Acid reflux is a condition that afflicts many people with fibromyalgia. In the United States, television advertisements promote a half dozen different medications to help people with this condition. Some ads even label the condition a disease calling it Acid Reflux Disease, (ARD) or Gastro-Esophageal Reflux Disease, (GERDs). Some of these ads go on to warn those suffering with acid reflux, that it could wear away the lining of the esophagus. People in the ad then respond with "I didn't know that!". Given the number of ads addressing this condition, acid reflux may be more prevalent in the US than one might think. In this article I will share some information on acid reflux and the digestive system that you may not know.

One thing that people may not know is that regular use of antacid products could deplete the body of important vitamins and minerals such as: Vitamin B-12, Folic Acid, Vitamin D, Calcium, Iron, Zinc, etc... (See slide "Drugs that deplete vitamins".) The manufacturer of one popular over-the-counter antacid tablet even goes so far as promoting their product as being a good source of calcium. This type of deceptive advertising irks me, almost as much as marketing candy with the words "fat free" printed on the wrapper.

In other postings I've shared information that suggests that magnesium deficiency may be more involved in bone loss than is a calcium deficiency. The good news is that the kinds of vegetables that are good sources for magnesium are also good sources for calcium; Green leafy vegetables. However, stomach acid is needed to ionize certain minerals in the food so that the body can absorb them; Hence mineral depletion with regular antacid consumption. When stomach acid is neutralized with an antacid the acid cannot ionize minerals in the food.

Acid reflux is indeed a problem for many people. And, over time acid reflux can damage the esophagus. It could even lead to cancer of the esophagus. So what is the answer? First lets get a better understanding of this part of the digestive system.

Stomach acid, hydrochloric acid or HCl, is a very caustic substance. The mucus lining of the stomach wall protects the stomach from being destroyed by the chemical action of HCl. The stomach normally produces 2 to 3 liters of gastric juices a day, much more than the size of stomach can hold.

Because HCl is so caustic it is manufactured only when the stomach receives the signal to do so. Specialized cells, called parietal cells, in the stomach wall generate HCl. The parietal cells contain many mitochondria, which require much oxygen to produce a lot of ATP to fuel the enzymatic processes that generate HCl for the stomach.

From the presentation "Fibromyalgia: A Hypothesis of Etiology" we saw why oxygen is critical for the production of ATP in the mitochondria. The oxygen provides a necessary receptor for the hydrogen ions, H+, after they produce ATP in the mitochondria. Without oxygen the mitochondria cannot perform this essential function, the production of ATP.

To produce HCl, the parietal cells start by taking carbon dioxide from the blood. When carbon dioxide is removed from the blood the blood becomes more concentrated with the alkaline buffering agent, sodium bicarbonate. The bicarbonate in the blood will be used later to neutralize the acidity of the chyme (food and acid mixture) after it moves from the stomach into the duodenum, the first part of the small intestine.

The very alkaline pH pancreatic juice, generated in part by the bicarbonate in the blood, will raise the pH of the chyme in the duodenum so that it can not cause damage to the intestinal lining. It may help to look at the picture on slide 27 to see how all the parts fit together and normal pH ranges.

From the presentation we can see how one byproduct of the production of ATP in the mitochondria is carbon dioxide, CO2. And, that when oxygen is not available for the cell, the cell cannot produce ATP in the mitochondria and the cell does not produce the byproduct of carbon dioxide.

When CO2 is combined to the other byproduct of the mitochondria, H2O or water, it forms carbonic acid which is released into the capillaries. (Note: the enzyme that does this task of combining CO2 and H2O is dependent upon the mineral zinc. Remember zinc absorption is impaired if the stomach acid pH is not correct. Zinc deficiency may also contribute to other problems related to fibromyalgia.)

The carbonic acid in the capillaries causes the blood in the area to become more acidic. This reduced pH in the tissue helps trigger oxygen release from the red blood cell. But if the pH is not lowered from carbon dioxide the blood holds onto the oxygen. (This is assuming that the blood is freely flowing through the capillaries. Which may not be the case as we will see later.)

Venous blood, blood that has "supposedly" delivered its oxygen and picked up the carbonic acid for transport to the lungs for elimination, should be more acidic (compared to arterial blood). But, some researchers have found that the venous blood in people with fibromyalgia is too alkaline. This suggests that the blood may not have picked up carbonic acid, which is logical since the cell can not produce CO2 without oxygen.

