Do you, or someone you know, ever have a burning feeling in the chest after eating? Do you sometimes feel like you are partially regurgitating food or wake with that acidic taste in your mouth?
What about a chronic cough or a persistent sore throat? These symptoms, and others, are common signs that you may be struggling with acid reflux and its most well-known symptom — heartburn.
What causes acid reflux, and what health risks do people take when they ignore it? Is there a natural “fire extinguisher” that can suppress the flames of heartburn on a long term basis without causing the unwanted side effects of certain medications? Just like fighting fire with fire isn’t obvious, the evidence may surprise you.
What is heartburn?
Although most people talk about heartburn as its own condition, it is technically a symptom of acid reflux. Acid reflux happens when an important muscle, the lower esophageal sphincter (LES) valve, doesn’t function properly. As a result, acid from the stomach can move backward into the esophagus and cause the “burning” symptoms associated with heartburn.
Since 1980, when the LES valve was discovered to be a cause of acid reflux, several studies (including one published in the American Journal of Gastroenterology) have reported that foods and beverages such as peppermint, garlic, onion, chocolate, coffee, alcohol and spicy foods can relax the LES valve and allow gastric acid to move upward. Further, any pressure on the LES valve can also create acid reflux, such as carbonated beverages or pressure caused from the delayed emptying of the stomach.
What causes the delay of emptying? There are “trigger” foods that delay the food from leaving the stomach because they are too acidic. Those foods include tomatoes, tomato sauces, and citrus fruits and juices. However, non-acidic food may be delayed from emptying for another common cause – decreased stomach acid. This delay can cause fermentation and gases to form, which create an upward pressure against the LES valve, which creates the acid reflux. Finally, anything that can create pressure on that LES valve can cause acid reflux, such as large meals, lying down, or even obesity. Those who suffer from acid reflux know that a large spicy Italian meal with red wine (or lager) followed by going straight to bed is a sure ticket to acid reflux.
Can heartburn simply be ignored?
This process of reflux can be very harmful to the body given the strong acidity present in the stomach. Specialized acid-producing cells within the wall of the stomach produce digestive acid with a pH of 1.5 to 3.5. For some perspective on how acidic this is, it is ten times more acidic than vinegar. This kind of acidity can be useful in the body, but only within the stomach where its lining can handle the acidity and use it to help digest food.
Many people downplay the importance of treating acid reflux and its accompanying heartburn. But when gastric acid interacts with the more sensitive tissues in your esophagus and throat, which are not able to handle exposure to such strong acid, it can create serious damage. When acid reflux is persistent, it is referred to as gastroesophageal reflux disease (GERD). Gradually, inflammation builds in the lining and results in a painful condition called esophagitis. While esophagitis can be caused by other conditions besides GERD, GERD is the most common cause. Over time, this process leads to erosions and ulcers within the lining of the throat. In a small percentage of people, long-term acid exposure can lead to abnormal cellular growth. These cells are precancerous and have a significant risk of turning cancerous.
Gastric acid, which is primarily hydrochloric acid (or HCl) helps create an environment needed in the stomach to break down proteins into smaller particles for them to be better absorbed. If a person’s acid production is lower than average, proteins are not properly digested. Pepsinogen, an enzyme secreted by the stomach, interacts with HCl and becomes pepsin – the enzyme responsible for breaking down proteins.
If the proteins aren’t digested efficiently, the food stays in the stomach longer before being passed into the small intestine for further digestion and nutrient absorption. The gas, excessive food, and accumulating digestive enzymes can create a backflow of pressure against the lower esophageal valve. This leads to the leakage of acid and digestive juices into the esophagus and the triggering of acid reflux symptoms. There is evidence that as one gets older, production of HCl decreases and with that, our ability to digest proteins and the increased potential for heartburn.
What can be done to help the digestive process?
Besides dietary modifications, one of the best natural solutions for heartburn is supplementing with hydrochloric acid (HCl) – a key component of the body’s own stomach acid. Hydrochloric acid sounds a little “scary,” but it is naturally produced by the stomach and an important part of maintaining a naturally healthy and efficient digestive system.
People looking to find out if HCl supplements might be able to help should consider the baking soda stomach acid test. Ingesting baking soda (sodium bicarbonate) should cause belching if HCl levels are sufficient. To perform the test, mix 1/4 teaspoon of baking soda into 4-6 ounces of cold water early in the morning before putting any food or drink into the body. Drink the solution, and see how long it takes to belch. If the body does not produce a belch within 5 minutes, stomach acid and HCl levels are likely too low. Note that this is not a perfect test, but rather a simple, easy, at-home way to see if low stomach acid may be the problem behind heartburn. The gold standard test for low stomach acid is called the Heidelberg Stomach Acid test, where a patient swallows an electronic capsule which measures the pH levels in the stomach and transmits the data to a computer. Unfortunately, this test is expensive and rarely covered by insurance.
What does the science say?
Although there are relatively few rigorous scientific studies on natural acid reflux treatments, the research that does exist confirms supplementation of HCl’s ability to treat heartburn.
