Rejuve Medical

What Really Causes Heartburn?

Did you know that heartburn actually has nothing to do with your heart? It’s actually stomach acid irritating your esophagus, causing a “burning” discomfort in the upper part of your chest or below your sternum. Stomach acid can escape if your lower esophageal sphincter (LES), a muscular valve located where your esophagus meets your stomach, opens too often or doesn’t close tightly enough. Your LES normally opens only to let food into the stomach (or to let you belch), and then closes right away. When the door of the LES is ajar, though, stomach acid can seep through (reflux). Occasional heartburn isn’t dangerous, but if you’re having chronic heartburn or gastroesophageal reflux disease (GERD), it can be indicative of other issues and lead to serious health problems. Keep reading to learn more about heartburn, GERD, their causes, and effective natural treatments.
What Are the Symptoms of Heartburn?
The pain caused by stomach acid refluxing into the esophagus is usually felt as a burning sensation behind the sternum or breastbone. The location and intensity of the pain can lead it to be mistaken for symptoms of a heart attack, which is likely how this digestive trouble wound up with the name heartburn. It can be a spasm or a sharp pain, and can remain in the chest or radiate to the back of the throat (this also causes waterbrash, a sour taste in your mouth). If stomach acid has made it near your larynx, you may experience coughing or become hoarse. Heartburn is sometimes made worse by leaning forward or lying down; it can strike in the middle of the night, affecting your sleep quality.
Occasional heartburn is not a major concern, but recurring reflux should be checked out. Your body naturally creates stomach acid, but it’s still an acid—it can wear away your tooth enamel, leading to decay, and it can cause irritation, inflammation, ulcers, and bleeding in your throat. Heartburn is the main symptom of GERD, which can lead to all of those problems as well as scarring, stricture, and changes in the cells lining the esophagus. This last issue can create a condition called Barrett’s esophagus, which has been linked to an increased risk of esophageal cancer.
If you are suffering from heartburn regularly, it’s important to consult a physician. While it may be GERD, other chest-related health problems that cause the same type of pain can be mistaken for heartburn. Once you have a proper diagnosis, you can work on identifying the source of your heartburn as well as your best treatment options.
What Causes Heartburn?
A wide range of causes can trigger heartburn, but these can be broken down into four categories: Medicines, foods, behaviors, and medical conditions.
Many medications—both prescription and over-the-counter—are linked to an increased risk of heartburn. In most cases, it is because they increase the production of stomach acid (often by depleting the “good bacteria” who help to keep your gut flora in balance). Never stop taking any prescription medication without talking to your doctor first. If you believe that one of your meds is causing heartburn, you and your doc can weigh the pros and cons to determine the right course of action.
Here are some of the most common medications that can cause heartburn:

  • Aspirin
  • Ibuprofen (Motrin, Advil)
  • Naproxen (Aleve, Naprosyn)
  • Anticholinergics (Benadryl)
  • Beta-blockers (taken for heart disease or high blood pressure)
  • Calcium channel blockers (taken for high blood pressure)
  • Dopamine-like drugs (taken for Parkinson’s disease)
  • Birth control pills (especially those with progestin) and progesterone
  • Sedatives (e.g., Valium)
  • Theophylline (taken for asthma or other lung diseases)
  • Tricyclic antidepressants (Norpramin, Tofranil, Vivactil)

In people’s minds, heartburn is most commonly linked with foods and eating. We tend to imagine rich, fatty foods like pizza or barbecued meats as bringing on heartburn, but a range of foods and beverages can ramp up your stomach’s acid production or cause your LES to be less vigilant about stopping acid from refluxing. Some food allergies and sensitivities can also have heartburn as a symptom. Here are some of the common foods that can trigger heartburn:

  • Alcoholic beverages
  • Caffeine (major acidity!)
