Heartburn is a very common problem that affects approximately 20% of the general public.
It’s commonly associated with symptoms such as bloating after meals, belching, a burning sensation of the stomach or in the center of the chest, a bitter taste in the mouth and regurgitation of stomach acid.
Most people assume heartburn (otherwise known as GERD or gastroesophageal reflux disease) is a condition of excessive acid production. This is understandable since we use antacids such as Tums, Zantac or Prilosec to decrease acid production and our symptoms seem to improve. But in reality, heartburn is a neurological problem.
Patients with heartburn have excessive stomach acid accumulation, not excessive acid production. Acid accumulates because it is not being emptied fast enough by the stomach. Just as a sink will overfill if the drain doesn’t empty correctly, so will your stomach.
The poor emptying of the stomach is also accompanied by an ineffective valve between the esophagus and the stomach that allows stomach acid to splash back up into the esophagus and results in the burning sensation in the chest, the regurgitation of acid and belching.
Your Intestinal Tract is A One-Way Conveyor Belt
The intestinal tract is in essence a one-way conveyor belt pushing your intestinal contents forwards. Food should pass through the mouth into the esophagus, from the esophagus into the stomach, then through the small and large intestines and finally passed out through the rectum and anus.
If the intestinal conveyor belt slows down at all, we get symptoms such as food sticking in our throat or esophagus, bloating and acid build-up in the stomach, abdominal cramps (such as in Irritable Bowel Syndrome) or constipation.
The slow forward motility of your conveyor belt-like intestinal tract is because your autonomic nervous system is not working correctly.
The Autonomic Nervous System
Briefly, the autonomic nervous system is a portion of your nervous system (brain, spinal cord and nerves) that controls the function of all the organs (heart, blood pressure system, bladder, skin, fat, stomach, intestine, etc.) of your body.
It helps the bladder to empty, helps maintain proper blood flow to the brain, regulates the sweating of our skin, coordinates erection and ejaculation, dilates and constricts your pupils as well as coordinates the muscles and valves that push the contents of our gastrointestinal tract forward.
The autonomic nervous system has three main divisions, sympathetic, parasympathetic and enteric. The sympathetic system is activated in response to stress, exercise, exposure to heat or cold, low blood glucose, and other environmental challenges. This system is critical for maintaining the correct brain blood pressure throughout the day whether we sit, stand or lay down.
For example when standing, a sympathetic autonomic reflex constricts the blood vessels in our legs and abdomen to keep blood from rushing away from our head. The sympathetic system also increases the frequency and strength of heartbeats during exercise and controls sweating and blood flow to the skin to maintain healthy body temperature.
The parasympathetic system is important for digesting and absorbing nutrients, slowing the heart during sleep and emptying the bladder and bowel. In many organs, the effects of the parasympathetic system oppose those of the sympathetic; for example, the sympathetic dilates the pupil in darkness and the parasympathetic constricts the pupil when exposed to bright light.
The enteric system is a network of fibers within the intestinal tract that automatically regulate intestine movement and function without any direct control from the brain. This is unlike the sympathetic and parasympathetic components because these 2 components engage in constant feedback between the various organ of the body and the brain. The enteric system works somewhat on its own without direct control from the brain.
When the autonomic nervous system fails to work properly, a wide variety of symptoms can occur. Patient can feel lightheaded when standing, have frequent urination or urgency, feel tired or fatigued, sweat too much or too little, develop dry eyes or dry mouth, experience constipation as well as bloating after meals and even heartburn.
Dyspepsia, Heart Burn and the Autonomic Nervous System
As we briefly discussed in the first section, heartburn (also known as reflux or GERD, gastroesophageal reflux disease) refers to the symptoms caused by stomach acid splashing backwards up into the esophagus (our swallowing tube). The esophagus is not designed to withstand the powerful acids within the stomach. It’s when these acids squirt back into the esophagus that we experience the pain, belching, chest tightness and the bitter taste in our mouth that we associate with heartburn.
The backwards splash of the acid is the result of 3 events happening simultaneously. The first step is inadequate emptying of the stomach. If the stomach isn’t actively emptying itself into the small intestine, stomach acid will accumulate. When this happens without steps 2 and 3, it’s often referred to as dyspepsia or indigestion. The decrease in stomach muscle contractions that causes the acid retention is often due to poor function of the autonomic system.
The second event is the distension or stretching of the stomach that occurs as a result of a buildup of stomach acids and the addition of food when we eat. This is why heartburn usually occurs after we eat; food stimulates an increase in stomach acid production.
And the third event is the relaxation and opening of the LES (lower esophageal sphincter) valve between the esophagus and the stomach. When the LES valve opens, stomach acid is able squirt backwards from the overfilled stomach into the esophagus.
