Acid reflux causes include the lower end of the gullet being weak, and/or the stomach being overfull of food plus acid gastric juice.
The last bit of the gullet, just before the stomach, is normally kept tight to prevent reflux. This can be weakened by the body in general being short of the substance Potassium, or when we have a hiatal hernia.
Medications such as diazepam, theophylline, nitrates, and calcium channel blockers may weaken the muscle.
One small study4 found temporomandibular joint dysfunction in a third of people with reflux. It is possible that this may interfere with normal propulsion in the gullet and encourage reflux.
If ones' entire abdominal cavity is overfull with fat (visceral obesity,) there isn't as much room for food in our stomach.
This also encourages reflux.
People at the top end of the weight scale get 50% more episodes of acid up their gullet, than those with healthy weight1.
Thirty-five years ago, Dr. Denis Burkitt concluded that based on his own research, GE reflux, hiatal hemias, low-fiher diets, delayed intestinal transit of leftovers, and suboptimal bowel habits were intrinsically related3.
extremely likely that our gullet's skin varies between individuals, in how well
it can tolerate acid or alkali.
variation is likely also, to be due to a mixture of inherited and environmental
factors. The importance of nutrition as one of these, is underlined by the
usefulness of Siberian pine nut oil in this condition.
continue...re. producing too much acid.
Excessive acidity in the stomach is commonly given as the explanation for GERD.
This is partly true. The acid is certainly secreted for too long and in too
great a volume, but read on...
part of our stomach makes the acid. The lower end (antrum) just before the
Duodenum, measures the strength of the acid (the pH.)
eat, the stomach pours out digestive juice containing acid and the digestive
is able to soak up a certain amount of acid, but as acid secretion continues
this “buffering capacity” of the food is exceeded, and the pH of the gastric
contents drops (more acid - lower pH.)
pH drops into the range of 1 to 3, the gastric antrum turns off the acid production
and the stomach gets on with digesting our food.
happens with reflux...
commonly, this reflux problem develops because the stomach can’t get the pH
sufficiently low for the antrum to “throw the switch” to turn off the acid
Not turned off appropriately, the acid production then continues too long and
causes havoc, including acid reflux.
situation is commonly due to deficiency of zinc and/or an infection of the
stomach lining with a germ called Helicobactor pylori.
Zinc is part of an enzyme (carbonic anhydrase) in the stomach lining which
makes the acid.
gastric antrum switch may malfunction and so be unable to turn the acid off at
an appropriate pH.
This may be due to inflammation from bile reflux (duodenogastric reflux, which
can also contain pancreatic juice.) Helicobactor infection, toxicity and food
intolerance are also possible causes.
Pathophysiology, causes and consequences.
It has been known for along time that the lower esophageal sphincter relaxes to allow the reflux1 but like a small child one has to keep asking why. This is the process in "root cause medicine" - getting to the bottom of things.
A good recent review2 has lots of detail but typically of medical literature leaves out nutrition.
Chris Kessler argues for the next development often being carbohydrate malabsorption and bacterial overgrowth.