What's the difference between acid reflux, heartburn, and GERD? You've probably heard of them all, and I know that I hear from many women feeling miserable after eating.
These three are often used interchangeably, which can be confusing! In this article, I'm going to clear up the confusion and banish the most common myths around these conditions, which might be making you feel worse.
Acid reflux occurs when acid from the stomach flows backward or "refluxes" up into the esophagus.
Normally, the peristalsis that causes your food to go down, and not up, is so strong that even if you stand on your head, it keeps it moving in the right direction down towards the intestines.
When the body needs to quickly get something out, it has a built-in reflux response. For example, vomiting or burping.
The lower end of the esophagus has a sphincter where it meets the stomach that's built like a valve, called the lower esophageal sphincter.
Normally it opens for food and drink to enter, then closes once the contents have been ingested.. It's also the mechanism that controls the reflux response.
When this valve opens when you're not eating, burping, or vomiting, problems can occur.
Food flowing back into the esophagus is troublesome because now it's mixed with hydrochloric acid from the stomach. While the stomach is lined with mucus and epithelial cells to protect if from the acid, the esophagus is not. The tissue surrounding the esophagus is delicate, so when acid reaches this tissue, it burns. This is the feeling we associate with heartburn.
Heartburn is the most common symptom of acid reflux.
The esophagus has acid-sensitive nerve ending to let you know that something isn't right. Please note that acid reflux and heartburn isn't an issue of having too much acid in the stomach, it's actually a problem with the lower esophageal sphincter.
However, not all heartburn is caused by acid reflux.
Heartburn can also be caused by stomach ulcers, which are sores caused by erosion in the lining of the GI tract. Another cause of heartburn is gastroparesis, a condition which prevents the stomach from properly emptying.
Anxiety and stress can also cause the sensation of heartburn. This is called functional heartburn because it's unrelated to stomach acid in the esophagus. Doctors aren't sure what causes functional heartburn, but people do notice that when they're under a lot of stress, they experience it more.
Acid Reflux Can Happen for Five Main Reasons
Reason One: Irritation or Weakening of the Lower Esophageal Sphincter
Certain foods can can weaken or irritate the muscle of the lower esophageal sphincter. If you're experiencing acid reflux, you may want to take a break from the following foods:
Because these foods have a high acid content, they can cause irritation. They decrease the pressure of the sphincter, causing it to relax. This then allows the contents of the stomach to travel in the wrong direction.
Peppermint and spearmint can also cause irritation by directly irritating the tissue of the sphincter causing a burning sensation.
Smoking is another trigger for acid reflux. One more reason to quit if you're a smoker!
Reason Two: Magnesium Deficiency
Magnesium helps to relax the sphincter muscle at the bottom of the stomach so that the food can continue its way down the digestive tract.
When magnesium levels are low, this function is hindered. This is why Milk of Magnesia can be helpful in settling acid reflux. Just remember, stomach acid is good, you just want everything moving in the right direction.
Reason Three: Consuming too much food, too quickly
When there's too much pressure or distention on the stomach, the natural mechanism for relief is to open the lower esophageal sphincter. Too much food or fat pushing on the belly can cause reflux. If you've ever been pregnant you know that you could only eat small meals, and even then you might experience heartburn.
Overeating can also slow down digestion. When digestion is slow, food stays in the stomach for too long often resulting in reflux.
Reason Four: Hiatal Hernia
When an internal organ pushes into a part of the body where it doesn't belong, it's called a hernia.
A hiatal hernia is caused when the stomach pushes into the diaphragm, creating a bulge. Because the alignment of the lower esophageal sphincter with the diaphragm creates the pressure that results in the locking effect, the mis-alignment from the bulge compromises the locking effect. The bulge is also a perfect spot for stomach acid to build, so it can easily be pushed upward with the sphincter compromised.
Hiatal hernias can be caused by constant pressure on the muscles of the stomach. This can happen from excessive coughing or vomiting, or from pushing too hard when trying to have a bowel movement. Pregnancy, obesity, or any other physical stress that puts too much pressure on the stomach can result in a hiatal hernia.
Reason Five: Low Stomach Acid
The biggest myth about acid reflux and heartburn is that they're caused by high stomach acid. Most often this isn't the case. It's more common for acid reflux and heartburn to be caused by low stomach acid.
When stomach acid is low, it can lead to bacteria overgrowth and cause reflux. When bacteria overgrow and populate areas of the digestive tract that they're not supposed to be in, they create gas. Gas puts pressure on the stomach, which lowers the pressure that keeps the lower esophageal sphincter closed. So, if there's an overgrowth of bacteria in the small intestine, as in the case of SIBO, the pressure from the gas they create could cause heartburn.
Also, when stomach acid is low, digestion isn't optimal which can induce heartburn, even as a result of eating foods not on the trigger list. Stomach acid not only helps to digest food, it also triggers the release of other digestive enzymes.
What About GERD?
Gastroesophageal reflux disease or GERD is a result of chronic reflux. Generally chronic means a person has experienced ongoing symptoms more than twice a week.
The most common symptoms of GERD are:
With GERD, the esophagus is inflamed as a result of the damage caused by chronic reflux.
Like with acid reflux, too much stomach acid isn't the problem. In fact, stomach acid declines with age, while the incidence of GERD increases.
To summarize: acid reflux is when stomach acid flows the wrong way, back up the tube from the stomach to the esophagus; heartburn is the painful sensation in the chest that occurs as a result; and GERD is a condition that develops as a result of chronic reflux.
Have you ever experienced heartburn? If so, did you notice something in particular that brought it on? What helped?
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