April 14, 2025

Contrary to popular belief, 90% of acid reflux cases stem from low stomach acid (hypochlorhydria), not excessive acid production, which means common treatments are actually making the problem worse not better. Yes, I said it - that Gaviscon, Rennie, insert other over-the-counter antacids, as well as PPIs like omeprazole and lansoprazole are all actually keeping you in a reflux cycle rather than remedying the issue. Let’s dive in.

Acid reflux, also known as heartburn, or gastroesophageal reflux disease (GERD) in its more severe state, is commonly associated with symptoms such as discomfort or burning in the centre of the chest, regurgitation, and indigestion. That feeling of eating and food not going anywhere. However, many lesser-known symptoms often go undiagnosed, or are misattributed to other conditions, or people just ignore them thinking they are normal. They aren’t.

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The most common ones, let’s see if some surprise you, are:

• Frequent sinusitis and persistent nasal congestion caused by stomach acid or acid vapour irritating the nasal passages.
• Chronic ear infections as acid vapour can reach the Eustachian tubes, leading to irritation and infection.
• Sore throats, post nasal drip and persistent coughs due to irritation.
• Excess mucus production as the body overproduces mucus as a protective mechanism against acid irritation.
• Nasal polyps and benign growths on the vocal chords as the tissue becomes inflamed and tries to heal itself.
• Fatigue caused by low nutrient absorption, which is then linked to generalised low nutrient levels and poor resilience, as stomach acid is necessary for the proper absorption of minerals like iron and zinc, as well as protein. Inadequate levels will lead to immune dysfunction, hair loss, and low energy levels.

So what is actually going on? How do we end up in this state and why are the most commonly prescribed treatments actually making the situation worse in the long term?

The stomach is the first stage of proper digestion. I say this as you do start to break down some carbohydrates in the mouth and chewing is integral for proper digestive function, but it’s when we get to the stomach that the proper work really begins. The stomach is a sac about the size of your clenched fist when it’s empty, and it will always contain some acid, enzymes and bacteria but it should have nice periods of dormancy (I’ll come back to this later) when it’s just chilling out. When you eat however, food enters and the two rings of muscle that frame the stomach, one at the top and one at the bottom, clamp tightly shut and it’s like a washing machine turns on. Lots of acid is produced, triggering the rest of your digestion to get ready and turning that food into a nice slurry called chyme. When that process is complete the bottom ring of muscle opens due to that really acidic environment being achieved and that slurry moves into the small intestine for the next stage of proceedings to occur.

Now imagine there is a hairpin in your washing machine. It tries to kick start but for whatever reason, examples coming very soon, you don’t get that tsunami of acid coming into the system. Food then sits in the stomach and you get upward pressure back into the oesophagus that creates classic indigestion, heartburn and discomfort. You’ll also burp as that food ferments, and feel full and heavy as if you’ve eaten a brick. Especially with high protein meals. And the classic way of treating heartburn is to take an antacid - a.k.a. a stomach acid lowering medication to prevent that natural acid that was in the stomach anyway being forced into the oesophagus by the food that was sitting there too long because you needed more acid to break it down. You get minor symptom relief in the moment but come the next meal and the next after that, you’ll actually have lowered your stomach acid further which means you will continue to need the over the counter antacids until they don’t do the job well enough. Which is when a doctor might prescribe a protein pump inhibitor (PPI).

So all the medications that end in azole - like lansoprazole, omeprazole and pantoprazole. Brand names you might see would be things like Nexium, but this is esomeprazole if you look at the label. PPIs stop the proton pump cells in your stomach from producing acid at all. In certain instances they are useful, such as if someone is taking incredibly strong painkillers after surgery which can irritate the stomach lining, but they are designed to be used for days to weeks, not for years which often happens. And again because they are killing your stomach acid totally, you’ll need more and more to control symptoms as symptoms worsen, and then they stop working. Whilst also hugely compromising digestive efficacy overall, and health. People will get stuck though, as they see information like this and think I must come off them but then take them out and get rebound reflux as everything tries to kick back into gear - but at a limp. You’ve got to re-educate the stomach to work properly and phase off these meds under the care of someone like myself, or at least with guidance, to avoid this.

As a point just to touch on here stomach acid is key to activate pepsin, an enzyme essential for protein digestion. It also kills harmful pathogens ingested with food, and facilitates the absorption of key nutrients like B12, iron, calcium, and zinc.

So low levels anyway are a concern, and uncomfortable, but then depressing them further makes someone increasingly vulnerable to ill health. The fun thing is, when we’re trying to discern if someone has low stomach acid, a lot of the symptoms seem counterintuitive - which is why people so often mistakenly think they have too much not too little.

In addition to the ones I mentioned earlier the classic presentation would be: frequent burping and bloating, IBS-like symptoms (alternating diarrhoea/constipation, bloating, gas), intense fullness after meals, especially after protein consumption, undigested food in stool, low energy and nutrient deficiencies.

