While many people experience heartburn either occasionally or frequently (the name is appropriate as it generally feels literally like a burning sensation behind the breastbone where the heart resides), acid reflux can actually be a relatively complex health concern. This is because acid reflux may be very mild and minor – an inconvenience once in a while after eating spicy foods or some other trigger, it can be a serious disease such as GERD (gastro-esophageal reflux disease) and pave the way for cancerous changes in the esophagus, or it can be completely “silent” with no clear digestive symptoms at all but with potential damage to internal tissues!

The plot thickens too when symptoms of heartburn are treated without deeper investigation as to the root cause. For some people it truly is a case of excessive stomach acid production (hyperchlorhydria) that escapes the upper sphincter of the stomach to cause acid burns on the esophagus. But in other people the feeling of excessive acid in the throat (or the heart) may actually be a symptom of too little stomach acid being produced (hypochlorhydria) or no stomach acid production (achlorhydria)1! It may sound counter-intuitive at first so let’s review the early stages of the digestive process…

Digestion 101

Step 1. The body is hungry and senses that food is near… delicious aromas, the sounds of slicing or sizzling, the visual impact of a well-presented plate. The first stage of digestion takes place in the brain, and the brain sends out signals to prepare the body for ingestion of food2. [Hopefully this happens! One of the problems with fast foods or convenience foods is that this stage may be missed, which in turn can lead to digestive discomfort from an under-prepared digestive tract.]

Step 2. Digestive juices are secreted all along the (long and winding) digestive tract: saliva, stomach acid, bile, and enzyme-rich fluids from the pancreas and small intestine. All serve a role in breaking down the food we eat and supporting the absorption of nutrients into our bodies. The differences between the various fluids being released by the various tissues are compartmentalized along the way thanks to various sphincters.

The stomach is supposed to be a highly acidic environment during digestion (a pH of 2-3 for the science buffs). This low pH helps to sterilize the food by killing off potentially pathogenic bacteria, and supports the digestion of proteins by treating them with such a strong acid that the long, long chains of amino acids that make up a protein unwind, exposing them to the digestive effects of enzymes. The stomach lining is designed to withstand these conditions but the tissues on either side of it (esophagus and small intestine) are not, so sphincters on either side of the stomach tighten up to keep the acids sloshing about inside with the food rather than splashing out. The sphincter between the esophagus and the stomach responds to pH feedback from the stomach cells – when acid is being excreted and the pH inside the stomach is low then that sphincter should be nice and tight, keeping the acidic contents in the stomach and protecting the esophagus. Conversely, when the food has passed through into the small intestine and the stomach isn’t actively digesting, the sphincter can then relax again until the next meal.

So sometimes the feeling of excess acid in the upper GI is because a lack of stomach acid has made it impossible for that upper sphincter to properly close, and what little acid is being added to the stomach contents is able to splash out and cause discomfort! Over the counter or prescription antacids or proton-pump inhibitors (PPIs) may exacerbate this problem in the long run.

Silent acid reflux is one of the top conditions a healthcare professional should consider in the case of a chronic cough. The diagnosis often comes as a surprise to the patient when they have no digestive complaints…and yet it happens.

Acid reflux, heartburn, or GERD may also correlate with appropriate stomach acid production but be a symptom of an underlying condition such as hiatal hernia, or SIBO (small intestine bacterial overgrowth).

Treatment

Until the root cause for heartburn/acid reflux has been determined by a trained medical professional, the goal of treatment becomes symptom management, and that comes down to soothing and healing the poor, inflamed tissue of the esophagus. The class of herbs that are best suited to this job are the “demulcents”. Think of putting aloe on a sunburn – demulcents are herbs that are generally slippery, cooling, and soothing, and can offer great relief to “burnt” internal tissues too.

Licorice (Glycyrrhiza glabra)– ideally as a tea or lozenge is a wonderful demulcent that is also soothing to tissues of the respiratory tract (and therefore may be of benefit in silent as well as painful acid reflux). Tincture form is also effective but better if well diluted so that the alcohol content doesn’t sting! Licorice can raise blood pressure so may not be appropriate for everyone.

Slippery elm (Ulmus fulva)– available as lozenges for both sore throats and heartburn, or as a powder which may be made into a gruel and taken in small amounts throughout the day.

Marshmallow (Filipendula ulmaris) – soft and fluffy as a dried herb, marshmallow tea is excellent as a cold-steeped infusion and sipped.

All of the demulcents may be used throughout the day for comfort but are most effective taken prior to a meal in order to help coat the area and protect the esophagus from the passage of food.

Chaga (Inonotus obliquus) is a phenomenal mushroom for healing external tissues, and our digestive tract is made of external tissues all the way along – our external tissues on the inside of us!

If you suffer from heartburn on a regular basis it is advisable to consult with a medical professional for a thorough investigation of your symptoms and potential underlying causes in order to determine the safest and most effective treatment for your unique case. The goal is optimal health, and heartburn is a symptom that is best nipped in the bud before irreparable damage is done.