Everything You Need to Know About Heartburn, Acid Reflux, and GERD

The Ultimate Guide to Heartburn, Acid Reflux, and GERD

Introduction

More than 60 million people in the US suffer from Heartburn, Acid Reflux, and GERD at least once per month, many experiencing it daily. Over half of pregnant women experience Acid Reflux regularly during the last trimester.


Acid Reflux is one of the most misdiagnosed ailments. The majority of patients are prescribed medications to treat excess stomach acid. In 99% of cases, low stomach acid is the underlying cause of acid reflux and GERD. This misdiagnosis likely happens because the symptoms for low stomach acid and excess stomach acid are the same. 

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Personal Experience

Do you suffer from Heartburn, Acid Reflux, and GERD? I am a long-time sufferer of first heartburn and then, later on, full-fledged Acid Reflux and GERD.


The first time I experienced heartburn I was about 14 years old. I’d been eating Cheetos and drinking Coke. I had consumed these many times before without consequence, but this time it caused a burning sensation in my upper chest and throat. It wouldn’t be the last time.


Heartburn in My Teens and Twenties


My mother gave me an antacid tablet, and it went away; for a while. I started getting it every few months. My parents assumed it was a genetic thing, “Everyone in the family has it!”, “You have a hiatal hernia,” I was told.


So I suffered from it for years, eating antacid tablets by the handful, right through my twenties. I carried them with me everywhere I went.


Acid Reflux In My Thirties, and Forties


Later on, in my mid-thirties and forties, I started waking up in the night with acid being expelled by my stomach into the back of my throat. A few times it went down into my lungs as well. It’s severely damaged my teeth and most likely my esophagus and very possibly my lungs.


GERD in My Fifties


In my fifties, I had full on Dysphagia, mostly in the early part of the day. I had issues with some foods over others - eating eggs and toast always triggered it, eating meat did sometimes.


My teeth are ruined, pieces chip away just from flossing my teeth, the teeth themselves are ground down to half their original size because they are softened by all the acid. My dentist says it looks like I have been chewing on Coke bottles.


Cured in My Sixties


I have recently altered my lifestyle, stopped taking so-called Acid Reflux medication, antacids or any type of acid reducing medication, added a few supplements to increase hydrochloric acid and improve my digestion, and consciously improved my posture.


I have experienced acid reflux once in the last 5 years; I used to experience it at least once a week for over 30 years. I feel that I have cured my GERD.  


In other articles on this site I will explain to you how to do the same.


When did you first get heartburn and do you know what caused it. Do you know what causes it now? 

WHAT IS HEARTBURN, ACID REFLUX, AND GERD? 
WHAT’S THE DIFFERENCE?

The terms heartburn, Acid Reflux, and GERD are often used interchangeably; what’s the difference?

 

Heartburn

Heartburn, also known as acid indigestion, is a painful burning sensation in the middle, upper chest (your esophagus). Heartburn is a symptom. Heartburn is the primary symptom of Acid Reflux and GERD. Mild, infrequent heartburn is probably nothing to worry about. It can be avoided by doing what I explain below.


Acid Reflux

Acid Reflux is a chronic condition where your stomach contents come back up into the esophagus resulting in either symptoms or complications.


GERD (Gastroesophageal Reflux Disease)

GERD is a chronic, more severe form of Acid Reflux. If you have Acid Reflux more than twice per week or if your esophagus appears swollen, you have GERD. You should be checked by a doctor, as GERD can lead to complications including esophagitis, esophageal strictures, and Barrett's esophagus.


LPR (Laryngopharyngeal Reflux)

This is another type of acid reflux that causes respiratory issues. Also referred to as extraesophageal reflux disease (EERD). Unlike GERD, LPR rarely produces heartburn symptoms so is sometimes called "Silent Reflux".

Symptoms of Acid Reflux and GERD

If you have acid reflux you are probably very aware of most of the symptoms.  There may be a few listed below that you experience but didn't realize they were associated with acid reflux.