  • Carbonated beverages (acidity and belching)
  • Highly acidic foods, like tomatoes or citrus fruits, as well as their juices
  • Refined carbohydrates
  • Chocolate
  • High-fat foods

Interestingly, some food allergies and sensitivities can also have heartburn as a symptom. Though you might think that the tomato sauce is causing you heartburn when you eat spaghetti, more often the problem is with the pasta: Gluten, a grain found in wheat, rye, barley, and oat is the most common food sensitivity. People who have Celiac disease—the most severe form of gluten sensitivity—have been found to have a significantly higher rate of GERD, especially at the time of diagnosis. For example, one study that compared 133 adults who had just been diagnosed with Celiac disease with a control group of 70 non-Celiac patients, more than 30% of those with Celiac disease had moderate to severe GERD. Of those without Celiac disease, fewer than 6% suffered from GERD. GERD was more common among those who experienced “classical” Celiac symptoms: Of the patients who suffered from such as diarrhea, bloating, weight loss, and fatigue, 35% had GERD. GERD was less common among those who had atypical or “silent” Celiac disease (in other words, those who are mainly asymptomatic), with just 15% complaining of GERD.
An article published in the September 2011 issue of Diseases of Esophagus noted that a number of published studies have shown that a gluten-free diet can efficiently control esophageal symptoms and help prevent recurrence. In one study from 2009, Italian researchers found that gluten-intolerant people on a gluten-free diet responded more favorably to GERD treatment with medication. They also found that those following a gluten-free diet were less likely to experience a recurrence of their GERD symptoms, compared with those on a regular diet. The researchers concluded that a gluten-free diet could help reduce GERD symptoms and prevent damaging acid reflux in those with celiac disease. Though the idea that food allergies cause GERD is not widely accepted by most doctors, including gastroenterologists, in Dr. Tang’s experience as well as in these studies, transitioning to a gluten-free diet has made a substantial difference in patients with sensitivities to gluten as well as to other foods.
Behavioral or lifestyle factors can also contribute to an increased risk of heartburn. Here’s yet another reason not to smoke: Smoking can cause the LES to relax, letting stomach acid reflux into your esophagus. Eating quickly or overeating (which can lead to swallowing air) can prompt heartburn. Keeping a healthy weight matters, too. Being overweight or obsess can increase the pressure in your abdomen, causing acid reflux.
Last, there are several medical conditions that are linked to heartburn. Know how we just said added weight can up the pressure in your chest, spurring heartburn? That’s also why heartburn is often a problem for pregnant women. A hiatal hernia—a condition where part of your stomach pokes up into your chest cavity, weakening your LES—can also increase the frequency of heartburn. Finally, heartburn is a major symptom for many esophageal diseases, which is another reason those who have regular heartburn should get a checkup.
Why Do Some People Get Heartburn and Others Don’t?
Reading the list of potential causes of heartburn, you might have thought to yourself “Those are foods that I eat, and I don’t get heartburn” or “I take that medication but I’ve never had heartburn.” Though there are a wide variety of potential causes for heartburn, it’s not always clear exactly why some people will get heartburn while others never do. Trying to get to the bottom of this puzzle has led some physicians to keep looking for an underlying cause that would influence your susceptibility to heartburn.
Again, heartburn can only happen when hydrochloric acid (HCL) gets to leave your stomach via the lower esophageal sphincter (LES). If you do not have enough pressure on the LES, or if you have too much pressure on your diaphragm (pregnancy is a major cause of the latter), it can keep the LES from fully closing. In those who aren’t pregnant, these changes in pressure are often caused by gastric distension, which is also called intra-abdominal pressure (IAP). Researchers have found that IAP causes the LES to open more frequently both in people who have gastroesophageal reflux disease (GERD) as well as those who don’t usually experience heartburn, pointing the finger of blame firmly at IAP. But what causes IAP in the first place?
