The sky is blue, racecar spelled backwards is still racecar, and in most cases heartburn is caused by low stomach acid, not high. Yes, seriously. After testing thousands of heartburn patients at his Tahoma Clinic, Jonathan Wright, M.D., concluded that excess stomach acid is not the problem in over 90% of cases. (source)
Last week I covered what he (and many others) say is the most common cause of heartburn, plus how acid blocking drugs can:
- Decrease our ability to resist infections
- Cause nutritional deficiencies
- And even increase our risk of certain diseases.
Fortunately, according to Dr. Wright, “In cases of mild to moderate heartburn, ‘acid indigestion,’ bloating, and gas, actual testing for stomach acid production at Tahoma Clinic shows that hypochlorhydria (too little acid production) occurs in over 90 percent of thousands tested since 1976. In these cases, a “natural strategy” is almost always successful.” (source)
As always, I want to remind you that I am not a doctor and this is not medical advice or a diagnosis. I’m just a former heartburn sufferer passing along information from experts that I’ve found helpful. Okay, let’s jump in!
How To Get Rid Of Heartburn Naturally
# 1: Remove dietary triggers
You probably already know a few foods that trigger heartburn for you – coffee, citrus, alcohol, onions, spicy foods. etc. Some foods, like carbonated drinks, may increase intra-abdominal pressure and push on the LES, which as we discussed in my previous post is the valve that protects the esophagus from stomach acid.
However, some triggers may not be quite as obvious. In this article, Chris Kresser LAc. explains why carbohydrates and fiber may contribute to some cases of heartburn, then discusses the potential benefits of temporarily reducing carbohydrate and fiber intake.
Other foods don’t weaken the LES, but are thought to directly irritate the esophagus. In general, it is recommended that known irritants be avoided for at least awhile. Some people say forever, but I personally reintroduced many of my “triggers” with no problem after I started feeling better.
Also, according to Dr. Wright, certain drugs – aspirin and ibuprofen, for example – are considered esophageal irritants, while others may weaken the LES.
#2: Increase stomach acid levels
If “this sounds like throwing gasoline on smoldering embers, that’s right, it does sound like it, but in fact it’s not,” says Dr. Wright. (Why Stomach Acid Is Good For You)
He adds that, “Not only does this strategy work to eliminate heartburn and GERD, it often goes a long way toward restoring and nutrient deficiencies and repairing the gastric bacterial barrier, not to mention the intestinal barrier.” (Why Stomach Acid Is Good For You)
Apple Cider Vinegar or Lemon Juice
One of the easiest ways to increase stomach acid levels is to drink a little apple cider vinegar or lemon juice right before a meal. Both are traditional folk remedies for indigestion, most likely due to their acid content and the presence of enzymes that support digestion. (Pasteurized apple cider vinegar does not contain live enzymes, but raw apple cider vinegar does.)
One thing to be aware of, however, is that according to Dr. Wright, “gradually increasing quantities of lemon juice (citric acid) or vinegar (acetic acid) will often relieve some or even all symptoms. This is supported by the common practice in some cultures of treating gastric discomfort with lemon juice or vinegar. Unfortunately, even though symptoms may be improved, actual nutrient digestion and assimilation are not improved nearly as much as with HCL” He’s talking about hydrochloric acid, which we’ll cover later in this post.
To Use: Most often, individuals add 1-2 teaspoons apple cider vinegar or lemon juice to a little water and drink just before meals. If needed, the amount is gradually increased until the individual determines the optimal amount for their body.
According to Katy Haldiman, MS, RN, “Another great option for increasing stomach acidity are digestive bitters, which can be found in most health food stores. Digestive bitters tap into the body’s neuro-lingual response that occurs when you taste something bitter. The bitter taste stimulates increased stomach acid production, as well as other digestive juices.” (source)
To Use: Follow the instructions on the label.
Using Digestive Bitters Safely During Pregnancy
Most digestive bitters contain angelica & gentian, which should be avoided during pregnancy. However, Urban Moonshine has created a version of digestive bitters that is free of those herbs and is considered helpful for occasional heartburn and morning sickness.
For individuals who are not pregnant, they have several other available flavors. You can see them all here.
HCL With Pepsin
Unlike digestive bitters, which stimulate the body’s own production of hydrochloric acid, HCL is actual hydrochloric acid. It is most often paired with Pepsin, because a deficiency in one usually signals a deficiency in the other.
It’s really best to work with a knowledgeable practitioner when supplementing HCL with Pepsin. However, if you’re interested in doing a brief trial on your own, Chris Kresser LAc. has put together some suggested guidelines here.
