It’s one thing to have the occasional bout of heartburn
or acid reflux. But if you’re finding yourself reaching for antacid medications
on a regular basis, or being awakened in the night with a burning sensation in your
chest, it may be time to look at your overall gut health for a larger GI tract problem,
such as irritable bowel syndrome (IBS).
Even though the esophagus and the intestines are at opposite ends of the GI tract,
many women who have IBS also have upper GI symptoms such as heartburn, reflux, “sour
stomach” or nausea. And the reason is pretty simple: Much of the time, the distressing
symptoms in the upper and lower GI tracts relate to problems in the middle — your
What causes acid reflux?
Acid reflux is often related to how the stomach processes food and empties itself.
The stomach breaks food down using a combination of chemicals — acids and various
enzymes — and motion, kind of like a washing machine agitates clothes through soapy
water to get them clean. But just like how there are some types of stains that even
the best machine can’t clear away, there are some kinds of foods that aren’t as
easy to break down in your stomach.
Foods that are high in fat — think pizza — can be difficult to digest, which causes
more “agitation” work for the stomach as well as slower emptying. Both may stimulate
higher production of acid than is normal. That acid, sloshing into the esophagus,
is one cause of heartburn. Heartburn often isn’t the only problem. Since food may
not have been fully broken down by the stomach, the intestines receive a larger
proportion of undigested food that can trigger uncomfortable symptoms like gas,
cramps or diarrhea.
4 factors that contribute to acid reflux and IBS
There’s no one-size-fits-all cause for GI problems. Other factors that can contribute
to both reflux and IBS are:
1. Low acid production. People sometimes produce
less acid than is needed to process their food — disorders that are called hypochlorhydria
(too little acid production) and achlorhydria (no acid production). This is often
related to nutrient deficiencies or infection by the bacterium that causes ulcers,
Low acid production may be temporary, but it can also become a self-sustaining situation,
particularly if symptoms such as reflux and diarrhea prompt the use of antacids
and other medications in an effort to relieve chronic symptoms (we’ll talk about
that more in a minute).
It’s a myth that drinking too much water with meals dilutes your stomach acid and
causes hypochlorhydria. The stomach is able to sense when its pH becomes too low
and produces more acid to compensate. If you’re drinking a lot of water with meals
and you suffer from reflux, you may want to cut back even so — because you could
be inadvertently encouraging greater acid production than is healthy!
2. Eating too fast, too much, or both. Many of us
are in a hurry when we eat. If you’ve ever been working or traveling and said, “I
need to get some food in my stomach before I…”, you know how this works. But digestion
doesn’t start in the stomach, it starts in the mouth. Enzymes in saliva and the
crushing and swishing motions of our teeth and tongue are what begins food breakdown.
If we bypass this “pre-stomach” of ours by “wolfing” our food, we lose a major contributor
to digestion. That means the stomach has to work harder. And often that means producing
The same is true when we overeat — which we’ve all done at some point! Putting too
much food into the stomach all at once stretches the walls of the stomach and reduces
its ability to churn the food around, which affects its ability to break food down
effectively so it has to work harder. Not only that, but if we overeat on a regular
basis, the opening between the esophagus and the stomach can become stretched and
lose its elasticity. This allows more acid to move upward into the esophagus to
cause heartburn. What’s more, acid that escapes the stomach isn’t doing its job
on the food itself.
3. Enzyme deficiencies and allergies. Hard-to-digest
fatty foods aren’t the only culprit, and many otherwise healthy foods can also cause
problems. If you’re lactose intolerant, for example, you get GI upset from anything
containing milk because you lack a key enzyme, lactase, to help break down milk
sugars. Or maybe it’s beans and broccoli that give you trouble because you don’t
produce enough galactosidase. It doesn’t have to involve an enzyme deficiency,
though — a food allergy will cause similar troubles. Gluten is one common allergen.
The body’s intolerance can even manifest as celiac disease, which is a serious autoimmune
response triggered by eating gluten. There are also many foods that can cause gastrointestinal
upset in a person with a mild or moderate allergy: eggs, fish or shellfish, nuts
and legumes (beans and peanuts).
4. Too much fiber all at once. Yes, fiber is good
for you. But too much of a good thing can have unintended results. If you eat a
large meal high in both soluble and insoluble fiber, it could be more than your
GI tract can handle, resulting in uncomfortable symptoms.
Do antacids help?
Certain types of antacids may help reduce symptoms in the short term. Unfortunately,
like many medications, they don’t alter the root causes — and without that, their
benefits may not last very long. Worse, if part of the issue you’re facing relates
to acid production — hypochlorhydria — you may unwittingly increase or prolong your
troubles by using medications that suppress acid in your stomach.
There are also some significant and concerning problems associated with long-term
use of some common antacid medications in the proton pump inhibitor class (think
Nexium or Prilosec). They range from deficiencies in important nutrients such as
iron, magnesium and vitamin B-12, to bone fragility and osteoporosis, to susceptibility
to infections in the GI tract, likely because they suppress the gut’s natural flora.
Using antacids may help for a few hours, but in the long run they generally make
things worse. For this reason, we strongly recommend you avoid using such medications
over-the-counter for more than occasional heartburn symptoms. Of course, if you
are currently taking a prescription medication for heartburn, don’t stop without
getting advice from your primary care provider first!
If not antacids, then what?
We always advocate seeking out the root causes of health issues so you can stop
them at their source. One way is to identify whether certain foods are triggering
GI symptoms by keeping a food/ symptom diary to see if symptoms happen when you
eat specific foods. Or you can eliminate a specific food that you know causes trouble
for a week or two, and see if your symptoms subside without using antacids. Supporting
healthy GI flora with a
probiotic and a
balanced multivitamin can also help reduce GI symptoms, particularly
if you’ve already been using antacids and find them becoming less and less effective.
If you experience symptoms primarily at night, when you’re lying down, it could
be a sign that your esophagus has become over-stretched. Try using a wedge pillow
that will support your upper body at an angle instead of lying flat, so that any
acids that may slosh out of your stomach drain back down into it rather than staying
in your esophagus. It can also be helpful to eat earlier — many of those with chronic
acid reflux find that an early dinner (5 to 6 PM) results in fewer nighttime symptoms
than a later one.
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