Every meal ends in discomfort. A burning sensation creeps up your chest, and you find yourself reaching for the antacids—again. If this is your daily reality with GERD (Gastroesophageal Reflux Disease), you’ve likely been told the problem is too much stomach acid. The standard solution? Medications to suppress that acid.
But what if this approach is only masking the symptoms while the real problem smolders underneath?
This GERD Awareness Week, it’s time to change the conversation. From a functional medicine perspective, chronic acid reflux is a complex sign of dysfunction, not an acid overdose disease. It’s often a symptom of a deeper issue, from a faulty valve to bacterial imbalances.
The Mechanics of Reflux: It Starts with a Leaky Valve
At the core of GERD is the malfunction of the Lower Esophageal Sphincter (LES). This critical ring of muscle at the bottom of your esophagus is designed to act as a one-way valve, opening to let food into the stomach and then closing tightly to prevent acidic contents from washing back up.
When the LES becomes weak or relaxes inappropriately (a condition called transient LES relaxation), the door between your stomach and esophagus is left ajar. This allows stomach acid to reflux into the delicate lining of the esophagus, causing the classic burn of heartburn.
The real question is: What causes the LES to fail in the first place?
Unmasking the True Culprits: The Root Causes of Reflux
Beyond simple anatomy like a hiatal hernia, the dysfunction of the LES is often driven by surprising underlying imbalances.
🔸 The Paradox of Low Stomach Acid (Hypochlorhydria)
It sounds counterintuitive, but one of the most common underlying drivers is inadequate stomach acid. Your stomach needs a highly acidic environment to properly break down food. When acid is too low:
- Food sits and ferments, producing gas.
- This gas creates upward pressure that pushes against and opens the LES.
- The result is reflux of even a small amount of acid, which the esophagus isn’t designed to handle.
This concept is supported by clinical observation, with a review in Gastroenterology & Hepatology noting that hypochlorhydria can contribute to the bacterial overgrowth that drives reflux symptoms.
🔸 Small Intestinal Bacterial Overgrowth (SIBO)
SIBO occurs when bacteria overgrow in the small intestine. These bacteria ferment carbohydrates, producing significant gas (hydrogen or methane). This gas buildup creates physical pressure that can force open the LES from below. Studies have found a significantly higher prevalence of SIBO in patients with GERD.
🔸 Dietary and Lifestyle Triggers
Your daily choices play a massive role in LES pressure and stomach irritation. Common triggers include:
- Dietary: Large, high-fat meals, chocolate, caffeine, spicy foods, onions, and mint can all relax the LES or delay stomach emptying.
- Lifestyle: Eating within 2-3 hours of bedtime, alcohol consumption, smoking, and chronic stress directly contribute to LES dysfunction and increased gastric pressure.
🔸 Other Contributing Factors
- Food Sensitivities: Triggers like gluten or dairy can cause inflammation and slow gut motility, leading to the pressure buildup that causes reflux.
- Medications: Certain drugs, including some for asthma, blood pressure, and allergies, can relax the LES.
- Obesity: Excess abdominal fat can increase pressure on the stomach, physically pushing contents through the LES.
The Problem with the “pill for an ill” Approach
While acid-blocking medications (PPIs) can provide essential short-term relief for severe inflammation, long-term use without addressing the root cause can be problematic. By reducing the stomach’s natural acid barrier, these medications can:
- Impair nutrient absorption, leading to deficiencies.
- Increase the risk of infections like C. difficile and SIBO.
- Create a dependency, as stopping them can cause a painful rebound of acid hypersecretion.
The goal is to use these drugs wisely as a temporary bridge while investigating and treating the underlying cause.
The Functional Medicine Path to Lasting Relief
Healing from GERD requires a systematic approach that looks at your entire digestive ecosystem.
- Investigate, Don’t Assume: We use comprehensive testing like SIBO breath tests and food sensitivity panels to identify your specific imbalances.
- Strategic Nutrition: We help you identify and eliminate trigger foods while using an anti-inflammatory, gut-healing diet to restore function.
- Support Digestion: Based on findings, this may involve supplemental betaine HCL (to support low acid) or digestive enzymes.
- Rebalance the Gut: If SIBO is present, we use targeted protocols to restore a healthy microbiome.
- Lifestyle Medicine: We work with you to implement key changes like stress management, meal timing, and posture to support LES function.
References & Further Reading
- Dukowicz AC, Lacy BE, Levine GM. Small intestinal bacterial overgrowth: a comprehensive review. Gastroenterol Hepatol (N Y). 2007
- Wang ZT, et al. Correlation Between Gastroesophageal Reflux Disease and Small Intestinal Bacterial Overgrowth: Analysis of Intestinal Microbiome and Metabolic Characteristics. J Inflamm Res. 2025
Ready to Uncover the Root Cause of Your Reflux?
If you’re tired of masking your symptoms and are ready to explore the underlying reasons for your GERD, we are here to guide you. You don’t have to accept heartburn as a life sentence.
Schedule a Functional GI Consultation Today to begin your journey toward uncovering the root cause of your digestive distress and achieving lasting freedom from reflux.