The sky is blue, racecar spelled backwards is still racecar, and in most cases heartburn is caused by low stomach acid, not high. Yes, seriously. After testing thousands of heartburn patients at his Tahoma Clinic, Jonathan Wright, M.D., concluded that excess stomach acid is not the problem in over 90% of cases. (1)

In this article I covered what he (and many others) say is the most common cause of heartburn, plus how acid blocking medications such as proton pump inhibitors can:

Decrease our ability to resist infections

Cause nutritional deficiencies

And even increase our risk of certain diseases.

Fortunately, according to Dr. Wright: 

In cases of mild to moderate heartburn, ‘acid indigestion,’ bloating, and gas, actual testing for stomach acid production at Tahoma Clinic shows that hypochlorhydria (too little acid production) occurs in over 90 percent of thousands tested since 1976. In these cases, a “natural strategy” is almost always successful.” (1)

As always, I want to mention that none of these statements have been evaluated by the FDA, this article is not medical advice, and it is not meant to diagnose or treat any condition. I’m just a former heartburn sufferer passing along information I’ve found helpful from respected physicians, clinical studies conducted by places like Johns Hopkins University, and articles from Scientific American and the Mayo Clinic.

Please talk with your healthcare provider about what approach is best for you, especially if you have frequent heartburn. Now that we’ve got that out of the way, let’s jump in!

Baking Soda Vs. Apple Cider Vinegar for Heartburn

If you’ve ever googled home remedies for heartburn, you’ve probably noticed that baking soda and apple cider vinegar are the top two recommendations. Like over-the-counter and prescription acid blockers, baking soda eases heartburn symptoms (such as a burning sensation or sour taste in the mouth) by lowering stomach acid levels. 

As a short-term strategy it can be helpful for relief, but as discussed my previous article most people actually need MORE acid, not less. 

How do we know if we have low stomach acid?

A doctor’s office can measure acid levels using the Heidelberg, which involves swallowing a capsule that contains a pH sensor and a radio transmitter that reports findings to a receiver located outside the body. After the results are recorded, the capsule can either be removed via the mouth or expelled via stool. 

In addition, some doctors look for anti-parietal cell antibodies, which are autoimmune cells that attach stomach acid producing cells. 

However, my functional medicine doctor asked that I do a simple at-home procedure before deciding whether to do additional testing. Here are the steps: 

1. First thing in the morning, right after waking, stir 1/4 teaspoon of baking soda into 1/2 cup water and drink it. 

2. Set a timer and make a note of how long it takes to burp. If five minutes pass, stop timing. 

The idea is that if you mix an acid (hydrochloric acid, aka stomach acid) with an alkaline base (baking soda), the two will react with each other to make carbon dioxide gas, which will then cause burping. Ideally a burp occurs within three minutes. If it takes a long time to burp or no burp occurs, it may mean that stomach acid levels are low. 

My doctor asked that I repeat the process for 3-5 mornings in order to make sure the result was consistent. 

It’s important note that this is not a diagnostic test and should not be considered a replacement for one. However, some practitioners (including mine) find it to be a helpful tool for gaining insight about digestive function. 

Lifestyle Changes & Home Remedies for Heartburn Relief

Two of my favorite resources on this subject – Why Stomach Acid Is Good For You: Natural Relief from Heartburn, Indigestion, Reflux and GERD and The 30 Day Heartburn Solution – offer lifestyle change and natural remedy suggestions that have worked for their clients. I’ve summarized the main ones below. 

1 – Remove dietary triggers

You probably already know a few foods that trigger heartburn for you – coffee, citrus fruits, alcohol, onions, spicy foods, etc. Peppermint and spearmint, although helpful for digestion in some cases, are both thought to weaken the lower esophageal sphincter (LES) and contribute to heartburn.

Some foods, like carbonated drinks, may increase intra-abdominal pressure and push on the LES, which as we discussed in my previous post is the valve that protects the esophagus from stomach acid.

However, some triggers may not be quite as obvious. In this article, Chris Kresser LAc. explains why carbohydrates and fiber may contribute to some cases of heartburn, then discusses the potential benefits of temporarily reducing carbohydrate and fiber intake.

Other foods don’t weaken the LES, but are thought to directly irritate the esophagus. In general, it is recommended that known irritants be avoided for at least a little while. Some people say forever, but I personally reintroduced many of my “triggers” with no problem after I started feeling better.

Also, according to Dr. Wright, certain drugs – aspirin and ibuprofen, for example – are considered esophageal irritants. Others, such as calcium channel blockers, can reduce lower esophageal sphincter tone (aka weaken the LES). (2)

2 – Increase stomach acid levels

If “this sounds like throwing gasoline on smoldering embers, that’s right, it does sound like it, but in fact it’s not,” says Dr. Wright. (1)

He adds that, “Not only does this strategy work to eliminate heartburn and GERD [gastroesophageal reflux disease], it often goes a long way toward restoring and nutrient deficiencies and repairing the gastric bacterial barrier, not to mention the intestinal barrier.” 

Three ways to support healthy stomach acid levels are: 

Apple cider vinegar or lemon juice

Digestive bitters

Hydrochloric acid (HCL) supplements

Apple Cider Vinegar or Lemon Juice

One of the easiest ways to increase stomach acid levels is to drink a little apple cider vinegar or lemon juice right before a meal. Both are traditional folk remedies for indigestion, most likely due to their acid content and the presence of enzymes that support digestion. (Pasteurized apple cider vinegar does not contain live enzymes, but raw apple cider vinegar does.)

One thing to be aware of, however, is that according to Dr. Wright, “gradually increasing quantities of lemon juice (citric acid) or vinegar (acetic acid) will often relieve some or even all symptoms. This is supported by the common practice in some cultures of treating gastric discomfort with lemon juice or vinegar. Unfortunately, even though symptoms may be improved, actual nutrient digestion and assimilation are not improved nearly as much as with HCL.” 

To Use: Most often, individuals add 1-2 teaspoons apple cider vinegar or lemon juice to a little water and drink just before meals. If needed, the amount is gradually increased until the individual determines the optimal amount for their body.