August 21

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.


The Lower Esophageal Sphincter (LES) is a muscular valve whose primary 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 correctly, it is the leading cause of GERD. A few different things could be the root cause for its failure to operate correctly. Still, they all fall under either a high pH level of stomach acid (high pH = low stomach acidity) or physically inhibiting the valve from being able to close, i.e., hiatal hernia.

What You Will Learn

  • What is the LES and what does it do?
  • The complications of a weakened or a dysfunctional LES?
  • What could have caused your LES to be weak or become 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. Its job is to keep your stomach contents in your stomach.

A weak or dysfunctional LES is the leading cause of GERD. If the LES does not entirely close, food can easily move back up through the esophagus.  A properly functioning LES relaxes to allow food to enter the stomach. This triggers the release of stomach acid to begin digestion. The increased stomach acid triggers the LES to close tightly to keep the stomach's contents 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 (high Ph), particular foods/drinks, overeating, medications, and physical activities 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. The increased stomach acid that should occur while eating triggers the LES to close tight enough to stop your stomach contents from backing up into your esophagus. If you have low stomach acid (high Ph), this trigger is insufficient 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 overeating – excessive and chronic LES pressure caused by overeating foods that cause bloating can weaken the LES or cause it to be temporarily dysfunctional.

  • 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, NSAIDs, 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). Low stomach acid allows bacteria to overgrow 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.
  • Poor posture can simulate a hiatal hernia. Maintain a good upright posture after eating. Read more here.

  • Sleep on your right side or 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/Dysfunctional LES?

  • If your LES is weak or dysfunctional, 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 while lying on your back or right side during sleep, because the weakened LES cannot use gravity to help hold back the stomach’s contents, allowing stomach acid 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 on your back can be almost as bad as lying on your right side. Raising the head of your bed 4 - 6 inches can improve if you must sleep on your back. However, 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 Betaine after your meals will help increase stomach acid to improve digestion and reduce bloating. Find your optimal dosage here.

  • 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, it often has some digestive enzymes (pepsin) included in the formula. I try to avoid Betaine formuals that contain pepsin. Excess pepsin can trigger LPR.

  • Apple Cider Vinegar (ACV) - ingesting 1-2 tbsp of organic apple cider vinegar with your meals will help increase stomach acid, 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 – you 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.


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 me. Read my article “How to Safely Increase Stomach Acid Naturally” article to determine your correct 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


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

  • Dear Dave,

    thank you for your interesting article. I suffer from GERD since I was 20 and now I am 46 years old. I always suspected that my condition was due to a reduced acid quantity in my stomach (digestion of not well cooked, not well leavened, not “tender” foods and of fat foods is always difficult for me). I had a gastroscopy yesterday and the diagnosis was “Weak LES” (in both directions). I suppose this is due to a pressure increase due to the reduced acid. May I ask you how to have a definitive diagnosis for acid reduction? Doctors tend to prescribe PPIs but I would like to demonstrate them that the problem is not “too acid” but “few acid”.

    Thanks a lot

    • Hi Domineco,
      A ‘Weak LES’ is a misleading term. Everyone requires sufficient stomach acid to trigger the LES to close properly and keep acid from being forced past the LES. The slow digestion due to low stomach acid allows food to ferment in the stomach causing bloating and pressure forcing the LES open. Certain foods (coffee, chocolate, citrus juice etc.) can irritate the LES causing it to not close properly. Alcohol and some medications can cause the LES to relax and unable to close tightly.

      Doctors prescribe PPIs because that is their standard protocol when starting to treat symptoms of gastric issues. They often do this without doing any initial testing. The problem is that PPIs will work initially by reducing the symptoms but make the problem worse over time. PPIs completely stop the natural production of stomach acid. PPIs are meant to be used primarily by patients with stomach ulcers – preventing the production of stomach acid will give the ulcer time to heal. They are not meant to be taken for more than 8 weeks. You probably know people who have been on PPIs for years. There have been studies done where PPIs have been given to on people without GERD who after 8 weeks of taking PPIs have developed GERD.

      The only test I know of to accurately test stomach acid is the Heidelberg test. But a good indicator of a person’s stomach acid levels is the baking soda test – there is an article explaining how to do this on my site. There are studies showing that the average person’s stomach acid levels reduce by 1% per year.
      I hope this helps.

  • high acid will make your gerd worse..this is really a dumb article…if u take medics for increasing stomach gonna struggle…les weakens due to acid first of all

    • Yash, You must be joking, right?

      Low stomach acid (greater than 3.5 pH) is the primary cause of GERD. Optimal stomach acid is 1.5 to 3.5 pH. If you have low stomach acid, your food won’t digest quickly enough, it starts to ferment, causing gas and bloating, which forces open the LES because there is insufficient stomach acid to trigger the LES to close tightly, forcing stomach acid into the esophagus.

      You have it completely backwards. Only one in every million people have high stomach acid. That disease is called Zollinger-Ellison Syndrome and it is extremely rare – do some research before you pass on bad information.

  • Hi Dave – in regards to the calcium citrate. Do I measure out 500mg of the powder, or do I measure out 500mg of calcium? The powder I have, (NOW brand), says that 1.5 teaspoons of powder weighs 3 grams and provides 600mg of calcium. Thanks!

    • Hi Lori,
      Sorry for the slow response, I was having trouble accessing the site. You would measure 500mg of the powder.
      I think you could use 600mg without any issues if it’s easier for you to measure.

  • 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

  • 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, 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

        • 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

      • 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:

      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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