What’s Really Behind Heartburn: Understanding the Root Causes and Finding Relief
🕒 7-8 min read
"Heartache makes for good poetry, heartburn not so much." - Sean Anthony Tarr
If you've ever felt that fiery burn in your chest known as heartburn, you're definitely not alone. It’s not just an occasional nuisance, millions of people deal with it regularly. In fact, more than 60 million Americans experience heartburn at least once a month, and nearly 20% of the U.S. population struggles with GERD (gastroesophageal reflux disease), which causes frequent acid reflux and discomfort.
Once you understand what heartburn is, what triggers it, and how to manage it, you can finally get the relief you’ve been looking for.
What Is Heartburn?
Despite its name, heartburn has nothing to do with your heart. That burning sensation in your chest actually comes from your esophagus, the passageway that carries food from your mouth to your stomach.
Just before your food enters your stomach, it passes through a gateway called the lower esophageal sphincter (LES). This gateway opens to let food in and stays closed between meals to keep stomach acid where it belongs. Unlike your stomach, which has a protective lining, your esophagus isn’t built to handle acid, so even small amounts can cause discomfort. When your LES is working well, everything stays in balance. But if it weakens or relaxes at the wrong time, acid can escape into the esophagus, leading to that all-too-familiar burning sensation.
Common Causes of Heartburn (And How to Fix Them)
Most people think heartburn happens because of too much stomach acid, but research suggests that too little stomach acid is often the real issue. Here are some of the most common culprits behind heartburn:
1. A Weak Lower Esophageal Sphincter (LES)
When your LES isn’t doing its job properly, acid can enter your esophagus. Some common reasons for LES dysfunction include:
Aging: Your LES naturally weakens over time.
Obesity: Extra weight increases pressure on your stomach, making reflux more likely.
Smoking: This habit weakens your LES and slows down esophageal healing.
Certain Medications: Some antidepressants and blood pressure medications can relax your LES.
Stress & Anxiety: Studies show that stress, anxiety, and depression can make heartburn worse, even if there’s no physical damage to your esophagus.
TIP: Manage stress, maintain a healthy weight, and quit smoking to support your LES.
2. Low Stomach Acid (Hypochlorhydria)
It sounds counterintuitive, but having too little stomach acid can actually cause heartburn. Here’s why: Stomach acid helps signal your LES to close tightly. If acid levels are too low, the LES may stay relaxed, allowing acid to come up into your esophagus.
Signs you might have low stomach acid include:
Feeling overly full or bloated after meals
Frequent burping or gas
Nutrient deficiencies (iron, B12, magnesium)
Brittle nails and thinning hair
TIP: Try digestive bitters or apple cider vinegar before a meal if you suspect low stomach acid.
3. Lifestyle & Dietary Triggers
Certain foods and habits can increase your risk of heartburn, including:
Eating too quickly or overeating
Lying down soon after meals, especially with a weak LES
Processed foods, sugar, and refined carbs
Alcohol and caffeine
Spicy, fatty, or acidic foods
TIP: Slow down at meals and focus on whole, nutrient-dense foods may to reduce heartburn triggers.
4. Poor Digestion Due to Low Enzymes
Your levels of digestive enzymes can cause heartburn as well. Digestive enzymes help break down food so your body can absorb its nutrients. When enzyme levels are low, food sits in your digestive system longer than it should, leading to fermentation, gas, and increased pressure on your LES - triggering reflux.
TIP: Take digestive enzymes to reduce bloating, reflux, and other digestive issues.
5. Bacterial and Fungal Imbalances
Your gut microbiome plays a major role in digestion, and imbalances can contribute to heartburn.
H. pylori infections can alter stomach acid levels, sometimes leading to too much acid and other times too little, depending on the type of infection. Many people with chronic H. pylori infections actually end up with low stomach acid, which can contribute to reflux symptoms.
Small Intestinal Bacterial Overgrowth (SIBO) is strongly linked to GERD and heartburn. When bacteria overgrow in the small intestine, they produce excess gas, increasing pressure on your stomach and pushing acid upward into your esophagus, increasing heartburn.
Fungal overgrowth, such as Candida overgrowth, can increase inflammation, disrupt digestion, and increase risk of heartburn.
TIP: Balance your gut bacteria through diet, lifestyle changes, and targeted supplements to help reduce heartburn symptoms.
6. Hiatal Hernia
A hiatal hernia happens when part of your stomach pushes up through your diaphragm, the muscle that separates your chest cavity from your abdominal cavity. Normally, your diaphragm helps keep stomach acid in place, but when a hernia shifts the position of your stomach, it can weaken the barrier between your esophagus and stomach, making acid reflux more likely.
When to See a Doctor
If you get heartburn occasionally, small lifestyle changes may help. However, seek medical attention if you experience:
Heartburn more than twice a week
Difficulty swallowing
A chronic cough or hoarseness
Regurgitation of food or sour liquid
Chest pain that could be mistaken for heartburn
Even people who don’t get frequent heartburn can develop conditions like Barrett’s Esophagus (a precancerous condition), so regular checkups are important, especially if you’re at high risk.
Final Thoughts: There’s Hope for Heartburn Relief
Heartburn isn’t just about discomfort, it’s often a sign that something deeper is going on with your digestion. When you begin to uncover the root causes - such as LES dysfunction, low stomach acid, bacterial imbalances, and lifestyle factors - you create space for true healing.
Even small, intentional changes can make a big difference. Whether it’s slowing down at meals, supporting your gut health, or exploring natural ways to enhance digestion, the path to relief doesn’t have to be overwhelming.
Key Takeaways
Heartburn is often linked to low stomach acid, not too much.
Stress, poor digestion, and gut imbalances are common root causes.
Relief starts with mindful eating, nervous system support, and gut-friendly habits.
Start here:
Try one simple shift this week - like tracking meals and symptoms with my free 7-Day Food & Observation Journal, adding digestive bitters before meals, or practicing a calming breath before you eat.
You’ll be amazed at what a little awareness can do. With the right approach, small changes can lead to big relief - helping you enjoy your meals (and your life) with greater comfort and confidence.
FAQs About Heartburn Relief
What foods trigger heartburn the most?
Common culprits include spicy foods, fried and fatty foods, citrus fruits, tomatoes, coffee, alcohol, chocolate, and carbonated drinks.
Is heartburn a sign of low or high stomach acid?
Many people assume heartburn is caused by too much stomach acid, but in many cases, low stomach acid is the real issue.
Can stress really cause acid reflux?
Yes! Stress affects digestion and can weaken your LES, making heartburn more likely. Managing stress through mindfulness, breathing exercises, and movement can help.
RESOURCES
American College of Gastroenterology. Acid Reflux / GERD Overview. https://gi.org/topics/acid-reflux/. Accessed April 1, 2025.
Antunes C, Aleem A, Curtis SA. Gastroesophageal Reflux Disease. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jul 3. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441938/
Beveridge CA, Hermanns C, Thanawala S, et al. Predictors of persistent symptoms in eosinophilic esophagitis after remission: fibrostenosis, eosinophilia, anxiety, and depression. Dis Esophagus. 2025;38(1):doae110. doi:10.1093/dote/doae110
Fatima R, Aziz M. Achlorhydria. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Aug 14. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507793/.