Acid reflux is one of the most common digestive complaints in the UK, affecting an estimated 20 to 30 per cent of the adult population. For many, it progresses to gastro-oesophageal reflux disease (GERD), a chronic condition where stomach acid repeatedly flows back into the oesophagus. The conventional approach typically involves long-term acid-suppressing medication, but this treats the symptom without addressing the underlying cause. A functional medicine approach looks deeper to understand why reflux is occurring and how gut health plays a central role.
What Is Acid Reflux and GERD?
Acid reflux occurs when the lower oesophageal sphincter (LES), a ring of muscle at the junction of the oesophagus and stomach, fails to close properly. This allows stomach acid and partially digested food to flow back into the oesophagus, causing irritation and the characteristic burning sensation known as heartburn.
GERD is diagnosed when reflux occurs frequently, typically two or more times per week, and causes troublesome symptoms or complications. While occasional reflux is common and usually harmless, chronic GERD can lead to oesophageal inflammation, ulceration, and in rare cases, precancerous changes known as Barrett's oesophagus.
Symptoms Beyond Heartburn
Many people associate reflux solely with heartburn, but GERD can present with a surprisingly wide range of symptoms, some of which seem unrelated to the digestive system.
| Symptom Category | Common Presentations | | :--- | :--- | | Classic | Heartburn, regurgitation, chest pain, difficulty swallowing | | Throat and Airway | Chronic cough, hoarseness, sore throat, laryngitis, asthma-like symptoms | | Oral | Dental erosion, bad breath, metallic taste | | Digestive | Bloating, nausea, early satiety, excessive belching | | Systemic | Disturbed sleep, anxiety about eating, reduced quality of life |
The extra-oesophageal symptoms, particularly chronic cough, hoarseness, and throat clearing, are often called silent reflux or laryngopharyngeal reflux (LPR). These symptoms can persist for months without the patient ever experiencing classic heartburn.
The Root Causes: Why Reflux Happens
Conventional medicine typically frames reflux as a problem of too much stomach acid. However, functional medicine recognises that the picture is far more nuanced. In many cases, reflux is actually associated with too little stomach acid, a condition known as hypochlorhydria.
Low Stomach Acid (Hypochlorhydria)
Adequate stomach acid is essential for proper digestion, nutrient absorption, and maintaining the pressure gradient that keeps the LES closed. When stomach acid is insufficient, food sits in the stomach longer, ferments, and produces gas that increases intra-abdominal pressure. This pressure pushes the LES open, allowing whatever acid is present to reflux upward.
Hypochlorhydria becomes more common with age, chronic stress, and long-term use of acid-suppressing medications. Ironically, the very drugs prescribed for reflux can perpetuate the cycle by further reducing acid production.
Small Intestinal Bacterial Overgrowth (SIBO)
SIBO is a condition where bacteria that normally reside in the large intestine migrate into the small intestine and proliferate. These bacteria ferment carbohydrates and produce hydrogen and methane gas, which increases intra-abdominal pressure and drives reflux. Research has shown a significant overlap between SIBO and GERD.
Helicobacter pylori Infection
H. pylori is a bacterium that colonises the stomach lining and can disrupt acid production, cause gastritis, and impair LES function. Comprehensive gut health testing can identify H. pylori and guide appropriate treatment.
Food Sensitivities and Intolerances
Food sensitivities can trigger inflammation in the gut lining and alter motility patterns, both of which can contribute to reflux. Common triggers include gluten, dairy, eggs, soy, and citrus. An elimination diet can help identify individual food triggers.
Hiatal Hernia
A hiatal hernia occurs when the upper part of the stomach pushes through the diaphragm into the chest cavity. This anatomical displacement weakens the LES and makes reflux more likely. While hiatal hernias are common and often asymptomatic, they can significantly worsen GERD symptoms.
Chronic Stress
Stress directly impacts gut function through the gut-brain axis. Elevated cortisol reduces stomach acid production, slows gastric emptying, increases visceral sensitivity, and weakens the LES. Many patients notice that their reflux worsens significantly during periods of high stress.
The Problem with Long-Term PPIs
Proton pump inhibitors (PPIs) such as omeprazole and lansoprazole are among the most widely prescribed medications in the UK. While they can provide short-term symptom relief, long-term use carries significant risks that are often not discussed.
