Who Turned Up the Heat? What Causes Acid Reflux and Heartburn?
The holidays are a time of festiveness, fun, food and family. If you or someone you know has been dealing with acid reflux, then you also know that the holidays can be a bit of a drag.
Here you are at the office party. Your favorite deviled eggs are on the tray, but you walk right by. Chips and salsa? Might be too much tomato. Same goes for Grandma's mostaccioli. And it used to be just Uncle Bob's super-spicy chili that was off limits, but these days it seems like anything - including the eggnog - might have you up all night with that burning, choking feeling in your chest.
Acid reflux, commonly known as heartburn and medically referred to as gastroesophageal reflux disease (GERD) when it becomes frequent or persistent, happens when stomach contents move back up into the esophagus.
It often starts small.
Maybe it happens a few times a year after a big meal. It robs you of sleep, but then it's gone for weeks and you forget about it.
Until it happens again.
Over time, reflux can become more frequent, leaving you worrying about almost everything you eat, buying special pillows to prop yourself up at night, and reaching for antacids or other medications just to get through the evening.
So what causes acid reflux?
That's the question we really need to answer.
Because there isn't one single cause of reflux. Different people can have very different reasons for experiencing the exact same burning sensation.
And if you want to actually get to the bottom of your digestive symptoms, figuring out which factors may be contributing to your reflux is an important place to start.
So What Causes Acid Reflux?
Let's take a look at some of the most common pieces of the puzzle.
1. Your Lower Esophageal Sphincter Isn't Working Properly
At the top of your stomach is a muscular valve called the lower esophageal sphincter, or LES.
Think of it like a doorway between your esophagus and stomach.
When you swallow, the LES relaxes to let food enter your stomach. It should then close again to help keep stomach contents where they belong.
When the LES relaxes too often, doesn't close properly, or doesn't provide an adequate barrier, stomach contents can move back up into the esophagus.
And that's when you can get that familiar burning sensation.
There are several reasons the LES may not function properly, which is why simply treating the burning doesn't necessarily tell you what's causing the reflux.
2. You May Have a Hiatal Hernia
A hiatal hernia is another common contributor to reflux.
Normally, your stomach sits below your diaphragm, and your esophagus passes through a small opening in the diaphragm before reaching your stomach.
With a hiatal hernia, part of the stomach moves upward through that opening.
This can interfere with the normal barrier between the stomach and esophagus and make it easier for stomach contents to move upward.
Not every hiatal hernia causes symptoms, and the severity can vary considerably.
But if you're experiencing persistent reflux - especially if it's worse after meals or when you're lying down - a hiatal hernia may be one piece of the puzzle worth investigating.
3. Your Stomach May Not Be Emptying Properly
Here's a piece of the reflux puzzle that doesn't get nearly as much attention.
Your stomach is supposed to receive your food, mix it with digestive secretions, break it down, and gradually move it into the small intestine.
If the stomach isn't emptying normally, food and gastric contents can remain there longer than they should.
That can contribute to a feeling of fullness, nausea, bloating, and discomfort - and may increase the opportunity for stomach contents to move back upward.
There are many possible reasons for delayed gastric emptying or impaired stomach motility, which is why persistent reflux accompanied by significant digestive symptoms deserves a closer look.
4. Your Meals May Be Making the Problem Worse
Sometimes the simplest explanation is that what you're doing around meals is aggravating the problem.
Large meals can make reflux more likely.
Eating and then lying down shortly afterward can make nighttime symptoms worse.
Certain foods and beverages can also trigger symptoms in some people, including:
High-fat meals
Spicy foods
Chocolate
Coffee and other caffeinated beverages
Alcohol
Mint
Tomatoes and citrus
But here's the important part:
Not everyone reacts to the same foods.
If tomatoes don't bother you, you don't necessarily need to swear off tomatoes forever.
If you consistently get heartburn after a giant plate of greasy food, however, that's useful information.
Instead of making a gigantic list of foods you're "not allowed" to eat, pay attention to your own patterns.
When do your symptoms happen?
What did you eat?
How much did you eat?
How long was it before you went to bed?
Those details can tell you much more than a generic list of reflux-triggering foods.
5. Certain Medications Can Contribute to Reflux
Another piece of the puzzle that is easy to overlook is medication.
Some medications can affect the lower esophageal sphincter, stomach emptying, gastrointestinal motility, or other aspects of digestion.
Depending on the medication, this can include certain sedatives, blood-pressure medications, asthma medications, NSAIDs, and others.
And if you're taking acid-suppressing medication, that is important information too.
Acid-reducing medications can be very effective for managing GERD symptoms and helping an irritated esophagus heal. But if you're continuing to experience reflux despite treatment, it may be worth discussing with your healthcare provider whether something else is contributing to your symptoms.
Never stop a prescribed medication on your own.
Instead, talk with the physician who prescribed it about whether it could be contributing to your symptoms and whether any adjustment is appropriate.
6. Your Digestive Health May Be Part of the Bigger Picture
Sometimes reflux doesn't happen all by itself.
You may also be dealing with:
Bloating
Excessive belching
Nausea
Feeling overly full after eating
Constipation
Diarrhea
Food intolerances
Indigestion
Other changes in digestion
When reflux occurs alongside several other digestive complaints, it can be useful to look beyond the symptom of heartburn itself.
