Several million people experience heartburn every day. Not to mention toddlers, infants, and pregnant women.
Before targeting individuals for prevention programs, we must identify what are the causes of heartburn in the first place.
In fact, just like any other medical condition, heartburn may vary from one person to another.
This is valid for symptoms but also causes. In other words, what may determine heartburn in a person, may not do the same for somebody else.
When heartburn is present, two things are important:
- the characteristics of individuals with heartburn, and
- the associated causes of this condition
Only when we the above with certainty (or, at least, with a high probability), we can start thinking about what to do to relieve symptoms.
We are about to discover some of the most common causes of heartburn.
When browsing the web, the most relevant factor appears to be foods and beverages.
But there’s more.
The first step is to consider the difference between heartburn and acid reflux.
What Are Causes Of Heartburn: First Things First
Before diving deep into the topic, a thing must be crystal clear.
Heartburn is not always related to acid reflux.
There is a particular condition, called “functional heartburn“, that makes things more complicated.
In short, this condition occurs when a person suffers from heartburn symptoms, even though acid reflux is not present.
You can find in the table below the criteria for functional heartburn (directly from Gastroenterology & Endoscopy News).
One of the most common causes is the high sensitivity of the esophagus, which leads to the typical heartburn symptoms.
But there is no acid reflux.
This means that, despite the burning sensation, the absence of common (and uncommon) causes of acid reflux makes the condition a totally different thing.
We’ll not cover it now, but it’s important to know that it exists.
Especially because functional heartburn is one of the most common functional esophageal disorders.
Due to its likely nervous-system-related origin, it’s frequently associated with other functional bowel disorders and psychological aspects, like somatization.
Whatever the case, it’s not so uncommon to find people with the condition.
This is relevant to us, because this type of heartburn is very hard to treat, and most medications don’t work well.
That being said, we can move forward to real causes of acid reflux leading to heartburn.
What Causes Acid Reflux
Generally, lifestyle and work habits, and certain food and beverage consumption are associated with heartburn. This has been the result of a study that has been carried out to assess heartburn risk factors, knowledge, and prevention strategies.
According to the same study, heartburn causes differ from men to women. In fact, women reported the onset of heartburn about 5 years later than men.
In the majority of cases, people still are not aware of the risk factors for heartburn, and sex-dependent differences in knowledge were apparent.
Some factors like increasing age, higher body mass index, and reduced level of education have been considered predictors of frequent vs infrequent heartburn in the population of this study.
There’s another study that shows the community perceptions of heartburn causes.
According to findings, a significant percentage of people (68% in the specific case) had suffered from heartburn at some time in the past and 37% had symptoms at least once every 4-6 months.
Older people suffered more and heartburn was more frequent in men than in women.
Interesting fact: no difference in frequency was found between the city and rural dwellers, or between white- and blue-collar workers.
Women reported greater problems than men, and this is a factor for another common condition: heartburn in pregnancy.
Among them, 15% reported severe pain or discomfort. This means that heartburn, even in the more serious form, can be quite frequent among the people.
In many cases, it’s not properly diagnosed first of all because the people don’t pay attention to the causes that lead to acid reflux (that causes heartburn).
That’s why we must list the most (and least) common causes for acid reflux.
Even because, as shown in the infographic below (source Healthline), the heartburn trend is growing over time.
The main factor
Heartburn does occur when the (acid) content of your stomach backs up into the esophagus.
During the swallowing act, the so-called lower esophageal sphincter (a band of muscles all around the bottom of the esophagus) relaxes. This allows the swallowed food to enter the stomach. Once the food is passed, this muscle-band tightens again, and so on.
The problem is when the lower esophageal sphincter has some trouble tightening after the passage of the food. Or, as often occurs in these cases, when it remains relaxed over time.
This makes the acid content of the stomach able to ascend along the esophagus and cause that series of annoying symptoms.
We call that “acid backup”. It’s worse when you’re lying down and/or you’re bent over.
Given that, we may conclude that everything that’s abe to abnormally cause a relaxation of the lower esophageal sphincter is basically able to cause acid reflux and heartburn as a direct consequence.
Some foods are blamed to be the main factor for determining acid reflux and heartburn.
However, they’re not alone.
And, what matters, even more, there are some “myths” to debunk, when it comes to listing foods able to cause heartburn.
We must avoid some (unfortunately common) mistakes.
Because some foods are not what they are thought to be.
Foods That Cause Heartburn: What You Need To Know
There are foods naturally able to relax the lower esophageal sphincter. They are a certain cause for acid reflux, and this leads to heartburn.
There are others that, however, can’t be considered as real factors for acid reflux. They can determine heartburn, but this doesn’t happen in all cases.
Because what counts is the final effect; this means that despite the action a food can promote, the characteristics of a person are the other important factor to consider.
This is always valid, and we pray you remember it very well.