Nutrient deficiencies are a well-documented consequence of prolonged PPI use. Stomach acid is essential for absorbing magnesium, calcium, iron, vitamin B12, and zinc. Chronic deficiency in these nutrients can lead to osteoporosis, anaemia, neurological symptoms, and impaired immune function.
Increased infection risk occurs because stomach acid serves as a barrier against pathogenic bacteria and fungi. Reducing acid allows organisms like Clostridium difficile, Salmonella, and candida to colonise the gut more easily.
Rebound acid hypersecretion makes stopping PPIs difficult. When the medication is withdrawn, the stomach often produces even more acid than before, causing severe rebound symptoms that lead many patients to restart the medication.
Microbiome disruption has been demonstrated in multiple studies showing that PPIs significantly alter the composition of the gut microbiome, reducing diversity and shifting the balance toward potentially harmful species.
A Functional Medicine Approach to GERD
Rather than suppressing acid production, a functional medicine approach aims to identify and address the root causes of reflux while supporting the body's natural digestive processes.
Step 1: Comprehensive Assessment
A thorough assessment includes detailed symptom history, dietary analysis, stress evaluation, medication review, and targeted testing. This may include comprehensive gut health testing, SIBO breath testing, H. pylori assessment, and food sensitivity panels.
Step 2: Dietary Modifications
Rather than a generic list of foods to avoid, a functional approach identifies your individual triggers through careful observation and, where appropriate, an elimination and reintroduction protocol. Common dietary strategies include eating smaller, more frequent meals, not eating within three hours of bedtime, and reducing foods that relax the LES.
Step 3: Support Digestive Function
For patients with low stomach acid, digestive support may include betaine HCl supplementation with meals, digestive enzyme support, and bitter herbs that stimulate natural acid production. These interventions should always be guided by a qualified practitioner.
Step 4: Address Underlying Infections
If SIBO or H. pylori is identified, targeted treatment protocols are implemented. For SIBO, this may involve specific antimicrobial herbs or antibiotics, followed by a structured reintroduction diet. H. pylori treatment typically combines antimicrobial agents with gut-healing nutrients.
Step 5: Gut Healing and Microbiome Support
Repairing the gut lining with nutrients such as L-glutamine, deglycyrrhizinated liquorice (DGL), slippery elm, and aloe vera can reduce inflammation and strengthen the mucosal barrier. Probiotic supplementation with strains that support upper GI health helps restore microbial balance.
Step 6: Lifestyle Optimisation
Stress management through techniques such as diaphragmatic breathing, meditation, and regular exercise can significantly reduce reflux symptoms. Elevating the head of the bed, maintaining a healthy weight, and avoiding tight clothing around the abdomen are practical measures that support LES function.
Frequently Asked Questions
Can acid reflux be cured permanently?
In many cases, yes. When the root causes of reflux are identified and addressed, many patients achieve lasting resolution of symptoms without ongoing medication. The key is a comprehensive approach that goes beyond symptom suppression to restore normal digestive function.
Is acid reflux caused by too much or too little stomach acid?
Contrary to popular belief, many cases of acid reflux are associated with too little stomach acid rather than too much. Low stomach acid leads to poor digestion, fermentation, and increased gas pressure that forces the LES open. This is why long-term acid suppression often fails to resolve the underlying problem.
How long does it take to heal GERD naturally?
Most patients begin to notice improvement within two to four weeks of starting a comprehensive functional medicine protocol. Full resolution typically takes three to six months, depending on the severity and duration of symptoms and the underlying causes identified.
Can I stop taking PPIs safely?
Yes, but it should be done gradually under professional guidance. Abrupt discontinuation can cause severe rebound acid production. A tapering protocol, combined with digestive support and dietary modifications, allows most patients to successfully transition off PPIs.
What foods help with acid reflux?
Foods that support digestive health and reduce inflammation are generally beneficial. These include non-citrus fruits, vegetables, lean proteins, healthy fats, ginger, turmeric, and fermented foods. However, individual triggers vary, so a personalised approach is essential.
Take the Next Step
If you have been living with acid reflux or GERD and are tired of relying on medication that only masks the symptoms, a functional medicine approach can help you find lasting relief. Book a discovery call with Elena to discuss your symptoms and explore how we can identify and address the root causes of your reflux. You can also learn more about our digestive health services and the comprehensive testing options available.