Another symptom of fibromyalgia, shallow breathing, further supports the idea of low CO2 levels. The brain regulates the rate and depth of breathing based on the levels of CO2 and hydrogen ions detected in the blood. In an attempt to raise blood CO2 levels the lungs take in less air. Many people with fibromyalgia have observed that their breathing tends to be shallow, upper chest breathing. It is not uncommon to hear reports of people with fibromyalgia not even breathing for several seconds at a time. (It may eventually be shown to be connected to intermittent nocturnal breathing and sleep apnea.)

Okay, lets get back to stomach acid. Recall that the parietal cells use CO2 from the blood to produce HCl. If the available CO2 supply in the blood is low it is logical to deduce that this will directly impact the amount of HCl that the stomach can produce since the production of HCl begins with CO2 from the blood.

But, (if you deal with acid reflux) you may be thinking, "My problem is that my stomach produces too much acid". As was mentioned earlier, the stomach normally produces much more HCl than it is able to hold. The reason that it does not accumulate and overflow the stomach, causing acid reflux, is that the fluid is always moving forward from the stomach into the small intestine. The sufficiently low acid pH is one of the triggers that signal the okay to move things along.

One thing that the acid does is triggers the creation of a hormone called gastrin. Gastrin signals the pyloric valve, the valve at the bottom of the stomach, to open and let the chyme move forward. Until the valve gets the go ahead everything stays in the stomach, in the case of acid reflux it stays much longer than is normal.

A doctor here in Salt Lake City that is an occasional speaker at the fibromyalgia support group has a son that suffers with chronic fatigue syndrome. In a presentation he made to the group he told about a checkup that his son had had. His son was instructed not to eat anything in the morning because they wanted to use a scope to inspect the stomach wall. The inspecting doctor was surprised to find that the stomach still contained the food from the previous evenings meal. Even if the meal was a heavy high fat meal, under normal conditions, it should have remained in the stomach for a couple hours at the most.

One function of stomach acid is to activate the enzymes that break down protein in our food. Another function is to kill any bacteria that may be present in the food. Killing bacteria at this stage is important because if allowed further into the intestines bacteria can cause greater damage. So the pyloric valve remains closed until it gets the signal that the acid pH level is low enough to assure that all critters in the food have been destroyed and proteins broken down.

If allowed to get into the intestinal tract bacteria can create disturbances that lead to inflammation in the lining of the intestines. When the cells become inflamed it creates swelling which then can produce a leaky gut situation where food particles are allowed into the blood stream, bypassing the normal tranport channels.

If protein that is not completely broken down (a function directly related to stomach acid pH) gets into the blood, via a leaky gut condition, it can cause the body to launch an immune attack because the system does not recognize the substance as being a harmless protein since it is not the size and shape protein which would have been transported through normal channels.

excess protein in the plasma can cause red blood cells to stick, or clump together, a condition called rouleau. When blood cells are clumped together it adds to the problem of not getting oxygen to the cells in the tissue because blood cells stuck together cannot flow through the capillaries which only provide space to allow the passage of one blood cell, one at a time, in single file.

In the case of acid reflux, it is not that the stomach is producing too much acid but that the pH of the acid is not low enough to do its job and signal things to move forward. The acid then accumulates in the stomach, creating an environment ideal for acid reflux to occur.

Current options offered to treat acid reflux are: medications to neutralize HCl, medications that reduce HCl production, medications that prevent the parietal cells from being able to generate HCl, or surgery. (see What is the medical treatment of GERD? and Consider Surgery For GERD Carefully)

While antacids may take care of the burning in the esophagus from the refluxed acid by neutralizing the acid, it prevents the body from being able to absorb a number of vitamins and minerals that are dependant on acid for absorption The other acid reflux medications have similar effects on mineral absorption.

If you have acid reflux, you may have found certain foods will aggravate the condition. Foods high in fat or high in protein may fall into this category. So now you find yourself modifying your diet to compensate for the acid reflux condition. (This may not be all that bad.) However it does nothing to correct the problem. Rather than reducing the foods that may aggravate reflux, foods that are liked, people may begin to rely upon the use of antacids so that they can still enjoy eatting these foods.

As I see it the causal factors to acid reflux may be due to a combination of insufficient oxygen to the parietal cell mitochondria and insufficient CO2 in the blood. Other contributing factors may be a zinc deficiency and deficiencies in other alkaline minerals and B vitamins.

From the Book "Chemistry of Man" by Bernard Jensen, we read: When oxygen is insufficient, digestion is poor and food is not assimilated properly; this encourages overeating because nourishment is needed.

