By Sarah Cotten, FNLP.
The functional medicine approach has uncovered causal factors regarding heartburn and uses an approach to remedy it different from conventional practices. The functional medicine practitioner wants to treat the root cause of the problem. Drugs, such as Prilosec can just mask the symptoms instead of treating the cause of the problem, and many have severe adverse effects.
Heartburn, however, isn’t caused by too much stomach acid, that is to say, too much HCl, as conventional practitioners have been taught; heartburn is caused by not enough stomach acid. Acid-blocking drugs not only have adverse side effects, but they do not treat the cause of the problem, they just exacerbate it.
It may seem a little counter-intuitive that HCl is necessary, but it will make more sense with a little understanding of digestive physiology. There are several reasons HCl is important. The stomach acid we call HCl, or hydrochloric acid, is your body’s first line of defense against pathogenic bacteria and microbes. An optimum level of healthy stomach acid will kill pathogens and keep them from turning into an infection.
Humans are meant to have significant levels of stomach acid because we evolved as omnivorous eaters, and
we need stomach acid to break down such proteins as found in meats, nuts, seeds, and fish. Aside from water,
protein is the most abundant molecule found in the body and is in all of our cells. It’s stomach acid that begins the process of breaking proteins down into amino acids, which are then used for cellular health, energy, the
immune system, production of hormones, and other fundamental aspects of the body.
Without enough protein, we cannot thrive. Without enough stomach acid, we cannot utilize protein, even if we are eating lots of it. Many of us are challenged with heartburn, also called gastroesophageal reflux disease, or GERD. This is a condition where stomach acid flows back into the esophageal tube that delivers food from your mouth to your stomach. Let’s look at how those GERD symptoms get started.
How Deficiency in Stomach Acid, or HCl Leads to Heartburn
When there is not enough stomach acid, the stomach has to work harder to break down protein and other
foods. It does this by ramping up its churning-and-squeezing muscular action. It has to make a stronger effort
to physically digest food when the chemical breakdown process initiated by stomach acid isn’t working as well
as it could if there were enough HCl.
Churning, Squeezing, Splashing, and Getting Stuck
This overly active churning and squeezing motion in the stomach causes pressure to build and stomach acid to splash, or back up into the esophagus. This results in the feeling known as heartburn, which is actually
esophagus burn. Also, when stomach acid is too low, this sends a message to the stomach’s release valve, known as the pyloric sphincter, to stay closed!
This sphincter is a band of smooth muscle located at the bottom of the stomach. When the stomach is done
breaking down food, this valve is supposed to open and release the digested contents of the stomach into the small intestine for further digestion. If the stomach is acidic enough, this acts as a key for the pyloric sphincter to open so that food can pass into the small intestine and digestion can continue easily.
Take a moment to digest that (pun intended)! Alternatively, if the stomach does not have enough HCl, the
pyloric sphincter valve isn’t stimulated to open, which means the food can’t enter the small intestine easily. Meanwhile, the muscular action of the stomach low in HCl will be continuing to churn along trying to digest the foods you’ve eaten, which often results in pushing existing stomach acid up into the esophagus.
This causes all those awful symptoms commonly but inaccurately called heartburn: throat irritation, a persistent cough, and the burning experience of acid coming up to where it doesn’t belong—and symptoms can include concerning chest and back pains. So, if heartburn is caused by too little stomach acid, it doesn’t make sense to treat it with medication such as Prilosec, which blocks acid production. The acid-suppressing drugs may address the symptoms to some degree, but they have little more than a band-aid effect, and can have very negative consequences.
The Risks of Acid-Blocking Drugs
In fact, acid-blocking drugs (proton pump inhibitors or PPIs) are among some of the most prescribed medicines, yet they come with a frightening list of adverse side effects. Stanford researchers did a robust study
of 2.9 million people and concluded that PPIs more than double the risk of death from a cardiac event.1 These drugs are also associated with increased risk of kidney disease2 and dementia.3
It bears repeating: PPIs lower stomach acid when there is already too little of it. As noted above, inadequate
stomach acid can lead to the uncomfortable and even painful symptoms of GERD, which can lead to esophageal cancer, and poor health in general because it impairs the absorption of protein and important nutrients like iron and B vitamins. Also, it is worth repeating, when stomach acid is insufficient, infectious microbes aren’t nullified upon entry and can take root in the body. These may develop into parasitic infections, small intestinal bacterial overgrowth (SIBO), a disrupted microbiome, or a host of other problems that can arise from poor gut health.
