In Canada, approximately 15% of the population suffers from gastroesophageal reflux disease (GERD).
Indeed, PPI (proton pump inhibitor) antacids are among the most widely used medications by the population. 1 However, GERD is not always associated with excessive acidity. On the contrary, a lack of acidity can also cause stomach contents to rise up into the esophagus.
Let's take a closer look at what hypochlorhydria and hyperchlorhydria are and what can be done to help reduce gastroesophageal reflux.
First of all, regardless of the cause of gastroesophageal reflux, certain simple habits can be put in place to reduce its incidence:
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Get in the right frame of mind : The vagus nerve plays an important role in digestive functions, particularly in the stomach. As part of the parasympathetic autonomic nervous system, stress inhibits its action. It is therefore important to eat calmly and mindfully. Relaxation exercises just before eating, such as a few deep breaths such as cardiac coherence, can help activate the parasympathetic ANS.
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Take the time to chew each mouthful thoroughly : The stomach requires its contents to become sufficiently homogeneous to allow their passage to the duodenum. Chewing is therefore essential to reduce gastric emptying time and limit the adverse effects of gastric stasis, which increases the risk of GERD.
The role of stomach acid
First, it's important to note that an acidic stomach is absolutely desirable. Acidity helps us begin digesting proteins and absorbing micronutrients like vitamin B12 and various minerals like iron, magnesium, calcium, and zinc.
Stomach acid also acts as a first line of defense against bacteria that may be present in what we ingest, which can even contribute to the development of what is called SIBO (small intestinal bacterial overgrowth). So you will understand that the goal is not to neutralize the contents of the stomach. 2,3
Hyperchlorhydria
Hyperchlorhydria, or hyperacidity, is described by an increased production of hydrochloric acid by the parietal cells of the stomach. However, it is not so much that the stomach actually becomes more acidic in terms of pH, but rather that the mechanisms for regulating acidity and protecting the mucosa are unbalanced.
The production of hydrochloric acid (HCl) is influenced by different stimuli 4 :
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Gastrin directly stimulates parietal cells to produce HCl. It is secreted during meal ingestion, particularly in response to protein. Coffee can also stimulate parietal cells to increase their production.
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Histamine is a molecule produced by the ECL cells of the stomach in response to gastrin and acetylcholine. It also binds to parietal cells to activate the production of HCl. Certain foods naturally contain histamine or increase its release, including fermented or aged foods, alcohol, cocoa, citrus fruits, tomatoes, etc.
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Acetylcholine is the main neurotransmitter in the vagus nerve that innervates the stomach. It is released even before eating, simply by the thought of an impending meal, but also in response to stomach distension and the presence of protein. It acts on the various cells of the stomach to increase the amount of HCl. This is one of the reasons that explains the increased sensation of acidity during a large meal.
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Somatostatin is a molecule produced by D cells in the stomach and is responsible for inhibiting the production of hydrochloric acid. Gastric inflammation (gastritis) can damage D cells, which decreases somatostatin and increases acidity, as can H. pilori infection.
Between the esophagus and the stomach is the lower esophageal sphincter (LES), which normally closes in response to gastric acid. However, long-term excess gastrin can disrupt the LES response and create hypotonia. Stress, by inhibiting the action of the vagus nerve, is also a common trigger for transient relaxation of the LES, as are various foods such as caffeine, tobacco, or cocoa. This relaxation will then allow acidity to rise back up into the esophagus.
Additionally, when stomach contents leave the duodenum, the duodenum will produce secretin in response to the acidity to prevent damage to the duodenal mucosa and prevent ulceration. Secretin will signal the pancreas to release its bicarbonate-rich pancreatic juice, neutralizing the chyme. Secretin will also slow gastric emptying to allow sufficient time for neutralization. 4
So, in case of hyperchlorhydria, there will be more secretin and therefore more stasis in the stomach. This may also explain why large meals seem to worsen gastric reflux because they stay in the stomach for a long time, which can increase intra-abdominal pressure and worsen reflux.
