Heartburn affects us all at one time or another – whether you drank a lot of orange juice too fast on an empty stomach, ate a big meal and then lay down to watch a movie, or ate before a stressful meeting, you likely know the feeling of burning behind your sternum.
The problem arises when heartburn becomes a common occurrence for you. We often see heartburn remedies advertised to us on TV, but the truth is, you shouldn’t need to take these with any regularity. If you find yourself dealing with heartburn more often than once or twice a year, you may need to look at the underlying cause.
According to the American College of Gastroenterology, tens of millions of Americans experience heartburn at least once a month, with around 20% of the population suffering from gastroesophageal reflux disorder (GERD). This is not surprising to me as I think about 70% to 80% of my patients experience GERD, or what they would call heartburn.
What is heartburn?
Heartburn is an increase in the amount of acid in the stomach, which is there to help us digest the foods we eat. When acid levels are normal, we remain unaware of our stomachs working away to break down our food, but there are certain states in which our stomach produces too much acid or it leads to acid reflux up the esophagus. If this happens only occasionally it can be described as heartburn, but when it happens more frequently it likely means that you have gastroesophageal reflux disorder.
If you are being bothered by heartburn or GERD, you may be able to reduce your symptoms simply by making small changes to your lifestyle. Here are the top 4 causes of heartburn:
Top 4 Causes of Heartburn and GERD
The number one cause of heartburn is stress, as it causes an increase in acid production. This is due to the fact that stress leads to the slowing down of normal digestion, meaning food remains in your stomach for longer giving more time for stomach acid to build up to a level that is above normal.
Stress also makes you more sensitive to pain and so, although your acid may not be any stronger than usual, you will find it more noticeable, and it will cause you some discomfort. Those with anxiety often experience chest pain as a symptom, which can be caused by heartburn, as their bodies don’t feel calm enough to digest the food they ate.
Although it is often easier said than done to reduce your stress levels, if you believe this to be the cause of your heartburn it is important that you find a way to manage your stress, such as exercise, getting the right amount of sleep, or practicing techniques such as yoga or meditation.
We live in a world that has normalized living with high levels of stress, but it’s important to not only manage your stress symptoms but take a long-term view. We all have to get through high-stress times in our lives at one time or another, but if you are in a situation that is causing you to endure chronic high-stress, you need to consider if there is a bigger change you need to make in your life to protect your quality of life and long-term health.
2. Poor Gut Microbiome
Another common cause of heartburn is a poor gut microbiome. If your gut flora is unbalanced, we know that it will disrupt the proper function of all things that happen in the gut, including acid production.
If you have the wrong balance of bacteria in your small intestine, the gas that is produced can put too much pressure through the intestines and into the stomach that it can cause a reflux of stomach acid into the esophagus.
Possibly the most obvious cause of heartburn is diet. There are a handful of specific foods or food groups that are more likely to worsen heartburn symptoms. These are:
Caffeine – caffeine can cause the esophagus to relax and so increase the instances of acid reflux
Alcohol (especially red wine) – alcohol can cause the esophagus to relax, allowing for reflux from the stomach, and it can also increase stomach acid levels
Spicy foods – many of these foods contain capsaicin which can slow digestion, increasing the risk of heartburn
Citrus – fruits such as orange, grapefruit, lemon, and lime are high in acids
Tomato paste – tomato products often contain a lot of malic and citric acid which contribute to stomach acid levels
These are the five things that I tell my patients to avoid if they’re experiencing heartburn symptoms, especially on an empty stomach.
The final top cause of heartburn or gastroesophageal reflux disorder is overeating beyond what your stomach can hold. Think about it like filling up a water bottle. If you overfill the water bottle it is going to overflow. A similar effect happens in the stomach.
If you eat too quickly, too much, or have a binge eating disorder, then increased acid production, and therefore higher levels of stomach acid, is soon to follow, leading to GERD or heartburn. Make sure you slow down when you’re eating and allow your body to tell you when you’re full. If you’re struggling with overeating from an emotional standpoint, talking to a therapist can help not only with the overeating but also in reducing heartburn symptoms.
It’s important to realize that many heartburn symptoms don’t happen in isolation. While someone may ignore the heartburn they get each morning after their glass of orange juice or coffee, many of the issues that can cause heartburn come hand-in-hand. For example, chronic stress may lead to eating late, right before bed, rising early to drink coffee to start the day with a helping hand, and then eating too fast and too much. Try to tackle these causes and don’t rely on heartburn medication to soothe your symptoms – a healthy, happy lifestyle is a much better cure.
Dr. Nancy Rahnama, MD, ABOM, ABIM, is a medical doctor board certified by both the American Board of Obesity Medicine and the American Board of Internal Medicine. Her specialty is Clinical Nutrition, that is, the use of nutrition by a medical doctor to diagnose and treat disease. Dr. Rahnama has helped thousands of people achieve their goals of weight loss, gut health, improved mood and sleep, and managing chronic disease.