ginger and celery juice help some and can be drunk in little shots daily for 10 days to two weeks (on waking). Digestive bitters/Swedish bitters can also be really helpful, but must be taken in the right way, i.e. swirled around the mouth for a few seconds (warning does not taste good) and not diluted with water afterwards if possible.

Osteopathic manipulation can be helpful in structural problems. You can email us if you want a referral to an expert.

Please note, you should always consult your doctor concerning any prescribed medication, and the content of this article does not replace proper medical advice. When considering changing your diet, particularly an elimination diet, it's also best to do so under the guise of a nutrition professional. Feel free to message me for a free online initial assessment.

If you have queries concerning your particular case - feel free to fill in our little mini-health review form on our website, and we’ll respond with a little review plus a few helpful tips.