Heartburn Causes & Simple Steps to Treat it
Do you suffer from heartburn and rely on medication to control it? Today, many people, especially those over the age of 40, suffer from acid reflux or heartburn, a less serious form of gastroesophageal reflux disease (GERD). GERD encompasses a broad spectrum of disorders in which the gastric contents of the stomach cause symptoms or damage to the esophagus or respiratory tract (1). Popular belief is that this is caused by too much acid in the stomach and is typically treated with some type of acid reducer like an antacid, such as TUMS, or, for longer lasting relief, a Proton Pump Inhibitor (PPI), like Nexium or Prilosec (2). In reality, however, is acid reflux really caused by making too much stomach acid? This article challenges that belief and discusses the true cause of heartburn and how to treat it.
Why do we get heartburn in the first place?
Current research shows that the reason we get GERD or heartburn is because there is a problem with the valve separating the stomach from the esophagus, called the Lower Esophageal Sphincter (LES). Low pressure in the LES occurs when there is an increase in abdominal pressure or gastric distension (3). Over time, with continued pressure, this valve can become weak or damaged. Abdominal pressure causes the acidic contents of the stomach to spill up into the esophagus, where it should not be, resulting in pain, discomfort, and sometimes damage.
What causes the backup of pressure?
Although there are very rare cases when the stomach produces too much acid, the majority of people are actually producing too little acid. When our stomach makes too little acid, our food is not broken down very well. The undigested food creates an overgrowth of bacteria in the intestines, which causes pressure to build up in the abdomen and results in a weakened or damaged LES(4). In addition to low acid, over consuming certain types of carbohydrates can also contribute to the problem. In his book, Heartburn Cured, Dr. Norman Robillard describes consuming difficult to digest carbohydrates as the primary cause of bacterial overgrowth creating gastrointestinal pressure and heartburn. He states that it only takes 30 grams (just over an ounce) of undigested carbohydrates to create 10 liters of gas, yikes (5)!
Why do we not make enough acid?
Some of the reasons for not making enough acid are:
Age- as we get older we start to produce less hydrochloric acid (HCl)
Stress- a major contributing factor to decreased production of HCl
Inadequate chewing- chewing helps stimulate the production of HCl
Inadequate water intake- sufficient water, outside of meal-time, is needed to make HCl
Underlying gut infection like H. pylori. H. pylori is an infection in the stomach that can destroy the cells in the stomach lining responsible for making HCl
Nutrient deficiencies like Zinc and B6 – you need these to make HCl
Why do we need adequate amounts of acid in the stomach?
Proper acid levels in the stomach provide very vital functions such as:
Help us to break down food for absorbing nutrients and preventing an overgrowth of bacteria
Protect us from harmful organisms by killing bad bacteria we may ingest
Help us absorb vital nutrients like B12 and iron, a common reason for anemia. Could this be a reason why you are so fatigued?
What are some of the signs of low stomach acid?
A few of the signs of low stomach acid are:
Bad breath, belching, bloating, fatigue, constipation, diarrhea, food sensitivities, gas, heartburn, headache, nausea, nutritional deficiencies, rectal itching, stomach upset after taking vitamins, sweat with strong odor, weak hair or nails, and yeast infection. Do any of these sound familiar?
What are the current treatments?
The primary treatments available for acid reflux continue to be therapies that help to reduce the production of acid in the stomach, either antacids for short-term relief or PPIs for longer term relief (6). The antacids work by neutralizing the acidity in your stomach and the PPIs work by blocking the mechanism in which your stomach makes acid; therefore, it lowers the amount of acidity and backwash to your esophagus. This seems logical, but for all the reasons previously discussed, decreasing the amount of acid in your stomach is not healthy long term. Also, these medications for heartburn or GERD were only meant to be used short term, which is not longer than 4-8 weeks according to the FDA, yet many people have been taking them for years and even decades. They are certainly front and center in any pharmacy you walk into making easy access to these seemingly benign drugs.
What can happen with long-term use of acid suppressing drugs?
