Heartburn Not Caused by Stomach Acid

Dr. Kasia Kines, Nutritionist, CEO and founder of EBV Educational Institute
Virtual clinic serving the US and globally
[email protected]

A new study that was just been published online on May 17 in JAMA explains some new information on the cause of heartburn. The study was influenced by a recent animal study suggesting that GERD was caused not by stomach acid but it was immune and inflammatory in nature. I put my notes in [ ] to help you see the relevance of the scientific data.

Aren’t we surprised to hear that heartburn is actually not caused by the excess of stomach acid made by your stomach? If you have worked with me, you are probably grinning. Finally, they are looking in the right direction. What sounds counter-intuitive is actually mostly true – the symptom of heartburn has mostly nothing to do with too much acid (hyper chlorhydia is extremely rare- I have yet to see a patient suffering from it) and has much more to do with the stomach acid being pushed up into your esophagus, where it does not belong or with undiagnosed or untreated hiatal hernia. If I had my way, anti-acids would only be used by prescription and only for 2-6 weeks maximum, and I would phase out their direct-to consumer advertising. In the best interest of people’s health. There is a video presentation blog I created for antacid-resistant GERD that you can enjoy for details. If you have occasional diet and lifestyle induced heartburn, please drink your aloe!  The link will take you to our super star Ultimate Aloe by Nutrametrix, the only one I personally trust.

The Heartburn Study

In the meantime, let’s see what the study actually says. This was a group of patients with reflux esophagitis successfully treated with proton pump inhibitors (PPIs). [What reflux esophagitis means is that the acid from the stomach travels up into the esophagus, as we suppose, which has no protective mechanism against it and becomes inflamed and damaged as a result. PPIs protect the esophageal lining by blocking whatever acid production in the stomach to prevent acid from traveling upstream. This, of course, does nothing to address the reason why the acid lands in the esophagus in the first place, if that is the case.]

Then the group underwent 24-hour esophageal pH and impedance monitoring and esophagoscopy (including confocal laser endomicroscopy [CLE]) with biopsies from noneroded areas of distal esophagus at baseline (taking PPIs) and at 1 week and 2 weeks after stopping the PPI medication. [pH was checked for stomach acid presence I am guessing; it was a great idea for them to actually take biopsies of the esophageal tissue.]

Then they stopped PPIs for two weeks.

They then tested the biopsied tissue for  lymphocytes, eosinophils, and neutrophils. [These are specific cells of your immune system.] They tested “changes in epithelial basal cell and papillary hyperplasia, surface erosions, intercellular space width, endoscopic grade of esophagitis, esophageal acid exposure, and mucosal impedance” [In other words, they did an extremely thorough evaluation of the esophageal changes.]

The main finding was that once PPIs were eliminated and patients experienced symptoms again, what did increase was specific inflammatory T-lymphocyte cells.   “(…) these findings suggest that the pathogenesis of reflux esophagitis may be cytokine-mediated rather than the result of chemical injury.” [Chemical injury indicates the effect of stomach acid; cytokines are inflammatory-modulating chemicals. To give you an example, NFKB is one notorious inflammatory cytokine, and NSAIDs like Tylenol are used to block it…or you can take nettle, turmeric, Omega 3, OPC-3 and such…].

“If the traditional notion were true, that acute GERD is caused by refluxed acid directly inflicting lethal, chemical injury to surface epithelial cells, then basal cell and papillary hyperplasia would have been expected only in areas with surface erosions [that would be due to physical contact with stomach acid], and the infiltrating inflammatory cells would have been granulocytes primarily,” the authors write. The earliest pathology occurred deep in the epithelium, not at the mucosal surface, where stomach acid could not have migrated without impairing the mucosa first [That is the single most important finding of the study].

I am also very glad that the issue of hiatal hernia is mentioned in the study because i find that many patient with heartburn actually suffer from hiatal hernia.

The GERD-is-caused-by-stomach acid paradigm started as early as 1930s, and with 20% of US population now suffering from GERD, it has fed the market of over-the-counter acid-blockers, which now are some of the most commonly used medications. I have seen so much damage done to health with long term indiscriminate use of PPIs. I have also seen patients on this medication daily for even 15 years. If you look at the initial studies, PPIs were designed for acute care of a few weeks only!!!

I will leave you with a loaded question…

Why is it that with so many cases, if we just remove common allergens as ….dairy (that would be my number one culprit for heartburn), many of my patients can alleviate the symptoms of heartburn? Would it have anything to do will allergic reactions (inflammatory) and underlying immune response or overreaction?  And by the way, coming back to aloe vera and heartburn, not only does aloe vera juice coat/repair/heal and feel the gastrointestinal lining including the esophageal one (you just have to sip it slowly for maximum exposure) but it also modulates your immune system (first five-star pointer for me) AND has anti-inflammatory actions (second five star score!!!). How interesting is it? I have been shipping literally with cases of this aloe product to my GI patients her the years because it is so successful. According to the study, we may be looking at allergic/immune and inflammatory reactions to foods and aloe reaping the upper GI yet in new ways: immune modulation and its anti-inflammatory function rather than just on-contact- repair!

No wonder!!!

To your health!

Dr. Kasia Kines, Nutritionist, CEO and founder of EBV Educational Institute
Virtual clinic serving the US and globally
[email protected]