Two important things to keep in mind are:
1 – “Paradoxically, adverse symptoms are most likely to occur in individuals with the lowest levels of stomach acid. This is because these people are the most likely to have atrophic gastritis (a thinned-out stomach lining), which makes them much more sensitive to even smaller quantities of HCL than a normal, thicker stomach lining.” (source)
2- “HCL should never be taken by anyone who is also using any kind of anti-inflammatory medication such as corticosteroids (e.g. Prednisone), aspirin, Indocin, ibuprofen (e.g. Motrin, Advil), or other NSAIDs. These drugs can initiate damage to the GI lining that supplemental HCL might aggravate, increasing the risk of gastric bleeding or ulcer.” (source)
#3: Support Healthy Digestion
In the 30 Day Heartburn Solution, Craig Fear LAc. recommends focusing on gut healing before even considering supplementation with apple cider vinegar, bitters, or HCL. Personally, I opted to incorporate all three strategies at ones: removing triggers, slowly raising stomach acid levels, and supporting optimal digestion using gut healing foods.
Interestingly, Chris Kresser LAc. recommends against probiotics that primarily produce D-lactate for individuals who might have small intestinal bacterial overgrowth, which is sometimes present with GERD/heartburn symptoms. I have written about before about why D-lactate containing probiotics may be problematic for some people, and I why I opt for L-lactate forming options instead (like this one) and soil-based probiotics (like this one.)
In addition, digestive enzymes may also be helpful. According to Dr. Wright, “In order to more closely simulate the natural process, it is best to take pancreatic enzymes at the end of a meal. (I know that the bottle labels usually state the opposite. I don’t agree!) Taking digestive enzymes after meals gives the food adequate time to undergo the ‘acid phase’ of digestion, as happens with normal digestive function.” (Why Stomach Acid Is Good For You)
What about H. Pylori?
As mentioned in my previous post, an overgrowth of certain organisms such as candida and H. pylori can lower stomach acid levels. Somewhere between 1/3 and 2/3 of the human population carries H. pylori – many times without any symptoms at all. (source) When acquired early in life, research suggests that h. pylori may actually be protective against allergies and asthma. (source) On the other hand, it also has a causative relationship with ulcers and gastric cancer.
So is H. pylori good or bad? In this talk, Chris Kresser LAc describes it as a somewhat neutral bacteria which may have benefits for some people (usually when acquired early in life) and downsides for others (especially when acquired later).
Normally, adequate levels of stomach acid will keep H. pylori levels in check. However, if acid levels dip for any reason (stress, medications, etc.), H. pylori may use that opportunity to grow out of control. To protect itself from being killed, H. pylori secretes an enzyme called urease which neutralizes hydrochloric acid. If H. pylori is present in significant quantities, it can release a substantial amount of urease and further lower stomach acid, creating a nice, cozy Hotel H. Pylori in the process.
When overgrowth is an issue, most practitioners recommend dealing directly with H. pylori in addition to other lifestyle changes. The conventional treatment is a mixture of heavy duty antibiotics with acid blockers. The idea is the the antibiotics will kill the H. pylori while the acid blockers lower acid levels so that the irritated stomach lining can heal. Unfortunately, antibiotic use can actually lead to more gut infections, and the success rate of this method is falling.
According to my friend Sylvie, who opted for a natural approach after being diagnosed with H. pylori, the usual treatment protocol now “fails for about 35% of patients – and the effectiveness is still falling. The reason is because bacteria has become resistant to antibiotics.”
In this article she outlines the natural strategy she used and shares her actual before/after lab results.
What if I’m currently taking an antacid?
Obviously you’ll want to talk to your healthcare provider about any changes you want to make (see my disclaimer above). However, according to Dr. Wright’s book section on “Weaning Yourself off Antacids and Acid Blockers,” he writes:
Since there is no ‘withdrawal’ from acid blockers or antacids, it is safe to just stop them and switch to natural alternatives, as long as symptoms are controlled. In cases of mild-to-moderate indigestion or heartburn, there’s usually no problem with switching. In more serious cases, particularly if there’s severe acid reflux with ongoing esophageal damage, it’s wisest to withdraw from acid blockers or antacids only in consultation with a knowledgeable physician.” (source)
Is pregnancy heartburn caused by low acid?
Possibly. However, there may be other factors that contribute to heartburn during pregnancy. According to Dr. Wright, sometimes it’s due to increased intra-abdominal pressure as everything shifts to accommodate baby. (source) In those cases, chiropractic care may be helpful.
Another possibility is that increased progesterone levels play a role. According to Raquel Dardik, M.D., clinical associate professor of gynecology at NYU Langone Medical Center, “Progesterone slows down contractions of the bowel, so it slows down how quickly food and gas move through. Everything slows down and backs up, so you feel bloated and constipated.”
If everything slows down, that means food may be staying in the stomach longer, potentially undergoing a little gas buildup. Another function of progesterone is to relax muscles, which may mean that it sometimes relaxes the LES (the muscle that keeps stomach acid out of the esophagus) a little too much. Remember, as mentioned earlier, Urban Moonshine has created a version of digestive bitters that is free of those herbs and is considered helpful for occasional heartburn and morning sickness.
Suggested Further Reading
Why Stomach Acid Is Good For You: Natural Relief from Heartburn, Indigestion, Reflux and GERD by Jonathan V. Wright, M.D. and Lane Lenard, Ph.D.
The 30 Day Heartburn Solution by Craig Fear LAc.