You’ll no doubt have seen the ads on TV for heartburn medicines, encouraging you to use over-the-counter medicines to reduce stomach acid. Or you may have visited your doctor and been prescribed heartburn medications. These medications are effective at lowering your stomach acid, so you no longer feel a burning sensation. However, this does not actually prevent stomach contents being regurgitated (“refluxed”) up into your oesophagus – you just can’t feel it happening. There are several reasons why this approach is far from ideal and can potentially result in long-term health issues.2
Stomach acid is there for a good reason
As explained in our article, The gut. From top to bottom, stomach acid has many vitally important roles in digestion:2
- Gastric juices work best to digest food when there is acid present
- Acid kills off potential disease-causing bacteria in the food
- Acid releases some nutrients from food that would not otherwise be extracted, namely vitamin B12 and minerals such as magnesium and iron
- The acidic solution of partially digested food that leaves the stomach stimulates the next phase of digestion that occurs in the small intestine
- The acidity of the stomach controls how fast food is released from the stomach into the small intestine, making sure food is not released to the next stage of digestion until the first phase is complete
- It also controls how tightly the band of muscle (sphincter) at the top of the stomach/bottom of the oesophagus, keeps the stomach closed. Thus less, stomach acid makes reflux more likely not less
- As acid leaves the stomach it ensures the first part of the small intestine is acidic too which stops unwanted bacteria growing and also creates the right conditions for the enzymes in the small intestine to work optimally.
Stomach acid, acts as the conductor, orchestrating much of our digestion. Long-term, lowering stomach acid has been shown to result in deficiencies in nutrients3,4and may have other health consequences such as an increased risk of stomach cancer, kidney disease, infections and risk of fractures.5
Hiding the symptoms vs solving the cause
Simply hiding the symptoms of reflux does not deal with the root cause and these causes may themselves bring health risks. For example, some common causes of reflux are:
- Obesity:6 links with diabetes, heart disease, cancers
- A diet high in refined carbohydrates:7 likely to cause obesity, heart disease and diabetes
- Smoking:6 links with heart disease and stroke, lung cancer, chronic obstructive pulmonary disease
- Food intolerances8 can be a cause of reflux and such intolerances may have further reaching impacts on health
- Low stomach acid!6,9 Studies of stomach acidity in patients with reflux find that in many cases stomach acid levels are low, not high as the adverts would have you believe.
- Gut infections:10,11 can also lead to irritable bowel syndrome and other chronic gut conditions
- Imbalance in gut bacteria:12 linked with a host of chronic health conditions
- Problems with stomach emptying,6which interferes with digestion, and can cause problems with blood sugar levels and nutrient absorption.
- Hiatus hernia.
One of the things that links several of these causes is an increase in intra-abdominal pressure, which acts to force the stomach contents back up the wrong way. Thus, lying down soon after eating, having large meals, being heavily pregnant will also make heartburn more likely to happen.
Causes of reflux
As you can see, many of these causes bring more problems with them than just heartburn. It’s far better to prevent reflux from happening than simply to hide the symptoms!
Removing the causes of heartburn
- Eat a healthy diet that is low in refined carbohydrates and sugar, and high in vegetables. This will help with overweight and gut bacteria imbalances. See our article on Improving your gut bacteria.
- Avoid known food triggers for heartburn. Common problem foods are dairy, wheat, spicy foods, citrus foods, tomato-based foods, and fried foods, alcohol, and caffeine.
- If you smoke, try to stop.
- Don’t eat during the 3 hours before bed. Give yourself a chance to digest your food.
- Avoid large meals Reflux is more likely when the stomach is over-full.
- Improve your digestion because poorly digested food will encourage gut bacteria to grow and ferment, creating gas and bloating which increases abdominal pressure. There are many aspects to ensuring digestion is working well.
- Start at the top by chewing your food properly and eating mindfully (by which I mean being really “present” when you eat so you can taste and enjoy every mouthful rather than being distracted by other things). This sets up your digestive system so that it can work efficiently.