Steps to Develop Heartburn
Step 1 – Inadequate Stomach Emptying
Step 2 – Stomach Distention or Stretching
Step 3 – LES Relaxation and Opening
Without the abnormal opening of the LES valve, heartburn would not occur. The same abnormal process that results in heartburn occurs in several different types of animals including humans.
The Myths of Heartburn
There are a lot of things that are spoken of as the cause for heartburn but a poorly functioning autonomic nervous system is the cause of heart burn in the vast majority of patients.
As we outlined above, it’s the stretching of the stomach that triggers the reflux. It’s not because you ate something spicy. Spicy food may taste worse than bland food when it refluxes into your esophagus and the back of your throat but there is no compelling evidence spicy food or anything else for that matter triggers heartburn alone.
It’s not from a hiatal hernia…
it’s not from drinking too much coffee….
and it’s not from eating spicy food.
Heartburn is primarily the result of a poorly functioning autonomic nervous system.
Carbohydrates and Autonomic Dysfunction
There is accumulating evidence that the excessive amount of carbohydrates (sugars and starches) in our diet is impairing the ability of our autonomic nervous system to function correctly. The exact mechanisms are unknown but excess dietary carbohydrates result in excessive sympathetic and diminished parasympathetic autonomic responses.
As we continually consume excessive carbohydrates, a diminished response of both the sympathetic and sympathetic components occurs leading to a generalized state of autonomic dysfunction. Autonomic dysfunction is often experienced by us as common physical ailments such as heartburn, constipation, bloating, abdominal cramps, fatigue, lightheadedness, erectile dysfunction or frequent urination.
Carbs-> ANS dysfunction -> heartburn, lightheadedness, fatigue, frequent urination
There is additional evidence that impairment of autonomic function triggers a rise in serum fatty acids from our fat tissue resulting in insulin resistance (IR).
Carbs-> ANS dysfunction -> Fat tissue releases fatty acids->IR
Remember, if insulin resistance remains unchecked it often results in medical conditions such as diabetes (DM), high blood pressure (HTN), heart attacks (CAD) and strokes.
Carbs->ANS dysfunction -> IR -> DM/HTN/CAD
Amazingly, it’s looking as if diabetes and high blood pressure are simply the consequence of impaired neurological functioning. And if this continues, the diffuse, unregulated inflammatory state and metabolic disruption that stems from insulin resistance leads to the development of heart attacks, ischemic strokes (CVA) and various forms of cancer (CA).
Carbs->ANS dysfunction -> IR -> DM/HTN/CAD -> CAD, CVA, CA
It seems the sequence of events surrounding carbohydrate toxicity unfolds as follows:
- Consume excessive amounts of carbohydrates for many months to years.
- Carbohydrates cause your autonomic nervous system to operate erratically.
- Insulin resistance develops with continued excessive carbohydrate consumption.
- Diseases such as diabetes, high blood pressure, gout, heart attacks or strokes follow after progressive worsening of insulin resistance.
Aside from the fact that heartburn is very uncomfortable, heartburn is a signal that your body is on the path towards the development of other diseases of carbohydrate toxicity, namely high blood pressure, diabetes and ultimately to ischemic stroke, heart attacks or cardiac arrest.
Autonomic Testing Guides Treatment for Improved Autonomic Function
The autonomic nervous system (ANS) can be tested and evaluated through a process known as spectral analysis. This simple, quick (15 minute) and painless test can provide the ritical understanding that helps your physician for their treatment plan.
The ANS can become imbalanced in many different ways. Some ANS dysfunction requires a short course of medication (3-6 months) alone or in concert with nutritional strategies to reduce systemic inflammation and oxidative stress in order for the brain to regain maximal function. The safest way to reverse heartburn is with a map of your autonomic nervous systems to guide treatment.
Dr. Nemechek often performs autonomic testing prior to initiating treatment for heartburn and other autonomic symptoms (lightheadedness, headaches, fatigue, constipation, frequent or urgent urination).
Lower Your Carbohydrate Intake to Reverse Heartburn
It strikes some patients as overly simplistic to say that if you reduce your carbohydrate intake, your heartburn will be greatly reduced within a few weeks and you probably won’t need any more antacids within 1 month.
Fortunately for you, it is this simple. This recent study of low carbohydrate eating tells us this approach works.
I have my patients reduce their carbohydrate intake (all sugars and starches) to less than 100 grams per day to reverse their heart burn. Not only does their heart burn get better but so do their diabetes, high blood pressure, gout, sleep apnea, bladder irritability, lightheadedness and erectile dysfunction.
Give it a try for a month and I know you’ll feel better than you have in a long time and you won’t be needing to take that expensive Prilosec, Protonix or Nexium any longer.