Halting Heartburn
 Heartburn hurts. It can make your chest feel like it’s on fire
as your stomach heaves and churns. Even the word heartburn conjures up visions
of burning pain inside a smoldering torso. But contrary to its descriptive name,
heartburn has little to do with the heart, and everything to do with the
digestive system. That sour, metallic taste that appears in your mouth right
after eating indicates indigestion produced by stomach acid flowing in the wrong
direction.
Because heartburn leaves you with the taste of gastric acid in
your mouth, and even a small amount of this digestive fluid in the esophagus can
cause discomfort, it’s a common misconception that heartburn is caused by too
much stomach acid. Medical treatment relies on the use of acid-lowering drugs
and antacids to neutralize the problem. These treatments are generally designed
for temporary symptomatic relief, for although the feeling of heartburn is not
present when taking these drugs, the stomach contents still wash into the
esophagus and can cause problems, even if the individual cannot feel it.
Despite the popularity of antacids and other over-the-counter
aids designed to limit stomach acid, experts believe that the majority of
digestive problems linked to heartburn actually stem from too little of one type
of acid in the stomach: hydrochloric acid. As a result, many suggest taking
betaine hydrochloric acid supplements to help prevent heartburn.
Heartburn Society
In surveys conducted by the American Gastroenterological
Association, findings show that ten percent of the American population (about 30
million people) experience heartburn weekly, and as many as 60 million Americans
may experience heartburn at least once a month. That represents a massive
epidemic of discomfort.
While almost anyone can experience a degree of heartburn after
a large, heavy meal, there are some conditions that may increase your risk.
Pregnant women, people with diabetes or hiatal hernia, and the elderly typically
experience higher rates of heartburn. So do smokers, heavy drinkers and people
who are overweight. All of those conditions and habits can interfere with the
movement of food through the stomach.
Heartburn also takes a toll on the nation’s finances,
resulting in lost work hours and increased medical expenses. According to the
Heartburn Alliance, one-third of sufferers report that heartburn prevents them
from doing the things they enjoy doing, such as hobbies, work, social activities
and spending quality time with their families. The burning pain of heartburn
also interrupts sleep and interferes with daily activities and job performance.
That Old Familiar Feeling
The signs of heartburn are easy to spot: Acid rises in the
throat as caustic fluid backs up into the esophagus. This sets off a fiery
sensation that radiates upward and frequently swells into the chest, causing
symptoms that may appear to be related to the cardiovascular system rather than
the digestive system. While occasional bouts of heartburn aren’t considered
intrinsically serious, prolonged frequent heartburn may lead to a chronic
disorder called gastroesophageal reflex disease (GERD), more commonly known as
acid reflux.
Other effects of heartburn include nausea, upper abdominal
pain (especially after meals), gas and belching, abdominal bloating, and a
feeling of extreme fullness after eating, as though food is stuck in the stomach
and not moving. Heartburn is also associated with wheezing, asthma symptoms and
noisy breathing. This happens when the delicate tissues of the windpipe are
damaged by exposure to stomach acid. In the case of persistent heartburn, a
knowledgeable health practitioner should diagnose the problem to rule out other
factors.
 The Origins of Heartburn
The stomach is a remarkable, self-contained organ. Its lining
is designed to withstand acidic conditions that would tear apart other sections
of the body, and cells in the stomach act as tiny acid pumps, releasing
hydrochloric acid necessary for the breakdown of food in the upper digestive
tract.
Normally, a valve at the top of the stomach called the lower
esophageal sphincter (LES) opens to receive food from the esophagus and closes
once the food enters the stomach. The interior of the stomach is covered with a
protective coating of mucus that keeps hydrochloric acid from eating holes
through the stomach walls. However, the delicate esophagus doesn’t possess this
insulation, so when hydrochloric acid backs out of the stomach across the
sensitive esophageal membranes, it causes a painful sensation.
The American Academy of Family Physicians notes that several
lifestyle factors contribute to heartburn, including bending over, lifting,
straining or squatting after a heavy meal. Lying down after meals and eating
right before bedtime may also lead to heartburn, as can tight, restrictive
clothing that puts pressure on the stomach and digestive tract.
In addition to acidic foods such as tomatoes and citrus,
indulging in chocolate, spicy foods, coffee, tea, alcoholic beverages, fatty and
fried foods, processed foods high in refined sugars, and carbonated beverages
may also ignite the spark of heartburn. Raw onions, garlic, black pepper and
vinegar (or vinegar-based foods such as pickles or chutneys) can be problematic
as well.
Slow Down – You Chew Too Fast
How and when you eat may also contribute to heartburn. Eating
in a hurry without taking time to adequately chew and enjoy food disrupts
digestion. So does eating under stress or when you are upset. When you’re
emotionally distraught, the stomach becomes distended and food is forced to stay
at the top of the stomach where it can pressure the valve to open. This can
cause partially digested food, stomach acid, enzymes and food-borne bacteria to
rise up the esophagus, which can cause damage to the throat and windpipe.
