Are you one of the 20% of Americans who regularly struggle with heartburn?
Today, heartburn medication is the second most prescribed class of drugs in the US. Interestingly, about 20% of the folks who take anti-acid medication do not get relief and are commonly prescribed an anti-depressant to de-stress and de-sensitize the nerves.
According to a recent survey, 20% of Americans experience at least one bout of heartburn a week (1) and about 7% or 22 million Americans experience a daily bout of heartburn (2).
Could it be fast food, eating too quickly, or just stress and an unsustainable pace that is causing an increase in heartburn in America?
In this article I want to describe some of the conventional wisdom regarding the causes of heartburn, and a very exciting Ayurvedic understanding of and treatment for heartburn.
What Is Heartburn?
There are many types of heartburn, but most commonly the acid burning feeling is part of a condition known as GERD (Gastroesophageal Reflux Disease). This is caused by stomach acid building up in the stomach and refluxing or moving up into the esophagus, irritating the esophageal lining. This can cause burning, an acid taste in the mouth, coughing, wheezing, hoarseness, ulcers, cancer and/or pain.
GERD is a chronic problem. When it happens over time, the lower esophageal sphincter (LES) which separates the stomach from the esophagus fails and acid is allowed to reflux up into and irritate the delicate tissue lining the esophagus.
How Does Heartburn Start?
The conventional understanding is that excess production of stomach acid (hydrochloric acid or HCL) causes heartburn. It is believed that when this acid is produced in excess, it will burn the stomach lining and, in the case of GERD, the esophageal lining as well.
Possible Causes of Too Much Acid
It is believed that excess spicy foods as well as citric fruits, tomatoes, garlic, onions, hot spices, sugar, rich foods, pizza, and fried foods can all contribute to the excess production of stomach acid.
Additionally, chronic stress will trigger the release of excess cortisol, a stress hormone, which stimulates the release of excess stomach acid.
Another Cause of Heartburn
Interestingly, a very large percentage of heartburn symptoms are not caused by too much acid, but too little! That’s right; heartburn can be caused by not enough acid production in the stomach. If there is too little stomach acid produced, the food and the stomach acid (even though there is less of it) will linger in the stomach and delay the emptying. The longer the food sits in the stomach, the higher the risk of irritation to the stomach and esophageal lining or GERD.
Conventional Causes of Too Little Acid
- Eating excess processed foods that are difficult to digest, depleting stomach acid.
- Eating while stressed will initially increase cortisol and increase stomach acid. But over time, with chronic stress the cortisol will underperform and acid production will be less than adequate.
- Overeating at night will bog down the digestive fire.
- Eating excess heavy and rich foods will bog down the digestive fire.
- Drinking large amounts of cold beverages with the meal.
Home Test to Determine Your Type of Heartburn
Too Much Acid
Mix 1/4 tsp of baking soda in a cup of water and drink during acid symptoms. If the burning is caused by too much acid, the baking soda – which is extremely alkaline – will buffer the acids and relieve the pain.
Too Little Acid
Mix 1 tbsp of lemon juice with 1 tbsp of apple cider vinegar and drink this during acid symptoms. This will increase acid and reduce the burning if this is due to too little acid.
An Ayurvedic Take on Heartburn
What seems to be missing in these conventional descriptions of heartburn is an inquiry into why the stomach acid doesn’t leave the stomach. In the case of too much acid, excess acid builds up in the stomach. In the case of too little acid, the weaker acid lingers in the stomach longer than a stronger acid would.
According to Ayurveda, the digestive organs work in harmony with each other and if one organ isn’t working, we look to the next organ either up or downstream from it. In the case of heartburn, there are some very obvious players we must look at.
The liver and gallbladder make a significant amount of bile that buffers acid when it leaves the stomach. The pancreas makes digestive enzymes that also buffer stomach acids (3). If the liver, gallbladder or pancreas is not producing adequate bile or enzymes, the stomach will simply not release the acid into the small intestine. The stomach triggers the release of the digestive acids only when enough buffers are present in the small intestine, ready to neutralize the acids. Instead, the stomach acids will build up in the stomach and potentially the esophagus and cause GERD or heartburn.