Pressure in the abdomen can be caused by several conditions, all of which are related to one another. If you read the Rejuvé blog regularly, you already know the importance of gut health. Heartburn is yet another ailment that underscores the importance of having healthy gut flora. Protein putrefaction (improperly or insufficiently digesting proteins) means bacteria are breaking down proteins instead of the HCL your stomach would usually use. This causes indigestion, bloating, gas, and diarrhea. Too little HCL and an overabundance of bad bacteria like H. pylori can contribute to carbohydrate malabsorption. Carbs are intestinal bacteria’s favorite meal, and bacteria will ferment any unabsorbed carbohydrates. When carbs are consumed in moderation and enough HCL is present, the carbohydrates can be broken down into glucose and absorbed by the small intestine before the bacteria have a chance to ferment them. But when there are too many bacteria and there’s not enough acid, the fermentation creates gas. This increases intestinal pressure and keeps the LES from fully closing, bringing on acid reflux, heartburn, and GERD.
How Can You Treat Heartburn?
Heartburn might seem like a minor annoyance, but as we’ve seen it can have some major consequences. Fortunately, there are numerous ways that you can treat heartburn and help prevent GERD.
Food and drink are obvious heartburn triggers. When stomach acid is low—which can happen from eating a vegan or vegetarian diet, regularly taking antacids, taking a course of antibiotics, or simply as a result of aging—bad bugs like H. pylori can multiply. When that happens, you can develop hypochlorhydria or gastritis (an inflammation of the stomach lining). Hypochlorhydria affects the ability of the LES sphincter to close, allowing acid to reflux and linking the condition to GERD. In addition, Chronic H. pylori infections have even worse consequences, having been linked to peptic ulcers, atrophic gastritis, dysplasia, and even stomach cancer. Low stomach acid also means that you may have trouble absorbing nutrients like Vitamin B12, calcium, magnesium, and iron, putting sufferers at higher risk of illnesses like osteoporosis. Letting the “bad bacteria” reign can also exacerbate intestinal permeability or Leaky Gut Syndrome.
Reducing or cutting out foods that spur heartburn—alcohol, caffeine, citrus fruits and juices, tomato products, chocolate, and spicy and fatty foods—can help you avoid occasional heartburn. If you’re suffering from it more regularly though, a lack of stomach acid and an overabundance of bacteria are more likely to be the cause, and these obvious dietary culprits probably aren’t to blame. Instead, it’s important to reduce sugars and carbohydrates in your diet. Sugars (even natural sugars and sugar alternatives like agave) can lead to bacterial overgrowth, because bacteria love to eat sugar. Foods that are difficult to absorb, like fiber and carbohydrates, can also create “leftovers” that you can’t digest but make a lovely meal for bacteria. It can become a cycle, as having too little stomach acid means you can’t break down food, with those unabsorbed sugars and carbs providing more food to fuel bad bacteria.
Many people supplement with prebiotics to help encourage a healthy gut, but it’s important to be cautious here as changing the gut flora can backfire and cause a rise in “bad” bacteria. The right probiotics can relieve stomach inflammation and heal stomach lining, helping you get your gut health back in balance. Research has shown that microbes like Bifidus bifidum can fight H. Pylori infection and heal tissue damaged by H. pylori. A common probiotic in fermented foods, Lactobacillus, has also been found helpful for restoring gut health and preventing heartburn. That said, it can be tricky to get probiotics right: You need to be taking in a sufficient quantity, and they need to be from a viable source. In many cases, foods don’t supply enough active cultures for the good bacteria to be able to establish themselves in your gut. If you aren’t sure whether your prebiotic is effective, talk to Dr. Tang about the supplements you’re taking.
Lifestyle can play a role in causing heartburn, so naturally lifestyle changes can also help reduce it. In addition to changing up what you eat, changing how you eat can ease heartburn by relieving the pressure in your abdomen. Eating smaller meals, eating more slowly, and scheduling dinner well away from bedtime (allow 3 to 4 hours before you hit the sack) can all make a difference. Tight-fitting belts or any clothing that cinches in your waist can squeeze your stomach, making reflux more likely. If your clothes are tight but it’s not for style reasons, work on losing weight: Extra weight increases your heartburn risk, and losing as little as 10 to 15 pounds can relieve symptoms. Reducing your stress levels with relaxation exercises like yoga or tai chi can lessen your chances of heartburn, but don’t do them right before bed or just after eating—bending and twisting on a full stomach could undo any heartburn prevention benefits. Last, sleep with your head raised roughly 6 inches, so that it’s not on the same level as your stomach. This can help prevent stomach acid from seeping past your LES at night.
