Heartburn Relief
Heartburn, also known as acid reflux, is experienced when stomach acid passes from the stomach to the esophagus, an alkaline environment. Some cases of heartburn can irritate the lungs, sometimes contributing to asthma. The acid however, isn’t the problem. The problem is the relaxation of the muscle that separates the stomach from the esophagus, known as the lower esophageal sphincter (LES). This muscle relaxes to allow food to pass through. When not eating, it’s supposed to stay tone to block acid from passing up.
Excess stomach acid, known as hydrochloric acid (HCL), is commonly blamed for acid reflux, but it’s eating behaviors and dietary choices that are usually the culprit. Not the acid. Taking a pill to reduce reflux symptoms provides relief by buffering the acid. This is definitely preferable to having strong acid in the esophagus, but the problem is that it doesn’t address the real issue, which is a relaxed LES. Buffering your HCL with a Tums on rare occasion likely won’t be a problem, but their habitual use can lead to incompetent digestion and infection from pathogens.
When beginning with a new client, I’m sure to ask about digestion because I know how disruptive poor digestion can be for those seeking greater fitness. This is true whether the goal is weight loss, improved energy, sharper brain function, or improved physical resilience and immunity. Digestion is always a factor. I’m somewhat bemused by the nonchalant attitude people take with their poor digestion, depicting just how unaware they are of its importance with health, fitness and body shaping. We live in a culture of a pill for every ill. If only it were that simple.
At a glance, it makes sense to buffer the acid with a pill. HCL in the esophagus is bad news and it can be extremely uncomfortable. However, consider that we also need that same acid to be acidic enough to properly digest the food we eat as well as kill the pathogens and contamination that’s on that food. Buffering an acid weakens it. Therefore, instead of focusing on the acid and how to reduce it, what if we asked how to keep our LES from relaxing? That is, how do we strengthen the barrier that separates our stomach from our esophagus, and thus prevent acid from splashing up?
Before we jump into this, note that the use of Tums or other acid buffers used for in-the-moment heartburn is better than suffering with heartburn. What I’m presenting here are preventative measures that support digestion so these substances aren’t needed in the first place. In most cases, acid reflux is an indicator of incorrect eating behaviors, incorrect food choices, or both.
How to Support Your Digestion
The LES can become relaxed for many reasons. The list below is not complete, but they are the top reasons I’ve seen in practice for achieving the most success with reducing or eliminating heartburn.
Eating Behaviors
Stress
Stress creates a bodily state we commonly refer to as fight or flight. In this state, our brain preferentially shunts blood away from our gastrointestinal tract so it can be used in the muscles of our limbs. Thus, our capacity to digest food is greatly reduced. In Jonathan Wright’s book, Why Stomach Acid is Good for You, he explains the following impact of stress on the GI tract:
Blood flow to the stomach is reduced up to four times less than usual.
Reduced enzymatic output of the stomach, pancreas, and small intestines.
Reduced salivary secretion: Less saliva equates to less amylase (a digestive enzyme) to digest food.
It’s not clear if stress relaxes the LES, but there is evidence to suggest that it exacerbates symptoms of heartburn (1, 2). It’s something to be aware of if you suffer with heartburn. Also take note of how often you eat on the go, or under pressure. As noted above, digestive capacity is diminished when eating under stressed. If stressed eating isn’t avoidable, then do your best to avoid the next three eating behaviors.
Fast eating
Mechanical breakdown of food is best accomplished by your teeth. When you eat too fast your stomach has to deal with large food particles that’s difficult to digest. Although your stomach has some ability to mechanically digest food (because of its three layers of muscle surrounding it), its primary method for digestion is accomplished chemically. Hydrochloric acid (HCL) being the primary and critical substance for digestion.
Incidentally, rapid eating is also a culprit with abdominal bloat and fatigue following meals. If you don’t properly chew your food, your stomach must do the work your teeth were supposed to do, and it takes a lot of energy to do so. Your stomach has a very difficult time “chewing” food.
Overeating
You’re likely to experience heartburn if you eat too much. There’s a limit to the amount of HCL and other chemicals you produce for digestion. It’s not an endless supply. For example, if you eat enough food to fill your stomach, and your body can only produce enough digestive chemicals for three-fourths stomach contents, food will remain in your stomach for longer periods and this can lead to heartburn symptoms. This is especially true if you lie down with large amounts of food in your stomach. The food puts pressure on your LES.
Drinking fluids with your meals
You need HCL to digest food. If you dilute an acid with fluid, it becomes weaker. Weakening your stomach acid can increase your difficulty with digestion. It also adds pressure to the LES.
Not all fluids are equal. Drinking water or milk with your meals will dilute stomach acid and possibly hamper digestion. Acidic drinks (such as wine) could potentially aid digestion. You may think that acidic drinks can cause or exacerbate heartburn, but that’s not always true. It largely depends on whether you tend to produce too much acid, or not enough. How do you know? The best way to start is by paying attention and experimenting. Listen to how your body feels following meals that include fluids vs no fluids. Let go of preconceived notions and listen to the feedback your body is providing in the 1-2 hours following a meal.
The eating behaviors mentioned above: eating too fast, drinking fluids with meals, and overeating tend to come together as an ugly threesome. In most cases symptoms will improve or even disappear just by correcting these behaviors. However, in some instances looking further is necessary.
Food Choices
Excess carbohydrates
A high carbohydrate (sugar) diet relative to your body’s needs can exacerbate reflux symptoms. (3, 4) Note: if you reduce your carbohydrates, be sure you have adequate healthy fats in your diet. Combining low fat and low carb is extremely difficult for most people.
Spicey and intolerant foods
Most people are familiar with how spicey foods can cause symptoms, but dairy products and gluten can also be problematic. Again, listen to your body’s feedback for up to two hours following a meal. Also, alcohol, coffee, and marijuana are three substances with the potential to relax the LES muscle.
Where Do You Begin?
The best way to decide where to start is to first become aware of what and how you’re eating. I usually suggest to clients to begin with correcting eating behaviors. If there isn’t a change within 2-3 days, take a look at your carbohydrate intake and reduce them. If after all this your heartburn isn’t drastically reduced, the next step is to take a look at other potential intolerant foods and substances. Experiment with eliminating coffee, alcohol, and marijuana. Then move on to dairy and gluten. Observe how you feel for 1-2 hours following meals. Your body will provide clues you can use to adjust going forward.
One last thing: You can try supporting your digestion with lemon water (half lemon squeezed with equal parts water), digestive bitters, or apple cider vinegar. I’ve had success with all of them. They are best if taken at the beginning of a meal. Only try one at a time.
Stay fit.
References:
Caroline E. Wright, et al. The effect of psychological stress on symptom severity and perception in patients with gastro-oesophageal reflux, Journal of Psychosomatic Research, Volume 59, Issue 6, 2005.
Bradley, Laurence A, et al. The Relationship between Stress and Symptoms of Gastroesophageal Reflux: The Influence of Psychological Factors. American Journal of Gastroenterology. Vol. 88 Issue 1, 1993.
Wu KL, et al. The effect of dietary carbohydrate on gastroesophageal reflux disease. Journal Formosan Medical Association. 117(11). 2018.
Austin, G.L., Thiny, M.T., Westman, E.C. et al. A Very Low-Carbohydrate Diet Improves Gastroesophageal Reflux and Its Symptoms. Dig Dis Sci 51, (2006).