The human digestive system, or gastrointestinal tract, is responsible for turning food into usable energy and nutrients while expelling unused waste. This starts from the mouth and ends at the anus, comprising everything in between (the esophagus, stomach, small intestine, large intestine, and rectum). The average human digestive system measures nine meters (about 30 feet) in its entirety.1
Such a vast system with so many varying parts is bound to deal with some problems, including heartburn and acid reflux. Heartburn describes irritation in your esophagus caused by stomach acids. Despite the name, heartburn has nothing to do with your heart, though it does cause pain and discomfort in your upper abdomen and below your breastbone.2 Acid reflux is the condition wherein stomach acids flow back up into the esophagus, causing the heartburn.3
Left untreated, constant reflux can lead to a condition called Barrett’s esophagus in which exposure of the esophagus to stomach acid can lead to cancerous changes of the esophageal tissue.
While consistent heartburn and acid reflux may potentially result in serious complications, more often than not, they will only cause pain and discomfort, which can be enough to ruin your day. Many people instinctively reach for acid-reducers and antacids when they get indigestion but before trying any supplements or over-the-counter products for heartburn, it is recommended that you change your diet to avoid flare-ups.
Lifestyle Changes to Reduce Your Heartburn and Acid Reflux
Lifestyle is just as important as additions to your diet. Some simple changes you can make that can have significant impacts include:
1. Avoid trigger foods
Different foods affect everyone differently, so consider keeping a food diary to determine foods that specifically cause acid reflux or heartburns. Some common trigger foods for heartburn include:
- Carbonated drinks
- Acidic foods
- Spicy foods
- High-fat foods10
2. Stop smoking
Nicotine is known to weaken the lower esophageal sphincter, a muscle that controls the opening between your stomach and esophagus. Weakening this muscle makes it easier for stomach acids to flow back up the esophagus. Smoking cessation is a good idea in general if you want to support better health.10
3. Eat smaller meals
Larger meals fill the stomach, putting excess pressure on your lower esophageal sphincter, which increases the chances of acid reflux and heartburn.10 Instead of eating 3 large meals per day we recommend eating 4-6 meals throughout the day.
4. Avoid sleeping or lying down after eating
Gravity normally keeps your food and stomach acids down, preventing acid reflux from developing. Lying takes gravity out of the equation, allowing stomach acids to press against the lower esophageal sphincter. Try to give yourself at least two to three hours after a meal before lying down.10
Exercise and moving around helps aid your stomach with mechanical digestion. It also helps promote blood flow and peristalsis, the rhythmic contractions that move the contents of the gut along.
6. Eat slowly
Eating slowly and chewing more helps your body mechanically break down food so the stomach doesn't have to work as hard to digest food. Eating slowly also helps your body recognize that you are full so you may end up eating less, helping you to lose weight.
7. Go for a walk after eating
Going for a walk after eating will help you avoid laying down and help support mechanical digestion.
Acid Reflux Medications and Over The Counter Treatments
If lifestyle and dietary changes have not helped your heartburn most people reach for many of the available over-the-counter and pharmaceutical drugs. Let’s take a closer look at these drugs and treatment strategies and compare them with natural remedies for fighting heartburn and acid reflux.
Gastric acid production is highly regulated in the body and there are multiple ways to reduce stomach acid. Some products directly target the acid. Over-the-counter antacids like Tums or Alka-Seltzer are made up of chemicals called bases. An example of a base reacting with an acid to neutralize the acid is pouring baking soda into vinegar. What results is a chemical reaction that renders the solution more neutral instead of acidic. In fact, this reaction powers many elementary school projects on volcanoes because a lot of bubbles are produced when an acid and a base react.
Other over-the-counter and prescription drugs work further upstream and interact with the signals going to parietal cells of the stomach which actually produce the acid. The first generation acid blockers are actually anti-histamines that block histamine from signaling to the parietal cell to increase in acid production. Common names for these drugs are Zantac (ranitidine), Pepcid (famotidine), and Tagamet (cimetidine). These drugs are affected by a reaction called tachyphylaxis, which is when the body overcomes the effects of the drug and more is required to achieve the same effect.
Proton Pump Inhibitors (PPI)
Second generation acid blockers do not have the same reaction. These drugs are called proton pump inhibitors and directly inhibit the pump that pumps acid into the stomach. They go by names such as Prilosec (omeprazole), Prevacid (lansoprazole), Nexium (esomeprazole), Protonix (pantoprazole), and others.
How PPIs Cause Indigestion
Using PPIs changes the digestive process. While acid itself helps break up food into smaller particles, the majority of the work is done by digestive enzymes. Inside the stomach, digestive enzymes are released in inactive forms called zymogens. These zymogens are then activated by the acidic, low pH environment inside the stomach. When you take PPIs, the stomach becomes less acidic and you lose the activity of digestive enzymes.
Specifically, to prevent autodigestion (digestion of oneself) parietal cells of the stomach release the inactive zymogen pepsinogen. Pepsinogen is then activated into pepsin in the low pH (acidic) conditions of the stomach. Studies have shown that people taking PPIs have higher levels of pepsinogen in their blood meaning the pepsinogen is not being activated. Without digestive enzymes a major part of digestion is lost which can itself promote more reflux as food remains undigested in the stomach longer.
