Heartburn and Acid Reflux

Heartburn, baby. You are being punished. That burning pain in your upper chest is payback for crimes against your stomach. Tums and Rollaids have become a food group. They're that second dessert you have after every meal.

You probably wouldn't be here if it was occasional mild heartburn - but if that's what you've got, read the rest of this page anyway, so you'll know what's coming.

I know what it feels like. What do I do about it?

Fix the cause.

I have too much acid! Why do you think I take all those antacids?

That's treating the symptom. The cause is getting worse the longer you wait.

Hardly anybody actually has too much acid. They (you) have acid in the wrong place.

Then why do the Tums work on heartburn?

Well obviously, they don't work as well as they once did.

Your stomach produces the amount of acid it needs to process the food that you shove down your pie-hole. Food is digested mainly by enzymes, and the enzymes that are used in your stomach need a very acidic environment (a pH around 2.0, since you asked). If you soak up that acid with Tums and Rolaids, or if you suppress that acid production with Pepcid-AC or similar, then you don't have enough for the stomach enzymes to properly break down the food you've eaten.

Your stomach struggles with it, and partially-processed food gets into your small intestine, where it is not really ready for the next stage of digestion. In particular, less acid in your stomach means less digestion of protein - the building blocks (and repair material) of practically everything in your body.

So, if it's not too much acid, then why do I have an acid problem?

The sphincter at the top of your stomach - or the bottom of your esophagus - is supposed to open, one-way, to allow entry to the food coming down your gullet. The rest of the time, it's supposed to remain closed, to keep stomach contents safely inside. There's even a mechanism to deal with any stray stomach contents that might accidentally pass back through the sphincter.

Sometimes that sphincter gets lazy or it receives mixed-up signals, and so it relaxes. Your stomach is a muscular sack, and part of its job is to squeeze and churn in order to mix food with acid and enzymes, so the food will break down. If the sphincter at the top of the stomach is loose, it allows part of your stomach contents to splash up into your esophagus.

Another cause of heartburn is the opening in your diaphragm, the hiatus. The diaphragm is a dome of muscle that separates your thorax from your abdomen. What that means is that it's the wall that keeps your heart, lungs, etc. in your chest, and your stomach, intestines, liver, spleen, etc. in your abdomen. It is movable, and assists the activity of breathing. Naturally, it needs an opening or two so that the pipe down to the stomach (the esophagus) can pass through, as well as some very large blood vessels between the heart and the lower body. Anyway, if the opening for the esophagus is too large or is badly oriented, it can allow part of the stomach to extend through, in what is called a hiatal hernia.

That sounds ugly, and it is, but you don't really notice it. What you notice is its effects, which can include various other difficulties, but the one we're interested in here is stomach contents passing upward into the esophagus.

Yet another cause of heartburn is that your stomach is simply too full. Once it receives food, it has to start churning food with acid and enzymes, and if it is stretched by too much food, that can lead to leakage. There are normally only two openings to the stomach - the inlet from your esophagus, and the outlet to your intestines. So too much food crammed into your stomach can squeeze some back up the pipe it came down... but now it's mixed with acid, and some really vicious enzymes that can shred meat into atoms... ok, molecules.

The movement of stomach contents back up the pipe is called reflux. If it is chronic, then it becomes gastroesophageal reflux disease (or GERD). If you're a Brit, it might be GORD because you spell it Oesophagus. If the wrong-way passage of stomach contents is really extreme and violent, it's vomiting, but that's for another discussion. We're talking about leakage, not wholesale evacuation.

Anyway, if you have chronic heartburn, especially if you also experience difficulty swallowing, see a doctor to either find, or rule out, a hiatal hernia. It can be fixed.

But whether or not the reflux is due to a hiatal hernia or other causes, you need to control it. If (say) you live in the USofA and don't have enough insurance, or if you live in Canada in an area where certain medical procedures are rationed, then you could be quite a while getting a hiatal hernia repaired. In the meantime, you need to contain and minimize the damage.

Your stomach is built to withstand harsh acids; your esophagus is not.

In the early stages of reflux disease, the esophagus is irritated. In later stages, it develops ulcers - it gets holes burnt into it. The irritation and then the ulceration are the heartburn that you feel.

How can I tighten up my stomach inlet?

There aren't any exercises.

What you can do is to stop loosening it or overriding it.

What that means is:

• stop over-stuffing it - eat smaller meals; eat a little slower
• stop eating foods that trigger the wrong action by the stomach's inlet valve.

But I need food!

Yes, and if you have an extremely active lifestyle, you need lots of food. In that case, the answer to the first recommendation is to simply have more meals but smaller meals during the day. Nothing says you can have only three meals per day, if you need more.

Of course, be sure that you actually need the quantity of food that you are consuming. If you are fat or obese, then obviously you do not, so take it down a notch or three.

And the trigger foods you mentioned? What are they?

The unfortunate answer is "it depends". People are different.

Fortunately, the list is not that extensive, and you probably already know the kinds of foods that are most likely to produce reflux for you.

Chocolate.

Chocolate!?! But I LOVE chocolate!

Fine. You can probably continue to consume mass quantities if that's what you wish - sure enough, it's what we want, here at MHT. We have learned to accommodate our heartburn and our love of chocolate.

The trick is to pick your times. Avoid having chocolate soon after a big meal.

