The real cause that not everyone knows about.
Your oesophagus burns after a meal. You taste something sour at the back of your throat. Your doctor says: "Too much acid — take a proton pump inhibitor." You take the pill. You feel relief for a while, but the problem comes back. Sound familiar?
But what if the problem is not too much acid, but too little?
The Myth of Excess Acid
For decades, conventional medicine assumed that acid reflux and heartburn were caused by overproduction of stomach acid. This led to the widespread use of drugs such as omeprazole, lansoprazole, rabeprazole, pantoprazole, esomeprazole, and others that block the secretion of hydrochloric acid in the stomach.
However, a growing body of research and clinical observations suggests that too little stomach acid — a condition known as hypochlorhydria — may be the main cause of reflux and other digestive problems, particularly in the context of poor gut health.
What Is Hypochlorhydria and Why Does It Cause Reflux?
Hypochlorhydria means insufficient production of hydrochloric acid in the stomach. Symptoms commonly associated with excess acid — including heartburn and reflux — may in reality stem from too little acid. Poor digestion caused by a lack of stomach acid can lead to the formation of gas bubbles that rise into the oesophagus and throat, carrying traces of acid with them. Even tiny amounts of acid in the throat can create the sensation of excess.
The mechanism is straightforward:
Without enough stomach acid, food is not properly digested. Undigested food can ferment, producing gas and increasing pressure in the abdominal cavity. This pressure can force open the lower oesophageal sphincter, allowing stomach contents to flow back into the oesophagus — causing the characteristic burning sensation.
In other words: the cause of reflux is not necessarily an excess of acid — it may also be a deficiency of acid and fermentation of undigested food.
Why Is Stomach Acid So Important?
Hydrochloric acid in the stomach is not your enemy — it is an essential ally. Its roles include:
- Digesting proteins and absorbing nutrients
- Absorbing iron, calcium, magnesium, and vitamin B12
- Killing bacteria, viruses, and parasites in food
- Maintaining proper tension in the lower oesophageal sphincter
- Signalling the pancreas and bile for proper fat digestion
Low stomach acid impairs the stomach's ability to sterilise food, increasing susceptibility to SIBO (small intestinal bacterial overgrowth), candida, parasites, and H. pylori.
What Causes Low Stomach Acid?
This is an important question — because treating reflux must begin with finding the cause, not masking the symptoms.
The most common causes of hypochlorhydria:
🔸 Chronic Stress
Chronic stress reduces stomach acid production. When we are in fight-or-flight mode, the body simply does not prioritise digestion. This is one of the most common and most underestimated causes of digestive problems.
🔸 Antacids and PPIs
Overuse of antacids and diet-induced excess acidity can lead to drug-induced hypochlorhydria. Paradoxically, reflux medications can make reflux worse.
🔸 H. pylori Infection
Infection with H. pylori — a bacterium that survives in the stomach by neutralising acid — leads to inflammation of the stomach lining and reduced acid production.
🔸 Age
Hypochlorhydria is significantly more common with age — people over 65 are at the greatest risk of low hydrochloric acid levels.
🔸 Nutrient Deficiencies
Nutrients such as iron, zinc, and B vitamins are essential for maintaining proper stomach acid levels. A poor diet can result in acid deficiency.
🔸 Thyroid Problems
Low stomach acid is very commonly found in people with Hashimoto's disease and hypothyroidism.
🔸 Toxic Load and the Vagus Nerve
The vagus nerve plays a key role in regulating stomach acid secretion. It acts through several mechanisms: direct stimulation of parietal cells via cholinergic signals (acetylcholine), stimulation of gastrin secretion from G cells, and inhibition of somatostatin (which normally suppresses acid production). When vagal function is impaired — due to damage, chronic stress, or toxic burden — this can lead to:
- reduced parietal cell stimulation
- insufficient hydrochloric acid secretion (hypochlorhydria)
- delayed gastric emptying (gastroparesis)
- impaired protein digestion and nutrient absorption
How to Recognise That You Have Too Little Stomach Acid
Symptoms of low stomach acid are often confused with excess acid. It is worth doing a simple home test to check.
Simple Home Test: Check how long it takes to burp after drinking ½ a glass of water with 1 level teaspoon of baking soda. The combination of stomach acid and baking soda produces carbon dioxide, which causes belching.
- 0–40 seconds — excess acid
- 40–90 seconds — appropriate acidity
- 90 seconds or more — stomach acid is too low
How We Can Help — Identifying the Cause and Detoxification
In a holistic approach, reflux is not a disease to be cured with a pill — it is a signal that something in the body is out of order. Real help begins with finding the cause.
Step 1: Identify the Source of the Problem
Stress, H. pylori infection, thyroid or vagus nerve issues, long-term medication use, or other factors. Each cause requires a different approach.
Step 2: Support Stomach Acid Production
- Eat slowly and chew food thoroughly
- Start meals with protein, which stimulates acid production
- Avoid drinking fluids during meals (at least 1 hour before and after eating)
- Consider supplementing with betaine HCL with pepsin — after consulting a therapist
- Apple cider vinegar (one teaspoon in a glass of water before a meal) may aid digestion
Step 3: Rebuild the Gut Microbiome
Gut detoxification is very important here: deworming, antifungal treatment, removal of intestinal toxins, and restoring proper gut pH. Probiotic supplementation can also be used to rebuild the microbiome — particularly when it has been damaged by antibiotics and stress.
Step 4: Detoxification and Reduction of Toxic Load
In a detoxification approach, reflux is often linked to the toxic burden on the liver and intestines. When the liver is overloaded, bile production drops, which further impairs fat digestion and stomach acidification. Supporting the liver, lymphatic drainage, and gut microbiome are key elements.
Step 5: Manage Stress
Since stress is one of the main causes of low acid, working with the nervous system is just as important as diet.
A Note on PPI Medications
Acid-blocking medications such as PPIs are intended for short-term use, yet many people take them for years. Chronic acid suppression can lead to deeper health problems over time.
If you have been taking PPIs for a long time, do not stop suddenly without consulting your doctor. But it is worth asking yourself: am I treating the cause, or just masking the symptom?
Summary
Reflux and heartburn are most often not a problem of excess acid — but a signal that the stomach is not working properly. Too little acid, fermentation of food, a weakened oesophageal sphincter, an overburdened liver, and stress are the real underlying causes — and these are worth addressing.
The body does not need another pill to suppress a symptom. It needs understanding and support from within.
⚠️ Disclaimer: The information in this article is for educational purposes only and does not constitute medical advice. Before making any changes to your treatment or supplementation, consult a qualified doctor or therapist.
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