In many cases, and this is also valid for heartburn and acid reflux, more factors are needed to determine this condition.
A list of foods that are potentially able to cause acid reflux should not be considered as a sort of “absolute prohibitions”.
Rather, the list should help you better understand what may be a danger for your lifestyle, in the balance with all others.
Sounds complicated? It’s not.
You’re only asked to do 2 things.
- You have to know what may be a risk for acid reflux, first of all
- Then, you must learn to listen to your body, that reacts to some of the listed foods
Once done, this list will make a lot more sense to you.
Please note that the following list is not complete, because we cover extensively the topic in another post.
The first food we want to include in the list is actually a group, namely acidic juices.
Pretty self-explanatory, they are able to increase the acidity then once back into the esophagus, the resulting effect is heartburn.
About acidic juices, the majority of people just think about citrus juice.
According to some studies, this juice has shown the capability to induce heartburn.
There’s another juice we can’t miss to consider: the orange juice.
In fact, there is a strong correlation between orange juice-induced heartburn and an abnormal lower esophageal sphincter pressure.
But, does this mean that orange juice can be a certain cause of acid reflux?
Things are still unclear, but it seems that despite the observation, orange juice can induce heartburn without necessarily promoting acid reflux.
This is more than interesting because of the different behavior of two acidic juices (citrus vs orange juice).
Spicy and Fatty Foods
There’s a thing that may look quite surprising.
Despite spicy and fatty foods are a widely accepted cause of heartburn and acid reflux, still, there are some “shadow zones” on this topic.
To make things clearer, we can refer to a specific study that has been carried out in 2007 (a bit outdated, but it’s worth it).
According to findings, meals with a high content of fats may be considered a cause of heartburn.
For sure, some highly spiced meals like hot Indian curry led to important heartburn episodes.
However, within the same fatty meal, the addition of spicy foods does not further increase the reflux.
This means that both of them, fatty and spicy foods, should be avoided.
Fatty meals have a lower power of inducing heartburn than spicy meals, but their action when combined seems not to add risks and dangers to the people.
Salt and Salted Foods
Salted foods are considered a cause of heartburn and acid reflux.
To be more precise, their damaging action is more effective in some people, who are at high risk because of their eating habits (high salt-diet).
Salt and salted foods are then a perfect example of what we’ve said before. A disease is a “battle” between the body’s defense system and the “attacking agent”.
In this case, it has been reported that people with good health are much less sensitive to the damaging action of salted foods.
While in the presence of other factors, things may be different.
Onions are definitely part of this list
Not only they can cause strong heartburn, but they also determine long-lasting symptoms.
This is widely known for several years by now, even though this is not enough because of the huge presence of this food on the tables.
Yet, onions show a different effect when in the presence of a heartburn sufferer and/or a healthy person.
In fact, always according to findings, ingestion of raw onions by healthy people did not affect the so-called “reflux parameters” (such as the number of reflux episodes, percentage of the time pH was less than four, heartburn episodes, and belches).
On the other hand, all the above parameters were highly affected after the ingestion of raw onions by heartburn sufferers.
They belong to the category of acidic foods and should be avoided by people who suffer from heartburn and acid reflux.
Tomatoes are among the diet components that people who suffer from heartburn are still likely to consume.
This generally makes things worse, because it’s more difficult to convince them to remove this food from their diet.
Tomatoes are a perfect example of foods that can be highly beneficial, or even dangerous, depending on the people who eat them. But there’s more.
This food is also sensitive to environmental conditions, and this can complicate things, especially when the vegetable it’s grown in a not-so-clean area.
Carbonated beverages should be avoided because of their capability of causing acid reflux.
Once ingested, they can reduce the pressure of the lower esophageal sphincter.
By doing so, they promote reflux with consequent heartburn.
However, there’s more: this action can occur also in healthy people. It has been observed that the ingestion of carbonated beverages induces the transient relaxation of the sphincter.
In other words, carbonated beverages not only worsen the situation for people who already suffer from heartburn. It can also put at risk healthy people.
Another study showed that the ingestion of a certain quantity (up to 300 ml) of a sweetened carbonated drink doesn’t affect the physiology of the digestive tract in healthy people.
This is true, but it’s not the point. Not at all.
Because the real point is the continued consumption, the wrong habit of drinking sweetened and carbonated beverages every day.
Studies of this kind may mislead you. The “one-time consumption” doesn’t count.
However, when it comes to carbonated water (different from fizzy beverages) things may be quite different.
In fact, depending on the water source and other parameters, heartburn may be prevented.
There’s another special post that covers carbonated water, and we strongly suggest reading it to deepen more about this topic.
Chocolate and Mint
Chocolate is able to act on the lower esophageal sphincter, by lowering the pressure.
This is the same action we observed for carbonated beverages, even though there’s more.
