September 29

A Weak LES is One of the Main Causes of GERD

A Weak LES is One of the Main Causes of GERD

Heartburn and GERD.

Introduction

The Lower Esophageal Sphincter (LES) is a muscular valve whose main purpose is to allow food and drink into the stomach and not allow anything other than gas or vomit out. If it is not functioning properly it can be one of the main causes of GERD. (Insufficient stomach acid is the primary cause.)

What You Will Learn

  • What is the LES and what does it do?
  • The complications of a weakened or dysfunctional LES?
  • What could have caused your LES to get weak or dysfunctional?
  • Activities that can weaken or cause your LES to dysfunction.
  • How Can You Reduce the Pressure on your LES?
  • Supplements that may help improve the functioning of your LES.


What Is The LES?

LES is the acronym for the Lower Esophageal Sphincter. It is  a muscle that wraps around the esophagus where it meets the stomach. It’s job is to keep your stomach contents in your stomach. 

A weak or dysfunctional LES is one of the main Causes of GERD.

A properly functioning LES relaxes to allow food to enter the stomach. This triggers the release of stomach acid to begin digestion. The increase of stomach acid triggers the LES to close tightly,  to keep contents of the stomach from backing up into the esophagus. The only other time the LES should relax is to allow air to exit out of the stomach as a burp or to allow vomiting.

However, when your LES is in a weakened or relaxed state, additional pressure caused by stomach bloating or poor body position can put the LES at a disadvantage, allowing stomach contents to flow back up into the esophagus resulting in heartburn, acid reflux, and GERD.

The lack of stomach acid, certain foods/drinks, overeating, medications, and physical activates can weaken the LES, over time.

How Did My LES Become Weakened?

The LES can become weakened over time if you:

  • Have low stomach acid. It is the increase of stomach acid that occurs while eating that triggers the LES to close tight enough to stop your stomach contents from backing up into your esophagus. If you have low stomach acid this trigger is not sufficient to keep the LES fully closed. This is the number one cause.

  • Consistently eat certain foods that can irritate the LES (peppermint, chocolate, tomatoes, or citrus juices). When the LES is irritated, it swells, and will not close tightly enough. 

  • Chronically overeat – excessive and chronic LES pressure caused by over eating foods that cause bloating can weaken the LES or cause it to temporarily dysfunction.

  • Ingest anything that contains nicotine or caffeine – nicotine and caffeine irritate the LES, causing it to swell.

  • Drink alcohol – drinking alcohol can cause the LES to relax, cause additional bloating, and irritate the LES. A relaxed and irritated LES, combined with the pressure from a bloated stomach, will not close tightly enough to keep stomach contents in the stomach. 

  • Eat foods that cause an allergic reaction - cow’s milk, other dairy products, wheat, and white flour. With certain allergies, these foods cause stomach bloating.

  • Take certain medications (SSRI antidepressants, anticholinergic medicines, sedatives, estrogen replacements, NSAID’s, bronchodilators, channel blockers, beta-blockers, anti anxiety drugs, and nitroglycerine) - these drugs can cause the LES to relax.

  • Have vagus nerve damage - poor posture along with muscular imbalances can cause the vagus nerve to misfire, as can excess alcohol or spicy foods. Stress can inflame the nerve, along with fatigue and anxiety.

  • Are suffering from SIBO (Small Intestinal Bacterial Overgrowth, defined as excessive bacteria in the small intestine).

  • Have a hiatal hernia - besides directly affecting the proper function of the LES a hiatal hernia also affects the functioning of the vagus nerve.

  • Sleep on your right side or flat on your back - this puts the LES at a disadvantage because in these positions the stomach and LES are at the same level making it easier for stomach contents to seep past the LES and into the esophagus. Always sleep on your left side or elevate the head of your bed.

  • Are overweight – being overweight can increase inner stomach pressure.


What Are The Complications Of A Weakened LES?

  • If your LES is weak, any excess pressure in your stomach can more easily push the stomach contents into the esophagus causing acid reflux symptoms.

  • Acid reflux occurs even more easily during sleep because the weakened LES cannot use gravity to help hold back the stomach’s contents, allowing stomach acid to back up into the esophagus.

  • Sleeping on your right side puts the LES at a disadvantage because this position puts the top opening of the stomach at the same height or even slightly above the LES, allowing the least bit of extra stomach pressure to cause acid to back up into the esophagus.

