Heartburn - what can I eat?

Many people know and fear it: a stabbing and biting pain, often paired with stomach pressure and nausea, which spreads from the stomach down the oesophagus.  Heartburn! Some people only suffer from it after heavy and hearty meals, others unfortunately suffer from it particularly at night. But all sufferers have one thing in common: it should stop immediately!

How can I combat it quickly and how can I prevent it in the long term through my diet? Do home remedies help better than pharmaceuticals? Here we have shed some light on the topic for you.

What is heartburn?

Heartburn (pyrosis) is the reflux of gastric juice into the oesophagus. It is not a disease in its own right, but merely a symptom [1]. Pyrosis occurs when gastric acid, which is produced in the cells of the stomach lining, flows back through the mouth of the stomach (cardia) into the oesophagus. This reflux attacks the sensitive mucous membrane of the oesophagus and can cause inflammation of the oesophagus (oesophagitis). Even without oesophagitis, the increased acidity is mainly noticeable through pain behind the breastbone. Unlike the cells of the gastric mucosa, the oesophageal mucosa is not equipped with a protective film against the aggressive digestive juice. It is therefore directly exposed to the aggressive effect of hydrochloric acid from the stomach.

What does reflux mean?

One cause of heartburn (pyrosis) can be so-called reflux disease (GERD = gastroesophageal reflux disease) [1]. Here, reflux refers to the backflow of food from the stomach into the oesophagus. The problem is said to be a poorly closing ring muscle located at the transition from the oesophagus to the stomach entrance. As the oesophageal mucosa does not have a protective layer like the stomach, it can become inflamed with frequent heartburn and reflux oesophagitis can develop.

Why is stomach acid so important?

Stomach acid is an essential component of our immune system and our digestion. It destroys harmful bacteria and parasites that arrive with food. It also ensures that the chyme is processed and prepares the digestion of proteins. This allows digestive enzymes to process the food better and nutrients and vital substances to be optimally absorbed. Some digestive enzymes are only activated by stomach acid, such as the protein-digesting pepsin.

But how is it possible that the stomach does not digest itself? The gastric mucosal cells also produce sodium hydrogen carbonate as an antagonist to the aggressive stomach acid. This is an alkaline substance that protects the stomach lining from burns caused by the strong stomach acid. Some of this sodium bicarbonate also enters our tissues and organs via the bloodstream to act as a buffer substance to neutralise acids produced during metabolic processes in the cells.

We also have an exciting report on the acid-base balance [find out more here], which can help to get rid of heartburn in the long term.

What causes heartburn?

It is usually caused by an unhealthy lifestyle and diet [2]:

Hazardous eating and stress, inadequate chewing, meals that are high in sugar or fat and too spicy, industrially processed foods, incorrectly composed meals or chronic acidification of the body due to an unhealthy diet and lifestyle.

In addition to the possible risk factors of obesity [1] and genetics, there are numerous other causes that can favour heartburn and exacerbate symptoms. Medications such as painkillers, some antibiotics or hormones can cause excess stomach acid to flow back into the stomach. In addition, the oesophageal mucosa in cancer patients can be irritated by chemotherapy or radiotherapy and in some cases the tumour itself can also increase pyrosis, e.g. by pressing on the stomach and oesophagus. An infection with the bacterium Helicobacter pylori can also be a cause.

When is the level of stomach acid at its highest?

The digestive juice is produced both between meals and during the night-time rest period. The intensity is at its highest around midnight and then decreases significantly until the early morning.

Why does heartburn often occur in the evening?

Sufferers often complain of severe symptoms at night. This is often due to the horizontal position in bed, i.e. simply the change in gravity. Excess acid or undigested food from a late or very rich meal can flow more easily into the oesophagus. If the closing mechanism is impaired, this condition can occur more frequently.

It is also possible that the reflux of stomach contents only occurs during sleep. This is often noticeable the next morning as a burning sensation in the throat, a mucousy throat or a clogged voice, as the acid in the gastric juice also attacks the mucous membrane in the throat. In this case, we also speak of silent reflux, which occurs without the actual heartburn.

For relief during sleep or while lying down, you can elevate your upper body slightly [3] so that the stomach and oesophagus are no longer at the same level and acidic gastric juice can flow out due to gravity. Another option is to lie on your left side. Due to the curved shape of the stomach, it is now below the oesophagus and reflux into it can be prevented.

It is recommended that you pay particular attention to your diet in the evening, avoid sweets and eat your last meal three to four hours before going to bed [2]. A short walk after dinner helps with digestion through exercise and can also strengthen the muscle at the end of the oesophagus.

What are the consequences of chronic heartburn?

If the symptoms recur regularly or perhaps even frequently, more than twice a week, the oesophagus can be damaged. The consequences can be pain, bleeding and narrowing with difficulty swallowing, in addition to the negative impact on quality of life [1]. Therefore, please take good care of your diet, drink plenty of water and strive for a stress-free lifestyle.

What can be done against excess stomach acid?

The doctor often prescribes medication, such as acid blockers (antacids) or proton pump inhibitors, for the aforementioned symptoms. Although these can alleviate the symptoms, they can also have side effects [2] [5] [6] [7].

If you have frequent symptoms, you should always consult a doctor to rule out diseases of the gastrointestinal tract!