Especially, avoid it after this next item...

Any combination of flour-and-sugar, or flour-and-fat, or all three together.

WHAT!?! That's every dessert I love, and most of my meals, too!

Uh huh. And look where it's got you. Acid reflux and horrible heartburn after every meal, every snack, every treat... Bet your waistline isn't very trim either. That extra belly-fat pushing up on the stomach. Half-digested food squeezed up into your esophagus. You have to loosen your belt, lean back to ease the pressure... But don't lean too far back - as soon as you get near horizontal, the stuff starts to leak out the top of your stomach.

One more little detail about chocolate. If you want to eat chocolate and not suffer reflux, learn to enjoy very dark chocolate. It has the intense chocolate flavor (high percentage of cocoa), and a fair amount of fat, but it has minimal sugar, and no dairy. Sugary milk chocolate is for kids - grow up.

Now, SOME people get heart-burn if they eat spicy stuff. It's an irritation thing. Your stomach or esophagus or the valve between them gets irritated, and the result is reflux, followed by heartburn. Those people should try a variety of spicy things (in small amounts), as a test. They might discover that only certain spices are actually irritants for their bodies, while others are just nice, middle-warming flavors that enhance food, and that don't actually promote reflux. Hooray!

A few unlucky people will discover that any spice with a hint of warm will result in heartburn. Capsaicin - the hot of hot peppers - is out. Sorry to say that you folks are doomed to a life of bland, but at least you took the time to verify.

A larger percentage of people affected by heartburn are not fazed by spicy stuff, but rather by grease-and-flour or grease-and-sugar. It's Christmas week and you have some of Mom's meat pie (or tourtiere) for supper, and then there are rich cookies or perhaps fruit pie for dessert. You are doomed. And coffee. Did we mention that coffee is also a trigger for heartburn?

Oh NO! Not coffee, too! No-o-o-o-ooo!

Yeah. As with the spicy stuff, coffee all by itself can be a trigger for some really sensitive people. For most it's not. BUT, coffee, chocolate, and maybe spicy food will all tip the balance if you've had fried food or grease-and-carbohydrate food. They'll either tip you over the threshhold to heartburn, or they will make a food-generated case of reflux much worse.

The thing is the combination. You could have a meal of veggies and meat, and then swallow a couple of tablespoons of sugar, and you probably would not get heartburn.

You could have that same meal of meat and veggies and then follow it with (say) some jam on bread... and very possibly not suffer reflux.

You could have the veggies smothered in butter, and the meat thickly, juicily marbled with fat... and if you stopped there, you would probably not be hit by heartburn. Possibly you could have some chocolate or coffee an hour later and still not trigger the reflux.

But include any significant quantity of high-glycemic carbohydrate (sugar, flour, potato) mixed with fat (butter, lard, margarine, various industrial "food" oils that are baked into processed snacks), and your heartburn is much more likely - and nearly inevitable if you also have coffee or chocolate.

So you are saying...?

We seem to be saying that you can probably do a little investigating of your own, to discover what your personal tolerances and personal triggers are. Then, you can manage your heartburn/reflux however you see fit.

And by "manage", you mean...?

Well, just that. You can be a little diligent and keep the problem foods separate, which - for most people - will go a long way toward alleviating the reflux and heartburn. For those occasions when it just doesn't work out, you can fall back to the antacids for relief.

But...

But?

But. Don't go back to swallowing fistsfull of antacids every day to "manage" your problem. If you have that much reflux, you are causing severe damage to your esophagus and other structures, and could end up with cancer or worse. It could very well be that hiatal hernia that we discussed above - they aren't all that rare. Find out.

Well, not much is worse than cancer, but a really well-advanced ulcer can punch a hole through your esophagus, and if that doesn't kill you, the cancer is coming next... after all the surgery and other treatments and attempted recovery. When you get that far, prognosis ain't great. Remember, there's no spare room inside the human body. Your esophagus is not the only thing that goes through that general area. There are some pretty sizeable blood vessels there, too, and acid passing through a gaping ulcer onto a huge vein or artery is ... well... there really aren't any GOOD ways to die, are there?

Also, we don't recommend blockers like Pepcid. Remember, it's usually not that you are producing too much acid. Too much acid would mean more than your stomach needs for the kinds of food you've put into it - protein takes a lot of acid to help those enzymes digest it. It's usually that you are letting the acid go to the wrong places. If you avoid overstuffing, and if you avoid the trigger food combinations (that you've verified as most applicable to you), chances are that you can be generally free of reflux, and therefore free of heartburn.

If you've been at it long enough and determinedly enough that you've started burning holes, then you might need some sort of acid-preventer while you are recovering (which won't be overnight - ulcers are like burns; they take forever to heal). But don't use that as an excuse to continue what got you into the problem. You'd just be masking one problem with another.

By that, we mean, there's a reason your stomach produces acid, and if you prevent that production, the reason doesn't go away - it just becomes a new and different problem further down your digestive tract.

Finally, if your doctor recommends a blocker, and has a good reason for it - other than that it will reduce your symptoms - then do what your doctor says. A doctor who prescribes a blocker for no better reason than to reduce symptoms of reflux is just being lazy... or knows you well enough that s/he realizes you'll never do what's needed to fix the problem, so they give up and prescribe a band-aid. Don't you be that person.

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