Your digestive tract is a connected system. What is happening in one part of that system can sometimes affect what is happening elsewhere.
That doesn't mean every digestive symptom has the same cause.
It means that the combination of symptoms can provide important clues.
7. Other Stomach or Digestive Conditions May Be Contributing
Reflux symptoms can overlap with symptoms from several other gastrointestinal conditions.
Problems involving the stomach, esophagus, gallbladder, pancreas, or intestines can sometimes produce symptoms that feel similar to - or occur alongside - heartburn.
For example, H. pylori infection can affect the stomach lining and is associated with gastritis and peptic ulcer disease.
That's one reason it's important not to assume that every episode of burning in your chest is simply "too much acid."
Sometimes the symptom you're experiencing is only one piece of a much larger digestive puzzle.
Why Does It Matter What's Causing Your Reflux?
If you're only interested in making the burning stop, an antacid or acid-reducing medication may be enough to provide temporary relief.
And there is absolutely a time and place for appropriate medical treatment.
But if you're experiencing reflux over and over again, it can be helpful to understand why it's happening.
Persistent GERD can irritate and damage the esophagus over time and may lead to complications such as esophagitis, strictures, or Barrett's esophagus.
So if heartburn is becoming a regular part of your life, it's worth paying attention to rather than simply accepting it as something you have to live with.
So How Do You Figure Out What's Causing YOUR Reflux?
This is where things get interesting.
Two people can both say:
"I have terrible heartburn."
But that doesn't mean they have the same problem.
One person may have a hiatal hernia.
Another may have symptoms that are strongly related to meal size and timing.
Someone else may have a medication contributing to the problem.
Another person may have problems with digestion or stomach emptying.
And sometimes there are several contributing factors at the same time.
That's why simply asking:
"What should I take for acid reflux?"
may not be the most useful place to start.
A better question is:
"What's happening in my body that is allowing this reflux to occur?"
What Should You Pay Attention To?
If you're trying to understand your own reflux, start paying attention to patterns.
Ask yourself:
When do my symptoms occur?
Are they worse after large meals?
Are they worse when I lie down?
Do they wake me up at night?
Which foods consistently trigger symptoms?
Do I also have bloating, nausea, belching, constipation, or diarrhea?
Did my symptoms begin after starting a medication?
Have I been taking acid-suppressing medication for a long time?
Have I ever been evaluated for a hiatal hernia or other digestive condition?
These aren't enough to diagnose the cause of your reflux on your own.
But they can provide valuable information when you're trying to figure out what is actually happening.
What About Low Stomach Acid?
You've probably heard the idea that low stomach acid can cause reflux, and there is a reason this idea comes up in conversations about digestive health.
Impaired stomach acid production can affect digestion and nutrient absorption, and changes in the stomach's environment can affect other parts of the digestive tract.
However, reflux should not automatically be blamed on low stomach acid.
The relationship between stomach acid and reflux is more complicated than simply saying:
"You have heartburn, so you must have too much acid."
or
"You have heartburn, so you must have too little acid."
If you're interested in that part of the story, we explore it in much more detail in our article Burning Desire to Get Rid of Acid Reflux? Here's What May Really Be Causing It.
The important takeaway here is simply that the amount of acid in your stomach is only one potential piece of a much larger puzzle.
If you're still wondering why reducing stomach acid doesn't necessarily address the underlying problem, read Burning Desire to Get Rid of Acid Reflux? Here's What May Really Be Causing It.
How We Approach Acid Reflux at Whole Health & Wellness
At Whole Health & Wellness, we don't assume that everyone with heartburn has the same underlying problem.
We want to understand the pattern.
That means looking at your symptoms, health history, eating patterns, medications and supplements, digestive function, and other factors that may be contributing to your symptoms.
Depending on your individual situation, evaluation may include functional laboratory testing, nutritional assessment, and other approaches that help us better understand what's happening.
And when conventional medical evaluation or testing is appropriate, we believe in that too.
Our goal isn't to tell everyone that their reflux is caused by the same thing.
It's to help you understand what may be contributing to your symptoms and what steps make sense for you.
That's a very different approach from simply asking:
"What can I take to make the burning stop?"
You Don't Have to Keep Living With Heartburn
If you're constantly reaching for antacids, waking up at night with reflux, avoiding foods you enjoy, or wondering why your digestive system seems to be working against you, don't just resign yourself to living with it.
There may be more to the story.
The goal isn't simply to make the burning disappear for a few hours.
The goal is to understand why it's happening in the first place.
If you're experiencing frequent or persistent reflux, or symptoms that aren't improving with appropriate treatment, it's worth talking with a healthcare professional.
And if you have difficulty or pain with swallowing, persistent vomiting, unexplained weight loss, vomiting blood, black or bloody stools, or chest pain, seek medical evaluation promptly.
Start Your Personalized Care Plan
If you're ready to better understand what's contributing to your digestive symptoms and take a more complete, natural approach to your health, we're here to help.
About the Author
Dr. Caroline Ricker, DC, DABCI, MTAA, is the founder of Whole Health & Wellness in St. Louis. Her practice combines functional medicine, clinical nutrition, functional laboratory testing, chiropractic care, acupuncture, and other integrative approaches for patients with chronic and recurring health concerns.
Learn more about Dr. Caroline Ricker and Whole Health & Wellness