  • Lying flat on your back can be almost as bad a lying on your right side. If you must sleep on your back, raising the head of your bed 4 - 6 inches can improve this. Simply placing a pillow or two under your head is not sufficient - the entire upper body must be elevated.

  • Avoid eating within a minimum of 3 hours before bedtime. If you have very low stomach acid this may need to be extended to 4 or more hours.

9 Things You Can Do To Reduce The Pressure On Your LES?

Follow these tips that can lower the pressure on your LES: 

  • Wear loose clothing and loosen your belt

  • Lose excess weight

  • Limit foods that irritate or relax the LES - keep a food diary to track this

  • Avoid or limit foods that cause bloating - keep a food diary to track this

  • Sleep on your left side – avoid sleeping on your right side or your back

  • Switch to medication that does not affect your LES

  • Make a conscious effort to chew your food completely before swallowing - this may reduce bloating and will improve digestion.

  • Eat smaller portions

  • Do not lie down or exercise within 3  to 4 hours after eating

What Supplements Can I Take To Compensate For My Weakened LES?

Some supplements can help by reducing stomach bloating. Some of these suggestions could help your LES function better: 

  • Betaine HCl – taking one or two capsules with your  meals will help increase stomach acid to improve digestion and reduce bloating.
  • Digestive enzymes – taking one with every meal will help break down food in the stomach to reduce bloating and pressure on the LES. It is okay to take these with Betaine HCl, in fact Betaine HCl often has some digestive enzymes (pepsin) included in the formula.

  • Apple Cider Vinegar - ingesting 1-2 tbsp of organic apple cider vinegar with your meals will help increase stomach acid to improve digestion and reduce bloating. Do not take this if you are also using Betaine HCl.

  • Swedish Bitters – can cause the body to make greater amounts of digestive enzymes.
  • Calcium citrate powder – take 500 mg, twice a day with water – studies have shown that this can tighten the LES in some people – not proven to work – must use the powder mixed with water as the calcium citrate must come into direct contact with the LES to work.

  • R-lipoic acid – has been shown in one study to stimulate the vagus nerve.
     

Recommendations

I have found these lifestyle changes to have the most impact on reducing my acid reflux symptoms: 

  • Take Betaine HCl capsules with high protein meals - personally, this has been life changing for myself. Read my article on "How to Safely Increase Stomach Acid Naturally" for determing dosage.

  • Eating smaller meals

  • Maintain good posture – never slouch, especially when seated

  • Take 1-2 digestive enzyme tablets with each meal

  • Do not eat within 3 hours of bedtime

  • Always sleep on your left side and/or raise the head of your bed


DISCLAIMER

The information contained here does not constitute medical advice and is not meant to diagnose, treat, prevent, or cure disease. Please contact your doctor. The information provided is for informational purposes only and are solely the views of the author.

Low Stomach Acid is the Main Cause of Heartburn, Acid Reflux, and GERD

Please Leave a Comment

  • Thanks so much for this very informative article.. so clearly explained. Liked the recommendations will definitely try all and see if it helps.
    Myself also suffering from low stomach acid and along with it several problems. Losing hair like crazy as the vitamins are not being absorbed.
    I have been taking acv, digestive enzymes, aloe vera juice, ala and licorice to help. Digestion is much better but gerd continues 😕 I take a herbal kinetic called haritaki. Really helps but I cannot take it at night as it keeps me awake.
    Thanks once again 🙏 for your educative article really appreciate your effort in helping others.

    • Hi Vandy,
      I’m glad you found the article helpful. I have had great success with taking Betaine HCl to increase my stomach acid. I have never tried bitters and I don’t like ACV mostly because of the taste but also because it is so bad for my teeth. I would recommend reading my article on Betaine, you may find it very helpful. It cured my GERD.
      Thanks for the comment and best regards
      Dave

  • I have a small Hiatol Hernia. Im on zantec to reduce acid in stomach, which has caused constipation and H pylori. If I understand right I need to increase the acid in my stomach. How do I control the symptoms of GERD. Biggest complanints are vegas nerve pressure and throat chest tightness. I tried skippping my med yestarday which is 150 mg or 75mg of ranitude and try teaspoon of apple cidar vinegar before each meal but by late afternoon neck, upper back and burning in jaw resorted back to 75mg of antacid. Which I see low acid weakens the valve which is why Im experencing symptoms in the first place!!! Any suggestions? I feel like I cant win either way!! Wont raising the acid levels increase my symptoms? But how do I heal the valve if my acids are low? Im on a protein vegetable diet. Following SIBO diet strictly. Any suggestion would be greatly appreciated. Also taking Iberogast for motility but now I see it has peppermint in it!! DGL licorice chews, ginger tea.

