A Weak LES is One of the Main Causes of GERD

Lower Esophageal Sphincter (LES)

Introduction

A Weak LES is one of the main Causes of GERD. 

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.) 

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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 I Weaken my LES?

The LES can become weakened over time if you:

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    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.
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    Consistently eat certain foods that can irritate the LES (peppermint, chocolate, tomatoes, or citrus juices).
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    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.
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    Ingest anything that contains nicotine or caffeine – nicotine and caffeine irritate the LES.
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    Drink alcohol – drinking alcohol can cause the LES to relax, cause additional bloating, and irritate the LES.
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    Eat foods that cause an allergic reaction - cow’s milk, other dairy products, wheat, and white flour.
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    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.
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    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.
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    Are suffering from SIBO (Small Intestinal Bacterial Overgrowth, defined as excessive bacteria in the small intestine).
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    Have a hiatal hernia - besides directly affecting the proper function of the LES a hiatal hernia also affects the functioning of the vagus nerve.
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    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.
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    Are overweight – being overweight can increase inner stomach pressure.

What are the Complications of a Weakened LES?

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    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.
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    Acid reflux occurs even more easily during sleep because the weakened LES cannot use gravity to help hold back the stomach’s contents, allowing them to back up into the esophagus.
  • Lying on your left side at night puts the LES at a higher level than the opening to the stomach which can reduce the pressure on the LES allowing it to remain closed and help relieve nighttime acid reflux.
  • 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 You Reduce the Pressure on your LES?

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

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    Wear loose clothing and loosen your belt
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    Lose excess weight
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    Limit foods that irritate or relax the LES
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    Avoid or limit foods that cause bloating
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    Sleep on your left side – avoid sleeping on your right side or your back
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    Switch to medication that does not affect your LES
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    Make a conscious effort to chew your food very well before swallowing - this may reduce bloating and will improve digestion.
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    Eat smaller portions
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    Do not lie down 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: 

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    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.
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    Betaine HCl – taking one or two capsules with your  meals will help increase stomach acid to improve digestion and reduce bloating.
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    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.
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    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.
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    R-lipoic acid – has been shown in one study to stimulate the vagus nerve. 
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    Swedish Bitters – can cause the body to make greater amounts of digestive enzymes.

Recommendations

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

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    Take 1-2 Betaine HCl capsules with high protein meals
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    Eating smaller meals
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    Maintain good posture – never slouch, especially when seated
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    Take 1-2 digestive enzyme tablets with each meal
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    Do not eat within 3 hours of bedtime
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    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

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