Today, acid reflux medication is the second most prescribed class of drugs in the US. About 20% of the folks who take antacid medication do not get relief and are commonly prescribed an anti-depressant to de-stress and de-sensitize the nerves. I have written a few articles on the risky side effects of antacid medications that you should be aware of if you are on these medications.
Could the cause of today’s rise in gastrointestinal distress be fast food, eating too quickly and processed foods? Or is it just stress and an unsustainable pace that is causing this?
In this article, I want to describe some of the conventional wisdom regarding possible underlying imbalances that can contribute to occasional heartburn, and a very exciting Ayurvedic understanding of and treatment for it.
How Does The Problem Start?
The conventional understanding is that excess production of stomach acid (hydrochloric acid or HCI) causes occasional heartburn. It is believed that when this acid is produced in excess, it will irritate the stomach lining.
Possible Causes of Too Much Acid
It is believed that excess spicy or processed 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, day-to-day stress can trigger the release of excess cortisol, a stress hormone, which stimulates the release of excess stomach acid. (1)
Another Possible Cause
Interestingly, occasional heartburn incidents aren’t always caused by too much acid, but also by too little acid! That’s right; gastric discomfort 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. (2)
Conventional Causes of Too Little Acid
- Eating excess processed foods that are difficult to digest, depleting stomach acid.
- Eating while stressed can initially increase cortisol and increase stomach acid.
- Overeating at night can bog down the digestive fire.
- Eating excess heavy and rich foods can bog down the digestive fire.
- Drinking large amounts of cold beverages with the meal.
Home Test to Determine Your Type of Imbalance
Too Much Acid
Mix 1/4 tsp of baking soda in a cup of water and drink before a meal. If you feel relief from the baking soda – which is extremely alkaline – you have too much acid.
Too Little Acid
Mix 1 tbsp of lemon juice with 1 tbsp of apple cider vinegar and drink before a meal. If you feel relief, you have too little acid.
An Ayurvedic Take on Occasional Heartburn
What seems to be missing in the conventional discussion 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 stomach acid imbalance, 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. (4) 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, causing irritation.
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 problem is not corrected, the lack of bile flow will cause irritation in the stomach, and the stomach will eventually decrease the production of acid, 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)
Lack of Bile?
Insufficient Bile Flow
If your occasional heartburn is caused by insufficient bile flow from the liver or gallbladder, it will 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.
This type of discomfort 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, causing burping or nausea.
What if it Burns Right Away?
If you feel uncomfortable 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 excess acid, too little bile to buffer it, or irritation of the stomach lining. When the stomach begins to turn off the production of acid, the stomach lining becomes very sensitive to almost any foods, but even worse with acidic foods.
Important Note: While most of us will suffer from occasional heartburn as some point in our lives, you should make an appointment with your primary care physician if any of the following are true:
- Your heartburn feels more severe or painful than normal
- You have a persistent cough that won’t go away
- Your heartburn occurs several times a week for more than two weeks
- You’ve been taking OTC medications for occasional heartburn for an extended time
- You develop a difficulty swallowing (dysphagia)
Strategies to Increase the Flow of Bile
For those with excess stomach acid:
Increase bile flow with:
- Foods: Cooked beets, cooked artichokes, cooked celery, cooked leafy greens, and olive oil and lemon
- Tea: Fenugreek, fennel, cumin, coriander
For those with too little stomach acid:
Increase stomach acid production with:
- Foods: Chia seeds, bananas, cooked greens and cooked root veggies
- Tea: Cardamom and peppermint
- Herbs: Ginger, coriander, cumin, fennel, and cardamom – all together with meals. These 5 spices make up LifeSpa’s Gentle Digest formula.
For those with either excess stomach acid or too little stomach acid (these work for both situations):
Soothe the irritated stomach lining with cooling herbs:
- Cooling Herbs: Slippery Elm, Marshmallow root, Licorice root
- Apply Downward Stomach Pressure:
Acid that lingers in the stomach can cause significant upward pressure, pushing the stomach against the diaphragm. This pressure can cause the stomach to stick or adhere to the underside of the diaphragm, causing the stomach to malfunction. If this gets really bad, it can cause a medical condition called a Hiatal Hernia, but years before this happens numerous digestive issues such as occasional heartburn can result. As the result, the stomach will hold excess acid and not contract fully because it is literally stuck to the diaphragm.
Massage the stomach diaphragm area using a technique called “Stomach Pulling.” Literally, help pull the stomach away from the diaphragm with your thumb.
Check out my article and video on Stomach Pulling, where I demonstrate the technique, “Cool Your Digestion: Self-Massage Technique.”