    • Hello Ginnie,
      I’m very sorry to hear about these health issues. I would advise speaking with your doctor. Tell him you would like to stop taking meds and try a natural approach.

      Alternatively here are my suggestions: Under no circumstance should you stop or skip taking your medication. Doing this will result in possibly the worst GERD you have ever experienced. Because the meds reduce the production of stomach acid, if you stop taking them all at once the stomach will produce an excess amount of stomach acid and I think by taking apple cider vinegar as well it was likely pretty bad. What you experienced is referred to as rebound acid reflux. This happens when you stop the acid reflux meds cold turkey. This is very dangerous, do not do this.

      You have to slowly ween yourself off the medication. What you should do is gradually reduce the amount of medication you take per day over the next few weeks. Get a pill cutter and take 3/4 of the amount you currently take for 4-5 days then reduce the amount to half for 4-5 days and then to a quarter for 4-5 days. Then you should be safe to stop taking the medication.

      Wait 4-5 days to see how you feel from that. If you have mild or no GERD symptoms during this time, take mild antacid tablets like Tums, or Rolaids. Gradually reduce those as well. Once you are able to go without taking anything and have no symptoms, I would then suggest performing the Stomach Acid test that is explained on the website. If it indicates low stomach acid (I’m pretty sure it will) then I would suggest adding either apple cider vinegar (ACV) or betaine before meals with high protein/fat content. I’m not a big fan of ACV because I don’t like the taste. I prefer taking Betaine HCl – if the Betaine capsules also include Pepsin this can also be helpful for digestion. Start with one capsule. Gradually increase the dose over time. If you take too much, you will experience a slight burning sensation in your stomach – it feels nothing like GERD symptoms. Drinking a few glasses of water should counteract this. For most people, this occurs when taking 5-6 Betaine caps.

      Once you determine how much Betaine you need to take just keep monitoring it because you will require less over time. Your stomach will start to produce more acid on its own. This is what you want. I sometimes can go weeks now without taking Betaine and when I do I rarely take more than 1. Also, once you get used to it you can take it after your meal if it feels like you are getting symptoms and it will relieve the symptoms. I hope this helps you.

      Have you read the other articles on the site. They will help you as well. I’m no expert on Hiatal Hernias but I think that making sure your posture is good, no slouching, that this will help tremendously. I tend to slouch and if I feel GERD symptoms coming on, if I straighten my posture they go away almost immediately.

      I really feel for you – I suffered from GERD from my twenties until 5 years ago when I finally gave up on my doctor and researched how to fix this naturally. I’m 64 now. Please let me know if this helped.
      Best Regards
      Dave

      • Dave, yikes! OK dont quit cold turkey! It was a horrible 3 days. I felt like I was coming off drug addiction. Im taking 75 mg of rantitude twice a day now with Tums intermittently. Mornings are ok but mid afternoon and evening the pressure in my neck and burning in jaw are substantial. Tums barely takes the edge off. My doctor initally perscribed 150 mg twice a day. Should I go back to that? I didnt take it very long as constipation set in and dont like being on meds but now I can see its necessary till I stabilize then stay a while and gradually cut back. How much antacid meds were you taking and how many times a day and did you have to supplement as well with Tums? Did you experience slight burning in face and pressure in neck? I know your not a doctor but it is so encouraging to hear from someone who has had victory in this area. Also, I know this is probably not something you normally do but would it be possible to call me as I would like to hear more about your process you went through? I could use some encouragement.I sent my number to your email address.
        Thank you
        Ginnie

        • Yes, never, ever quit acid reflux meds cold turkey. This was clearly warned against on the site. Always gradually reduce the amount until you are off. I would suggest reducing the of meds weekly and if you make it through the week without discomfort then reduce a bit more the following week. Do not rush this process. This could take numerous weeks to gradually reduce the meds.

