Heartburn is a digestive symptom characterised by painful burning sensations in the chest or upper abdomen. It is so common these days that Nexium and Rennie have almost become the new Tic Tacs. Antacids are profitable so the industry is not interested in treating the actual cause. One thing is certain: if you wish to end your heartburn forever, you’ll need to tackle the underlying triggers and not just the symptoms.
True cause and mechanism of heartburn
It is commonly believed that heartburn is caused by too much stomach acid. But heartburn is more related to the incorrect functioning of the lower oesophageal sphincter (the flap that closes the stomach from the food pipe) than acid itself.
Normally, the flap remains open only when food is coming. But when too much pressure is created in the abdomen, the flap is pushed up and remains open towards the oesophagus. Since the oesophagus is not coated by a protective film like the stomach, it can take as little as acidic fumes to cause a severe burning sensation. In other words, there would be no heartburn if the flap remained closed. The four most common causes of increased abdominal pressure are:
pregnancy
abdominal obesity
small intestinal bacterial overgrowth (SIBO)
excessive fermentation of carbohydrates; often goes hand in hand with SIBO
Paradoxically, the main cause of bacterial overgrowth and excessive carbohydrate fermentation is low stomach acid. Not only is strong stomach acid necessary to signal the pancreas to release its carbohydrate digesting enzymes, but is also the first line of defence against unwanted organisms. Contrary to the popular belief, it is low stomach acid that is a major culprit of heartburn, and I’ve had great success with clients by restoring their stomach acidity.
Some of the reasons for decreased stomach acidity include:
eating a diet rich in processed carbohydrates (bread and other baked goods, pasta)
eating too much starch together with animal foods (e.g. burger in a bun, with potato fries)
chronic stress
prolonged or frequent use of medication
helicobacter pylori (h-pylori overgrowth happens when stomach acid is too low, and then the bacteria themselves have the ability to further reduce stomach acidity)
autoimmunity against the parietal cells of the stomach
Factors which can further exacerbate the symptoms include:
lack of protective microbes in the stomach and oesophagus
eating foods that relax the sphincter such as alcohol, chocolate, coffee, garlic, leeks, onions, peppermint, spicy foods, shallots, strong black tea
smoking, as it also relaxes the flap
foods that delay gastric emptying; mostly high fibre foods
While antacids take the initial edge off, they often make the problem worse in the long run by contributing to the root cause: low stomach acid. This perpetuates the vicious cycle of relying on antacids, unless dietary and lifestyle changes are implemented.
What to do
Heartburn requires dietary and lifestyle modifications. Unfortunately, a diet that is colloquially called 'healthy' often fails to improve the symptoms because e.g. wholemeal bread, bran and whole grains can significantly worsen heartburn. It’s important to note that the reaction to foods is an individual matter, so the diet should be tailored to the person’s needs. Beyond looking into the usual suspects like coffee, sweet drinks and spicy foods , the following can make a real difference:
Consult your doctor about the possible removal of antacids while working on the underlying causes.
Cooking vegetables and stewing fruit might be a better idea than eating them raw.
Optimally, all grains should be removed until symptoms subside but if you cannot live without bread and pasta, spelt is the grain to go for. Rye can be problematic.
Practice simple food combining of eating animal foods with vegetables, and starches also with vegetables. Try not to combine starch and animal foods in one meal until digestion improves.
Be mindful about your milk intake. Soothing as it may initially seem, it can contribute to chronic heartburn.
Fermented foods like sauerkraut or home made yoghurt (can be coconut) are associated with the reduction of symptoms.
Home made stock and broth calm down the digestive tract. They can be used in soups, stews and curries, or enjoyed as a warm drink.
Raw honey should be the sweetener of choice because it has soothing and antimicrobial properties.
Address your stress levels and stress tolerance, practice relaxation and good sleep hygiene.
See a professional to help you restore stomach acidity and address any pathogenic outgrowths. The therapy includes a dietary and lifestyle plan, along with individually tailored supplementation consisting of digestive support, targeted probiotics, antimicrobials and botanicals that soothe the digestive tract.
At GLOW, I deal with various health concerns which can successfully be supported with functional nutritional therapy and lifestyle medicine. The cornerstone of my work is uncovering and addressing the underlying causes. Online consultations from any location, visits on yachts, in villas and workplaces are available.
Article published in The Islander, July ‘19 edition.