A Breathing Practice for Occasional Heartburn

Learn the benefits of this well-studied breathing technique, used to manage gastroesophageal reflux disorder (GERD), heartburn, and hiatal hernia.

In This Article

The Mystery of the Diaphragm

Did you know the diaphragm is arguably the most important muscle of the body? Sadly, few understand its function; most simply think of it as the breathing muscle. Read on to uncover the mysteries of the diaphragm!   

lifespa image, emergence, human body, anatomy exploded illustration

The diaphragm divides the body in half: above the diaphragm, the thoracic cavity contains the heart and lungs; below it, the abdominal cavity contains the stomach and liver. In this article, I make a case that the organs in these two cavities are directly impacted by the diaphragm’s efficiency. 

This article will focus on the benefits of a well-studied breathing technique for the diaphragm to support health concerns such as GERD (gastroesophageal reflux disorder), heartburn, and hiatal hernia.2, 3 

What is the diaphragm? 

parachute sky fly

The diaphragm is a parachute-shaped muscle with two domes, one under each lung. It is the primary muscle in inspiration/inhalation. When the diaphragm contracts, the two domes contract, pulling oxygen into the lungs’ lower lobes. When the diaphragm relaxes, the ribcage squeezes the lungs to force an exhalation. The diaphragm is penetrated but three structures: the aorta, the esophagus, and inferior vena cava. 

Most relevant to this discussion is the lower esophageal sphincter (LES). The LES allows the esophagus and the vagus nerve to pass through the diaphragm. Each time the diaphragm contracts, the vagus nerve is stimulated, which activates the parasympathetic nervous system, which allows us to rest, digest, and repair. Each time the diaphragm contracts, the LES, the vagus nerve, the stomach, and the liver are all stimulated. (See images below.)2,3 

Liver - Wikipedia
Hiatal Hernia: Symptoms, Causes, Diagnosis, and Treatment

Diaphragmatic Fatigue 

If the diaphragm does not fully contract or relax, or if it becomes fatigued after its daily 26,000 contractions, not only are the heart and lungs negatively affected, but so are the functions of the stomach, liver, LES, and vagus nerve.2,3 Without full diaphragmatic contraction, upper digestive function and ability to handle stress become severely compromised. 

To give you an idea of how common diaphragmatic fatigue is, let us consider the results of a recent study: approximately half of elite athletes in the study showed signs of diaphragmatic fatigue after an exhaustive workout.1 If half of the best athletes in the world have a weak and fatigued diaphragm, the vast majority of nonelite athletes have weak diaphragms as well.  

But why is it so important to have a strong diaphragm? 

We Recommend
Strengthen Your Lungs Now: Pratiloma Pranayama + Inspiratory Muscle Training

Solving Digestion Issues with the Diaphragm 

GERD (gastroesophageal reflux), heartburn, hiatal hernia, and indigestion are caused by the stomach exerting upward pressure on the diaphragm and LES. If this upward pressure (called udvarta in Ayurveda) persists, stomach acid can linger and leak through the LES .

man stomach fat distended digestion

The liver and stomach, seated directly below the diaphragm, play coordinated roles to support optimal digestion. The stomach produces acid, which is buffered by the liver’s production of bile. If the liver becomes congested or compromised by pollutants, processed foods, or pesticides, bile flow will be compromised and the stomach will either: 

  1. Hold on to the food and acid, causing upward-moving digestion, heartburn, indigestion, or eventually hiatal hernia. 
  2. Reduce its acid production, which can cause a host of digestive issues, including heartburn. 

Breathe Your Occasional Heartburn Away 

Pratiloma pranayama is a form of inspiratory muscle training (IMT), used in hospitals around the world. It has been shown repeatedly to improve heart, lung, and digestive function.2-5 It has been demonstrated that strengthening the diaphragm through pratiloma pranayama restores healthy function of the LES and is an effective therapy for GERD and other upper digestive health concerns.3-5 

pregnant breath breathe dog text woman

Pratiloma is a yogic breathing technique (pranayama), involving partially closing the nostrils while inhaling in order to create resistance. What is the benefit of inspiratory resistance? When airway resistance is created during inhalation, it exercises the diaphragm in ways normal breathing does not. Shallow breathing, a sedentary lifestyle, and chronic mouth breathing renders many muscles of breathing underactive, weak, and easily fatigued.   

