If you have ever experienced that distressing burning pain in your chest, hoarse voice, recurring hiccups, unexplained nausea or felt a bit of food coming back into the mouth shortly after eating, then you already know what heartburn and acid reflux feel like.
Acid reflux is a common condition that features a burning pain, known as heartburn, in the lower chest area. It happens when stomach acid flows back up into the food pipe. When acid reflux occurs more than twice a week it is diagnosed as Gastro-Oesophageal Reflux Disease (GORD).
Indigestion (dyspepsia) on the other hand, can fit many symptoms under the “indigestion umbrella” including bloating, burping, heartburn, discomfort, or pain in the upper abdomen, feeling full quickly after eating, flatulence (gas), loss of appetite and nausea.
How common is acid reflux and heartburn?
While the exact figures vary, recently incidence of heartburn has risen making it a common stomach complaint worldwide (link). The American College of Gastroenterology reported that over 60 million Americans experience heartburn at least once a month, and at least 15 million as often as daily (link). From 10% to 20% of adults in Western countries and nearly 5% of those in Asia experience GORD symptoms at least weekly (link).
Are acid reflux, GORD and heartburn the same?
These terms are often used interchangeably, however, they are different. GORD is the disease or diagnosis defined as regular symptoms caused by the flow of gastric contents into the oesophagus. Heartburn is one of the symptoms of GORD. Acid reflux is the reason why an individual has GORD.
Heartburn and Indigestion
Heartburn and indigestion may have similar triggers (including caffeine, spicy, fatty, or acidic foods) and are often treated similarly. Indigestion may also be caused by eating large meals, eating too fast or heavy exercise too soon after eating. While indigestion primarily affects the abdominal area, heartburn symptoms can be felt in the chest and oesophageal areas. It is important to note that it’s also possible to experience both indigestion and heartburn at the same time. Indigestion could also be caused by underlying gastrointestinal disorders, including GORD, stomach cancer, peptic ulcers, gall bladder disease, gastritis, IBS, lactose intolerance and bacterial infection. Anxiety and depression may also upset stomach in some individuals leading to indigestion issues (link).
What causes acid reflux and heartburn?
To understand what causes acid reflux, lets first understand what happens with digestion. The oesophagus is the long muscular tube that carries food from the mouth to the stomach. The contractions of its muscles called peristalsis push food down the oesophagus. At the bottom of the oesophagus, food passes through a muscular valve called the lower oesophageal sphincter (LES) and then passes into the stomach. When functioning properly, this ring of tissue plays a crucial role in helping us eat. But when LES malfunctions, it becomes the main player in heartburn.
Heartburn starts in an area called the gastroesophageal junction, where the LES is located. This smooth muscular ring of LES is moderated by an intricate tree of nerve roots that connect to the brain, heart, and lungs. LES ensures one-way flow from the oesophagus to the stomach. The stomach contains hydrochloric acid, a strong acid that helps break down food and protect against pathogens such as bacteria. While the lining of the stomach is specially adapted to protect it from the powerful acid, the oesophagus is not protected. When we eat, this valve opens to let food pass into the stomach, but for the rest of the time, it should remain tightly shut to stop contents of the stomach surging back up again. The LES contracts, squeezing the stomach entrance and creating a high-pressure zone that prevents digestive acids from seeping out. If, however, LES fails to do its job, where the valve relaxes (you can think of it as a faulty, ill-fitting lid), either temporarily or permanently, then stomach contents that also includes highly acidic digestive juices are regurgitated back up into the oesophagus (link). This is acid reflux, and it causes heartburn, but if it’s severe and prolonged, the acid can cause inflammation in the oesophagus, and sometimes ulcers.
Specific lifestyle factors are known to increase the risk of heartburn, indigestion, and acid reflux. The good news is that many of these are preventable.
One cause that is not preventable is a hiatal (or hiatus) hernia. A hole in the diaphragm allows the upper part of the stomach to enter the chest cavity, sometimes leading to GORD.
Gastroparesis is also one of the risk factors of GORD where food does not move from the stomach into the intestine at a normal rate as it should (delayed gastric emptying). Gastroparesis is a motility disorder, which means there is no physical obstruction preventing timely digestion, but rather a problem with muscular activity regulation. It occurs when the pair of nerves that connects the brainstem to the gastrointestinal tract (vagus nerve) is damaged or not functioning properly. Since the vagus nerve is unable to send the necessary messages to ensure that the muscles in the stomach continue to work normally, food remains in the stomach for too long, leading to symptoms.
Other risk factors include:
- weight gain & obesity
- low levels of physical activity or inactivity
- certain medications including those for asthma, high blood pressure, birth control and depression
- drinking too much alcohol
- eating large meals before bed
Pregnant women often experience more heartburn due to the pressure of a growing baby on their stomachs and the levels of certain hormones in their bodies.
❗️DISCLAIMER❗️ This article is for information only. It is not intended to constitute or be a substitute for professional medical advice, diagnosis, or treatment. Always consult a healthcare professional before making changes to your diet. Changes in eating habits should be overseen by registered healthcare professionals who are qualified to guide patients in the correct application and implementation of diets by tailoring for your individual circumstances.
