Acid Reflux: The Whole Picture
We all know that feeling: that hot, burning feeling in the chest following a large meal. It is a common misconception that heartburn occurs from too much acid in the stomach, however, the true cause of acid reflux is insufficient stomach acids.
The stomach is an acidic environment. Stomach acids facilitate the chemical digestion of food, as well as protect the body against pathogens by creating a hostile environment for bacteria and parasites. Sufficient stomach acid is crucial to digestion and assimilation of nutrients. There are several sphincters throughout the digestive tract that act as doors that open and close as needed. One of these sphincters, called the esophageal sphincter, is located where the esophagus empties into the stomach. This sphincter is designed to open when we are ingesting food, and close after the meal, when the stomach is full and busy digesting the meal. Food stays in the stomach for 4-6 hours following a meal before it is ready to be sent to the small intestine for the next phase of digestion. The whole digestive process is a symphony of signals that allow the self organization of the digestive process. Stomach acids increase when food is ingested. The cells of the stomach secrete hydrochloric acid which sets off a cascade of other enzymes and hormones that all play an important role in digestion. The presence of hydrochloric acid in the stomach sends a signal to the esophageal sphincter that digestion is currently taking place in the stomach, and it is time to close. The closing of the esophageal sphincter protects the tissues of the esophagus from the stomach acids that are currently facilitating digestion. When there are insufficient gastric secretions, this signaling system is weakened, and the sphincter does not receive a strong message to close. The sphincter remains open, thereby exposing the esophagus to the stomach acids and causing the symptoms of acid reflux. Therefore, acid reflux is caused by insufficient stomach acids rather than excess stomach acids. It is common for folks to take antacids for symptom relief of acid reflux. This temporarily quells the symptoms by neutralizing some of the stomach acids in the esophagus. However, antacids do not address the root cause of acid reflux and will make the problem of insufficient stomach acid worse.
What causes insufficient stomach acid?
There can be numerous reasons for insufficient stomach acid. Digestion is under parasympathetic control: rest and digest. When we are in a state of stress, this undermines our body’s ability to produce digestive secretions. When we are stressed, the blood moves away from our inner organs to our skeletal muscles, and digestion comes to a halt. Rushing through a meal, eating while driving/ working/ being on the phone, or being in a state of chronic stress impairs our ability to produce sufficient digestive secretions, including hydrochloric acid. Nutrient deficiencies can also cause insufficient stomach acids as there are key nutrients that form the building blocks for the creation of stomach acid. Deficiencies in magnesium and zinc can play a role in low stomach acid in this way. Over eating can also result in inadequate stomach acid to digest such a large quantity of food. Additionally, digestive stagnation further down the GI tract can prevent the Qi of the stomach from descending and cause reflux symptoms of stomach acid ascending into the esophagus. According to TCM, the Qi of the stomach should descend, and digestive issues can arise when the Qi is not descending.
How to alleviate acid reflux?
Continuously taking antacids does not address the root cause of acid reflux and will exacerbate the issue over time. Primarily, we want to focus on soothing the tissues that are damaged/ irritated by the presence of stomach acid in the esophagus. Herbs such as licorice, marshmallow and slippery elm are soothing and supportive to the mucus membranes that protect these tissues. Teas and cold infusions are the recommended way to deliver medicine in this case, due to their superior ability to extract the demulcent (moistening) qualities of these herbs. Additionally, we want to incorporate herbs that can help promote the healing of damaged tissues. Herbs such as plantain, chamomile and meadowsweet can be helpful vulneraries and anti-inflammatories to reduce painful symptoms. Ultimately, once tissues are healed, we need to address the root cause of acid reflux: low stomach acid/ weak digestion. As previously mentioned, there are multiple causes for low stomach acid, such as, stress while eating, nutrient deficiencies, nervous system dysregulation, liver stagnation etc. Luckily, we have many tools and herbs that can help promote gastric secretions. Please note: the use of bitter herbs/ foods may make acid reflux symptoms worse, if tissues are not first soothed and healed.
As always, this is for educational purposes only and is not medical advice. Please consult a medical practitioner for medical advice.