Note: Sometimes some of the stomach acid exits the stomach into the small intestine with less than enough bile or enzymes to neutralize it. This can irritate the lining of the small intestine and cause heartburn as well.
If this happens repeatedly, the chronic burning and irritation from the stomach acid will signal the stomach to decrease the production of the stomach acid in the first place, in an attempt to protect the stomach lining. An easy way to think of it is that the stomach simply matches the lack of bile and digestive enzymes available in the small intestine with a commensurate lack of stomach acid. In other words, low bile flow = low acid production (3).
Is it Lack of Bile or Enzymes?
Insufficient Bile Flow
If the heartburn is caused by insufficient bile flow from the liver or gallbladder, the heartburn usually kicks in at night, or 30-60 minutes after a meal. This happens because it takes some time for the stomach acid to build up and/or spill small amounts of acid into a small intestine that has produced inadequate amounts of bile to buffer it.
Bile Flow heartburn is caused by eating heavy, rich, fatty or fried foods more so than spicy foods. This is because bile is responsible for the breakdown of fats. If there is inadequate bile flow, the fatty meal will sit in the stomach undigested and burn, cause burping or nausea.
Lacking Pancreatic Enzymes
Pancreatic enzymes are involved in digesting fats, proteins and carbs, making it difficult to distinguish a pancreatic flow issue by the foods eaten. The best way to find out is to take some over-the-counter digestive enzymes and, if you feel better, you are probably lacking in the production of your own digestive enzymes.
What if it Burns Right Away?
If the stomach lining burns right away after eating acidic or spicy foods, this is usually due to too little acid. When the stomach begins to turn off the production of stomach acid it is typically due to a long standing issue of excess acid, too little bile and/or pancreatic enzymes to buffer it, and chronic irritation of the stomach lining. When the stomach begins to turn off the production of stomach acid, the stomach lining becomes very sensitive to almost any foods but even worse with acid foods.
Note: In a low-acid environment, the bacteria called H Pylori may proliferate and irritate the stomach lining further, causing another form of heartburn.
If it Starts to Burn in 10-15 Minutes, or When You Don’t Eat!
If this happens, it is likely due to too much acid and we must evaluate why the acid is not leaving the stomach.
*Further diagnosis is required to understand why the liver, gallbladder and pancreas are not producing enough bile or enzymes. Heartburn and GERD is a medical condition and should be evaluated by your medical doctor.
Strategies to Increase the Flow of Bile and Pancreatic Enzymes
FOODS – Eat more of these foods:
- Cinnamon (small amounts, 1/8 tsp)
- Leafy greens
- Fenugreek (add to food or as a tea)
- Fennel (add to food or as a tea)
Food-based remedy: Drink 1 tbsp olive oil mixed with 1 tsp lemon juice each day before bed for one month.
- Shilajit – De-obstructing for bile and pancreatic ducts
- Turmeric – Support healthy bile and pancreatic enzyme flow
- Amalaki – Support healthy bile and pancreatic enzyme flow
- LifeSpa Formula: Beet Cleanse – A special formula for congested bile and pancreatic ducts, digestive strength, and overall intestinal health.
Strategies to Increase Stomach Acid Production
- Ginger tea before or with a meal
- Black pepper – Stimulates stomach acid production
- 8-12 oz of water 15-20 min before each meal to hydrate the stomach lining
- Ginger – Strengthens stomach acid production
- Black pepper – Stimulates stomach acid production
- LifeSpa Formula: Warm Digest – Supports stronger digestive fire, healthy detoxification and fat metabolism.
Strategies for GERD – Highly Irritated Stomach and Esophageal Lining
- Chia and flax seeds
- Warm milk
- High fiber foods, especially those high in soluble fiber
- Slippery elm – Demulcent and healing for acid irritation
- Marshmallow Root – Demulcent and healing for acid irritation
- Licorice Root – Demulcent and healing for acid irritation
- Avipattikar Churna – Classic Ayurvedic formula for heartburn
- Amalaki – Cools and repairs acid irritation
- Brahmi - Cools and repairs acid irritation