The Root Cause of Acid Reflux: Why Low Stomach Acid Leads to GERD and How Apple Cider Vinegar Helps

This podcast episode by Dr. Ekberg challenges the common misconception that heartburn and GERD (Gastro Esophageal Reflux Disease) are caused by too much stomach acid. Instead, he argues that the vast majority of cases stem from hypochlorhydria, a condition of insufficient hydrochloric acid production in the stomach. A healthy stomach pH of 1-3 is crucial for signaling the lower esophageal sphincter (LES) to close, digesting proteins, killing pathogens, and absorbing essential minerals and vitamins like B-12. When stomach acid is too low (pH 4-6), the LES may remain partially open, leading to reflux of stomach contents into the unprotected esophagus, causing irritation and symptoms.

Dr. Ekberg details a wide array of symptoms and conditions associated with hypochlorhydria, extending beyond digestive discomfort. These include a lack of appetite for meat, gas and bloating, irritable bowel syndrome, thin hair and nails, leaky gut, food sensitivities, and even autoimmune conditions like lupus, Hashimoto's thyroiditis, and psoriasis. Nutritional deficiencies, osteoporosis, and pernicious anemia are also common due to impaired absorption. Furthermore, chronic reflux can lead to serious esophageal changes like Barrett's esophagus, metaplasia, dysplasia, and an increased risk of cancer.

The episode identifies several root causes for hypochlorhydria, including an underactive thyroid (hypothyroid), H. pylori infection, the chronic use of antacids (which temporarily relieve symptoms but exacerbate the underlying problem), and stress. Stress, by activating the fight-or-flight response, diverts resources away from digestion, effectively shutting down acid production. Increasing age is also noted as a factor, though Dr. Ekberg emphasizes that degeneration is not inevitable with age if health is maintained. These factors often create a vicious cycle, making the condition difficult to resolve without addressing the root cause.

Given this understanding, Dr. Ekberg explains how apple cider vinegar (ACV) can be highly beneficial for GERD and heartburn. With a pH of 2.5, ACV helps restore the stomach's acidity to its optimal range, thereby improving LES signaling and overall digestion. He reports that 90-95% of his patients experience significant improvement with ACV or betaine hydrochloride (stomach acid in a pill). However, he cautions that if the esophagus is already severely irritated, inflamed, or ulcerated, starting with acid-containing supplements might worsen symptoms, suggesting a preliminary phase of soothing digestive aids without acid. The core message is to always address the root cause and heal the body, rather than merely masking symptoms with antacids, which perpetuate the problem.

The third thing you probably hear is that it's because there is too much acid in the stomach and that is just not correct because most people don't have enough acid.

Your stomach is supposed to contain or produce something called hydrochloric acid which puts its pH at a very low level. So if the pH is between 1 and 3, which it's supposed to be in the stomach, that puts it right down here at the bottom of the scale.

This low pH; it signals to the body to close this lower esophageal sphincter to prevent the back flow.

The stomach has this mucus on the lining but the esophagus doesn't have any of that. So that's why the esophagus gets very very irritated when it gets acid and now you experience the symptoms of heartburn or GERD.

Interestingly the first one is heartburn. The sensation of too much acid is because you don't have enough.

Stress is one of the most common cause stress causes everything have you noticed well it's because with stress your body shifts you have your fight flight system and your feed breed system your digestive system so when you're in a fight flight mode... it turns off everything to do with digestion.

Apple cider vinegar could actually be beneficial that its pH is 2.5 so it's right in that range of what the stomach needs to be when you're digesting protein and even though it seems counterintuitive to some people that it feels like you have too much acid why would you add more it actually works if you understand what we just talked about.

Always remember that you don't want to treat the symptom you want to address the root cause you want to heal the body you want to reduce the stress you're going to give your body the proper nutrients.

No you calm down the symptom temporarily but by taking that antacid you're setting yourself up for all of the problems all the conditions that we talked about on the previous slide.

The vast majority get better now if you already have some irritation if you have an ulcer or you have gastritis if it's just really raw and irritated then you may notice that it feels a little worse if you take that apple cider vinegar or the betaine hydrochloride and that just means you're not quite ready for it yet.