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    Severe heartburn
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    Regurgitation of foods or liquids with a sour or bitter acidic taste in the back of the throat
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    Difficulty swallowing - Dysphagia
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    A persistent sore throat
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    Persistent hoarseness or laryngitis
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    Excessive burping or hiccups shortly after eating
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    Stomach bloating
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    Nausea
Lower Esophageal Sphincter (LES)

What Causes Acid Reflux/GERD?

Below is a list of the primary causes of acid reflux. They are listed in order of most likely causes but you may also have more than one from the list. I hope you won't be surprised that "Too much stomach acid," is not on the list. 

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    Not Enough Stomach Acid:
    Am I crazy! Despite what they tell you on the TV commercials and despite the common sense of how it feels, it’s extremely rare to have too much stomach acid. As you age, your body produces less and less stomach acid.

    Strangely the symptoms of too much stomach acid and too little stomach acid are almost the same. Although antacid pills will give you relief initially, they make the problem worse over time.


    Read More: How to Determine If You Have Hypochlorhydria



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    An Improperly Working Lower Esophageal Sphincter (LES): 
    This is the valve between the stomach and the esophagus. When working correctly, it is only supposed to open when swallowing food, burping or vomiting.  

    But an improperly functioning LES can also be forced open by the pressure exerted against it by the bloating that occurs after eating certain foods, or when the body is in a position (see Poor Body Position below) that allows the opening of the stomach to be at the same level or higher than the esophagus, allowing your stomach contents to be forced up into the esophagus. 

    The main reason your LES is not functioning correctly is because of insufficient stomach acid. It is the additional acid that is produced during the digestion process that triggers the LES to close tightly. Without sufficient stomach acid this won't happen.

    Read More: A Weak LES is One of the Main Causes of GERD



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    Poor Body Position:  
    Bad posture allows the opening to the stomach to be at the same level or higher than the esophagus. This can be from slouching when sitting or standing or while sleeping on your back or right side. Poor posture can simulate the effects of a hiatal hernia. 

    Read More: Improve Your Posture to Improve Your GERD



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    Poor Body Position:  
    Bad posture allows the opening to the stomach to be at the same level or higher than the esophagus. This can be from slouching when sitting or standing or while sleeping on your back or right side. Poor posture can simulate the effects of a hiatal hernia. 

    Read More: Improve Your Posture to Improve Your GERD



  • Pregnancy: 
    Some women experience Acid Reflux for the first time during pregnancy. Acid Reflux, in this case, may be the result of higher hormone levels combined with the increased stomach pressure from the growing fetus. It’s usually worse during the third trimester, but the symptoms almost always go away after delivery.

    Read More: How to Relieve and Manage Heartburn During Pregnancy
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    Pregnancy: 
    Some women experience Acid Reflux for the first time during pregnancy. Acid Reflux, in this case, may be the result of higher hormone levels combined with the increased stomach pressure from the growing fetus. It’s usually worse during the third trimester, but the symptoms almost always go away after delivery.

    Read More: How to Relieve and Manage Heartburn During Pregnancy



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    Pregnancy: 
    Some women experience Acid Reflux for the first time during pregnancy. Acid Reflux, in this case, may be the result of higher hormone levels combined with the increased stomach pressure from the growing fetus. It’s usually worse during the third trimester, but the symptoms almost always go away after delivery.

    Read More: How to Relieve and Manage Heartburn During Pregnancy



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    Pregnancy: 
    Some women experience Acid Reflux for the first time during pregnancy. Acid Reflux, in this case, may be the result of higher hormone levels combined with the increased stomach pressure from the growing fetus. It’s usually worse during the third trimester, but the symptoms almost always go away after delivery.

    Read More: How to Relieve and Manage Heartburn During Pregnancy



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    Pregnancy: 
    Some women experience Acid Reflux for the first time during pregnancy. Acid Reflux, in this case, may be the result of higher hormone levels combined with the increased stomach pressure from the growing fetus. It’s usually worse during the third trimester, but the symptoms almost always go away after delivery.

    Read More: How to Relieve and Manage Heartburn During Pregnancy



  • A Hiatal Hernia:
    A common cause of Acid Reflux disease is a hiatal hernia. A hiatal hernia is a stomach abnormality, which can occur in people of any age.  A hiatal hernia occurs when the upper part of the stomach and the LES pushes up through your diaphragm and into your chest region. The diaphragm separates your stomach from your chest.

