You Probably Don't Have Too Much Acid: 5 Common Causes of Heartburn and GERD

There's a burning fiery pit in your chest. It's not a heart attack. You've checked with your doctor before.
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It's feels heavy, uncomfortable and burns. At your last visit you were told that you probable have GERD. And you think, "what a goofy name for something that feels like hell!"

Heartburn, or Gastroesophageal Reflux Disease (GERD) accounts for one out of three primary care visits, and has been increasing quite dramatically over the last two decades (1). It's now estimated that 18-27% of adults in North America experience heartburn at least once weekly (2), and many experience it daily. Which absolutely sucks.

This sharp increase can be attributed to rising rates of obesity, and is more common amoungst smokers and with age.

Common symptoms of GERD include:

• sensation of hoarseness or lump in your throat
• dry cough or throat clearing, last longer than 8 weeks
• burning in esophagus, throat or chest
• symptoms worse at night
• trouble or pain with swallowing
• bitter or sour taste in mouth
• nausea and regurgitation

(*most common symptoms, although not all need to be present)

A diagnosis of GERD is often made at the physicians office, and then commonly, anatacids (Gavison, Rolaids, Tums), H-2 receptor blockers (Pepcid AC, Zantac) or Proton pump inhibitors (PPIs, like Prevacid, Losec etc.) are recommended to "stop the burning". If it helps, it is assumed that GERD was your problem. 

But we seem to have gotten a little caught up with this idea that burning = too much acid. If you've read my blog "Why Does My Stomach Hurt?" you'll see that it is a little more complicated than that.

Heartburn typically stems from one of four causes:

1. abnormal esophageal movements - the esophagus acts like a tube to carry food down to your stomach, via gentle muscular squeezes called peristalsis. Sometimes, these movements can become uncoordinated, resulting in spasms. If there has been long term damage (like strictures), it can really throw off this pattern.
2. weak lower esophageal tone - the Lower Esophageal Sphincter ("LES", also known as the Cardiac Sphincter) acts as a one way valve from the esophagus down to the resevoir, the stomach. Normally, the LES will stay shut, unless there is pressure from above (hello incoming dinner!) for it to relax and open. Once food passes, it should close up tightly again. However, if the sphincter is weakened from too much pressure within the stomach (overeating, too much carbonation, laying down after meals, extra weight, pregnancy etc.) it may open, causing heartburn. Certain foods, like peppermint, spicy foods, coffee, alcohol can tend to aggravate and weaken the LES as well, but are not the cause.
3. hiatal hernia - a structural condition where the upper part of the stomach and LES actually sit above the diaphragm, which can constrict the passage of food, weaken LES tone and create a pocket of trapped acid
4. delayed gastric emptying - more common in women and in people with either Type 1 or Type 2 Diabetes, longer retention of food in the stomach (gastroparesis) can increase pressure within the stomach and thus weaken the LES. This occurs in about 40% of GERD cases (3). 
5. inflammation - a recent study (4) demonstrated that GERD may actually be caused by a cellular inflammation process, rather than by stomach acid burning the esophagus. It was concluded that if stomach acid were truly the cause of erosive damage to the esophagus, the effected area would be the superficial layers of the esophagus (in contact with food and acid) and appear like chemical burns. Instead, it was found that the damage began at the deeper levels and had the appearance of inflammation elsewhere in the body. 
6. low stomach acid - acid within the stomach is required to properly break down food and protect our body against illness. Stomach acid production tends to decline with age. However, having adequate stomach acid actually stimulates the LES to stay closed. In absence of enough acid, the LES can tend to relax.. and thus we get splash up.

Very rarely have I ever seen increased stomach acid cause heartburn. Rather, it is most likely a combination of low stomach acid, over-eating and a weak lower esophageal sphincter.

Zollinger-Eillison Syndrome is the only known cause of increased stomach acid, and is a very rare condition where one or more tumours in the small intestine or pancreas (gastrinomas) secrete a large amount of the hormone gastrin which then causes the stomach to produce too much acid (5).

In summary, your stomach is probably not too acidic. But something else is going on, making your uncomfortable. Don't you want to find out.. and fix it?

If you or someone you love is experiencing heartburn and want to treat the cause, please book a Free 15 Minute Health Discovery Session with me.

In our next few blogs, I will outline how to know if GERD is part of a larger puzzle and how you can start improving it naturally.

Until then, happy digesting!

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Let's fix my heartburn!

References:

1. http://www.medscape.org/viewarticle/560076
2. http://www.ncbi.nlm.nih.gov/pubmed/23853213
3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886367/
4. http://jama.jamanetwork.com/article.aspx?articleid=2521970 
5. http://www.mayoclinic.org/diseases-conditions/zollinger-ellison-syndrome/basics/definition/con-20024097