Heartburn is miserable. That aching, acidy feeling that you have in the middle of your chest or throat area is common to more than 60 million Americans at least once per month and 15 million adults daily. Heartburn, also known as gastroesophageal reflux disease (GERD) is a digestive disorder affecting the stomach and the lower esophageal sphincter (LES), the ring of muscle between the esophagus and stomach. This condition refers to the reflux, or return of the stomach’s contents back up into the esophagus.

In normal digestion, the LES opens to allow food to pass into the stomach and closes to prevent food and stomach acid juices from flowing back into the esophagus. You may assume the cause of GERD is too much acid. But the truth is more complicated. As people age, the digestive tract muscles become weaker and stomach acid levels naturally decrease. This means that heartburn may actually be caused by too little acid, known as hypochlorhydria, or by other issues related to muscle weakness. A certain amount of stomach acid is needed to help close the LES, so when stomach acids are low, the LES cannot fully close.

Other factors that contribute to GERD include being overweight, taking medication that weakens the LES (calcium blockers and certain hormones), eating when stressed or rushed and eating too late at night. Heartburn can also be a symptom of celiac disease or other food allergies.

Some doctors believe a hiatal hernia may weaken the LES and increase the risk for GERD. Hiatal hernia occurs when the upper part of the stomach moves up into the chest through a small opening in the diaphragm (a muscle separating the abdomen from the chest). The opening in the diaphragm supports the lower end of the esophagus. Having a hiatal hernia may allow stomach contents to reflux more easily into the esophagus. Many people with a hiatal hernia may not have problems. Most people do not require treatment unless the hernia is severe enough to raise the risk of strangulation (twisting that cuts off the blood supply) or heartburn symptoms are severe.

So what can you do?
1. Eat smaller frequent meals. Do not overeat. Stop eating when you are no longer hungry vs eating until you “feel” full.
2. Chew your food. When chewing your food, saliva has its own essential digestive enzymes that help break down your food and improve the digestive process.
3. Don’t eat when rushed, and eat your last meal/snack at least 2-3 hours before bedtime.
4. Avoid trigger foods: chocolate, peppermint, coffee, alcohol, tomatoes, citrus foods, fatty foods and fried foods.
5. Supplements can be helpful: Dr. Leo Galland MD in NYC recommends a combination of calcium citrate (chewable or drinking a calcium citrate drink) after each meal and Melatonin at bedtime to help strengthen the LES valve.
6. Supplementing with Betain hydrochloric acid (HCL) right before each meal may help restore stomach acid levels. Other options are to take 1 dropper of chinese bitters in a tincture or 1 Tbsp of organic apple cider vinegar in 1 cup of warm water before meals.
7. Stop Smoking

Talk to your practitioner before adding any supplements. Ask about any underlying issues that might be causing your heartburn and what treatments might work best for you. The treatment might be a change in the medications you are taking.

References: Galland, L. “Heartburn? why low acid might be the problem”. mymagazine.us, p 25-26.
Khatri, M. Webmd.com. “Gastroesophageal Reflux disease (GERD). September 19, 2019.