To review, heartburn and GERD are not considered to be diseases of excess stomach acid, instead they are caused by a dysfunction of the muscular valve that separates the lower end of the esophagus and the stomach (LES). When the LES is malfunctioning, as it is in GERD, acid from the stomach goes back into the esophagus and affects its delicate lining. The amount of acid in the stomach is not important. So what causes the LES to malfunction?” Let’s look at the role of increased intra-abdominal pressure (IAP).

Acid reflux occurs when stomach bloating pushes the stomach contents through the LES into the esophagus. Beside of obesity, eating too heavy or too late there are 2 primary causes of increased intra–abdominal pressure: Bacterial overgrowth and mal-digested carbohydrates. Both conditions produce gas.

Bacterial overgrowth
One of the main roles of stomach acid is to inhibit bacterial overgrowth. The normal ph of the stomach is about 3 and most bacteria cannot survive this environment. But when the stomach acid is reduced and rises above ph 5, bacteria can grow. The long term use of acid reducing drugs reduces the stomach acid to almost zero.

Maldigestion of carbohydrates
Stomach acid stimulates the absorption of carbohydrates by helping the release of pancreatic enzymes into the small intestines. If there is insufficient acid, the carbohydrates will not be broken down properly. Normally, when carbohydrates are consumed in moderation, they are broken down into glucose and then they get fast absorbed in the small intestine before they can be fermented by microbes. Microbes preferred energy sources are carbohydrates (ref: Heartburn Cured by Dr. Robillard). Undigested carbohydrates produce hydrogen gas. Such an environment is ideal for digestive tract infections i.g. Amebas, Salmonella, E. coli, and others. H.pylori itself can suppress stomach acid. This creates a vicious cycle that reinforces each other in disturbing the digestive function.

Irritable Bowel Syndrome (IBS)
Several studies have shown the link between Gerd and IBS. An extremely high percentage of people with Gerd suffer from IBS and vice versa. Some scientists believe that the underlying cause of IBS may be an overgrowth of bacteria, especially H.pylori.

Successful treatments therefore have to address following aspects:

1. Reduce factors that promote bacterial overgrowth and intra-abdominal pressure by initiating a very low carb diet. This often creates significant improvements of the symptoms.
2. Replace stomach acid (apple cider vinegar, lemon juice, pickles, betaine hydrochloric acid.
3. Use Enzymes (Pepsin)
4. Use Bitter and other digestive herbs: Milk thistle, Caraway, Fennel, Gentian root, Barberry bark, Dandelion, Wormwood, Estafate and Epazote (Mex. herbs), etc.
5. Restore beneficial bacteria and a healthy lining in the intestines with probiotics.

Beneficial bacteria (probiotics) protect against harmful bacteria through “competitive inhibition”. They are not able to eradicate H. pylori.  But studies have shown that they are effective in treating and preventing many digestive infections and conditions, including Crohn’s disease, ulcerative colitis, etc.
I am often asked what type of probiotics is recommended. I think that we should always get the nutrients we need from food, rather than by supplements. Especially probiotics may not contain the amount of microorganisms they claim. Fermented food might be a better source of probiotics than just supplements.  Unpasteurized sauerkraut and pickles, fermented drinks (kombucha, kefir) or homemade yogurt are good sources of beneficial bacteria.  To introduce these foods to your system, start with small amounts in therapeutic quantities.

Bone broth
Homemade bone broth soups have many health benefits. They are rich in collagen and gelatin and play an important role in the metabolic process of the intestinal cells.

Everything is connected and we see how such simple medications as stomach acid inhibitors can initiate a chain of consequences resulting in reducing our overall health and well being.

Barbara Rotthaler, German certified Naturopath, can be reached (376) 1080444 or (376) 765 30 32, email: barbararotthaler@gmail.com www. ChapalaHealth.com