Stomach acid reflux and your diet
Food and dietary habits that have been linked to acid reflux include:
- a high intake of table salt
- a diet low in dietary fibre
- eating large meals
- consuming carbonated drinks and acidic juices
Some of the same food triggers for heartburn may also be involved in causing indigestion. Mild indigestion caused by food or drink often goes away after an hour or two. Indigestion caused by a medical condition may linger until it’s treated professionally.
Acid-reflux disease and gut dysbiosis
Many chronic diseases have been shown to alter the gut microbiota, like diabetes, respiratory diseases, asthma and even cancers. And now there is developing evidence linking an imbalanced gut microbiome (gut dysbiosis) with oesophageal diseases, including GORD (link).
The mechanism linking the two isn’t fully understood yet. It’s not clear whether alterations in the gut microbiota composition cause the condition, or whether changes in the oesophageal environment lead to disturbances in the composition of the gut microbiota.
What is the treatment for heartburn and indigestion?
There are treatments available for treating heartburn and indigestion depending on the severity and what’s causing the problem. An occasional bout of heartburn isn’t necessarily something to worry about.
But if heartburn starts happening regularly over a prolonged period, it can weaken the LES muscle over time, letting more and more acid escape. Hence, for chronic heartburn, it is critical to talk to your doctor as prolonged acid reflux can cause severe damage to the oesophagus if left untreated.
Overtime, constant acid leakage from heartburn may form scar tissue which narrows the oesophageal tube, making it harder to swallow food. Ongoing reflux can also damage the cells lining the oesophagus – a condition called Barrett’s Oesophagus, which can elevate the risk of oesophageal cancer.
Antacids available over the counter the local pharmacy and supermarkets can be used for infrequent heartburns or indigestion. They work by neutralising your stomach acid to stop the burning sensation.
For chronic heartburn or indigestion, a doctor can prescribe proton pump inhibitors (PPIs) or H2 blockers that inhibit the production of gastric juices for acid reflux relief.
** It is critical to appreciate however that acid reflux medications, including those available over the counter, alter the stomach acidity and this can have negative consequences on your digestive health. A more neutral stomach acid can affect your ability to absorb certain nutrients like vitamin B12 and Calcium leading to nutritional deficiencies. PPIs can also change the composition of the gut microbiota leading to a less healthy microbiome. **
Surgery is usually reserved for severe cases of LES valve dysfunction if GORD doesn’t respond to treatment or lifestyle changes.
Lifestyle changes one can adopt to manage or control acid reflux
Making some lifestyle changes can help effectively prevent or improve symptoms of acid reflux as confirmed by number of studies in humans.
Diet is a major contributing factor to the onset of acid reflux and GORD.
A person may prevent heartburn by avoiding certain foods know to trigger symptoms like acidic, spicy, or fatty foods and carbonated drinks and drinks that contain caffeine. It is important however to work with an Accredited Practising Dietitian who will guide you identify your trigger for heartburn and acid reflux symptoms. They will also ensure your nutrient needs are met based on your individual circumstances.
A study suggests that dietary changes may be as effective as PPIs in treating acid reflux (link). In a study, high fibre diet has been shown to reduce frequency of heartburn and pressure on oesophageal sphincter as well as improve oesophageal motility in patients with gastro-oesophageal acid reflux (link). Similarly, in a recent study, 3-week supplementation of virgin sugarcane prebiotic fibre has been shown to effectively reduce heartburn and total GORD symptoms score in patients (link).
In yet another study involving 184 patients, there was no significant difference in reflux symptom index reduction between patients treated with a plant-based, Mediterranean-style diet, and standard reflux precautions vs those treated with proton pump inhibitors (PPI) and standard reflux precautions (link). Thus, such dietary approach that may effectively improve symptoms could avoid the costs and adverse effects of pharmacological intervention as well as afford the additional health benefits associated with a healthy, plant-based diet.
Additionally, intake of diet rich in prebiotic dietary fibre would support a healthy and diverse gut microbiome, a key to a healthy digestive functions and improved gut health.
If you need little help in meeting your daily recommended dietary fibre intake or support for digestive health, try KfibrePro Dietary Indigestion & Bloating. It is a Low FODMAP accredited synbiotic (prebiotic + probiotic) that is formulated to support normalisation of bloating, gas & indigestion.
- Other lifestyle factors:
Cutting down your alcohol consumption, giving up smoking, and getting a good night’s sleep can also reduce risk of heartburn and other associated symptoms. Also, getting more exercise, eating smaller meals, and sitting upright after eating may also help avert heartburn.
Acid reflux is a common condition and is on the rise in the western world. Western diet which has poor nutritious quality and sedentary lifestyles are known to be contributing factors. It’s important however, that you determine if your symptoms are related to any underlying gastrointestinal issues. But there are things you can do to reduce the risk of acid reflux disrupting your life. Making some lifestyle & dietary changes can help to prevent or improve symptoms and help avoid having to feel the burn.
If you are experiencing persistent acid reflux, heartburn, or indigestion, it is important to talk to a healthcare professional who can help identify the cause of your bloating. To ensure that your nutrient needs are met and determine your individual circumstance its best to work with an Accredited Practising Dietitian when making significant changes to your diet.
By Dr Tanvi Shinde, PhD