by Kari Collett, RDN, LDN, CLT
When we experience the discomfort of heartburn, as most of us do at one time or another, we tend to attribute it to too much stomach acid. While it’s true that stomach acid backing up into the esophagus is the cause of heartburn, it’s not always the case that we have too much stomach acid. In fact, it could be that you have too little. How does that happen?
The lower esophageal sphincter at the base of the esophagus opens to let food through to the stomach and then closes. The LES has ‘sensors’ that measure the acidity of the stomach contents. As the acid level rises, the closing pressure of the LES increases. In the case of too much acid, if it opens too often or does not close tight enough, stomach acid can reflux up into the esophagus. In the case of too little acid, the LES valve stays open allowing acid up into the esophagus.
On the other end of the stomach is the pyloric sphincter. It works in exactly the opposite manner as the LES in that it opens to let food through when the stomach acid has reached adequate levels. This helps ensure that our food is properly digested before being released into our intestines. If the stomach has too little acid, it will take a long time to reach the proper level and digestion will linger causing gas, bloating, and perhaps forcing stomach acid back up into the esophagus.
Having occasional heartburn isn’t a serious problem but having chronic burning symptoms can lead to more serious health challenges such as Barrett’s esophagus, asthma, or insomnia. Chronic heartburn shouldn’t be ignored. But before you seek over-the-counter or pharmaceutical treatment, determine whether you have too much or too little acid. Treating heartburn with an acid inhibitor when your acid levels are already too low can have its own series of health consequences. Stomach acid plays a critical role in absorption of many nutrients as well as protecting us from pathogens in our food.
Despite the cause of your heartburn, there are a number of dietary and lifestyle changes that can be implemented to give you relief from the pain of heartburn and offer additional health benefits. A couple of easy strategies include staying well hydrated and eating small frequent meals. The right foods and the right supplements can help your digestive process and help you eat more of the foods you enjoy! To learn more about your unique dietary recommendations to manage your heartburn, contact a local dietitian.