          I felt like I was coming off drug addiction. I’m taking 75 mg of rantitude twice a day now with Tums intermittently. Mornings are ok but mid-afternoon and evening the pressure in my neck and burning in the jaw are substantial. Tums barely takes the edge off.

          I think you are reducing your meds too quickly. Do it a week at a time. Don’t rush this process.

          My doctor initially prescribed 150 mg twice a day. Should I go back to that?

          You say you are taking 75 mg of rantitude now but still experiencing GERD. I would suggest asking your doctor what you should do.

          I didn’t take it very long as constipation set in and don’t like being on meds but now I can see its necessary till I stabilize then stay awhile and gradually cut back. How much antacid meds were you taking and how many times a day and did you have to supplement as well with Tums?

          I was taking 150 mg of Zantac once or twice daily depending on how I felt. While reducing my meds at first I would take Tums to help get through the day. Then I slowed down the rate at which I was reducing my meds so I could stabilize. During this time avoid foods that cause bloating and sleep on your left side – never on your back or right side. Do not eat or drink anything within 3 hours of going to bed.

          Did you experience slight burning in face and pressure in the neck?
          No, I’ve never experienced this. My issues were primarily acid reflux. My teeth are ruined – the acid ate all the enamel. And I aspirated quite often so my lungs were probably damaged as well.

          I know you are not a doctor but it is so encouraging to hear from someone who has had victory in this area. Also, I know this is probably not something you normally do but would it be possible to call me as I would like to hear more about your process you went through? I could use some encouragement. I sent my number to your email address.

          What does your doctor say about the H Pylori? Should this be addressed first before trying to get off the acid meds? I have no experience with H Pylori.

          As stated, I am not a doctor and you have other underlying issues that I have no experience with and don’t feel comfortable giving advice. You should see your doctor about these issues.

          Thank you
          Ginnie

      • Dave, I’m having a horrible time figuring out what to take now to control symptoms to stabilize. Are the heaviness in chest area and pressure in neck about 2 hours after taking 150 mg zantec from acid reflux? Shouldnt the meds be taking care of that? Should I supplement with Tums when that happens? I went to ER at the beginning of this for pressure in chest and everything checked out ok and they said it was GERD related. I took two 75 mg, yestarday and morning was better on that then the 150 today. But afternoons and evenings are always tough. Any suggestions?

        • Please ask your doctor. Because you quit your medication cold turkey I think you may still be experiencing rebound acid production.

  • Very interesting. I suffer from GERD and I’m taking 4 tabs a day for this. They are just masking the fact I have a weak LES sphincter

    • Hi Sheila, thanks for your comment.

      A weak LES is a bit of a misnomer. Let me explain. When you eat, the stomach is triggered to increase stomach acid, to digest the food ingested. This increase of stomach acid should cause the LES to close tightly to keep food and stomach acid from going back up into your oesophagus. If you have low stomach acid the LES does not close as tightly and it causes the food to take longer to digest. The food ferments a build-up of gas. Because the LES is not able to close tightly the pressure from the gas formed by the fermenting food forces the stomach contents and stomach acid into the oesophagus.

      By taking 4 tabs per day you are further restricting the amount of stomach acid your stomach is able to produce making this situation worse. The tabs seem to help because they will reduce the symptoms of GERD but are actually making the situation worse. Only about 2% of people with GERD actually have excess stomach acid. Try the test for low stomach acid on this site. If the test shows that you have lo stomach acid you should ween yourself off of the medication you are taking (do not quit cold turkey) and then gradually increase your stomach acid naturally by supplementing with Betaine Hcl.

      Read these articles:
      https://theacidrefluxsolution.com/how-to-determine-if-you-have-hypochlorhydria/
      https://theacidrefluxsolution.com/safely-increase-stomach-acid-naturally/
      https://theacidrefluxsolution.com/you-need-to-stop-treating-your-heartburn-symptoms/

      I have not experienced acid Reflux or GERD for over 7 years since I discovered this.

    • Shelia I’m just curious. What are you taking for meds 4 times a day and is it working to control symptoms? I’m having a hard time regulating my meds to find what helps. I have 75 mg zantec over the counter and 150 mg zantec perscription. then adding tums between when symptoms flair up. Nothing is working to well.

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