The risk of not treating the underlying causes of heartburn and GERD are serious. You are putting yourself at risk for infection, nutrient deficiency, cancer, and other diseases. This is the fifth article in a series about the heartburn and GERD. This is the fifth article in a series about heartburn and GERD. If you haven’t read the first, second, third, and fourth (part A) article, I would suggest doing that first.
In the last article, I discussed the first two consequences of low stomach acid. In this article I will cover the final two consequences of having not treating the underlying causes of heartburn and GERD:
- Overgrowth of gut bacteria
- Nutrient deficiency
- Increased risk of infection
- Increased risk of cancer and other diseases
Stomach acid kills bad germs
The bacteria that live in your mouth, esophagus, and intestines are important for you to be healthy. However, your stomach, in a healthy state, should be almost completely germ-free because stomach acid kills germs.
Stomach acid is important to keep bacteria from causing gut infections. Stomach acid prevents bad bacteria that may be present in food or liquids we consume or the air we breathe from getting into our intestines. Stomach acid also prevents normal and good bacteria from our intestines from moving into the stomach and esophagus where they could cause problems.
Normally, the low pH (high acid) of the stomach is 3 or lower between meals. (1) At this pH level bacteria don’t last more than 15 minutes. (2) But as the pH rises to 5 or more (low acid), many species of bacteria can survive and thrive.
- Campylobacter jejuni
- E. coli (bad strains)
- C. difficile
Having low stomach acid also weakens your immune system’s ability to fight off infections once you have them. (7)
Low stomach acid and other serious diseases
We showed in the first article that stomach acid decreases as we age. We also found this likely occurs because H. Pylori infection increases with age. H. Pylori infection not only decreases stomach acid but it is also the leading cause of atrophic gastritis. Atrophic gastritis is due to a loss of cells that produce stomach acid thereby creating low stomach acid.
Atrophic gastritis is associated with a wide range of serious diseases:
- Stomach cancer
- Bronchial asthma
- Depression, anxiety, mood disorders
- Pernicious anemia
- Skin diseases, including forms of acne, dermatitis, eczema, and urticaria
- Gall bladder disease (gallstones)
- Autoimmune diseases, such as Rheumatoid arthritis and Graves disease
- Irritable bowel syndrome (IBS), Crohn’s disease (CD), Ulcerative colitis (UC)
- Chronic hepatitis
- Type 1 diabetes
- Heartburn and GERD
To keep this article short, I will focus on a few of the disorders above.
Atrophic gastritis is a major risk factor for stomach cancer. H. Pylori is the leading cause of atrophic gastritis. Having low stomach acid worsens current H. pylori infections, increase the rate of H. pylori infection, and increase the rates of other gut infections.
I think it is safe to say when you ignore the underlying cause of heartburn and GERD creating low stomach acid that the increase the risk of stomach cancer would increase in those infected with H. Pylori. And remember the rate of H. Pylori infection is high. More than 50% of the population worldwide are infected with H. Pylori.
Elevated nitrites (chemicals that preserve food) might also increase the risk of stomach cancer. In a healthy stomach, ascorbic acid (vitamin C), removes nitrite from gastric juice converting it to nitric oxide. This process, however, can only happen if the pH is 4 or less. The consequence of low stomach acid is higher amounts of nitrites in the stomach with an increased risk of stomach cancer.
Gastric and Duodenal Ulcers
About 90% of duodenal (intestinal) and 65% of gastric ulcers are caused by H. Pylori. Again, H. Pylori infection likely only occurs when stomach acid is low. (8) Low stomach acid increases the risk of H. Pylori infection and the development of ulcers.
Irritable Bowel Syndrome, Crohn’s Disease, Ulcerative Colitis
Having low stomach acid has been shown to decrease a chemical in our body called adenosine. (9) Adenosine helps resolve gut inflammation(swelling) in Crohn’s and Ulcerative Colitis. (10) So unresolved heartburn and GERD may cause serious inflammatory bowel disorders. As a side note, adenosine is a chemical that builds up during the day create what is called sleep pressure. This chemical is important for you to be able to sleep well at night.
Low stomach acid can cause bacteria overgrowth as explained in the second and third article of this series. Irritable bowel syndrome (IBS) is caused at least in part by small intestine bacterial overgrowth (SIBO). (11) It makes perfect sense that taking antacids over a long period of time could cause someone to develop IBS and worsen the condition in those that have it already.
Depression, anxiety, and mood disorders
When you eat food, stomach acid causes the release of an enzyme called pepsin. Pepsin breaks down protein into smaller amino acids and peptides (two more amino acids linked together) so you can absorb them. Low stomach acid (say by taking antacid drugs) causes a decrease in pepsin. You won’t be able to break down the protein you eat into these amino acids and peptides.
There are certain amino acids that are “essential” because we can only get them from food rather making them in our bodies. Phenylalanine and tryptophan are essential amino acids that play a crucial role in the your mental and behavioural health. Low stomach acid could cause you to develop depression, anxiety, and mood disorders.
Low stomach acid and the bacterial overgrowth can cause the intestine to become permeable or leaky (“leaky gut syndrome”). Undigested proteins from food which are normally kept inside the gut are allowed to “leak” into the blood. The immune system considers these proteins as “foreign” just as the immune system would consider “germs” as foreign. What happens next is the immune system kicks into high gear (i.e. T cells, B cells, antibodies) and starts to attack the protein. Antibodies may be produced against the proteins. This type of immune response against proteins we eat can cause food allergies and intolerances.
If the proteins in food look like proteins in your tissues , your immune system can start attacking and destroying that tissue. This is how an autoimmune disease can start such as: lupus, rheumatoid arthritis, type 1 diabetes, Crohn’s and ulcerative colitis, and multiple sclerosis.
There is a big connection between asthma and gastric reflux (GERD). Besides wheezing, one of the common symptoms of asthma is reflux. About 80 percent of people with asthma have GERD. (12)
When acid gets into the windpipe, the ability of the lungs to take in and breathe out air drops by tenfold. (13)
Remember, when you lower stomach acid you can get an overgrowth of bacteria which will in turn make the reflux worse. This can make the asthma worse.
From previous articles we have learned that heartburn and GERD are caused by too little stomach acid NOT too much stomach acid. Furthermore, we have also learned that not having enough stomach acid is associated with overgrowth of bacteria, nutrient deficiency, increased risk of infection, stomach cancer, IBS and other gut disorders, depression and mood disorders, autoimmune diseases, and asthma.
If you continue to ignore the underlying causes of your heartburn and GERD you are putting yourself at risk for developing serious diseases.
In the next and final article of this series, I will discuss what you can do to treat the underlying causes of heartburn and GERD naturally.