Let’s talk about heartburn today. It’s something that most of us have experienced once or twice. And for those that have it more often than that, you know that it sucks. It’s an uncomfortable feeling, you often don’t know why it’s happening, and sometimes it feels like it will never go away.
First let’s get the language straight. There are 3 terms that are often used interchangeably - heartburn, acid reflux & GERD.
Acid reflux is what’s happening (ie. the acid is backing up into the esophagus)
Heartburn is the symptom that you experience because of acid reflux
And GERD is what happens when you have chronic acid reflux and you start getting other complications like pain in your throat, a cough, or dental problems.
And just in case there is anyone wondering… Heartburn doesn’t have anything to do with your heart it’s just named that because most people feel their reflux symptoms under the sternum, near the heart.
The reason you feel burning/pain/pressure with heartburn is because the acidic contents of your stomach are moving where they shouldn’t be. The cells that line your stomach are very different than the cells that line your esophagus. The ones in your esophagus are not meant to be exposed to acid, so when they are they don’t like it very much. They’re essentially getting burned, which is why you feel heat.
As we already talked about, heartburn as a symptom that is caused by the reflux of acid up into the esophagus. This happens when the stopper between the stomach and the esophagus doesn’t do its job. This stopper is called the lower esophageal sphincter or LES.
The LES is open when food is going into the stomach and then shuts tight until the stomach releases its contents into the small intestine. If the LES doesn’t do its job properly stomach contents can flow the wrong way (ie. upwards).
Heartburn is caused by having a weak LES, not having too much acid in your stomach.
One point of clarification before I go on - I’m not saying that heartburn is not caused by acid. It is. It’s caused by acid going up into your esophagus. But the cause of the acid going up your esophagus is not because you have too much acid in your stomach but rather because your LES is not staying tight enough while your stomach is digesting. This is why taking TUMS or other antacids works to relieve your symptoms; but it doesn’t mean that the root cause is too much acid.
You could have a hiatal hernia; this is not super common but it’s worth mentioning. Your esophagus travels thru your diaphragm on it’s way to the stomach. If this hole in the diaphragm is too loose the top of your stomach can actually slide through your diaphragm. And this can decrease LES tone. To figure out if you have this you need to have imaging done.
Medications can also decrease LES tone - these include many heart medications and benzodiazepines
There are some food items that decrease LES tone - notably alcohol and peppermint.
But the most common cause of lowered LES tone is low stomach acid. This is definitely the most common thing I see in practice.
Low stomach acid can be caused by zinc deficiency, stress, aging and PPIs (proton pump inhibitors, which are often prescribed for heartburn).
It can also be caused by H. Pylori infection - H. Pylori is a bacteria that actually lives in the stomach of 50% of the population and doesn’t always cause harm - but when it’s active it can decrease stomach acid.
First you need to figure out why you are having heartburn and then treat that.
While you’re figuring that out there are some symptomatic treatments you can try:
Decrease foods known to worsen heartburn like alcohol, caffeine, fatty foods, peppermint, tomatoes & chocolate
Increase things that are anti-inflammatory and healing for the esophagus like chamomile, turmeric, aloe, slippery elm & licorice
Another huge thing is to pay attention to your eating habits
Make sure you’re eating slowly, chewing thoroughly, not eating too much, and not having too much fluid with your meal
If you’re curious about the root cause of your digestive issues let’s get on a call!