It is now accepted by the medical community that GERD is, in fact, caused by an increase in intra-abdominal pressure (IAP). Bloating, or gastric distention causes acid reflux by physically pushing the stomach contents, including the acid, through the LES and into the esophagus.
Factors that contribute to gastric distention are known to include overeating, obesity, physically bending over or lying down after eating and eating spicy or fatty foods. But beyond these factors, there are two primary causes of Increased intra-abdominal pressure (IAP):
Carbohydrate Malabsorption leading to bacterial overgrowth, resulting in IAP and causing reflux
But what causes this in the first place? LOW STOMACH ACID.
Another shocking reason for having a dysfunction of the LES is low stomach acid. Yes, when the stomach acid becomes low, the LES relaxes. This is because high stomach acid signals to the LES to close. As you can see, our current therapies for GERD can worsen the problem of heartburn as well as interfere with proper nutrient absorption, food breakdown, and killing foreign bacteria and fungi (as we mentioned previously).
Aside from acid reflux medications that lower stomach acid, people can have lower stomach acid for various reasons (which we will dive into later).
Low stomach acid contributes to bacterial overgrowth (no matter what your carbohydrate intake is) AND carbohydrate malabsorption.