7 Minutes

Most of us will experience mild, temporary heartburn at some stage in our life. For most, it’s simply an occasional annoying discomfort that is our body telling us we have overdone it and giving us ‘payback’ for all that spicy, rich, or fatty food or one too many beers we put into it. For others, though, heartburn can be a debilitating daily phenomenon with potentially serious consequences. In this article, we address some of the FAQs around the topic of heartburn and offer some tips on how to manage and prevent it.

What is heartburn and what does it feel like?

Firstly, despite the name, this condition has nothing to do with the heart, although back in the 16th century doctors thought otherwise, literally it was thought to be the heart burning! In reality, it’s an irritation in the food pipe known as the oesophagus which connects the mouth to the stomach and runs behind the breastbone. Stomach acid ‘takes the heat’ as the cause of heartburn. It’s not the stomach acid per se but where it’s sitting that’s the problem. Stomach acid is wonderful and very much needed i.e. in the stomach; it’s when it relocates to the oesophagus that heartburn begins.

It’s generally a burning feeling behind the breastbone in the middle of your chest, and sometimes it can even extend into the throat with a burning, sour, hot or bitter sensation and taste, making swallowing difficult. In some more serious cases, the movement of acid into the back of the throat can cause coughing, unexplained sore throat, hoarseness of the voice or even regurgitation of food into the mouth.

Heartburn vs indigestion?

We often mix these terms up; heartburn can be one feature of indigestion, which is a broader term that describes a general imbalanced digestive process. There is some overlap of symptoms, but if you have heartburn plus other digestive symptoms like bloating, gas, wind, burping or a sensation of being over-full after eating, then you more accurately are experiencing indigestion. Indigestion also shares most of the common triggers of heartburn.

When does heartburn suggest GORD/GERD?

Gastro-oesophageal reflux disease (GORD) or GERD, depending on how you spell it either oesophagus (English) or eosophagus (American), is a more serious condition which usually is ongoing and present long-term. We’re not talking about occasional heartburn after a fatty meal here, this is different; heartburn is persistent and occurs unprovoked. The presence of highly acidic stomach acid in the oesophagus on a regular basis can damage the lining of the oesophagus causing oesophagitis. When the acid reaches the mouth, teeth can be damaged as well. If heartburn symptoms occur on a regular basis and without an obvious trigger, see your doctor for a thorough assessment.

Why is heartburn worse when lying down or bending?

A quick anatomy lesson explains this nicely – at the lower end of the oesophagus, a ‘one-way valve’ called the lower oesophageal sphincter (LES) controls the movement of food and fluids from the food pipe into the stomach. When we eat and drink, it relaxes and lets food and drink into the stomach. The rest of the time it’s meant to be shut tight. If this one-way valve becomes faulty, stomach acid can leak up into the oesophagus giving us heartburn, something often referred to as ‘reflux’.

This is one scenario where gravity is your friend! When your lower oesophageal sphincter doesn’t close, all that keeps your stomach acid where it belongs is gravity, but lie flat or bend down with a leaky valve, and your stomach acid has free reign of the oesophagus. Bending makes it even worse because bending squeezes the stomach, putting more pressure on the leaky valve.

Acid Reflux

Why is heartburn so much worse at night?

Now that we understand how it all works, we can also see why typically it’s so much worse at night. This is when we are horizontal of course, but for most, the evening meal is also the largest meal of the day and when we are most likely to eat most of the trigger foods (discussed later), not to mention drink alcohol which fuels the fire! Eating a big meal later at night and then going to bed within an hour or so is a recipe for disaster if you are prone to heartburn because the fuller the stomach, the more pressure on the weakened valve, plus lying flat removes the protective effect of gravity!

Is heartburn affecting your sleep? What’s the best way around this?

A few simple lifestyle changes may be all you need:

  • eat slower, chew thoroughly
  • don’t eat main meals at night
  • don’t eat dinner too late (allow at least two hours between eating and lying down)
  • avoid eating trigger foods at night
  • don’t overfill the stomach by drinking large volumes of liquid with meals
  • prop yourself up at night with an extra pillow or two and let gravity help to keep the stomach contents where they should be

Typical foods that trigger heartburn

So, what are the typical foods that trigger heartburn?

This is variable from person to person but there are some common culprits, these are known to either cause the lower oesophageal sphincter to relax and/or delay the emptying of the stomach into the small intestines below. Either of these situations could cause or aggravate heartburn. These foods include peppermint, garlic, and onions (relax the sphincter) and fatty, spicy or fried and fatty foods which both relax the sphincter and slow down the emptying of the stomach. The longer food sits in the stomach, the more likely it is to end up in the oesophagus.

Some foods, however, may offer protection, such as more fibre in your diet. Research confirms that fibre intake has the opposite effect of fatty foods on heartburn. These foods fill you up quicker and may prevent you from overeating. Include unrefined grains such as brown rice, oats, quinoa and green leafy and root vegetables.

Who’s most at risk of getting heartburn then?

Heartburn sufferers were surveyed to see what typical triggers set them off compared to those who considered themselves healthy. This helps us build a profile of those most likely to be affected:

Trigger % of Heartburn Healthy persons
Fatty foods 36% 2%
Stress 36% 2%
Alcohol 32% 4%
Eating too quickly 27% 0%
Large meals 27% 2%
Bending down 23% 2%
Time of eating 18% 2%
Eating while slouching 14% 0%
Lying down 14% 0%
Smoking 5% 0%

Oliver et al. (2011)

Being overweight, specifically what is known as central/abdominal obesity where most extra weight is carried around the tummy area, is widely known to increase the risk of heartburn. There are various possible explanations for this, these include extra mechanical pressure pushing on the stomach and straining the lower oesophageal sphincter, as well as hormonal imbalances which occur in obesity.

