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Considering the Differential Diagnoses of Chest Pain? Consider This.

Guest Post, by Paul Burgess of Athletic Nutrition.

There is a common misconception that if someone experiences heart burn it is because they have too much stomach acid that is passing up the lower esophageal sphincter (LES). The LES is the valve which, in a healthy person, prevents this from happening. Interestingly, many patients presenting with heart burn actually have LOW stomach acid, which results in the same symptoms.


Super Summary

• Low stomach acid is more likely to be the cause of heartburn
• Bloating and food intolerances may be heightened by low stomach acid
• Anti acid medications can make the problem worse
• Getting into a decent sleep pattern can make all the difference.

Anatomy in Images

The Stomach’s location

The stomach in relation to other organs

What causes low stomach acid?

Low stomach acid is the result of many factors that come into play at the same time. These factors, or causes are common in our modern day lifestyle, far more common than the causes of potentially high stomach acid. Their prevalence means that in the majority of cases you can be pretty sure that the cause of heart burn is not high but low stomach acid.

Attributing causes are:
• Poor sleep
• Under eating (e.g on a diet)
• Stress
• Too much exercise in a calorie deprived state
• Over use of antibiotics
• Regular use of NSAIDs
• H Pylori
• Eating too quickly
• Small intestinal bacteria overgrowth
• Yeast infections
• Food sensitivities
• Age
• Alcohol

Now if you look through the list above you probably know a few people (if not many) who fit into at least 3 or 4 of those categories. If nothing else most people are sleep deprived and even if they do actually get to bed, the quality of their sleep is poor and broken. A high number of people have been on some kind of diet (which usually means calorie restriction) for many years. They are likely stressed and probably have a drink now and then.

As you can see, it’s easy to live what is considered an apparently ‘normal’ lifestyle nowadays, a lifestyle that causes low stomach acid.


What is Stomach Acid & Why Is It Important?

Stomach acid is also called hydrochloric acid due to its chemical structure of one hydrogen ion combined to one chlorine ion, making HCL. It is responsible for sterilizing any food that wishes to make it into your gut. It assists with killing off viruses, yeast, parasites and breaking down protein.

Its most important role is the breakdown of protein in to its constituent amino acid parts, ready for absorption later in the digestive process.

So, without adequate levels of stomach acid, there is a vicious cycle of poor digestion, chronic gut inflammation, microbial overgrowth, leaky gut, elevated stress hormones and lowered nutrient absorption. The only things that will break this loop are to reduce stress in all its forms and support adequate stomach acid production.

So What's Wrong With Omeprazole?

This is the problem with mistaking low stomach acid symptoms for high stomach acid:

The GP will recommend any one of a number of anti-acid medications such as Omeprazole, or the patient will self medicate with over the counter remedies such as Rennies or Gaviscon.

If this is the case it will stop the feeling of heartburn BUT it will actually push the stomach acid down even further. Once this happens the health of the patient will decline over time due to even poorer absorption of nutrients, higher chances of bacterial infections and higher elevation of stress hormones.

So What's the Answer?

So what’s the answer?

Its pretty simple really. The first thing to do is manage the lifestyle factors causing the issue in the first place. Better sleep, manage stress, less alcohol, etc.

From a support point of view a good digestive enzyme that includes HCL with each meal would be all you really need to stop the pain immediately. For good measure, a 30 day course of probitiocs to improve the good bacteria in the gut would be a positive step.

Questions To Be Answered Soon

Should we continue encouraging patients to try their own gaviscon in non-cardiac sounding chest pain as a one-off measure to see if it resolves the pain?

If the gaviscon does resolve the pain, what does this tell us about the likely cause of the chest pain? (Remember, trop-t levels may still be necessary).

Do acidic or alkaline foods affect the reflux much?

This was the first of Article 999’s Guest Posts, posts that have been written by other professionals. These posts, unlike the remainder of Article 999’s, are not referenced to academic sources as they are the expert opinion of the author. These posts are additions to the category of ‘nice to know’. Please remember to check your local guidelines and read our full disclaimer before putting into practice anything you see here.

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