The real story behind heartburn

The Prilosec works…sort of. Except you find that you can’t go a day without taking it unless you want to experience intense rebound heartburn, worse than before you were taking the medication.

What’s the solution? Do you stay on the medication for the rest of your life?

Acid reflux and its chronic condition, gastroesophageal reflux disease (usually shortened to GERD), are so common it’s estimated that 20 to 30 percent of people experience it weekly and about 7 million people in the United States experience it chronically.

The conventional treatment is to prescribe a proton pump inhibitor (PPI) such as omeprazole, which shuts down the production of stomach acid. The conventional assumption is that your stomach is making too much acid, causing heartburn, so by blocking its production heartburn is prevented. Makes sense, right?

But what if I told you that heartburn is rarely, if at all, caused by too much stomach acid?

In fact, too little stomach acid is most often the cause. It’s true!

You see, your stomach is sandwiched between two sphincters: the lower esophageal sphincter and the pyloric sphincter.

These sphincters act as doorways. The lower esophageal sphincter keeps food and gastric juices in your stomach, while the pyloric sphincter allows food to enter your small intestine. When your body functions optimally, the lower esophageal sphincter tightly closes the stomach off to prevent stomach acid from refluxing up into your esophagus, thereby preventing heartburn.

So what triggers the lower esophageal sphincter to close, then? Answer: Stomach acid!

The lower esophageal sphincter is triggered to close when the contents of your stomach reach an adequate level of acidity. If you don’t have enough stomach acid then the lower esophageal sphincter remains open and what little acid you have is allowed to reflux up into your esophagus. This is why PPIs only mask the cause of heartburn and can make it worse in the long run.

You don’t need less stomach acid, you need more!

The reasons your body might make too little stomach acid are varied: too much stress, a failure to thoroughly chew food, too many fluids during meals, and not enough protein in your system to make stomach acid with are just a few. And there are other reasons for the lower esophageal sphincter to not function properly, too, such as increased weight putting pressure on the lower esophageal sphincter, surgical trauma, and, yes, eating the aforementioned foods can relax the lower esophageal sphincter, although those foods shouldn’t be a problem when you have enough acid to begin with.

Rarely do stomachs actually create too much acid. This is usually due to inflammation of the stomach lining (known as gastritis), which can often be corrected with appropriate dietary changes and a short course of herbal treatment. A PPI can also be used, albeit briefly, while the stomach is healing from gastritis. And truth be told, the FDA only approved omeprazole to be used for up six weeks, and only for the intention of protecting the esophagus during GERD -- not as a long-term treatment for heartburn or GERD itself. The biggest issue with taking omeprazole or other PPIs long term is that we actually need stomach acid to trigger the enzymes that break down our foods. So, without adequate stomach acid, we won’t be able to have proper absorption of our vitamins and minerals. This is why chronic PPI use can lead to osteoporosis, decreased magnesium absorption, B12 deficiency, and anemia.

The good news is that there are a variety of therapies to help increase stomach acid production, thereby increasing the tone of your lower esophageal sphincter. A thorough history of the heartburn or GERD you experience is required to know which treatment is best, but symptoms can often be managed very quickly and the root cause of your heartburn can be dealt with efficiently. So if you or a loved one have been diagnosed with heartburn or GERD then I encourage you to make an appointment at the Seattle Naturopathy and Acupuncture Center so that the root cause of your condition can be uncovered and your nutritional status can stop being compromised.

DR. TRESSA PINKLETON is a primary care physician who specializes in chronic health conditions, mental wellness, and preventative care. She studied naturopathic medicine at Bastyr University and practices at the Seattle Naturopathy and Acupuncture Center, located on 2705 E. Madison St. You can contact her office for appointments at 206-328-7929 or snabc.com.