Certain medications also contribute to heartburn and GERD. Non-steroidal
anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen and naproxen relax
the LES, which allows heartburn to rise. NSAIDs, along with some antibiotics,
heart medications and minerals, can also irritate the stomach lining and disrupt
gastric juices. Swallowing too much air during a meal may also contribute to
heartburn. A case study conducted by the University of Genoa found that air in
the stomach can create persistent heartburn that often does not respond to
normal therapies. (Dig Liv Dis. 2005 Jun;37(6):454-7) Not drinking enough water
also adds to heartburn woes.
Hydrochloric Acid: So Misunderstood
While the backflow of hydrochloric acid often gets the blame
for the fiery pain associated with heartburn and GERD, researchers now know that
simply reducing the amount of acid in the stomach may be the wrong way to treat
heartburn. As a matter of fact, too little hydrochloric acid is often to blame
for heartburn.
Hydrochloric acid (HCl) serves two primary functions in the
stomach. It creates an acidic environment designed to start the breakdown of
nutrients, and it helps protect the digestive tract from infection, as few
microorganisms make it through the acid alive. Mixed with food as it leaves the
stomach, HCl keeps the bacteria residing in the colon from progressing back into
the small intestine where they can cause problems.
Acid Underproduction
When stomach acid levels are low, undigested food becomes a
breeding ground for bacteria. A 2005 study conducted by the University of
Michigan found that too little stomach acid causes chronic inflammation.
(Oncogene 2005 Mar 31;24(14):2354-2366) In the study, researchers found a
relationship between chronic inflammation and chronic disease, especially in
association with low levels of gastrin—a hormone that stimulates the stomach
lining to produce HCl.
Scientists also found that the overproduction of HCl, which is
the stomach’s primary response to bacterial colonization, offers protection
against infection, and that inflammation was the main trigger for stomach acid.
(Am J Physiol Gastrointest Liver Physiol. 2002; 282:G175-G183) “Inflammation of
the stomach lining … triggers parietal cells in the stomach lining to produce
more hydrochloric acid, which kills off most invading microbes. If you inhibit
gastric acid production, you interfere with the stomach’s natural defense
mechanism,” says researcher Juanita L. Merchant, MD of the Michigan Medical
School.
Many health problems may also be linked to low stomach acid,
including chronic hives, fatigue, eczema, anemia, cracked fingernails, unhealthy
looking skin and hair, depression and bad breath due to inefficient digestion.
Lack of Acid
Lack of stomach acid is a more common problem than many people
realize. Some experts estimate that one of every three people over the age of 60
have virtually no stomach acid at all. (Jrnl AM Ger Soc, 1986;34:800) Research
indicates that older women are particularly susceptible to a lack of stomach
acid, with one study finding that 40 percent of postmenopausal women had little
or no stomach acid. (Gastroenterology, 1963; 45:15)
In addition to being linked to heartburn, low stomach acid
interferes with digestion in several serious ways: High acidity is needed to
help absorb minerals such as iron, zinc, calcium and magnesium. It is also
necessary for the efficient assimilation of vitamin C, beta carotene and B
vitamins. So, even if you think you are eating a nutritious diet and taking
valuable dietary supplements, without enough stomach acid many of those crucial
nutrients may be passing right through your body.
Stomach acid also enables the enzyme pepsin to begin the
breakdown of proteins into amino acids, which the body will use to manufacture
new tissues. It stimulates the pancreatic production of enzymes necessary for
digesting carbohydrates, fats and proteins; makes minerals more soluble; aids
digestion by stimulating intestinal bacteria; and supplies acidity to the small
intestine, where it helps control the growth of unwanted bacteria.
Stress and Heartburn
 The consumption and digestion of food should be a pleasurable
experience. Food is meant to be enjoyed and savored, and the digestive system
responds to careful eating. The best digestion occurs when you dine slowly and
focus on chewing your food adequately. Paradoxically, the more you rush through
a meal, the slower and more problematic the digestive process becomes.
Unfortunately, everyday stress has invaded our meals,
resulting in too few people taking the time to relax and enjoy their food.
Instead, we often grab quick bites throughout the day, whizzing in and out of
fast-food drive-through restaurants, ingesting half-chewed food while carelessly
swallowing air and big gulps of bubbly soft drinks. Add in the tension of
weaving through traffic, one hand on the steering wheel with the other on the
bun, and acid reflux seems inevitable.
Research confirms that stress leads to heartburn; the higher
your stress level, the greater your chances of heartburn. (Scand J Gastroenterol
1995; 30: 1–5) If you are anxious or tense, your esophagus becomes more
sensitive to acid reflux. This is one reason why digestive issues are more
pronounced when you’re nervous and upset. When researchers in California looked
at heartburn symptoms among 60 middleaged people, they found that those who were
the most anxious and depressed suffered the most heartburn. (Psychosomatic
Medicine 66:426-434; 2004) Research also showed that sustained stress can slow
stomach function and allow accumulated stomach acid to back up into the
esophagus. In contrast, learning to relax more and defuse stress with activities
such as meditation and exercise may significantly decrease heartburn, as will
sitting down and thoroughly chewing food during meals.
For those who endure stubborn heartburn, each meal can be an
ordeal, but for many heartburn sufferers, prevention is simple: Add a little
betaine hydrochloric acid into your daily diet, commit to a more relaxed eating
routine, and better digestion is soon to follow.
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