- Try a digestive pickle or digestive tea with your meals. These contain spices that stimulate digestive secretions and encourage
- Digestive pickle Take one full ginger root, peeled and grated, add to a jar and mix together with: the juice of one lemon and a teaspoon of good quality sea salt. Leave overnight in the refrigerator to ‘pickle’. Take 1/2–1 teaspoons before meals.
- Digestive tea Put 1/2 tsp. each of coriander seeds, cumin seeds and fennel seeds and a tablespoon of grated fresh ginger root in 1 litre (4 cups) of water. Bring to a boil, let steep, strain and drink a cupful about half an hour before meals. In the summer, add fresh mint and lemon or lime juice and serve cold.
- Take targeted digestive supplements get advice from an expert trained in the use of such supplements before trying this as some can make matters worse.
Reduce stress when we are stressed the body puts digestion in the back seat, and instead prepares the body for fight or flight (there is no point digesting your food efficiently if you fail to escape the lion that is chasing you!). Try some deep breathing and calming exercises before you start your meal.
If you need immediate relief from heartburn, try sitting or standing very straight, stretching your head upwards as if you want the top of your head to touch the ceiling. Because of the way the oesophagus is constructed, this stretching will help tighten the opening preventing reflux.13
- Kahrilas PJ, Jonsson A, Denison H, Wernersson B, Hughes N, Howden CW. Regurgitation Is Less Responsive to Acid Suppression Than Heartburn in Patients With Gastroesophageal Reflux Disease. Clinical Gastroenterology and Hepatology. 2012;10(6):612-619. doi:10.1016/j.cgh.2012.01.022
- Kanpur C, Resident S. “Implications of Low Stomach Acid: An Update.” J Med Sci. 2016;2(2):16-26.
- Lam JR, Schneider JL, Zhao W, Corley DA. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12deficiency. JAMA - Journal of the American Medical Association. Published online 2013. doi:10.1001/jama.2013.280490
- Heidelbaugh JJ. Proton pump inhibitors and risks of mineral deficiency: evidence and clinical implications. Therapeutic Advances in Drug Safety. 2013;4:125-133. doi:10.1177/2042098613482484
- Fossmark R, Martinsen TC, Waldum HL. Adverse effects of proton pump inhibitors—evidence and plausibility. International Journal of Molecular Sciences. 2019;20(20). doi:10.3390/ijms20205203
- Diamant NE. Pathophysiology of gastroesophageal reflux disease. GI Motility online, Published online: 16 May 2006; | doi:101038/gimo21. Published online May 16, 2006. doi:10.1038/gimo21
- Wu KL, Kuo CM, Yao CC, et al. The effect of dietary carbohydrate on gastroesophageal reflux disease. Journal of the Formosan Medical Association. 2018;117(11):973-978. doi:10.1016/j.jfma.2017.11.001
- Caselli M, Zuliani G, Cassol F, et al. Test-based exclusion diets in gastro-esophageal reflux disease patients: A randomized controlled pilot trial. World Journal of Gastroenterology. 2014;20(45):17190-17195. doi:10.3748/wjg.v20.i45.17190
- Ayazi S, Leers JM, Oezcelik A, et al. Measurement of gastric pH in ambulatory esophageal pH monitoring. Surgical Endoscopy. 2009;23(9):1968-1973. doi:10.1007/s00464-008-0218-0
- Kim KM, Kim BT, Lee DJ, et al. Erosive esophagitis may be related to small intestinal bacterial overgrowth. Scandinavian Journal of Gastroenterology. 2012;47(5):493-498. doi:10.3109/00365521.2012.668932
- Tziatzios G, Gkolfakis P, Papanikolaou IS, et al. High prevalence of small intestinal bacterial overgrowth among functional dyspepsia patients. Digestive Diseases. Published online October 2, 2020. doi:10.1159/000511944
- Cheng J, Ouwehand AC. Gastroesophageal reflux disease and probiotics: A systematic review. Nutrients. 2020;12(1). doi:10.3390/nu12010132
- Enders G. Gut. Scribe Publications; 2015.