    Typically the diaphragm helps keep stomach contents from backing up into your esophagus. If you have a hiatal hernia, the diaphragm will actually push your stomach contents up into your esophagus.Note: Poor posture can cause hiatal hernia like symptoms. 
Healthy Lifestyle

Other Contributing Causes

Without one or more of the main causes none of these will cause a problem on their own.  

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    Smoking: Smoking can contribute to Acid Reflux by:
  • Damaging mucous membranes
  • Impairing muscle reflexes in the throat
  • Irritation and swelling of the LES reducing efficient muscle function
  • Reducing saliva, impairing digestion
  • Nicotine has a relaxing effect on the muscles of the LES
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    Foods and Drinks That Cause Bloating or LES Irritation or Relaxation:  Eating large meals or in particular, foods that can cause bloating can trigger heartburn and other symptoms of Acid Reflux disease. Note: Acidic foods do not cause heartburn. These are some of the foods that cause bloating trigger heartburn:
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    Note: Acidic foods do not cause heartburn. Low stomach acid reduces the efficiency of digestion allowing food to remain in the stomach for an extended period and ferment causing stomach bloating.
  • Alcohol - Alcohol causes the LES to relax and it also contributes to bloating if you drink it with or soon after eating because it slows the digestive process by diluting stomach acid and because alcohol takes priority over the digestion of food. Alcohol mixed with carbonated drinks and the gas released from beer can increase the chances of acid reflux symptoms as well.
  • Carbonated Beverages (regular and diet) - Carbonated drinks can cause bloating because the carbon dioxide trapped in the bubbles creates gas in the stomach. Just to prove this, measure your waist, then drink a can of carbonated soda. Wait an hour and measure your waist again. You’ll notice a 1-2 inch difference. Combined with the caffeine (which relaxes the LES) this added pressure can force stomach contents back up into the esophagus. Add alcohol to the coke and your LES will be even more relaxed. Diet soft drinks are worse than regular - see artificial sweeteners below.
  • Coffee or Tea (regular or decaffeinated) - There have been no studies conducted that prove that caffeine increases the chances of GERD so this may be particular to just certain people. I find that sometimes caffeine bothers me and sometimes I can drink 4 or more coffees with no problems. Keep coffee and tea consumption to less than four cups per day.
  • Artificial Sweeteners - Most artificial sweeteners cannot be digested so they linger in the stomach until they can be excreted into the large intestine; they cause the fermentation of bacteria resulting in the production of gas, bloating the stomach. So diet carbonated drinks (with caffeine) compounds the problem.
  • Dairy Products - If you are lactose intolerant, consuming dairy products will make you feel bloated. This condition is common, especially among people of Asian, African and Southern European descent. The lactose in the dairy product cannot be completely digested and will pass to the colon where gas is produced by the bacteria trying to break it down.
  • High Sodium Foods - Use only the required amount of salt while cooking and don’t add more once it’s on the table. (Better yet replace all table salt with pink Himalayan Sea Salt). Check the sodium content on all processed foods. This includes canned soups and vegetables, bottled salad dressings, condiments, and sauces. Keep your sodium intake below 2,300 mg per day (1,500 mg for all people 50-plus, and for anyone with diabetes or high blood pressure, as well as all African-Americans, who are at high risk for hypertension).
  • Gassy Vegetables - Baked beans, broccoli, Brussels sprouts, cabbage, cauliflower, lentils, Lima beans, onions, and peppers produce gas. Some people are more sensitive to this than others. If you find these vegetables make you bloated, you should avoid eating too much of them or don’t eat them at all.
  • Certain Fruits and Fruit Juices - If you are not able to digest fructose properly, the fruit will cause excess gas and gastric bloating. Choose lower fructose fruits, like sweet melon and apricots, instead of high-fructose fruits like apples, cherries, mangoes, watermelon, and pears. It is also best to eat fruit separately from a meal - either 30 minutes before or at least two hours after. And don’t eat more than one or two pieces per day even low-fructose fruits - a little adds up to a lot.
  • Foods with High Glycemic Index - High glycemic foods take longer to digest. If you find you get bloated after eating potatoes or pasta, substitute them with rice. Rice is the only starch that does not cause gas. Avoid foods made with white flour like white bread, donuts, cakes, and cookies, etc. You will find whole wheat to be better, but it too may cause bloating if eaten in excess.
  • Fatty or fried foods - High-fat foods like burgers and ribs or deep-fried foods like French fries, fried onion rings, fried chicken samosas, and doughnuts can cause bloating because it takes longer for the stomach to break down the fats and digest the food. This allows gas to build up, causing bloating.
  • Foods Containing Tomatoes - such as spaghetti sauce, salsa, or pizza - Foods containing tomatoes irritate the LES.
  • Garlic and Onions - garlic and onions irritate the LES.
  • Mint (Peppermint being the worst) - relaxes the LES.
  • Spicy foods - such as those containing chili or curry - Spicy foods can irritate the esophagus and the LES causing it to become swollen and remain partially open. Limit your intake of black pepper, nutmeg, cloves, chili powder, curry, onions, garlic, mustard, BBQ sauce, horseradish, tomato sauce, and vinegar.
  • Chocolate - The cocoa in chocolate can cause the intestinal cells that relax the LES to release a surge of serotonin. Chocolate also contains caffeine and theobromine, which can increase symptoms.
  • Certain Medications - non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, blood pressure or heart medications such as calcium channel blockers and nitroglycerin, osteoporosis drugs called bisphosphonates, Progestins, such as progesterone, medicines that reduce the amount of saliva you produce, such as antihistamines and antidepressants. Always consult your doctor before altering quantities or stopping any prescribed medications. 

