Written by: Kathleen Regan, ND
Symptoms of high stomach acid can be diagnosed as Hyperchlorhydria (High Stomach Acid) or Gastroesophageal Reflux Disease (GERD).
Hyperchlorhydria refers to abnormally high levels of stomach acid. It can lead to symptoms such as heartburn, indigestion, bloating, and abdominal discomfort. In extreme cases, high acid can become quite painful and may trigger esophageal spasm or other symptoms that might feel like a heart attack.
GERD is a chronic condition characterized by the reflux of stomach acid into the esophagus, leading to symptoms such as heartburn, regurgitation, chest pain, and difficulty swallowing. While GERD often involves the reflux of stomach acid, it is primarily caused by dysfunction of the lower esophageal sphincter (LES), hiatal hernia, and impaired esophageal clearance also play significant roles.
Not all individuals with GERD symptoms necessarily have high stomach acid levels. Some people may experience GERD symptoms due to low stomach acid levels or other factors such as impaired LES function, esophageal anatomy or delayed gastric emptying.
Because the symptoms of high stomach acid and GERD may present in a similar way, it makes sense to be aware of the factors that cause both conditions and make dietary and lifestyle changes that heal both conditions.
Here are some of the main factors that can contribute to elevated stomach acid levels and/or GERD:
1. Helicobacter pylori Infection: H. pylori is a bacteria that may be found commonly in humans. The problem is when levels of this bacteria rise, they can disrupt the stomach lining, leading to inflammation (gastritis) and increased stomach acid production. This infection is a common cause of peptic ulcers and can also contribute to other gastrointestinal issues.
2. Stress and Anxiety: Psychological stress and anxiety can stimulate the production of stomach acid through the activation of the sympathetic nervous system leading to the elevation of stomach acid.
3. Dietary Factors: Certain foods and beverages can trigger the production of stomach acid or irritate the stomach lining, leading to increased acidity. Examples include spicy foods, acidic foods (such as citrus fruits and tomatoes), caffeinated beverages, alcohol, and carbonated drinks. In addition, some foods cause the LES between the stomach and the esophagus to stay open longer allowing acidic contents to flow upwards. These include high fat foods and aromatic foods such as peppermint or fennel. Some therapeutic diets may trigger high acid or GERD symptoms especially programs that reduce carbohydrates which in many cases coat and protect the lining of the digestive system. These diets are still medically beneficial but they need to be applied in a way that won’t aggravate stomach acid.
4. The Ketogenic Diet: The combination of carbohydrate reduction and increases in fat consumption can trigger high acid for a number of reasons. Carbohydrates create mucus which helps soothe the digestive system. Carbohydrates are also soothing for the nervous system. Reducing overall intake can aggravate stress or anxiety which can trigger the digestive system. Increased fats lead to a prolonged opening of the LES but also trigger chemicals in the body that increase production of stomach acid.
5. Fasting Diets: During fasting, the absence of food intake can trigger the release of gastrin, a hormone that stimulates stomach acid secretion. Gastrin levels typically rise in response to the empty stomach, signaling the stomach to produce more acid to prepare for digestion. In some individuals, prolonged fasting or frequent fasting cycles may result in elevated gastrin levels and increased stomach acid secretion, potentially leading to symptoms of hyperchlorhydria. Also, fasting can delay gastric emptying, causing food to remain in the stomach for longer periods. This prolonged retention of food in the stomach can lead to increased acid production.
6. Smoking can weaken the lower esophageal sphincter (LES), the muscle that controls the opening between the esophagus and the stomach, allowing stomach acid to reflux into the esophagus.
7. Supplements: Many supplements in capsule form taken on an empty stomach can irritate high acid symptoms. Also, there are specific supplements which may aggravate the stomach including calcium, magnesium and potassium supplements in high doses (especially if they are in a citrate form), Ascorbic Acid (Vitamin C), B Vitamins, Iron and Fish Oil.
8. Medications: Some medications can increase stomach acid production or irritate the stomach lining, leading to hyperchlorhydria. These may include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, bisphosphonates, certain antibiotics, and potassium supplements.
9. Medical conditions: Certain medical conditions, such as gastritis, Zollinger-Ellison syndrome, and hypercalcemia, can lead to high stomach acid levels.
10. Hormonal Imbalances: Hormonal changes, such as those occurring during pregnancy, menstruation, or menopause, can affect stomach acid levels. For example, pregnancy hormones like progesterone can relax the LES, leading to increased reflux of stomach acid into the esophagus. Low estrogen can decrease production of stomach acid, decrease stomach motility and aggravate symptoms such as bloating, indigestion, and acid reflux.
11. Hiatal Hernia: A hiatal hernia occurs when a portion of the stomach protrudes through the diaphragm into the chest cavity. This condition can affect the function of the LES, allowing stomach acid to reflux into the esophagus.
12. Straining during bowel movements due to chronic constipation can increase intra-abdominal pressure: This elevated pressure within the abdomen can, in turn, put pressure on the stomach and lower esophageal sphincter (LES), the muscle that normally prevents the reflux of stomach contents into the esophagus. When the LES is weakened or compromised by increased pressure, it may fail to function properly, allowing stomach acid and contents to reflux into the esophagus, leading to symptoms of GERD.
13. Genetic Factors: Some individuals may have a genetic predisposition to produce higher levels of stomach acid due to variations in genes related to gastric acid secretion or regulation or the formation of protective mucus in the stomach.
14. Disruption of Mucin Production: Mucins form a gel-like layer that covers the surface of the stomach lining, creating a protective barrier against mechanical and chemical damage. Mucins help to neutralize acid and maintain a slightly alkaline pH at the mucosal surface. By neutralizing acid, mucins contribute to the maintenance of mucosal integrity and prevent acid-induced damage to the stomach lining. Mucins also have antimicrobial properties that prevent the growth of bacteria such as Helicobacter pylori. Mucins also promote mucosal healing and regeneration in response to injury or inflammation. The mucous layer serves as a habitat for helpful bacteria, providing them with nutrients and protection from harsh environmental conditions. Mucins facilitate the movement of food through the stomach and promote efficient digestion and nutrient absorption. Disruption of mucin production or composition can affect gastric motility and contribute to symptoms of dyspepsia, bloating, and abdominal discomfort.
Many of the above factors contribute to reduced mucin formation including dehydration, triggering foods, alcohol consumption, smoking, stress, medications and genetics.
It's important to identify and address the underlying cause of high stomach acid to effectively manage symptoms and prevent complications. You may need to speak with a practitioner who can guide you with the right supports. A good place to start with healing the stomach and esophagus is to avoid acid triggering, avoid foods that prolong esophageal sphincter opening and work on way to maintain regular bowel movements.