Obviously, drugs like PPIs are relevant in some cases such as ulcers or gastritis in the short term, while recovery takes place. However, more and more studies warn against long-term use which would be risky, among other things for nutrient malabsorption which, over several years, seems associated with various problems such as certain cardiovascular and renal problems, an increase in fractures or dementia. 5
Relevant supplements
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Glutamine : Amino acid that nourishes enterocytes and promotes repair of the gastric and intestinal mucosa. Can reduce local inflammation. 6
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Aloe : Anti-inflammatory and healing effect on digestive mucous membranes, helps soothe irritation. 7
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Mucilage : Derived from various plants such as marshmallow root or soluble fibers (psyllium, slippery elm) for example, it acts as a protective gel on the mucous membrane, reducing direct contact with acid. 7
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Melatonin : Can increase lower esophageal sphincter tone, stimulate protective mucus production, and reduce acid secretion via gastrin inhibition. 7
Hypochlorhydria
Hypochlorhydria is characterized by a decrease in stomach acidity due to a lack of hydrochloric acid. Normally, the pH of the stomach is between 1 and 3. In cases of hypochlorhydria, it can be between 3 and 5, or even 6 or 7 in more severe cases. 2,3
Several factors can explain a decrease in hydrochloric acid production:
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Chronic stress, and therefore constantly elevated cortisol, inhibits the vagus nerve, which is associated with the parasympathetic nervous system. This blocks acetylcholine and its action on the various cells in the stomach to produce hydrochloric acid. 2,3
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Insufficient intake of zinc, an important cofactor for carbonic anhydrase, an enzyme that produces H+ protons for the production of hydrochloric acid (HCl). 3
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Salt (NaCl) is the main source of chloride (Cl-) in the diet. A diet too low in salt could impair the formation of hydrochloric acid (HCl). 3
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An alteration of the stomach lining and therefore of the parietal cells, due to chronic inflammation or late-stage H. Pylori infection. There is also a decrease in the number of parietal cells with age. Chronic use of acid-reducing medication can also make the glands inactive during prolonged use. 2
Since the LES closes in response to sufficient acidity, among other things, in the case of hypochlorhydria, it will close less effectively. This will therefore allow the stomach contents to rise, which, even at a less acidic or even neutral pH, will be irritating to the esophagus. 2,3
In addition, pepsin, an enzyme necessary for protein digestion, is only activated when the pH is less than 3. Otherwise, protein digestion will be more difficult and may delay gastric emptying until the chyme is more homogeneous and ready to leave the stomach, hence the impression of slow digestion. Also, since one of the roles of acidity is to "sterilize" the bolus, in cases of hypochlorhydria and associated gastric stasis, there is often more fermentation. This will have the effect of increasing intra-abdominal pressure and a feeling of heaviness after meals as well as frequent belching.
Relevant supplements:
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Zinc: Cofactor of carbonic anhydrase, essential for the production of protons for HCl. Also promotes the regeneration of the gastric mucosa since it is necessary for cell replication. 3
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Vinegar or lemon : When consumed just before meals, they temporarily acidify the gastric contents, improving digestion and promoting the closure of the lower esophageal sphincter.
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Bitter plants (dandelion, milk thistle, burdock, ginger, mint, etc.): Are traditionally used in herbalism to stimulate the production of various digestive juices, including gastric juices, for better digestion. 3
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Magnesium : While not having a direct effect on the stomach, magnesium is known to support the function of the parasympathetic autonomic nervous system, which is important for vagal stimulation of the stomach and gastric acid secretion.
How to know if our stomach is acidic enough
There's a simple test you can do to check your stomach pH. Before eating, simply take half a cup of water and add 1/4 teaspoon of baking soda. When you drink it, if your stomach pH is acidic enough, the reaction between the baking soda and hydrochloric acid will produce effervescence and therefore a belch within 3 to 5 minutes. If nothing happens, it may be a sign that your stomach pH is too high. 2 It is also possible to obtain an accurate measurement of stomach pH from your doctor.
Ultimately, whether you suspect you have gastroesophageal reflux disease (GERD), whether it's caused by hypochlorhydria or hyperchlorhydria, it's always important to discuss it with your healthcare professional to assess whether there's an underlying cause that requires medical treatment, such as an H. Pylori infection. Your healthcare professional can also guide you on the best approach if you're considering using natural health products.
References
1. “Gastroesophageal Reflux Disease” Canadian Digestive Health Foundation. (Accessed August 10, 2025). https://cdhf.ca/en/digestive-conditions/gerd/
2. “Hypochlorhydria” Cleaveland Clinic. June 27, 2022. (Accessed August 10, 2025). https://my.clevelandclinic.org/health/diseases/23392-hypochlorhydria
3. Saverioni, Lorenza. “Hypochlorhydria, Too Often Ignored” ANAQ. (Accessed August 10, 2025). https://anaq.ca/habits-of-life/understanding-hypochlorhydria/
4. McKinley P, O'Loughlin VD, Bidle TS. (2013). Anatomy & Physiology - An integrative Approach. 3rd ed., McGraw-Hill. 1478 pp.
5. Maideen NMP. Adverse Effects Associated with Long-Term Use of Proton Pump Inhibitors. Chonnam Med J. 2023 May;59(2):115-127. doi: 10.4068/cmj.2023.59.2.115. Epub 2023 May 25. PMID: 37303818; PMCID: PMC10248387.
6. Shen J, Guo Y, Cao R. The relationship between amino acids and gastroesophageal reflux disease: evidence from a Mendelian randomization analysis combined with a meta-analysis. Front Immunol. 2025 Mar 4;16:1420132. doi: 10.3389/fimmu.2025.1420132. PMID: 40103821; PMCID: PMC11914792.
7. Komolafe K, Komolafe TR, Crown OO, Ajiboye B, Noubissi F, Ogungbe IV, Graham B. Natural Products in the Management of Gastroesophageal Reflux Disease: Mechanisms, Efficacy, and Future Directions. Nutrients. 2025 Mar 19;17(6):1069. doi:10.3390/nu17061069. PMID: 40292509; PMCID: PMC11944625.
Maison Jacynthe disclaims all liability. All information contained on this page is not intended to replace justified allopathic treatment, nor to disregard the expertise of the medical profession. It is up to each individual to take charge of their own health, to inform themselves, and to make the necessary changes to improve their condition. Therapeutic supervision by a qualified health professional is obviously recommended.
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