Heartburn

Heartburn, also referred to as acid reflux, is an all-too-common problem: heartburn medications are some of the most commonly written prescriptions. Not only is heartburn quite uncomfortable, and sometimes painful, if it isn't treated, it can cause additional problems. However, the side effects of heartburn medications, such as osteoporosis, can be serious. The good news is that there are ways to actually prevent heartburn from occurring in the first place.



Current Medical Thinking

The most prevalent theory about heartburn is that it is due to excess stomach acid. The excess acid escapes by passing through the valve between the stomach and the esophagus and moves upward, burning the sensitive tissues in the chest. The result is a burning sensation in the chest, close to the heart, hence the name heartburn. Medications including over-the-counter antacids work by inactivating the acid so the tissues aren't harmed.

In normal digestion, the valve between the stomach and the esophagus remains closed. The valve between the stomach and the small intestine (called the pyloric valve) opens and the stomach contents are gradually released into the small intestine.



Some Facts About Stomach Acid and Digestion

Stomach acid, or hydrochloric acid, plays several roles in digestion. These include:

• digesting proteins,
• facilitating the assimilation of vitamins and minerals (such as the B vitamins, calcium, iron, zinc, and magnesium),
• killing bacteria, viruses, parasites, and other disease-causing organisms that are present in food, and
• promoting the release of digestive juices from the pancreas, gall bladder, and small intestine.

If sufficient hydrochloric acid isn't present in the digestive process, we aren't able to digest food fully and we leave ourselves vulnerable to other organisms. Problems that can occur as the result of inadequate stomach acid are:

• poor assimilation of nutrients, which can result in a mild form of malnutrition,
• gas and distension from foods sitting undigested in the stomach, and
• proliferation of bad microbes that can cause diarrhea, gas, or constipation.

Stomach acid is so strong that it could burn through concrete, so it's a wonder that our stomachs don't burn from the inside out. But the stomach has a special protective layer that usually prevents it from being injured. The stomach is a big muscular bag and works by contracting so that its contents get shaken and stirred. If the esophageal valve isn't closed tight, the caustic contents of the stomach will splash upward and damage the sensitive tissues of the esophagus, which do not have a protective coating as the stomach does. This is where the role of stomach acid becomes even more interesting: it is the presence of stomach acid that actually signals the esophageal valve to close tight.

Furthermore, if there is insufficient stomach acid, then the pyloric valve, between the stomach and the small intestine, won't release the contents of the stomach. As the undigested food sits in the stomach, fats become rancid, proteins putrefy, and carbohydrates ferment. This results in gas and bloating, which puts additional pressure on the esophageal valve and increases the likelihood that acid reflux will occur.

In other words, heartburn may sometimes occur because of too much stomach acid or structural issues, but in the majority of cases, patients experience heartburn because there is too little hydrochloric acid in their stomach. It's common for heartburn to occur more frequently as people age; this parallels the fact that the production of stomach acid also declines as people age. It is paradoxical that the common treatment for heartburn is to decrease the production of the very thing that will prevent it: stomach acid.



The Downward Spirals

Taking antacid medications, such as acid blockers or proton pump inhibitors, prevent the production of hydrochloric acid. This can result in dependency on those medications for relief from symptoms which begin to worsen.

In addition to age, other factors that can trigger a decline in the production of stomach acid are:

• stress,
• too many carbohydrates (e.g. sugar), and
• vegan and vegetarian diets.

As less stomach acid is produced, our ability to digest food properly and absorb its nutrients decreases. This means we don't have enough of the ingredients necessary to make hydrochloric acid. With less stomach acid we don't digest our food as well, and so the cycle continues.

Taking medications such as acid blockers or proton pump inhibitors can create another downward spiral. These medications prevent the production of hydrochloric acid. This makes the symptoms worse, so the patient takes more antacid medications, and the cycle continues. Another danger is that the patient can become dependent on the antacid medications. Often when the patient attempts to discontinue using the medications the heartburn comes back worse than before.

To treat heartburn and prevent it from occurring, it's very important that we do the things that support digestion, including the production of healthy amounts of stomach acid.



East Meets West

One of the fundamental principles of Oriental medicine is that diet and digestion play critical roles in our health. This is very clearly the case with heartburn.

Eating too many starches and sweets, or not eating enough protein puts your body at risk for not getting enough of the raw materials it needs to produce adequate amounts of stomach acid.

Both oriental and nutritional medicine work to heal heartburn by increasing the production of stomach acid. A common treatment in nutritional medicine is to prescribe supplemental hydrochloric acid or digestive enzymes until the body is producing enough of its own. In oriental medicine, one of the acupuncture points for improving digestion has been shown to increase the production of stomach acid.



How To Avoid Heartburn

The best thing you can do for heartburn is to prevent it from happening in the first place.

Drinking raw apple cider vinegar with meals is a great way to facilitate digestion. Simply dilute 1-2 tablespoons of vinegar in 4 ounces of water and drink it with your meal.

Another option is to take bitters, such as Angostura or Peychaud bitters. These are made of herbs that stimulate the digestive processes. Some of the same herbs are commonly used in oriental medicine to treat digestive problems.

Chewing your food well and eating when relaxed also helps to promote better digestion. Avoid foods that are stressful to your body, such as caffeine and sugar.



What To Do If You Have Heartburn

If you feel heartburn coming on when your stomach is empty, try drinking a little bit of water or fresh, raw milk. This will help to protect the sensitive tissues. Or, you can take some of the diluted raw apple cider vinegar mentioned above. The vinegar mixture may intensify the burning sensation a bit momentarily, but it should subside as the vinegar begins to help digestion.



Food Highlight: Raw Apple Cider Vinegar

Vinegars can be thought of as wines that have over-soured. Apple cider vinegar is the orange-brownish solution that results when apples are crushed and the natural fermentation process is allowed to occur. Raw apple cider vinegar is very acidic and full of enzymes, nutrients, and beneficial bacteria. If the vinegar is pasteurized, many of its beneficial components are destroyed. Raw apple cider vinegar is not clear because it has the “mother” culture in it. Look for this feature to know you’re getting a good product.



Conclusion

Despite the prevailing notion that heartburn is caused by excess stomach acid, in the majority of cases heartburn is due to too little stomach acid. Although many people find themselves dependent on medications in order to find relief from heartburn, this is not the optimal situation. There are often other ways that are effective in treating heartburn that simultaneously improve digestion and overall health.



Further Reading & Resources

'Theory of Aging Part I' by Jonathan Wright, MD

Folk Medicine by D.C. Jarvis, MD