Risks and Side Effects of PPIs
PPIs are much more powerful than acid reducers. Your body is not able to overcome the effects of PPIs like it can with acid reducers. PPIs induce a state of achlorhydria or hypochlorhydria or low acid levels. Achlorhydria can result in complications such as bacterial overgrowth (increased chances of C diff and pneumonia due to decreased killing of pathogens with stomach acid), intestinal metaplasia, and hip fracture. It can also cause abdominal discomfort, early satiety, weight loss, reflux symptoms, and abdominal bloating. One other effect of achlorhydria is that it makes iron much more difficult to absorb which can lead to iron-deficiency anemia.
Many people mistake indigestion for heartburn and take an acid reducer when their problem is poor digestion, not too much acid production. PPIs are very powerful drugs and PPI-induced achlorhydria has been shown to increase the time that food remains in the stomach (gastric emptying time).
In summary, PPIs reduce the body’s ability to digest food in the following manners:
- Reduced acid production
- Reduced activation of digestive enzymes that rely on an acidic stomach to be activated
- Increased gastric emptying time
That said, PPIs do play a vital role in treating excessive acid production in cases such as gastrinoma or Zollinger-Ellison Syndrome. However, the inclination is towards overuse of PPIs as a cure-all for all digestive ailments. The first step in treating indigestion and promoting digestion should be lifestyle adjustments. If that fails, medical treatment may be necessary. A proper workup will help determine if your problem is too much acid or too little acid. If you prefer natural remedies for acid reflux and indigestion some of the following may help.
Natural Remedies for Indigestion, Achlorhydria, Heartburn and Acid Reflux
8. Digestive Enzymes
Digestive enzymes are the powerhouses that break up food on the molecular level, allowing your body to absorb and utilize the nutrients locked within your food. Common digestive enzymes include:
- Lipase for breaking down fats
- Proteases and peptidases for breaking down proteins
- Amylase for breaking down carbohydrates12
As we have discussed earlier, the lack of an acidic environment in the stomach impairs activation of digestive enzymes in the stomach. Some digestive enzyme supplements, such as DrFormulas® Digestive Enzymes, are already active and do not require an acidic environment to start working.
9. Apple Cider Vinegar
In some individuals, acid reflux may be a sign of not enough stomach acid. Vinegar, also known as acetic acid, can help aid digestion by helping to promote a more acidic environment in the stomach. Apple cider vinegar is made from apples and has a pleasant apple taste. Bacteria and yeast are added to crushed apples, allowing for fermentation. Given enough time, the liquid turns into vinegar. Apple cider vinegar can introduce more acid into the digestive tract, which may help to balance your stomach’s pH. The acetic acid in apple cider vinegar may also act as an effective anti-microbial agent to combat bacteria and other foreign bodies.
Apple cider vinegar is generally considered safe to consume on its own in smaller amounts when diluted with water. However, taking the liquid form in larger amounts can increase tooth decay and throat irritation, so we recommend taking apple cider vinegar in pill or capsule form.11
Probiotics are good bacteria that make up the gut. Probiotics increase the serotonin that is produced in the gut. By increasing levels of serotonin, probiotics facilitate contractions of the gut and the movement of food through the digestive system.
11. Betaine Hydrochloride
Gastric acid is made up of hydrochloric acid. Betaine hydrochloride supplements are used to supplement the amount of hydrochloric acid in your stomach and are used to treat achlorhydria or low stomach acid. One study found that betaine hydrochloride rapidly reversed the low acidity in persons taking a proton pump inhibitor. Taking betaine HCl will help your digestive enzymes be more active during the digestive process.
12. Vitamin C
Vitamin C, also known as ascorbic acid, can also aid digestion by promoting a more acidic environment in the stomach.
13. Baking Soda
A natural way to neutralize acid is by using baking soda. The key ingredient in baking soda is sodium bicarbonate, the same compound that is naturally produced in your to neutralize stomach acid.4
It’s important to note that this using a base is meant to be a temporary remedy. For some, the sudden decrease in stomach acids caused by baking soda can result in an acid rebound, leading to your acid reflux symptoms returning even worse than before.
14. Fennel Seeds
Fennel is a perennial herb indigenous to Europe and the Mediterranean. It has commonly been used for centuries to support digestive health, including indigestion, heartburn, and acid reflux. The seeds of the plant contain a variety of active constituents, including limonene, fenchone, and anethole.
When ingested, fennel has been found to sooth the digestive tract, reduce stomach acids, and calm inflammation. Chewing fennel seeds after a meal can help to prevent heartburn and aid in overall digestion. Fennel is also available as a tincture or liquid extract.7
Ginger root is rich in antioxidants and a variety of components that can support your health. Phenolic compounds in ginger can help to relieve irritation in your gastrointestinal tract and reduce gastric cramps, both of which ultimately reduce the potential for stomach acids to flow into your esophagus.8 Research also suggests that ginger may effectively reduce inflammation in the digestive tract.9
Ginger can be used in its raw form and incorporated into various dishes, but it is also available in powders, capsules, and teas. If you do use ginger, keep moderation in mind. Ginger is a spice, meaning that taking too much of it can potentially aggravate stomach acids and result in more heartburn.
Wrapping Up Fighting Heartburn and Acid Reflux
In conclusion, heartburn is one symptom of indigestion. Heartburn is also a symptom of too much acid production. Recurring heartburn is bad because constantly exposing the esophagus to stomach contents can lead to cancerous changes in your esophagus. Acid reflux may be remedied with simple lifestyle changes but if that does not work it is important to figure out what is causing your heartburn, either too much or too little acid, and to treat it accordingly. Improper use of PPIs can worsen digestion and make indigestion worse.
If you want to support better digestion, we recommend DrFormulas™ Digestive Enzymes, which offers a combination of 18 different natural digestive enzymes to support normal digestion.