What's the deal with HEARTBURN?

Heartburn is the miserable companion of one-third of the population. That burning sensation in your chest, feeling like someone just threw salt water on your sunburn, is enough to ruin anyone’s day. But what is the underlying cause behind heartburn? What is the deal with those over-the-counter medications? And will I ever be able to eat my beloved hot sauce again?  

What is it?  

At its most basic level, heartburn happens when the valve at the end of the esophagus (called the sphincter) fails to close completely. This band of muscles is usually charged with the task of sealing off the stomach from the esophagus and only opening when food is passing through, in order to keep the acidic content of the stomach from reaching the esophagus. There are a few reasons this may fail to happen correctly, but they all result in the same thing- stomach acid leaking back up the esophagus where it does not belong.  

Common triggers that heartburn victims will point to include overeating, fried foods, carbonated beverages (especially soda), alcohol, and coffee. It is also recommended to avoid laying down for a few hours after eating. Many medications can also relax the esophageal sphincter, including NSAIDs (ibuprofen), aspirin, birth control pills, nicotine, valium, calcium channel blockers, and certain heart medications.

For many, however, the underlying cause of heartburn is more complicated than you are led to believe!

What causes it? 

THE SHORT ANSWER:

Heartburn happens when the muscles at the base of the esophagus allow stomach acid back into the esophagus. This can happen in people with excess stomach acid, but can also occur in those with too little stomach acid. It’s important to know which camp you are in, as the path to healing looks different for too much vs too little acid.  

THE JUICY ANSWER: 

Many people (logically) assume that heartburn is caused by excess stomach acid. While that can be the case, a weak esophageal sphincter can exist with or without excess stomach acid. Even the right amount of stomach acid can cause problems when it travels places it doesn’t belong…..like ANYWHERE other the stomach. Plus, many people suffering from heartburn actually have low stomach acid, not high! Huh?  

Stomach acid (which includes all-important hydrochloric acid, or HCl) is responsible for breaking down the food we eat (especially proteins) preparing nutrients for absorption by the body, and keeping harmful bacteria out of the body. In the case of low stomach acid, food sits undigested for too long, which results in excess gas and pressure. This in turn acts on the esophageal sphincter and BAM. What little stomach acid there is is forced into the esophagus. Additionally, low stomach acid allows bad bacteria to grow unchecked, also impacting the pressure and function of stomach muscles and the esophageal sphincter.

Just to make things more confusing, taking antacids and acid-blockers can temporarily improve symptoms, even if the cause is low stomach acid, as it calms the pressure/gas in the stomach and brings the acidity level in the stomach down. It’s easy to see, however, that this starts a vicious cycle- low stomach acid causes digestive imbalances, which causes heartburn symptoms, to which we take antacids, which lowers stomach acid even more! This cycle creates a dependency on over-the-counter heartburn meds, none of which have been approved for anything other than short-term use. Additionally, regular antacid or proton-pump inhibitor use is associated with serious nutrient deficiencies, especially B12, magnesium, and iron, and have even been linked to increased risk of stomach cancers, heart disease, and osteoporosis.  

Some people suffering from heartburn may have even started out with sufficient or excess stomach acid, but through months or years of regular antacid use are now experiencing medication-induced low stomach acid and the heartburn that accompanies it.  

So….am I high or low? 

So what do we do? Whether your cause is low or high stomach acid, or something else entirely, the best thing to do is to enhance overall digestive function. A great place to start is HCl (hydrochloric acid) tablets. This is an at-home experiment that can give you a starting direction for healing. Start by taking one HCl tablet (500-600 mg) at the end of a large meal. If your symptoms worsen or you feel significant warming or burning, you probably have too much stomach acid. If you don’t experience any change, gradually increase the dose until you experience the warming/burning sensation in your stomach. If your symptoms improve, low stomach acid is the culprit and you can modify foods and supplements accordingly! If the idea of taking straight stomach acid feels rubbing salt in a wound, you can do a similar experiment with one tablespoon of lemon juice or apple cider vinegar during an episode of discomfort.  

No matter your cause, focusing on improved digestive function and a whole-foods, nutrient-rich diet can be helpful. As a nutrition consultant, I also have many food and herb-based strategies that can make a big difference! For further support, reach out for a FREE 20-minute health consult.

Have you found any other triggers or remedies for your heartburn? Comment below!