Everyone is Different – Recognize Your Own Triggers

There will be foods or drinks not on these lists that may affect you and no one else. There will be foods and drinks on this list that may never bother you.


I have a big problem with dry roasted peanuts. I love these things, but the powder or dust that they are coated with irritates my esophagus causing my LES to relax or not properly close. If I have a coke and a few handfuls of these dry roasted nuts within a few hours of going to sleep, I can almost guarantee that I will be woken an hour or so into my sleep with severe acid reflux.

 

Keep a Food Diary

Write down everything you eat and make a note of how you feel after. This will allow you to determine which foods cause you to have acid reflux symptoms. Include the time you ate, approximately how much you ate, and the time the symptom occurred. 

Other Contributing Factors

While these factors do not cause acid reflux they do contribute heavily if you already have acid reflux or GERD: 

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    Being overweight or obese
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    Eating a heavy meal and then lying on your back or bending over at the waist
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    Eating within an hour or two of bedtime or lying down right after eating a large meal
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    Taking aspirin or ibuprofen, some muscle relaxers, or certain blood pressure medications

How Is Acid Reflux Disease Diagnosed?

If you have Acid Reflux symptoms more than twice per week, it is time to visit your doctor. Heartburn is the key indicator in diagnosing Acid Reflux disease, especially if lifestyle changes, antacids, or acid-blocking medications help reduce these symptoms.

 

If your symptoms are severe or frequent, your doctor will order tests to confirm a diagnosis and check for other problems. You may need one or more of the following tests: 

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    Barium Swallow (esophagogram): checks for ulcers or a narrowing of the esophagus (esophageal stricture).
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    Esophageal manometry: checks the function of the esophagus and lower esophageal sphincter (LES). It identifies problems with movement and pressure in the esophagus by measuring the strength and muscle coordination of your esophagus when you swallow.
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    pH monitoring: checks for acid in your esophagus.
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    Endoscopy: checks for problems in your esophagus or stomach.
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    A biopsy may be taken during the endoscopy to check samples of tissue under a microscope for infection or abnormalities.

WhaT are the Complications of Acid Reflux?

If left unchecked there are numerous health issues associated with long-term Acid Reflux and GERD.