Tips for Increasing HCl
Because the gut is a first line foundation for physical wellness, achieving a healthy level of stomach acid is a
very important step in supporting the health of your brain and body. If you suspect that you have low stomach
acid, here are some tips for naturally increasing HCl production:
1. Drink fresh celery juice on an empty stomach first thing in the morning. It helps restore HCl because it is high in bioactive sodium, and rich in enzymes and coenzymes that also help to raise stomach acid levels.
Celery juice is truly a superfood and digestive tonic. It is antibacterial and can also lower inflammation in the
digestive tract. It aids in detoxification and alkalizes, soothes, and repairs the mucosal lining of the gut. Alkalinizing the mucosal lining of the gut helps the body to produce adequate HCl, which then makes the environment of the stomach appropriately more acidic.
2. For some people, probiotic-rich fermented vegetables, such as raw sauerkraut or kimchi, can help. You
might take a few bites before meals to stimulate acid production in your stomach. If fermented foods work for you, you can also enjoy the fermented beverage kombucha, or drink water with a splash of raw apple cider vinegar, which is a detoxifying, fermented food. Caution: The bacterial infection helicobacter pylori can be a root cause in acid reflux. It is also the cause of most ulcers that are found in the esophagus, stomach, and upper intestines.4
Fermented foods may be irritating and should not be eaten if ulcers are suspected. Also, fermented foods should be avoided in some cases of small intestinal bacterial overgrowth (SIBO). If you experience digestive discomfort when you eat fermented foods, avoid them and find a qualified functional medicine practitioner who can guide you through testing for H Pylori, SIBO, and other infections such as parasites, which may in fact be complicating matters.
3. Maintain good posture! Slouching causes the diaphragm to compress the stomach and can cause or worsen
reflux symptoms. *
4. Squeeze a slice of lemon into your water and sip it to stimulate HCl production and detoxify the liver.
5 . Use a botanical supplement of digestive bitters.
6. Supplement with HCl (hydrochloric acid) tablets. This can be an effective way to increase stomach acidity,
but it should only be done under the guidance of a qualified functional nutrition professional or holistic
healthcare provider, as it is contraindicated for some people.
7. Consider a therapy called visceral manipulation, a type of bodywork that gently adjusts the internal organs
and relieves restrictions on them. When the stomach is not in its ideal location, this is referred to as a hiatal
hernia, which can be a cause of acid reflux. Visceral manipulation can restore the stomach to its proper position and resolve GERD symptoms.
You might want to experiment with these tips and see which may work best for you. You might also consider
finding a functional medicine practitioner who can help you search for the cause of your reflux. She or he can
professionally guide you into recovery as you gradually rebuild your stomach acid. For some people, it is necessary to clear digestive infections such as H pylori, SIBO, or parasites first.
It’s good to keep in mind that a knowledgeable functional medicine practitioner will search for what are
called subclinical infections. These are not the acute conditions a typical gastroenterologist would test for, but
rather they are low-grade infections that act as stressors, trigger inflammation, and disrupt the microbiome.
Again, they are not acute—or not the type of infections that would have you running to the bathroom every
five minutes—therefore, within the “disease model” of conventional medicine, they tend to get ignored. They
can, however, drive uncomfortable symptoms such as reflux, constipation, insomnia, or fatigue, which, if left
untreated, may become more severe. A functional medicine practitioner can test, assess, and support you.
Working together with your chosen professional, you can discover the root causes of digestive problems such as acid reflux and take natural steps to bring your systems into recovery.
Finally: Remember the take away: Even though conventional practices claim that heartburn is caused by too
much stomach acid, heartburn, or esophagus burn, is actually caused by too little stomach acid, or HCl.
*Ed Note: See the excellent article by biofeedback expert Erik Peper, PhD, “You Don’t Have to Slouch: Improve Health with Posture Feedback,” in the Summer 2020 issue of Well Being Journal
Sarah Cotten, FNLP, is an Integrative Health Specialist and founder of the Gut Instinct® Method. Her work is centered on the gut-brain connection and blends Somatic Experiencing® stress, and trauma resolution with functional nutrition practices. More at: www.gutinstinct.clinic
This article was revised and expanded by the author for Well Being Journal from an earlier published version titled, “The Story of Heartburn…It’s Not What You Think!” at www.gutinstinct.clinic
1. Stanford study https://www.ncbi.nlm.nih.gov/pubmed/26061035
2. PPIs and kidney impairment https://jasn.asnjournals.org/content/27/10/3153
3. PPIs and dementia https://jamanetwork.com/journals/jamaneurology/fullarticle/
4. H. pylori and ulcers https://www.mayoclinicproceedings.org/article/S0025-
See the print version of this article and the entire issue here:
Also see this short video from our friend and biofeedback expert Erik Peper, PhD, explaining how abdominal breathing, instead of thoracic, helped eliminate acid reflux.