Chocolate is a food possibly to avoid for people who already suffer from heartburn.
However, there’s an interesting article published by Stanford University according to which chocolate, along with coffee, should not be considered as a “forbidden food”.
This even for people who suffer from active heartburn.
The topic is a delicate one, that’s why we decided to dive deeper into a dedicated article.
For what concerns mint, in the past it was considered a healer for certain digestive conditions.
Nowadays, it has been observed that mint determines heartburn.
Once again, we want to stress the importance of thinking about the specific context.
In fact, even though proved a cause for heartburn, some peppermint-derived products (like peppermint oil) have been proven effective to alleviate other digestive conditions like the IBS (Irritable Bowel Syndrome).
The above list should add other foods and edibles that may cause heartburn.
There also are some controversies, for example when it comes to cheese, coffee, and chocolate.
And carbonated water is not an exception.
The bottom line is: there are some foods able to promote acid reflux because they work on the lower sphincter.
But this is only one piece of the pie.
And a single causal factor is hardly enough to make the condition happen.
Does Chewing Tobacco Cause Heartburn?
Many people think that tobacco chewing (and smoking) is just a risk factor for heartburn and acid reflux.
Unfortunately, this is not true.
In fact, tobacco is a powerful cause for developing acid reflux and subsequently heartburn.
Tobacco reduces the pressure of the lower esophageal sphincter and this leads to acid reflux.
In addition, tobacco reduces the production of saliva rich in bicarbonate. This is a problem because this component is important for buffering and clearance of acid in the mouth and esophagus.
Stopping smoking (and chewing) tobacco leads to a strong reduction of heartburn symptoms.
What Helps Acid Reflux: Risk Factors To Consider
According to the 2nd study mentioned in the above paragraph, aggravating factors for heartburn include spicy foods, greasy-rich foods, stress, alcohol, overeating, pregnancy, smoking, food allergy, and coffee.
Despite what many people and scientists may believe, alcohol has to be considered a “risk factor”, more than a causal factor.
To be more precise, we should define it as a “triggering factor”. It has a direct effect on the oesophageal mucosa, and this makes acidic injury easier.
More than this, there is still no evidence that reducing alcohol consumption may decrease symptoms.
That’s why prevention is the key.
Another risk factor for acid reflux is hiatal hernia.
This happens when a portion of the stomach (the corner on the top left, to give an idea) is found inside the chest, instead of the abdomen.
With this condition, people are more likely to suffer from nocturnal reflux.
For more information on hiatal hernia, you can watch the short video below (it’s about the likely most common hiatal hernia type).
When a person is obese, the pressure inside the abdomen increases.
Such an increase is a factor for reflux. Recalling what we’ve considered above about the battle between the body’s defense and the attacking agent, you have to imagine a balance of forces.
The increased pressure pushes from the bottom (abdomen), while the stomach tries to send eaten foods below.
When the abdominal pressure is too high, reflux is easier to happen.
A similar effect can also be evoked in slim people who wear clothes that are too tight around the waist.
Generally, physical exercise is good for health.
This is especially valid for mild-to-moderate intensity exercises. No reasons to doubt that.
However, under some circumstances, things may be different.
It has been noted that acute, “strenuous” exercises may be a trigger for heartburn, along with other gastrointestinal conditions.
Moreover, the frequency of adverse health effects following hard exercising seems to be almost twice as high during running than during other endurance sports like cycling or swimming.
Finally, this is not a skill-related aspect.
In fact, elite athletes seem to suffer from more episodes, meaning that even if you’re well trained you’re not protected.
Diseases of Esophagus
There are some esophagus diseases that can promote the onset of heartburn.
Not the most common risk factors, however, it’s worth mentioning them.
Below a video for a more detailed explanation of the relationships between the esophagus and scleroderma.
This is another important factor, and one of the most frequent.
Overeating may be related to obesity, but it may also refer to other conditions.
Heavy meals, rich in fatty or spicy foods, regardless of obesity, lead to a slower stomach emptying time and the direct consequence can be heartburn.
In general terms, overeating is always a factor for gastrointestinal troubles.
Stress and Anxiety
This topic presents two distinct aspects to consider.
The first one is the possibility to correlate stress (and anxiety) to a general deterioration in the quality of life, including eating habits and digestive troubles.
The other one, as reported by the Academic Medical Center in Amsterdam (NED), shows that in the presence of gastroesophageal reflux disease, increased levels of anxiety are closely related to increased severity of retrosternal pain and heartburn, as well as a reduced quality of life.
Stress and anxiety are even more closely related to other digestive conditions, such as IBS.
This means that everything has to do with our quality of life, which is a factor for our digestive system.
Starting from this assumption, we could understand our health conditions much better.
Drugs That Cause Heartburn: What They Are?
Prescription medications and more in general drugs can cause heartburn as a side effect.