A scientific review of functional heartburn published in Gut discusses a study that subjected patients to an HCl treatment. That study found no acid reflux symptoms in the patients during the HCl therapy. A study published in Gastroenterology reached similar conclusions and also found that pepsin output reduces as people get older. This may be the reason why many people complain of heartburn more with age. Without pepsin, the body’s ability to metabolize proteins is severely compromised.
Numerous doctors and researchers have also written books about how low stomach acid is the cause of acid reflux and heartburn. One of the most talked-about is by Dr. Johnathan Wright, medical director of the Tahoma Clinic, and is entitled, “Why Stomach Acid Is Good For You.” In the book, Dr. Wright discusses how he has studied acid reflux in his patients and concludes that it is a “digestive failure” (found mostly in older people) which can be helped with supplemental HCl.
Are there any other solutions that work?
When people feel acid in their throats, their natural reaction is to want to get rid of it. They often will reach for few glasses of water and something that will counteract the acid. While water in the esophagus to wash out the painful gastric acid is good, having more water in the stomach dilutes the HCl further reducing its effectiveness to create pepsin and digest proteins.
The other natural tendency is to counteract the acid with an antacid. Anyone who has tested the pH levels of pool or hot tub water may remember that higher pH levels means a substance is less acidic. It is the same with stomach acid. Milk of magnesia (magnesium hydroxide) is a base with a pH of over 10, which counteracts the acid. Antacids reduce the acidity of the stomach’s gastric juices, and may only be providing a short term benefit to the esophagus. If acid reflux is rare and is believed that it was brought on by an acidic meal (tomato sauce, fruits and fruit juices), then a onetime use of an acid reducer may be appropriate. However, a person with frequent acid reflux may have the issue of low HCl — and antacids likely won’t solve the underlying problem and may be making it worse.
People with impaired kidney function or a history of kidney stones should not take antacids. Antacids that contain aluminum can weaken bones. The most common side effect of antacids is the taste – but antacids containing magnesium may cause diarrhea. Those containing aluminum may also cause constipation – which is why some (Mylanta® or Maalox®) may contain both to balance the effects. The biggest side effect of antacids is the body’s inability to digest vitamin B12 and calcium as sufficient stomach acid is necessary for proper digestion of these.
Many people take proton pump inhibitors (PPIs) like Prilosec®, Prevacid®, Nexium®, and others (omeprazole, which is the generic Prilosec, is the fourth most prescribed drug in the US), for long periods of time to deal with acid reflux and heartburn. But these were only approved by the FDA for short term use to allow the esophagus a chance to heal and can come with some significant side effects when taken for an extended period of time. Both these PPIs and H2 blockers (Pepcid®, Tagamet®, Zantac®) decrease acid production and, while providing temporary relief, may be adding to the real cause — too little stomach acid to digest proteins.
Research from Integrative Medicine notes that PPI medications also lead to undesirable side effects such as a decrease in the absorption of important vitamins and minerals (such as calcium, which can increase risk of developing osteoporosis) and an overgrowth of harmful bacteria in the gut.
Besides having smaller more frequent meals, another thing to try for temporary relief of heartburn is to use gravity. Don’t eat less than three hours before lying down — that means no late night snacks. The esophageal valve is located on the top of your stomach and laying down puts more pressure on that valve. Avoid bending over at the waist after eating — especially undressing at bedtime. Try raising the head of your bed 6-8 inches by putting blocks under the frame or sleeping in a recliner chair.
There are lifestyle changes as well. Avoid those trigger foods mentioned earlier and consider the possibility of food allergies. If you smoke, or use smokeless tobacco, stop. If overweight, dropping just 5-10 pounds can help.
Which HCl supplements should I try first?
Those who wish to discover what HCl supplementation can do should consider Thorne Research’s Betaine HCl & Pepsin. It not only contains a strong, effective dose of HCl but also includes pure, undiluted, lactose-free pepsin as well. This allows patients to directly boost levels of both of these key digestion substances. HCl supplements should be taken with a meal, never on an empty stomach.
Another way to naturally address acid reflux is to combine an HCl supplement with an array of digestive enzymes. Pure Encapsulations does this with their Digestive Enzymes Ultra w/Betaine HCl. This HCl supplement ensures better digestion of everything from proteins to fiber through its enhancement by an all-encompassing profile of vegetarian enzymes.
Although many people will find that they need more acid production (especially those over 40), some may need the opposite. If you take the baking soda stomach acid test and it makes you belch immediately, consider a complex of natural GI tract-soothing herbs and plant enzymes such as Pure Encapsulations’ Heartburn Essentials and pay attention to the foods you eat that triggers acid reflux so that they can be avoided.
I hope this article inspires you, or someone you care about, to look beyond antacids and PPIs for acid reflux and heartburn and begin learning how natural remedies can better address the problem. If you have any questions about the products or suggestions discussed here, or need help placing your order, our customer service team is standing by and ready to assist you in any way they can. You can reach them by phone at (888) 460-3091 or you can email them at: [email protected].
Until next time, stay healthy!
Yours in health,
Dr. Gregg Gittins
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