Numerous studies have been done on the benefits of pratiloma, but under a different name. In Western medicine, this technique is called inspiratory muscle training (IMT). IMT is an effective treatment for numerous health concerns, including breathing afflictions, heart health concerns, and digestive issues (such as GERD and reflux), along with significantly enhancing athletic performance.2-12  

One study concludes IMT decreases heartburn and regurgitation scores. IMT improves esophageal junction pressure, reduces gastroesophageal reflux, and reduces GERD-related digestive symptoms. Some GERD patients had diaphragmatic failure and IMT proved beneficial as an auxiliary treatment.5 

woman yoga squat frog pelvic floor strength

Note: In yoga, a pranayama technique where resistance is created during exhalation rather than inhalation with partially closed nostrils is called anuloma. It too has numerous health benefits, but I will reserve that discussion for an upcoming article.  

How to Perform Pratiloma 

NOTE: Always checking with your medical doctor before starting any breathing practice. 

meditate hand
  • Sit comfortably with back straight. Stop immediately if you ever feel uncomfortable.  
  • Take 10 deep inhalations through partially closed nostrils, creating enough resistance to feel the diaphragm contract as you inhale.  
  • Follow each inhalation with a full exhalation without any nostril resistance.  
  • Perform 5 rounds of this practice twice a day before breakfast and in the evening.  

How to Perform Pratiloma with Kumbhaka (Breath Retention)  

Adding a breath hold to this practice is the traditional way it is practiced. When you begin to see breath hold improvements or longer effortless periods of breath retention (kumbhaka), you’re beginning to glean the benefits of what is called intermittant hypoxia. These benefits include boosting stem cells, nitric oxide, EPO (erythropoietin), vascular endothelial growth factors, and transcription factors that protect the genome while powerfully lowering blood sugar.11 

We Recommend
How Does Pranayama Work? The Science of Breath Retention (Kumbhaka)

Note: Always check with your doctor before practicing any pranayama exercises that incorporates breath holding or kumbhaka.  

  • Sit comfortably with back straight. Stop immediately if you ever feel uncomfortable.  
  • Take 10 deep inhalations through partially closed nostrils, creating enough resistance to feel the diaphragm contract as you inhale.  
  • Follow with a full exhalation without any nostril resistance.  
  • After the full exhalation, perform an exhalation breath hold for as long as comfortable (no strain).  
  • Perform 5 rounds of this practice twice a day before breakfast and in the evening.  

Have you tried pratiloma? What did you find?  

We Recommend
Learn Stomach Pulling for Superior Digestion in 4 Minutes a Day

References

  1. https://pubmed.ncbi.nlm.nih.gov/16439429/ 
  2. https://pubmed.ncbi.nlm.nih.gov/9256871/ 
  3. https://pubmed.ncbi.nlm.nih.gov/24113771/ 
  4. https://www.europeanreview.org/wp/wp-content/uploads/4547-4552-Breathing-training-on-lower-esophageal-sphincter.pdf   
  5. https://journals.physiology.org/doi/full/10.1152/ajpgi.00054.2013   
  6. https://www.ncbi.nlm.nih.gov/pubmed/29178489/   
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571650/   
  8. https://pdfs.semanticscholar.org/3a3f/219fcdef05a749569b47454d6993d8c6c5fd.pdf   
  9. https://www.ncbi.nlm.nih.gov/pubmed/27182763/   
  10. https://www.powerbreathe.com/blog/2018/11/26/respiratory-muscle-induced-metaboreflex/   
  11. https://www.ncbi.nlm.nih.gov/pubmed/30307818/   
  12. https://www.ncbi.nlm.nih.gov/pubmed/29652761/ 

7 thoughts on “A Breathing Practice for Occasional Heartburn”

  1. Dr. John,
    I write a column for our Council On Aging newsletter here in Chesterfield, Massachusetts. May I quote your paragraph about the stomach and liver functions in relationship to a strong diaphragm and GERD?

    Reply
  2. I have a question about how to breath through your nose while doing lap swimming. I’m a lap swimmer. I’ve been swimming for decades. It’s my sport and I’m serious about it. It seems like I’m creating more of a problem for my diaphragm and my lower organs. But I’m not about to give up swimming. How do I breath through my nose while swimming laps? Any ideas?

    Reply
  3. Hello Dr. D: That was awesome! I am trying to get into the swing of it. I’m a little unclear as there seems to be some discrepancy in pattern, depending on where I look in the article or what I think I heard on the video. But I did a series of 10, three times. At the very end, I did the hold, and then watched my oximeter drop down to 80. I’m not sure if I did it correctly, but I thought this was a good start. It appears the article instructs doing 5 times before breakfast. I can do that. Just trying to be clear. Will look forward with curiosity to the upcoming one you mentioned as well. Be well! (As always)

    Reply
  4. All my breathing and indigestion started after gallbladder surgery. Will these breathing and pulling help? I have H hernia as well

    Reply

Leave a Comment