Originating from the mid-13th century as a term referring to feelings of lust, the word heartburn, while still referring to an undeniable and powerful feeling, is hardly that warm inner emotion people yearn for from the days of yore. Rather, heartburn now more commonly refers to the sensation of burning in the chest that often, but not always, stems from gastrointestinal (GI) issues.
As the saying goes, the way to one’s heart is through his/her stomach… although acid is not typically included in those directions. As we’ll see, heartburn is a symptom not to be ignored and can signify various issues that extend beyond just the GI tract. According to epidemiology research, heartburn is exceedingly common with over 50% of people reporting the symptom (1). It has been associated with various organ systems including the GI tract, the heart, and even emotional/psychological distress.
Gastrointestinal Tract: System function
The most common and most well-known issues associated with heartburn fall into the category of GI issues. In fact, to many, the symptom of heartburn is synonymous with its most commonly associated diagnosis – acid reflux, or Gastro-Esophageal Reflux Disease (GERD).
GERD is a disease whereby acid made in the stomach to help digest food becomes your enemy. The stomach, unlike other parts of your GI tract, is made to handle these highly acidic secretions. For certain lucky people, this acid ascends upward into the esophagus – the muscular tube connecting the mouth to the stomach – which is ill-prepared to deal with such digestive chemicals.
As you could imagine from your school-age science experiments, acid is not gentle, and dealing with acid reflux is not always an easy task. When it enters the lower part of the esophagus, which sits in your chest directly behind your heart, it can cause symptoms like irritation, inflammation, and can even result in changes to occur over time to the cells lining the esophagus, called Barrett’s Esophagus that increase the risk of developing cancer in about 5-15% of people (2). Although rare in and of itself, GERD is the biggest risk factor for developing esophageal cancer.
How to manage GERD and ease acid reflux naturally
Since this form of heartburn is associated with increased acid production that refluxes into the esophagus, there are several ways to go about trying to improve this condition and improve your gut health.
First and foremost is to try to control and/or eliminate the risk factors as much as possible. Some of the most important risk factors for GERD are obesity, smoking, diet, and non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen and aspirin) (3).
Obesity, especially in the abdomen, is thought to increase the pressure on the stomach and delay the emptying of acid out of the stomach, which both can allow it to go in the reverse direction. As for smoking, in case you needed one more reason to stop, here it is.
Diet is also an important contributor and avoiding certain foods that increase acidic conditions in the stomach can make a big difference in these symptoms. The usual foods to avoid to try to help GERD and heartburn are caffeinated beverages (including your beloved coffee, unfortunately), citrus fruits, tomatoes, chocolate, spicy foods, and mint. It’s also recommended to sit upright instead of reclining or lying down after meals since gravity can be your friend here. You may ask yourself what’s left to eat that tastes good, but I’m sure you’ll find that food tastes better when it doesn’t literally cause you pain.
If you do take medications that fall into the category of NSAIDs and have heartburn, there may be alternatives you can use that help. If these lifestyle modifications don’t do the trick, there are effective medications you can try that target various parts of the acid production process in order to help prevent you from feeling the pain and discomfort of GERD, acid reflux and stomach pain.
Causes of heartburn
One of the lesser known and yet perhaps more important to recognize causes of heartburn can actually be your heart. While chest pain is the most common symptom of a heart attack, did you know that feelings of indigestion are close behind? In particular, women and patients with diabetes are more likely to have what are referred to as atypical symptoms, or symptoms other than chest pain.
In one study, 56-67% of women and just about half of men reported GI symptoms of indigestion prior to being diagnosed with a heart attack (4). In fact, indigestion was blamed more commonly than a heart problem for people in this study experiencing symptoms with many people stating they presented for medical care only because the discomfort was persistent.
Some key points that might indicate your heartburn is from a blockage in your heart rather than acid creeping up into your esophagus could be related to timing, other risk factors for heart disease, and any associated symptoms you get. Heartburn that comes on while you’re exerting yourself and goes away at rest rather than after meals might be a sign of a heart problem.
Other symptoms to pay attention to and certainly not to brush off are chest pain or pressure, dizziness, nausea, vomiting, shortness of breath, and palpitations. It’s also important to know your risk of heart disease. If you have high blood pressure, high cholesterol, are overweight, smoke, and have a strong family history of heart disease among other things, you should also probably take this symptom to heart… literally.
How your emotions and stress affect your GI system
Ever feel stressed out to the point where you feel like there’s a knot in your stomach? Or maybe like your stomach is in your throat? Although all the mysteries are not yet explained, the GI system has long been associated with people’s emotional/psychological states. Studies have shown that stress and fatigue are actually associated with GERD. Furthermore, the same study showed that the higher someone’s stress level actually is, the worse their GERD symptoms were (5). While there may be other factors at play and this certainly doesn’t establish that one causes the other, it does raise the point that the mind and the body are intertwined in times of health and disease. Researchers have shown that increased stress and anxiety can increase someone’s perception of their symptoms, in this case, worsening their heartburn, even if it did not actually increase the amount of acid production (6). They then showed that people in the study who underwent a relaxation intervention improved their symptoms compared to those who didn’t.
All in all, although common and often treatable, heartburn is one of those things where you don’t know until you know. The most important thing is to talk to your doctor about what your symptoms could be telling you. Together, you can decide if there is any other testing needed in order to figure out an action plan. While the way to your heart may be through your stomach, the way to deal with heartburn may be a heart-to-heart with your doctor.
1. E Cohen, R Bolus, D Khanna, RD Hays, L Chang, GY Melmed, P Khanna, and B Spiegel. GERD Symptoms in the General Population: Prevalence and Severity Versus Care-Seeking Patients. Dig Dis Sci. 2014 Oct; 59 (10): 2488-2496.
2. TM Runge, JA Abrams, and NJ Shaheen. Epidemiology of Barrett’s Esophagus and Esophageal Adenocarcinoma. Gastroenterol Clin North Am. 2015 Jun; 44 (2): 203-231.
3. A Argyrou, E Legaki, C Koutserimpas, M Gazouli, I Papaconstantinou, G Gkiokas, and G Karamanolis. Risk Factors for Gastroesophageal Reflux Disease and Analysis of Genetic Contributors. World J Clin Cases. 2018 Aug 16; 6 (8): 176-182.
4. JH Lichtman, EC Leifheit, B Safdar, H Bao, HM Krumholz, NPLorenze, M Daneshvar, JA Spertus, and G D’Onofrio. Sex Differencs in the Presentation and Perception of Symptoms Among Young Patients with Myocardial Infarction: Evidence from the VIRGO Study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients). Circulation. 20 Feb 2018; 137 (8): 781-790.
5. EM Song, H-K Jung, and JM Jung. The Association Between Reflux Esophagitis and Psychological Stress. Dig Dis Sci. 2013 Feb; 58 (2): 471-477.
6. J McDonald-Haile, LA Bradley, MA Bailey, CA Schan, and JE Richter. Relaxation Training Reduces Symptom Reports and Acid Exposure in Patients with Gastroesophageal Reflux Disease. Gastroenterology. 1994 Jul; 107 (1): 61-69.