If you are prone to symptoms, you should adjust your diet and generally favour a low-fat and high-protein diet without hot spices. Eating several small meals instead of two large ones is also easier on the stomach. A balanced, plant-based and predominantly alkaline diet can generally reduce excessive acidic gastric juices. You should avoid stress, alcohol, coffee and nicotine [2].
These foods are generally not harmful:
Camomile tea, fennel tea, potatoes, wholemeal pasta and rice, lean meat, low-acid vegetables (courgettes, pumpkin, carrots, parsnips, fennel, asparagus, spinach, swedes, broccoli and cauliflower), low-acid fruit (bananas, grapes, mango, apricots, pears, fresh strawberries, papaya, plums, peaches, melon, pears and the apple varieties Jonagold, Gala, Cox and Golden Delicious), nuts and seeds, fish and lean meat.

What helps quickly against heartburn?

Try some simple home remedies:

Soda (baking soda) dissolved in a glass of water
Healing clay stirred into water
Bananas (their potassium content has an alkalising effect and thus raises the pH value slightly)
Sango sea coral consists mainly of calcium and magnesium carbonate (alkaline compounds), which can provide relief by binding excessive stomach acid.
Flaxseed soaked in water
Slowly chewed peeled almonds are a very popular home remedy for hyperacidity

Which foods should you avoid if you suffer from heartburn?

When it comes to your diet, you should carefully approach each food individually and pay attention to your body's reaction. The following products often put additional strain on the stomach in this situation:
Very fresh bread (especially fresh sourdough bread), fatty baked goods (e.g. buttercream cake or pasta baked in fat), fatty foods (including chips), acidic fruit (pineapple, grapefruit, kiwi, mandarin, nectarine, orange, grapefruit, sour cherry, lemon), fatty meat products (e.g. meat loaf, salami, sour cherry), and other fatty foods. meat products (e.g. meat loaf, salami, mortadella, bacon, breaded and deep-fried meat, bratwurst and bockwurst), vegetables that are difficult to digest (e.g. onions, garlic, cabbage, leeks, mushrooms, red and sauerkraut), eggs, hot spices, cheese from 45% fat in dry matter, Alcohol, fruit juices, cocoa, chocolate, carbonated drinks, very hot or cold drinks in general, fruit and peppermint tea, pickled vegetables, ready meals such as pizza and white flour products. Nicotine puts a strain on the body in general, but it can particularly cause the stomach closure muscle to slacken, which in turn allows the acid to flow upwards more easily.

Does milk help against heartburn?

Milk is often used as a remedy for pyrosis. However, this home remedy is just as often controversial [8] as it is recommended.

We summarise the pros and cons here:

Pro milk and dairy products
Many sufferers prefer milk or dairy products and feel a cooling relief.
On the one hand, this could be a placebo effect due to the cooling effect, on the other hand, it could possibly be due to the very high protein content in milk, which can neutralise stomach acid. Milk provides about 8 grams of protein per 1 cup (245 ml). A study of 217 people with pyrosis also found that those who consumed more protein had fewer pyrosis symptoms [2]. Scientists believe that the more protein you consume, the higher the concentration of gastrin in your blood. This peptide hormone stimulates the smooth muscles of the oesophageal sphincter, which then closes better [3]. Milk may therefore be a natural remedy for pyrosis.

Contra milk and dairy products
Scientists believe that milk can even increase pyrosis and explain this theory as follows:

Milk has a slightly acidic pH value of 4.5. The neutralisation of stomach acid with a slightly acidic solution cannot work in this way.
Calcium only acts in the form of a base in pyrosis, i.e. only as calcium carbonate (CaCO3) and not in its pure form (Ca) as in milk. Calcium carbonate reacts with stomach acid, which is neutralised in the process and causes the pH value to rise. This can quickly alleviate the symptoms. Calcium carbonate is therefore often used as an antacid due to its acid-neutralising effect.
A glass (245 ml) of whole milk contains approx. 8 grams of fat. Studies show that fatty foods are a common trigger for pyrosis [2]. High-fat foods relax the muscles of the lower oesophageal sphincter and thus facilitate the reflux of stomach contents [3]. As fats take longer to digest than proteins and carbohydrates, they also delay gastric emptying. This means that the stomach empties its contents more slowly - a problem that is already common in people with pyrosis [4].

Why does heartburn occur with a lack of stomach acid?

Are you already paying close attention to your diet and still experiencing symptoms? Do you avoid foods that could provoke hyperacidity, drink little coffee and alcohol, and favour mild fruit and meat that has not been deep-fried or heavily seasoned? Sometimes it's not just the food you eat. A lack of stomach acid can also lead to pyrosis despite an adapted diet!
A stomach with low acidity has to work particularly hard to mix the chyme with the small amount of acid present. This takes time and strong contractions. In addition to these obstacles, the chyme remains in the stomach for a long time, which promotes fermentation processes. The stomach now tries to mix the chyme with the small amount of stomach acid using strong muscle contractions. This can result in parts of the chyme being pushed into the oesophagus and causing a burning sensation.

Do you already know our other reports on the topic of hyperacidity?

Here you will find a small selection:

Sources

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497367/

[2] https://pubmed.ncbi.nlm.nih.gov/28521699/

[3] https://pubmed.ncbi.nlm.nih.gov/16682569/

[4] https://pubmed.ncbi.nlm.nih.gov/2650735/

[5] https://pubmed.ncbi.nlm.nih.gov/29205415/

[6] https://pubmed.ncbi.nlm.nih.gov/26657899/

[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4816248/

[8] https://pubmed.ncbi.nlm.nih.gov/35294608/

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