A Weak LES is One of the Main Causes of 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.