From "The complete Book of Minerals for Health" by J.I. Rodale and Staff, we read ... there is evidence that lack of B vitamins can bring about a lack of digestive juices in the stomach. And also, ... if the diet is lacking in vitamin B1, B2, niacin, pantothenic acid or choline, the stomach is unable to secrete sufficient hydochloric acid to dissolve iron.

Iron is the key ingredient in hemoglobin, that part of the red blood cell that carries oxygen. Catch-22: Without oxygen digestion is upset, iron is not absorbed, and without iron blood cannot carry oxygen.

Supplementing with HCl tablets at dinner might help. Some people have reported benefitting from it. In some cases this may work. But recall that when the parietal cell produces HCl, CO2 is removed from the blood leaving an alkaline bicarbonate buffering agent in the blood. When HCl is taken as a supplement there may be insufficient buffering agent in the blood to bring this supplemented HCl to the correct pH for safe passage through the intestines. Taking too much supplemented HCl might create a condition where the contents of the stomach are more acid than available alkaline buffers in the blood can neutralize to the correct level for the intestines.

The digestive system typically deals with a too acidic chyme condition with diarrhea, moving the chyme quickly through the intestines and out of the body. Diarrhea is also the way that the digestive system expels an infecting virus or bacteria, to prevent it from entering the body. Too much, or too frequent, diarrhea can lead to dehydration and electrolyte imbalance.

One reason for the low blood CO2 levels may be that capillary blood flow through the tissue/muscles is impaired because the muscles are in a constant state of tension. Role of intracellular calcium ions in the physiopathology of fibromyalgia syndrome, this abstract tells of the effect that low calcium levels have on muscle tension. (Calcium requires acid for absorption.) Now we have another catch-22 situation. The muscles must be relaxed to facilitate blood flow through the tissue to get oxygen to the cells to produce CO2 to produce HCl. But to relax the muscles, the muscle cells need calcium which first needs HCl.

I've mentioned earlier that rouleau, the clumping of red blood cells, restricts free blood flow through the capillaries. The biconcave shape of the red blood cell, RBC, facilitates its function to carry oxygen and carbon dioxide and the design adds to the cells flexibility to flow through the narrow capillaries.

Some researchers report that in people with fibromyalgia there is found misshappen red blood cells. The irregular shape of these blood cells negatively affect the ability of the blood cell to carry oxygen or to flow freely through the capillaries to deliver oxygen.

From another site on the web I pulled the following: "The importance for maintaining an optimal venous blood pH cannot be over emphasized. Any deviation from optimal venous blood pH of 7.46 can result in lack of utilization of enzymes, lack of absorption of trace nutrients, vitamins, minerals, and fatty acids."

At this point you have probably read more about the digestive system than you care. Unfortunately the majority of people don't care how or why something happens in the body. They just want to know what they have to take to feel better. But, if a person does not understand how the body works they will continue to do that that caused the body to break down in the first place. As an engineer, I find the design quite fascinating.

What can be done to help remedy the condition? Our approach has been to help increase metabolism and tissue blood flow using far infrared sauna, to hydrate the body with alkaline ionized drinking water, and to supplement some minerals that would likely be deficient due to prolonged acid reflux. I see supplementation as being needed only until the body is once more able to get its minerals from food.

Some people will tell you that it does not matter that the water is alkaline because the stomach acid will reduce the pH before it goes into the intestines. This is correct. But there is a law call the "Conservation of Matter" which simply states that matter can not be created or destroyed, it can only be changed. The stomach does not just make acid from nothing. As was described earlier, the stomach makes acid by pulling acidic substances from the blood. The more CO2 pulled from the blood to neutralize the alkalinity of the water, the greater the shift to more alkaline buffers in the blood. (Note: the health benefits to drinking alkaline ionized water is not due only to its alkaline properties)

The reverse is also true. If a person drinks too much very acidic soda pop, it does not require much, if any, stomach acid to bring it to the correct pH. However, when the chyme with that soda pop moves forward there may be less available bicarbonate in the blood to raise the pH to the correct pH for the intestines, so it must borrow alkalizing minerals from the bone and tissue to help raise the pH. (But this is topic for another Soapbox lecture.)

I hope that this explanation has helped you better understand the disgestion process and what may be at the root of acid reflux. There may be some errors in the logic or some of the assumptions made. However, everyone to date that has followed this approach has seen relief of acid reflux as well as other symptoms of fibromyalgia. Medications have their place. But, for acid reflux, it is my opinion, that medications and surgery are not the answer and do not address the root of the problem.

The Parietal Cell: Mechanism of Acid Secretion
THE SIGNIFICANCE OF THE HYDROGEN ION CONCENTRATION FOR THE DIGESTION OF PROTEINS BY PEPSIN