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.
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.
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.