These may include the following:

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    Esophagitis: The lining of the esophagus may become inflamed resulting in a narrowing of the esophagus making it difficult to swallow.
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    Esophageal Ulcers: The inflamed esophagus may severely erode causing ulcers to form (open sores) if left untreated long enough making it difficult and painful to swallow. People with esophageal ulcers may cough or vomit blood. Tell your doctor immediately if you have such symptoms.
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    Esophageal Strictures: Over a longer period of time the lining of the esophagus may become permanently scarred. As the scar tissue builds up (called strictures), the esophagus will become more and more narrow making harder and harder to swallow food and liquids. Strictures can be treated by dilation or stretching of the esophagus.
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    Barrett’s Esophagus: Stomach acid can change the cell lining of the esophagus increasing the likelihood of cancer – this is rare – only 5% to 10% of Acid Reflux sufferers get Barrett’s Esophagus, and only 1% of those get cancer. If caught early doctors can remove these abnormal cells. The problem is catching it early because symptoms of chest pain or difficulty swallowing don’t appear until the disease reaches a later stage. Ask your doctor about getting screened if you are over 50 years old and have had acid reflux for more than 10 years.
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    Breathing Problems: The aspiration of stomach contents into the lungs can cause hoarseness, a chronic dry cough, asthma or even pneumonia.
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    Damage to Teeth Enamel: Stomach acid wears down tooth enamel weakening teeth and leading to cavities and chipped teeth.
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    Compromised Quality of Life: Many people that have acid reflux report a reduced quality of life due to problems with food, drink, and sleep. Also, social and physical limitations.

Side Effects of Acid Reflux Medication

An estimated 60 million people take Acid Reflux medication daily. That’s based on prescribed medications – there is no estimating how much OTC medications are consumed. It was thought for many years that these medications were relatively safe.


PPI's and H2 Blockers are to Be Taken for Two to Eight Weeks

Acid Reflux medication is usually only meant to be taken for two to eight weeks. This is stated on the packaging. 


When taken for only two to eight weeks they are probably safe, but most patients are on them for the rest of their lives when they never needed to be on them in the first place. They should never be prescribed in most cases.


These Medications Reduce Stomach Acid

There are three types of Acid Reflux medication: Proton Pump Inhibitors (PPI’s), H-2 Blockers, and antacid tablets. They all inhibit or reduce stomach acid. These medications work by suppressing or reducing the production of stomach acid. As stated above, having too much stomach acid is not the cause of Acid Reflux disease.


PPI’s and H-2 Blockers were intended for people suffering from an inflamed esophagus or stomach ulcers by reducing stomach acid for two to eight weeks giving these problems a chance to heal. They were not intended to combat Acid Reflux or be taken long term. See side effects of long term use in the next section.


Insufficient stomach acid is the primary cause, and by taking these medications, stomach acid is reduced even further resulting in many issues. Most of the side effects of these medications are caused by having insufficient stomach acid.

 Some of the side effects of Acid Reflux medication are:

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    Reduction of the natural barrier (hydrochloric acid) against bacteria and pathogens that may be digested with our food. This can leave us more susceptible to infections (C. difficile) and cases of food poisoning (Salmonella)
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    Greater chance of pneumonia
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    Nutritional deficiencies of vitamins, minerals and other nutrients we need from our food because of their effects on digestion. This is caused by the acid neutralizing effects of this medication resulting in poor digestion and therefore poor uptake of nutrients.
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    Reduced bone density making them more susceptible to bone fractures by 35%.
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    Increased risk of chronic kidney disease (20-50%), and heart disease (20%) in some people.
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    Researchers found that regular users of PPI’s had at least 44% increased risk of dementia compared to non-users.
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    Both PPI’s and H-2 blockers may shorten telomeres – discussion of telomeres is too lengthy to discuss here – basically, this is increased oxidative stress i.e you age faster.
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    Researchers calculated that, for every 500 people taking PPIs for a year, there is one extra death that would not have otherwise occurred.

The risks increase the longer these medications are used. Some people are taking them more than once per day increasing the risks even further.


Note: Some of these findings could be because generally, people with Acid Reflux disease are in less than perfect health so these diseases could be pre-existing. To compensate for this, the researchers now compare people on PPI’s to people on H2 Blockers. Over a five-year period, 15 percent of PPI users were diagnosed with chronic kidney disease, versus 11 percent of those on H2-blockers.