We dedicate a wide analysis of these aspects here, but on this occasion, we want to point out some essential aspects.
IMPORTANT: Do you know the relationships between PPIs and COVID-19? Please read here to stay informed.
There are some drugs that, because of their mechanism of activity, can cause heartburn and acid reflux.
The first categories of drugs we want to report are painkillers and, more in general, anti-inflammatory medications.
Other drugs that can trigger heartburn are medicines used for treating high blood pressure, as well as asthma, osteoporosis, anxiety, depression, and Parkinson’s disease.
We also must remember heartburn related to cancer drugs, and even medications used for hormone therapy have been included in the list of heartburn triggers.
As we report in another post, when it comes to drugs and medications, the fewer the better.
This also applies to heartburn and acid reflux.
IMPORTANT: To know everything about the very best herbal remedies for reflux, you can find all that you need here.
What Causes Heartburn In Pregnancy
Pregnancy time deserves a special mention when discussing heartburn and acid reflux.
You can find more info in our dedicated article, however, it’s important to cover the basics.
The main factor for the onset of heartburn during pregnancy is the increased abdominal pressure.
This event causes much more effects than simple heartburn, however, the reason is this one.
In association with nausea and vomiting, heartburn during pregnancy has to be considered a common event.
In addition, there is sufficient evidence to say that heartburn during pregnancy does not appear to adversely affect the outcome of pregnancy. The same is for vomiting and nausea.
Scientific literature explains that women with a personal story of heartburn are more likely to develop it during pregnancy.
Last, but not least, women with heartburn during pregnancy are more predisposed to early postpartum heartburn.
What causes acid reflux in babies
Under normal circumstances, they are called “happy spitters“.
This means that the majority of infants (more than 70%) face this physiologic condition (regurgitation) that occurs several times a day, mostly postprandial with no symptoms.
In most cases, this condition doesn’t deserve any treatment, and it resolves on its own within the first year of life (even less).
The cause, once again, is the lower pressure of the esophageal sphincter.
The problem arises when these regurgitation episodes lead to feeding difficulties and poor weight gain.
It’s important to constantly monitor the situation, but only in a few cases, this condition persists after the first 7-10 months of life.
Anyway, you can find more about that.
Not just for babies and infants, eating some dairy products can increase the risk, even though a significant number of people report relief from symptoms.
What Causes Heartburn Everyday
Persistent heartburn (that occurs every day) may not be always related to gastroesophageal reflux disease.
This means that many people suffering from heartburn, are actually affected by functional heartburn (in the absence of reflux).
Some other people are affected by atypical chest pain.
In short, heartburn every day is a common condition, and the causes are different. This is a very important condition, which deserves the greatest attention (as highlighted in the picture below by the Action Against Heartburn campaign).
We can define “persistent heartburn” as the result of not successful therapies, which in the vast majority of cases is made by PPI (Proton Pump Inhibitors).
Whatever the specific reason, it’s very important to precisely understand the causes of everyday heartburn, because of the significant impairment it can exert on the quality of life.
As we can read from this work carried out in Chicago IL, more than 10% of people under medical therapy developed frequent regurgitation.
This fact negatively affects sleep and work productivity as well.
Even worse, this discomfort induces to increase in the dose of medications, which continue to be ineffective. This triggers a vicious circuit from which it is necessary to exit as soon as possible.
Waking up with heartburn in the middle of the night
The night is one of the most crucial moments in the life of a person with heartburn.
Sleeping on the left side can help, because (due to the anatomy of the stomach) by doing so we prevent the flow of acid content to ascend along the esophagus.
Totally different things if a person sleeps on the right side: in this case, the acid content can move easily and heartburn doesn’t take long to manifest itself.
In such cases, the sensation of waking up in the middle of the night is common, and this fact limits a lot the quality of sleep.
To better understand, we can analyze sleep-related gastroesophageal reflux.
The final result is that nighttime heartburn may indicate a more clinically significant condition.
That’s why people suffering from heartburn at night must be even more careful to avoid causes and limit risk factors.
Conclusions: The 9 Things That Promote Reflux
Now, let’s make a recap of what we considered above.
There are 9 things to remember.
What To Do Next
Now that you have a better idea of the causes of heartburn, it’s time to take a step forward.
Our TOP suggestion is to visit the page dedicated to the best herbal mixtures you can use to get rid of reflux faster.
If you are concerned about the relationships between PPIs and COVID-19, you can read here to keep informed and safe.
To do so, we strongly suggest checking the recommended resources below.
Here you can find the current best (natural, drugs-free) options to get rid of acid reflux, by working on the determining causes and risk factors.
This is very important because when dealing with heartburn and reflux you should not focus the attention on symptoms alone, even though they are crucial to your quality of life.
Thank you for your visit and the time you dedicated to this long post.
Enjoy your stay!
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