Let's talk a little about heartburn because it is amazingly common.
So what's the problem? Think of your stomach as being like a soda bottle, which would make your stomach acid the soda (which actually has about the same level of acidity). That bottle is well designed to deal with the soda in it swishing and swashing the same way your stomach lining has evolved to be very thick so it can handle all the acid.
Occasionally, or frequently, you open the bottle and drop something in so it can start dissolving and moving in to your small intestine. That bottle cap is called the lower esophageal sphincter (LES) and it is an involuntary muscle (so you can't control it) that relaxes and contracts to allow food to come in. But it also is there to keep stomach acid from splashing up into the esophagus BECAUSE the esophagus does not have the same kind of thick walls the stomach does so it is easily damaged.
There are a number of ways that the LES can be interfered with, including:
- You can eat/drink things that relax the LES, meaning it's not as tight of a seal and so acid can splash up. The big ones that do this are alcohol, coffee (with or without caffeine), caffeinated beverages, chocolate, peppermint, garlic, onions. I've often wondered if cold brew coffee has the same effect because it's less acidic but I'm not sure. Tobacco smoke fits in this category as well
- You can slow emptying of food through the stomach. The longer food sits in the stomach, the more acid builds up and if it's not going out one way, it'll go out the other. The main culprits are big meals with fatty foods and fried foods.
- Putting extra acids in your stomach can do this - this means citrus fruits, tomatoes and tomato-based products, carbonated beverages and spicy foods.
- Physics can work against you. If you lay down flat after a big meal, it's easier for stomach acid to move up towards your mouth than down to the intestines.
- Your LES can be distorted so it doesn't work as well. If you are overweight, the extra fat can warp the LES out of position like a door that won't shut. Similarly, if you have a hiatal hernia, it means part of your stomach has been pushed up into the chest cavity and is not in a good position to close. Eating very large meals can do this as well
When you get stomach acid up in your esophagus, that is what's called acid-reflux or gastroesophageal reflux disease (GERD). Now you don't really have any nerves for sensing pain in your GI tract so when you get the acid moving up in your esophagus, a few things can happen
* A burning sensation behind your breastbone called ... Heartburn! Sometimes this can actually be acid damaging the lining of the esophagus (erosive esophagitis), but much more commonly it doesn't cause any damage and people just have pain (non-erosive reflux disease or NERD - I know it's a great acronym)
* An acidic taste in the back of your throat
* Hoarseness from the acid irritating your vocal cords
* A nagging cough from the acid going up high enough that it drops down to irritate the bronchial tubes
* ... Nothing. I told you - there's not really any pain nerves there. Actually, most people who end up with major problems from GERD, never actually have pain from it, which is why it ends up getting so bad.
The bad stuff that can happen from GERD is usually an ulcer (a breakdown in the lining of the stomach that can bleed and potentially go all the way through the stomach - ulcers are painless 75% of the time too) or esophageal cancer (usually preceded by something called Barrett's Esophagus after years of acid irritating the lower esophagus).
And just to touch on ulcers briefly, medications like Advil (ibuprofen), Aleve (naproxen), motrin, mobic, etc. All stop the body from replenishing the protective lining in the stomach. Hence heavy use of those anti-inflammatory medications for long periods of time can lead to a thin lining in the stomach and an ulcer.
The most effective and safest treatment for GERD is to change lifestyle habits mentioned above if you can. I don't have the space and you might not have attention span to let me talk about all the treatments for it so we'll save that for another time.
Here's some more information for you about what heartburn is (a.k.a. gastroesophageal reflux disease) and how you can help treat it and prevent it at home.