Long term use of PPI’s may be associated with:
Increased cardiovascular risk even in patients without a history of cardiovascular disease (7)
Chronic kidney disease (8)
Decreased absorption of magnesium (9)
B12 and iron deficiency (10)
Increased risk of developing fractures, osteopenia and osteoporosis (11)
Potential risk for developing dementia (12)
What is a better treatment for heartburn?
First, it’s important to note that no one should suddenly stop their medications as this may cause rebound reflux, which make symptoms worse. Instead, work with your physician or functional medicine provider to gradually and safely get off of your PPI.
*Increase your own HCl naturally by –
Chewing your foods to liquids - this means slowing down when you eat
Drinking lemon in water or a small amount of apple cider vinegar (I use Braggs Raw ACV) with water before your meals
Using a digestive enzyme to help break down food in your stomach and intestines
Consuming adequate amounts of water throughout the day but not during your meals, which can dilute your HCl and digestive enzymes
* Eliminate the following foods at least for the short term. Although some believe that these foods are not the cause of heartburn, it may be helpful.
Ice cold drinks
Caffeine, sugar, and alcohol
Major food sensitivities like gluten, dairy, and soy
Chocolate, citrus, tomatoes, onions, peppers, peppermint, soda
* Take probiotics to increase the good bacteria and balance the microflora from an overgrowth of bad bacteria
*Incorporate a low-carbohydrate diet which will help decrease the amount of bacterial overgrowth in the intestines(13).
*Reduce stress- incorporate relaxation techniques like meditation, yoga, tai chi, or Heart Math.
Lastly, if heartburn is severe and difficult to treat, further investigation may be needed to rule out a bacterial or other cause of low stomach acid.
Hopefully, this gives you a better understanding of heartburn, one of the most common medical issues today, and how to approach it. Inappropriate use of PPIs is not the answer and has been shown to cause serious problems if used long term. Natural food agents along with dietary changes, supplements, and stress reduction can all help improve stomach acidity and digestion to prevent heartburn and other related disorders.
This is not intended to be medical advice and is not a substitute for being under the care of a physician. Check with your physician before stopping or starting a new program.
If you are interested in more information to help with a digestive issue or for an individualized program to help get off of your heartburn medication, please contact me at firstname.lastname@example.org.
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2. Richter JE. “Long-Term Management of Gastroesophageal Reflux Disease and Its Complications.”Am J Gastroenterol. Department of Gastroenterology, Cleveland Clinic Foundation, Ohio 44195, USA. Apr 1997; 92.
3. Diamont, M.D. Nicholas E. “Pathophysiology of gastroesophageal reflux disease” GI Motility Online. 16 May 2006.
4. Anini, Y., et al. “Modulation by Colonic Fermentation of LES Function in Humans.” American Journal of Physiology. Gastrointestinal Liver Physiology. 2000 Apr;278(4).
5. Robillard, Norm, PhD. Heartburn cured: the low carb miracle. N.p.: n.p., n.d. Print.
6. Robinson, M. “Drugs, Bugs and Esophageal pH Profiles” Yale Journal of Biological Medicine. 1999 Mar-Jun; 72(2-3): 169–172. University of Oklahoma College of Medicine, Oklahoma Foundation for Digestive Research, Oklahoma City 73104, USA.
7. Hong. K. “Potential Cardiovascular Risks of Proton Pump Inhibitors in the General Population.” International Heart Journal. 2017 Mar 17. Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University. Abstract
8. Chang, A.R, et al. Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease. JAMA Intern Med. 2016 Feb;176(2):238-46. doi: 10.1001/jamainternmed.2015.7193.
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11. Akbari, et al. “Proton Pump Inhibitors Use and Change in Bone Mineral Density. Int J Rheum Dis. 2016 Sep;19(9):864-8. 2016 May 31.
12. Broich. “Association of Proton Pump Inhibitors WIth Risk of Dementia: APharmacoepidemiological Claims Data Analysis.” JAMA Neurol. 2016 Apr;73(4):410-6.
13. Austin, Gregory L., et al. “A Very Low-Carbohydrate Diet Improves Gastroesophageal Reflux and Its Symptoms.” Digestive Diseases and Sciences. August 2006; 51 (1307–1312)