The quickest way to check at home is to do something called the 'bicarb burp test'. You will need 1/4 tsp bicarbonate of soda, baking soda in the states, 150–200 ml cold water, and a stopwatch. You need to do this on an empty stomach first thing in the morning, before eating or drinking anything - even water. Mix the bicarb into the water, stirring well until fully dissolved. Then drink the mixture and start your timer. Sit calmly, no moving around or doing things. Time how long it takes for you to burp - a natural release of gas, not forced.
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• 0-2 mins = normal
• 2-5 mins = possible low stomach acid, or lower than ideal
• 5+ mins or no burp = low stomach acid
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This is a suggestive test rather than a clinical diagnosis, but it gives a pretty solid indication. I tend to encourage people to do 3 days in a row to confirm.

So we’ve established the current situation, but what are the factors that can cause this to happen in the first place? Because we need to sort those out if we’re going to prevent this coming back.

• Chronic stress, is the top one. This activates the sympathetic nervous system (fight-or-flight response), reducing digestive function as its not deemed necessary to survival. You would be unlikely to be eating if you were running for your life.
• Aging – Stomach acid naturally declines with age, which increases the risk of reflux if not supported. There is also another layer that if people develop issues with their teeth they might opt for softer and less textural foods, which would then remove the natural triggering for stomach function that chewing provides.
• Poor eating habits – Eating too quickly, on the go, or while distracted, reducing stomach acid production.
• Bacterial overgrowth (SIBO) – Low stomach acid allows harmful bacteria to proliferate, leading to gas, bloating, and reflux.
• Overuse of antacids/PPIs – Long-term suppression of acid production leads to worsened digestion and nutrient deficiencies.

The fab thing is the stomach is very much a copycat. If you show it what it should be doing it’ll try its hardest to get back to that place. So rather than suppressing symptoms, the goal should be to support the stomach in producing adequate acid naturally, which we can do in a few ways. But to begin we have to get out of our own way and tweak our meal time habits.
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Are you ready? Because here comes the optimal digestion hit list! And we should all be doing this, irrespective of whether we have digestive dysfunction or not.

• Start meals with bitter foods – these stimulate digestive secretions and help you to absorb food properly. Keep a jar of mixed nuts and seeds in the centre of the table and chew a small spoonful before eating. So hazelnuts, brazil nuts, pumpkin seeds, sunflower seeds.
• Chew thoroughly – Proper chewing signals to the stomach food is coming so it will start to produce acid.
• Eliminate distractions – No watching TV or scrolling on your phone while eating. Think about your digestion as being the worst multitasker ever!
• Breathe properly while chewing – Try my three-chew trick: Take a bite, chew while breathing in through your nose, and observe where the breath goes. If it’s high in the chest, put your fork down, keep chewing, and work on breathing to open your ribs back and out. This relaxes the diaphragm and will allow your food to be broken down effectively.
• Use candles or soft lighting at dinner – This helps shift the nervous system into a parasympathetic (rest-and-digest) state, as opposed to fight-or-flight.

We then also have several options to help resolve acid reflux by promoting, rather than suppressing, stomach acid production.
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1. Raw Apple Cider Vinegar (ACV)
This helps to acidify the stomach and improve digestion, it is also naturally fermented so contains digestive enzymes and some probiotic bacteria to help break your food down. Simply mix 1 to 2 teaspoons into water and sip with meals. If you have active ulcers, lots of heartburn still pain or gastritis, this wouldn’t be a suitable option until you have healed that inflammation.
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2. Betaine Hydrochloride (HCl)
This is a supplement that directly increases stomach acid levels by providing the raw materials for your stomach to make acid. Dosing is individual, you start with one capsule at the beginning of a protein-rich meal, gradually increasing until you feel a warm sensation here. Then reduce by one and that's your dose with your meal. You’ll need this for a bit but then you will phase off it in the same way, as over time your stomach takes over. You'll find these range in strength from 250mg per cap, to 700mg per cap. I would tend to start someone around 500mg and establish either up or down depending on how many caps they need to achieve the warming sensation. And just check if you swap between brands that you're not suddenly changing your dose hugely by going from a 500mg to a 250mg. Again not recommended for those with ulcers or on non-steroidal anti-inflammatories until any inflammation is healed or those medications are stopped.
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3. Digestive Enzymes
Help break down food when stomach acid is low. You would naturally have these in digestive secretions so when you aren’t producing those you won’t have as many of these. Look for broad-spectrum enzymes, including protease, amylase, and lipase. I like products that also contain other digestive support such as ginger, peppermint and gentian, and maybe marshmallow root as well. They're often referred to as 'digestive aids'. These can be especially beneficial for those with pancreatic insufficiency or age-related stomach acid decline.
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4. Slippery Elm
This is more of a soothing adjunct that protects the oesophagus from irritation while supporting gut health. When I refer to healing inflammation you would use this to create a protective layer over those sore tissues to allow them to recover. If you experience heartburn when eating most of the time, I would take this 15 minutes before meals and then add your digestive support like betaine and enzymes when you eat. Capsule or tea forms are available. When someone is starting out I suggest the teas/powders as with low stomach acid you can struggle to breakdown capsule shells and you won't get the benefits.
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5. Zinc Carnosine
This supports stomach lining repair and helps stimulate acid production, and is one of the key nutrients depleted by low stomach acid so adding in a therapeutic level of 30mg a day, in split doses, after meals is incredibly useful.

Now all of the above should be tallied alongside dietary tweaks too, but these are individual to the person as we all have preferences, and more often than not when we’ve had ongoing digestive issues we develop food behaviours based on things that trigger our symptoms more or less.