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Acid Reflux and GERD
Reflux is usually a problem of pressure and position, not simply too much acid. We look at the valve, the diaphragm, the vagus nerve, and the gut.
What you may be noticing
Burning behind the breastbone after meals or lying down. A sour taste, frequent throat clearing, hoarseness, or a cough at night. Bloating, belching, or nausea. You may have taken acid-blocking medication for years and still not feel right.
Why it is rarely one thing
Reflux is not usually caused by too much stomach acid. It is caused by acid going where it does not belong. The lower esophageal sphincter, a valve at the top of the stomach, should stay closed except when swallowing. When it relaxes inappropriately, or when pressure in the abdomen pushes upward, contents reflux into the esophagus.
That shifts the question to why the valve is relaxing and why pressure is rising. Common answers include large late meals, bloating from SIBO, constipation, a hiatal hernia, weak diaphragm support, low vagal tone, excess weight around the middle, and certain foods and medications.
I see healthy digestion as four coordinated functions: adequate stomach acid, digestive enzymes, smooth muscle peristalsis, and a balanced microbiome. Much of what feels like excess acid is slow or incomplete digestion, with food sitting too long in the stomach. The vagus nerve and the brainstem direct that rhythm, which is why I treat reflux as a gut and nervous system pattern together.
Acid-blocking medication can be important, especially if there is damage to the esophagus. Any change is made slowly and with your prescribing physician, because stopping abruptly can cause rebound acid. Long-term acid suppression can affect absorption of B12, magnesium, iron, and calcium, so those are worth monitoring.
Patterns we look for
- Lower esophageal sphincter function and transient relaxations.
- Hiatal hernia and diaphragm function.
- Intra-abdominal pressure from bloating, SIBO, or constipation.
- Vagal tone and brainstem regulation of stomach motility.
- Stomach acid, enzyme output, and gastric emptying speed.
- H. pylori infection.
- Circadian rhythm of digestion: skipped breakfasts and late, heavy dinners.
- Food triggers such as alcohol, spicy foods, large fatty meals, chocolate, mint, and caffeine in sensitive people.
- Post-nasal drip and sinus congestion, which can mimic or amplify throat symptoms.
- Histamine and mast cell activity.
- Nutrient status after long-term acid suppression.
How I evaluate it
A comprehensive functional neurological exam assesses vagal function, including swallowing, palate elevation, and autonomic tone. A physical exam of the abdomen and diaphragm looks for mechanical contributors such as a hiatal hernia.
Functional labs may include H. pylori testing, SIBO breath testing, B12, magnesium, ferritin, and comprehensive stool analysis. Trouble swallowing, food sticking, vomiting blood, black stools, unexplained weight loss, or new symptoms after age 50 need prompt gastroenterology evaluation. Chest pain, especially with exertion, shortness of breath, or sweating, needs emergency care first.
How we address it
- Change the mechanics: smaller meals, a regular breakfast, earlier dinners, staying upright after eating, and an elevated head of the bed.
- Restore stomach function first: digestive support and an anti-inflammatory, gut-soothing food plan while the lining heals.
- Address bloating, SIBO, and constipation that raise abdominal pressure, and open drainage through daily bowel movements.
- Treat H. pylori when present.
- Strengthen the diaphragm with breath training and specific diaphragm exercises, and activate the vagus nerve and brainstem with humming and gargling.
- Soothe and repair the esophageal and stomach lining with targeted categories of support that protect the mucosa rather than simply blocking acid.
- Work with your physician on a gradual medication plan, and replenish nutrients affected by acid suppression.
When the valve, the pressure, and the nervous system are balanced, digestion becomes comfortable again.
Book your Comprehensive Functional Medicine Eval/Neurological Exam today to discover what the contributing root causes are that are underlying your health concerns.