Should I Take PPIs for Heartburn?
One cure for heartburn that you may have noticed we haven’t mentioned: Prescription drugs, including H2 blockers like Zantac and Tagamet proton pump inhibitors (PPIs) like Prilosec and Protonix, and antibiotics, as well as over-the-counter meds like antacids (think Tums, Maalox, etc.). These all focus on reducing stomach acid so that it can’t reflux through the LES. But as we just learned, the real issue isn’t too much stomach acid—it’s too little. Intra-abdominal pressure caused by insufficient stomach acid, incomplete digestion of protein and carbohydrates, and flourishing bad bacteria keeps the LES from properly doing its job.
Here’s the rub: Drugs for heartburn may provide temporary relief, but using these medications long-term wreaks havoc on your gut flora. Antibiotics too often don’t discriminate, taking out good gut bacteria along with the bad. It’s not uncommon for people to finish a round of antibiotics and find that they’ve got a new bacterial infection like Clostridium difficile–associated diarrhea.
PPIs like omeprazole are the usual prescription for heartburn. These drugs are powerful acid suppressors, limiting the ability of parietal cells to manufacture stomach acid. The common understanding of acid reflux is that it’s caused by too much stomach acid, but as we’ve seen, an acid deficit is really the problem—and by taking PPIs for heartburn, you could go from not having enough stomach acid to having way too little of it. HCL has critical functions in the stomach—aiding in digestion, helping the body absorb nutrients, and keeping bad bacteria in check—which is likely why PPIs have been shown to have extensive side effects. Both short-term and long-term PPI use have been linked to Clostridium difficile–associated diarrhea, dysbiosis (imbalance of gut bacteria due to an overgrowth of bad bacteria), community-acquired pneumonia, an increased risk of bone fractures, inhibition of antiplatelet therapy, and decreased absorption of vitamins and minerals including Vitamin B12, calcium, iron, and magnesium. Though having reduced levels of stomach acid can make acid reflux less uncomfortable, overall it seems that PPIs may do very little to solve the underlying problem. Not only that, even short-term use of PPIs may exacerbate GERD or lead to other ailments.
Is There an Alternative Way to Treat Heartburn?
If you are looking for a natural alternative for treating heartburn, Dr. Tang recommends GastroMend-HP from Designs for Health. These quick-release capsules help to heal your stomach tissue and reduce bad bacteria like H. pylori. GastroMend-HP combines natural botanicals and minerals to alleviate the underlying causes of heartburn. Mastic gum, a tree resin that can literally be chewed to reduce stomach pain, is a key ingredient, as is Methylmethionine Sulfonium Chloride, which is a derivative of the methionine found in raw cabbage. It’s been called “Vitamin U” for its efficacy in fighting ulcers, and in fact raw cabbage juice has long been used in some parts of the world to help treat digestive problems. While the botanicals heal, vitamins and minerals including Zinc Carnosine and Vitamin C keep up the fight against H. pylori. By decreasing levels of bad bacteria and alleviating irritated stomach lining, GastroMend-HP can help restore your gut balance and thus help you find relief from heartburn.
Another product Dr. Tang finds helpful is Aloe Detox from Premiere Research Labs. It is a whole-leaf product derived from a type of aloe plant called Aloe Arborescens which is found only in South America. Aloe Detox is a completely pure, raw, natural product without any added preservatives, boasting power anti-inflammatory ingredients that help heal the stomach. The aloe itself is also a highly effective immune booster, while and the bentonite clay has detoxifying properties.
Do you have questions about natural treatments for problems like heartburn, or do you want to know which supplements could help you reach your optimum vitality? A one-on-one consultation with Dr. Tang is the perfect way to get expert, individualized advice. Call Rejuvé today at 408-740-5320 to set up an appointment.