The influence of hormones and the mechanical effects of extra weight around the tummy is also the reason why pregnant women are so susceptible to heartburn too.

Are any heartburn medicines safe during pregnancy?

This is an important topic since many pregnant women suffer from heartburn. During pregnancy, both hormonal and mechanical factors increase this risk. The same preventative measures described earlier apply i.e. smaller meals, eating slower, not lying down after eating, avoiding trigger foods etc. but are there safe remedies which could be considered too?

Start by trying to eat small quantities of soothing alkaline foods, like fat-free milk or natural low-fat yoghurt or watery alkaline foods like celery, cucumber, and watermelon.

The golden rule is always when in doubt, discuss the use of any medicines in pregnancy with your doctor first.

These are some remedies considered to be safe in pregnancy:

A.Vogel Multiforce Alkaline Powder – A source of calcium, magnesium, phosphorus and potassium, as well as citrate and bicarbonate salts (alkalising minerals) and has a systemic alkalinising effect.

Pegasus Gastric Plus 30C – A homeopathic remedy for all aspects of abdominal discomfort including fullness, distension, bloating, flatulence, acid reflux, heartburn and indigestion.

Nat Phos D6 Tissue Salts (No. 10) – the tissue salt for hyperacidity.

Homeopathic remedies are generally considered safe in pregnancy. Consider seeing a registered homeopathic doctor for personalised solutions – you can find one using this link.

How long does heartburn last?

Typically, simple heartburn is short-lived, lasting a few minutes to an hour, and when it happens there is usually an obvious trigger. It usually resolves on its own or from simple antiacids or other home remedies.

When should you become concerned or see a doctor about heartburn?

If your ‘heartburn’ like symptoms start occurring more often, too easily and don’t resolve easily on their own, this could suggest another more complex issue such as a stomach ulcer, for example, which needs to be investigated by a medical professional. Some red flags to watch out for include:

  • persistent abdominal pain
  • nausea
  • vomiting
  • unexplained weightloss
  • change in bowel habits or dark-coloured stools

Can heartburn look like a heart attack?

Occasionally, a possible heart attack could be confused with heartburn symptoms. If your heartburn is accompanied by these additional symptoms, you should seek medical attention:

  • pale appearance
  • cold sweating
  • shortness of breath
  • vomiting or nausea
  • chest pain which feels like squeezing or crushing that extends to the arm, back, neck or jaw

Natural remedies for heartburn sufferers

Although an antiacid may help to temporarily soothe simple heartburn, it’s simply treating the symptoms and not the cause of the problem. If heartburn is an ongoing problem, you should see your doctor for a formal assessment and diagnosis to rule out any serious pathology.

Once you have that all clear, first, make all the dietary and lifestyle changes we have already discussed, then consider the following possible remedies:

  1. A.Vogel Boldocynara – a Western herbal medicine which acts as a tonic to support the function of the liver, gallbladder and digestive system. For the relief of unhealthy liver symptoms such as indigestion, nausea, a sensation of fullness, bloating and flatulence.
    • One of the consequences of poor production and flow of bile from the liver is indigestion and heartburn. Consider the liver as a possible underlying contributor to indigestion.
  2. A.Vogel Indigestion Formula – a homeopathic medicine for the supportive treatment of heartburn, indigestion and associated symptoms.
    • Ingredients balance excessive stomach acid, promote the healthy secretion of digestive fluids to improve digestion, reduce discomfort and combat the effects of overindulgence.
  3. A.Vogel Multiforce Alkaline Powder – A source of calcium, magnesium, phosphorus and potassium, as well as citrate and bicarbonate salts (alkalising minerals) and has a systemic alkalinising effect.
    • Hyperacidity in the digestive tract may be a sign of systemic acidity, so consider methods to address systemic pH as a potential long-term solution to heartburn.
  4. Herbal remedies for heartburn include:
    • Slippery Elm (Ulmus fulva) root bark powder, add 1-2 tablespoons in a glass of water and take this after meals and/or before going to bed.
    • Marshmallow (Althea officinalis) herb can also give symptomatic relief, make tea from a tablespoon of the root and/or leaf and drink it three times daily.
    • Chamomile (Matricaria recituta), take a tablespoon of the flowers and make a tea, cover it and allow it to steep for a few minutes before drinking 3-4 times daily.


  1. El-Serag, H.B., Satia, J.A. and Rabeneck, L. 2005. Dietary intake and the risk of gastro-oesophageal reflux disease: a cross sectional study in volunteers. Gut, 54(1): p. 11-17.
  2. Oliver, K., Davies, G., and Dettmar, P. 2011 Diet and lifestyle as trigger factors for the onset of heartburn. Nursing Standard (through 2013), 25(36): p. 44-8.
  3. University of Wisconsin Integrative Medicine – Department of Family Medicine. 2012. An Integrative Approach to GERD (Gastroesophageal Reflux Disease) – Patient Handout. University of Wisconsin School of Medicine and Public Health: Wisconsin. [online] https://www.fammed.wisc.edu/files/webfm-uploads/documents/outreach/im/module_gerd_patient.pdf.