Heartburn has become so common that a handful of drug companies make billions of dollars a year by suppressing it one day at a time with acid-blocking pills. For some, heartburn is no more than an uncomfortable nuisance, prompting them to keep a bottle of Tums close at hand. For others, it’s a terrifying experience waking up in the night with severe chest pain.

Too Much Acid?

Whatever the experience, our instinctive response is to look for a pill that takes away the pain so we can get on with our day—or night—and hopefully forget about it. Naturally, discovering that antacids and acid-blocking drugs make the pain go away convinces us that our problem is too much acid production in the stomach. But the television commercials never prompt us to ask ourselves (or our doctors) why we might be producing too much acid, or even to confirm that we are. Confirmation is accomplished using a 24-hour pH probe in the stomach. But this is rarely done anymore. Instead, we are led to conclude that if an acid-blocking drug makes the pain go away, this is proof-positive that excess acid is the culprit.

Do We Need Acid?

While this line of reasoning makes sense, it is inaccurate. Heartburn can be caused by too much acid, but this is usually not the case. The stomach was designed to make acid for a number of reasons. For example, acid is required for protein digestion. Proteins themselves are too large to be absorbed into the bloodstream. They have to be broken down into amino acids, which can then be absorbed. Cells throughout the body then use amino acids to make enzymes, muscles, bones, joints, many of our neurotransmitters, and much more.

Stomach acid is also essential for adequate absorption of Vitamins D and vitamin B12, magnesium, calcium, zinc, iron, chromium, manganese, copper and other vitamins and minerals. Over time, deficiencies of these nutrients contribute to depression, osteoporosis, cancer, autoimmune disease, anxiety, insomnia, yeast overgrowth, hair loss, charley horses, food allergies, rashes (including hives), diarrhea, constipation, weak fingernails, acne, asthma, bloating, belching, gas, gallbladder problems, etc.

Low stomach acid further allows infecting organisms (that would normally be killed by the acid) to get past the stomach and set up infections in other areas. This can lead to either food poisoning or imbalance between the healthy and unhealthy bacteria in the gut.

Why Do I Hurt?

By design, therefore, the stomach should have a pH between 1 and 3, which is very acidic. By contrast, the esophagus naturally has a pH around 7, which is neutral. Whenever acid makes its way from the stomach into the esophagus, you may experience a very uncomfortable burning sensation (some people develop a chronic cough instead). This sensation does not mean you have too much acid. Rather, it means you have acid in a part of the body that was not designed for it.

So, your next question should be: How did acid get from a place where it belongs to a place where it does not belong? The answer lies in the chemistry and physiology of a segment of muscle that separates the stomach from the esophagus.

What Causes Heartburn?

The esophageal sphincter opens when you swallow so food can move into your stomach. The rest of the time, this muscle remains tight enough to prevent food and stomach acid from going the wrong way. Well, that’s the way it’s supposed to work. But a variety of triggers cause this muscle to relax when it’s not supposed to, allowing acid to enter and burn the esophagus.

One very common trigger that may surprise you is low stomach acid. If the pH of the stomach is too high from not having enough acid, the esophageal sphincter relaxes. How does this happen? Eating too fast prevents the stomach from making enough acid in time. Age is another common culprit: More than half of people over age 60 have low stomach acid. By age 85, this number climbs to 80%. A third common trigger of low acid is a microorganism called Helicobacter Pylori. This bacterium is better known for its ability to cause ulcers. What you may not realize is that it causes far more heartburn than it does ulcers. Additional causes of low stomach acid include thyroid deficiency, suboptimal adrenal function, and prolonged stress.

Other conditions lead to inappropriate opening of the esophageal sphincter. Obesity, as well as pregnancy, increases pressure on the stomach, which increases pressure on the sphincter muscle. Unhealthy bacteria in the intestines, yeast overgrowth, food sensitivities, nicotine, alcohol, caffeine, bile deficiency, digestive enzyme deficiency, too much exercise, magnesium deficiency, low-chloride diet, parasites, hiatal hernia, and some medications also cause heartburn.

Finally, there are foods that can further relax an already-weakened sphincter: high-fat foods, mint, spicy foods, citrus juices, chocolate, salt and salty foods, onions, carbonated beverages, and milk.

Let’s Get At The Root Of The Problem

Like many other health conditions, heartburn often results from a combination of factors rather than a single trigger. Identifying and fixing the underlying causes not only prevents you from having to take a dangerous acid-blocking pill for the rest of your life: It will likely eliminate other symptoms you are having, and reduce your risks of many diseases down the road as well.

To your health,

Ray Andrew, MD

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