WARNING:

Do not stop taking your medication without discussing with your doctor. Quitting these medications cold-turkey cause "acid rebound affect" - this will be the most sever acid reflux you have ever endured.

How to Manage Acid Reflux and GERD 
Naturally Without Medication

You will find that the most effective way you can manage your Acid Reflux symptoms is to avoid eating foods or consuming beverages that trigger the symptoms and to make some changes in your current lifestyle. Getting off the medication and using supplements to increase stomach acid production will resolve your acid reflux issues long term.


I'll repeat this in case you missed it above: Do not stop taking your medication without discussing with your doctor. Quitting these medications cold-turkey cause "Acid Rebound Effect" - this will be the most severe acid reflux you have ever endured.

Implementing any of these small changes could add up to drastic reduction of your acid reflux symptoms. Try implementing one or two of these every few weeks:

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    Avoid foods and drinks that cause bloating. It’s the bloating that causes Acid Reflux, not acidic foods. The added pressure in the stomach forces that acid up into the esophagus through the LES.
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    Eat smaller meal portions, but eat more frequently (every 3-4 hours).
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    Quit smoking or at least reduce the amount you smoke.
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    Elevate your bed. Raise the head of your bed four to six inches by placing blocks under the head of your bed. This slight change of gravity will reduce the likelihood of stomach contents backing up into the esophagus.
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    Sleep on your left side. This may not work for everyone, but I find that sleeping on my left side helps a lot. For anatomical/gravity reasons, when you lie on your left side the opening to the stomach is lower than the esophagus so that your stomach contents are less likely to back up into your throat.
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    Lying on your right side or on your back puts the opening to the stomach at the same level or slightly above the esophagus making it easier for your stomach contents to back up into the esophagus.
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    Don't eat at least 3 to 4 hours before lying down or going to bed. If you must lie down, i.e., bedridden, then lie on your left side and elevate the head of your bed.
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    Don't wear tight clothes or tight belts.
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    If you're overweight or obese, do your best to lose weight with exercise and diet changes.
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    Exercise regularly. I find that if I exercise regularly, this alone reduces my Acid Reflux symptoms.
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    Sit and stand up straight. Bad posture can affect many bodily functions including the incidence of Acid Reflux symptoms.
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    Keep a journal. Write down, or use a smartphone app to record everything you eat/drink, and the time you ingested it. If you get heartburn after, record the time and the severity. There may be other foods or combinations of foods, not on the list that may cause heartburn for you.

    By keeping a food journal, I discovered that eating dry roasted peanuts with a small amount of alcohol within a few hours of going to bed caused Acid Reflux 90% of the time for me. Strangely, more than three drinks did not have this effect.
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    Ask your doctor whether any medication you are taking could be triggering your heartburn or other symptoms of Acid Reflux disease.

Summary

You should seek medical advice if you start having heartburn more than once or twice per week or if the burning sensation gets more severe and you experience other symptoms of Acid Reflux.


If your doctor wants to put you on antacids or proton pump inhibitors, you must question him as to why. In most cases, doctors do not test for low stomach acid which is the primary cause in 99% of people. Here is a link to a self-test you can perform at home. 


In fact, most doctors test for Acid Reflux by prescribing Acid Reflux medications and only when the symptoms continue will they conduct real tests. Just because Acid Reflux medication relieves the Acid Reflux symptoms does not mean it is the best course of action. Acid Reflux is caused by low stomach acid, a weakened lower esophageal sphincter (LES), and an unhealthy lifestyle.


The information presented on this website is not intended as specific medical advice and is not a substitute for professional medical treatment or diagnosis. Please consult your doctor. 

References

"Heartburn? 9 Reasons Not To Ignore Symptoms - CBS News." N.p., n.d. Web. 08 Nov. 2017 https://www.cbsnews.com/pictures/heartburn-9-reasons-not-to-ignore-symptoms/5/


Disclaimer

The information contained here does not constitute medical advice and is not meant to diagnose, treat, prevent, or cure disease. Please contact your doctor. The information provided is for informational purposes only and are solely the views of the author.

Low Stomach Acid is the Main Cause of Heartburn, Acid Reflux, and GERD

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