Maybe it’s after a bowl of garlicky pasta. Or a night of drinking alcohol. Or when you eat late at night. But that slow burn inevitably wells up in your chest and you begin dreading the hours of painful and annoying symptoms to come. It’s an experience so many people have. More than 60 million Americans suffer from heartburn once a month, and one-quarter of those may get acid reflux daily, according to the American College of Gastroenterology (ACG).
“Heartburn is one of the most common conditions I see at Parsley Health,” says Mary Stratos, PA-C, a physician assistant at Parsley Health in New York City.
Heartburn is when acid from the stomach flows back into the esophagus, which prompts the burning and discomfort that swells into your throat. If this happens two or more times per week, it’s considered GERD, or gastroesophageal reflux disease.
Heartburn symptoms aren’t just the “burn”
While a burning sensation in your throat is one of the most common symptoms we associate with heartburn, it’s not the only one. And it’s possible you might not even feel the traditional burn at all. You may experience one or more of these heartburn symptoms:
- Burning in chest
- Acidic taste in mouth
- Difficulty swallowing
- Chronic cough
Should you take a heartburn medication?
Proton pump inhibitors, or PPIs, are common over-the-counter and prescription medications used for acid reflux and GERD. While they can offer some relief in the short term and have their place in certain doctor-recommended treatments, they can also be problematic. A PPI essentially shuts down stomach acid production, and was originally designed as a prescribed short-term solution in the treatment of gastric ulcers, Stratos points out.
Long-term use of this heartburn medication has been associated with an increased risk of fractures, pneumonia, C. Diff illness, vitamin B12 deficiency, low magnesium levels, chronic kidney disease, and dementia, according to a 2018 review in Mayo Clinic Proceedings. There’s also concern that chronic use is linked with type 2 diabetes. And, according to a study in the journal Gut, patients on PPIs are 73% more likely to have a severe case of COVID-19 if infected with the virus compared to COVID patients not taking the meds.
It’s worth addressing the root cause of GERD and recurring heartburn rather than just living with it or masking it with medication. Aside from the fact that GERD is extremely uncomfortable and you deserve to feel good after you eat, long-term, it can injure the esophagus and, at worst, increase the risk of developing esophageal cancer, which is estimated to kill more than than 16,000 people this year, according to the National Cancer Institute.
Instead of reaching for a PPI, “we need to understand why stomach acid is escaping upward into the esophagus,” says Stratos.
The myth of too much stomach acid
Contrary to what’s commonly believed, too much acid is not the problem when it comes to reflux. “We need stomach acid, it’s a critical part of our health and wellbeing. But when it gets pushed into the esophagus, that becomes problematic because the esophagus doesn’t have the same protective lining as the stomach,” says Stratos.
Stomach acid has a few vital roles in your body: It kills off pathogens, helps break down food, and stimulates pancreatic enzymes and bile during digestion, adds Stratos. The important thing is making sure you have the right amount of acid in your stomach, as well as preventing it from escaping upward into your throat.
What causes heartburn, then?
As Stratos explains, you have a lower esophageal sphincter (LES). With the exception of swallowing or burping, it remains tightly shut to prevent the acidic contents of your stomach from splashing back up. When the LES opens, though, the acid has access to your more fragile esophagus, which can lead to some of the nasty acid reflux symptoms.
So, next question: What’s up in your body that’s causing the LES to open when it shouldn’t?
One of the main causes of GERD is increased intra-abdominal pressure, says Stratos, which can be triggered by:
- Conditions including SIBO (small intestinal bacterial overgrowth), gut dysbiosis (imbalance of the gut microbiota), or maldigested food.
- Eating large meals
- Poor stress management. “Stress diverts blood flow away from the digestive tract and reduces the production of gastric enzymes that break down food properly,” Stratos says.
- Certain clothing that will put physical pressure on your stomach, like high-waisted jeans, legging, or tight belts.
And that brings us back to stomach acid. It may seem counterintuitive, but low stomach acid is actually more likely to contribute to be at play here. “Without enough of this helpful stomach acid to break down food, maldigested food gets into the GI tract and GI pathogens overgrow, perpetuating the problem,” explains Stratos.
This is where underlying digestive conditions like SIBO come in. SIBO is caused by an overgrowth of “bad” microbes in the gut that leads to bloating, flatulence, and abdominal pain. As a result, the condition can cause this pressure that leads to LES leaks. What’s more, as Dr. Lilli Link, M.D., a board-certified internist and functional medicine practitioner at Parsley Health said previously, “people without enough stomach acid are at risk for SIBO.” Meaning, you may be suffering a constellation of GI symptoms that all stem from low stomach acid.
Ultimately, you need more stomach acid to combat the issue. Unfortunately, taking a PPI long-term will only suppress stomach acid production, making heartburn symptoms worse. Parsley Health providers focus on addressing the underlying cause first rather than jumping straight into PPI use.
How to get rid of heartburn when it happens
As soon as you feel that tell-tale burn begin to well up, you can take action. “The short-term goal is to optimize digestive function and restore stomach acid,” says Stratos. In the moment, one option is to take bitter herbs, which will stimulate pancreatic enzymes and bile to break down food and, downstream, decrease the overgrowth of pathogenic bacteria that causes intra-abdominal pressure. Reduce your intake of carbs, which will remove the fuel source for the bugs. And while hydration is important, avoid trying to drink a lot of water (or other liquid), as that will dilute stomach acid (which remember, is key in good digestion).
If you are stressed, take a nice, long inhale and exhale (and repeat as needed) in order to send blood flow back to your digestive system.
You may have also heard the recommendation to take apple cider vinegar to get rid of heartburn. While some people do find this useful, Stratos suggests diluting a tablespoon of ACV in water before knocking it back, as straight-up will be too harsh.
Your gameplan for constant heartburn
If you experience acid reflux often, you’ll want to work with a provider on a long term strategy. At Parsley Health, members work with a doctor and health coach to tackle ongoing heartburn with a three-step plan that will identify and treat the cause of intra-abdominal pressure and low stomach acid.
1. Restore a healthy gut lining
Parsley doctors design a supplement protocol that will work for your individual needs. You may be advised to take supplements that are proven and formulated to soothe an injured gut lining. The goal: Increase comfort after eating.
Parsley Health coaches also suggest gut healing foods that work for your diet and creative recipes to use them in.
2. Increase digestive functioning
Your doctor may recommend a supplemental source of acid to increase stomach acid. While these can be found over the counter, you’ll want to work with a practitioner who can recommend the right dose and monitor your progress. “Your gastric lining can experience some erosion, and any type of acid can worsen it and cause pain,” says Stratos.
Digestive enzymes may be another option to assist your body in breaking down food. Bitter greens also encourage GI health, so eating more dandelion greens, arugula, and kale can help.
Because your digestive function is also closely related to your mental wellbeing, your health coach can be a great resource for helping you find sound stress management strategies. (It’s not the easiest during a pandemic, social justice movement, and election year, but stress easily stalls digestion, so do what you can to find calm.)
3. Assess GI issues
Acid reflux can be caused by other digestive issues, so your doctor may evaluate you for SIBO, a helicobacter pylori (H. pylori) infection, or dysbiosis. This can help rule out a deeper issue, and If a digestive problem is uncovered, your care team can treat you.
“Acid reflux and heartburn don’t have to be a chronic condition. We are able to get a lot of people off their PPIs,” says Stratos. Because PPIs often exacerbate the problem, Parsley will examine the root cause of the reflux, work to soothe your gut lining, and improve digestive function to get rid of heartburn for good.