Michael Garko, Ph.D.
Host of Let’s Talk Nutrition
Acid indigestion is among the most common digestive disorders affecting millions of Americans. It affects approximately 25% of the population annually. It can cause considerable discomfort and ill-health for people of almost any age and for both men and women (see Bazaldua & Schneider, 1999).
As prevalent as it is, there is still some confusion among the general public and even health professionals about what acid indigestion is and how to treat it. The extent of the conceptual confusion associated with acid indigestion is enough to cause a person to have heartburn (not to be confused with acid indigestion).
The purpose of the December, 2008, issue of Healthful Hints is to help you understand what acid indigestion is, its causes and symptoms and what you can do about it in terms of diet, nutritional supplementation, the use of kitchen spices and herbs to help aid and support your digestive system and the best way to take those herbs.
Definition of Acid Indigestion
Acid indigestion or dyspepsia is discomfort (i.e., burning feeling) in the pit or lower part of the stomach or abdomen (National Institute of Diabetes and Digestive and Kidney Diseases/NIDDK, 2004). It is also referred to colloquially as indigestion or upset stomach. The discomfort caused by acid indigestion can be episodic/intermittent or chronic/constant.
Mowrey (1986) in his book, The Scientific Validation of Herbal Medicine, defines “indigestion (dyspepsia) [as] both a physiological state and a feeling” (p. 74). He asserts that the “physiological state” is attributable to faulty or improper digestion of foods, while “the feeling is one of discomfort, being ‘stuffed,’ pain, cramps, heartburn, gas and nausea” (Mowrey, 1986, p. 74)
Conceptual and Terminological Confusion
There is considerable conceptual and terminological confusion surrounding acid indigestion. It is often confused with gastro esophageal reflux disease (GERD) also referred to colloquially as heartburn because heartburn is a major symptom of GERD. For example, NIDDK (2007) uses the terms “heartburn” and “acid indigestion” synonymously, while other healthcare experts make a distinction between acid indigestion and GERD/heartburn. Kesel (2007) treats them as different. According to him, “severe indigestion may lead to heartburn but heartburn cannot cause indigestion” (Kesel, 2007, p.1). My position is that while they may share similar symptoms, contributing etiologies/causes and treatment options, acid indigestion and GERD/heartburn are different digestive disorders. 
Most likely the confusion involving acid indigestion and GERD/heartburn can be attributed to the fact that both conditions have a burning-type of pain or sensation associated with them. However, compared to acid indigestion, the burning feeling from GERD occurs in the mid-abdomen and in the lower middle portion of the chest, just behind the breast bone (NIDDK, 2007), while the burning pain from acid indigestion occurs in the pit or lower part of the stomach or abdomen. Furthermore, GERD is caused by stomach acid (i.e., hydrochloric acid) backing up into the esophagus. Stomach acid leaks back or refluxes into the esophagus because of a malfunctioning lower esophageal sphincter muscle (LES) weakened by age or hiatal hernia (i.e., when part of the stomach pushes up into the diaphragm). Acid indigestion is caused by different factors, which are discussed next.
Causes of Acid Indigestion
There are a number of factors which can cause acid indigestion. Some of the more common etiologies/causes of acid indigestion include peptic ulcers and gastroesophageal reflux. Although rare, gastric and pancreatic cancers can sometimes cause acid indigestion. In short, acid indigestion can be caused by disease or ulcer in the digestive tract (NIDDK, 2004). Frequently, the symptoms of potential causes can overlap, making diagnosis difficult (Bazaldua & Schneider, 1999).
Beyond it being caused by disease or an ulcer, most people experience acid indigestion because of eating too much, eating too fast, eating foods high in fat or eating foods during stressful times. Other factors causing acid indigestion or making it worse include eating too large a meal, eating a lot of spicy foods, consuming too much caffeine or carbonated soft drinks on a regular basis, eating irregularly, allowing long intervals of time between meals, drinking too much alcohol, smoking too much, suffering from fatigue, experiencing chronic stress or anxiety, taking medications irritating to the stomach lining and exercising on a full stomach (see NIDDK, 2004; Protocare Corporation, 1997).
Certain people will experience persistent/chronic acid indigestion which is not related to any of these mentioned factors. This type of indigestion is called functional or non-ulcer dyspepsia (NUD) caused by the irregular movement of food through the digestive tract (NIDDK, 2004).
According to NIDDK (2004), excess stomach acid does not necessarily cause or result from acid indigestion. However, this is not to say that hydrochloric acid is not implicated with acid indigestion. Some medical experts believe that the burning pain in the stomach results from there not being enough mucus lining protecting the stomach (Protocare Corporation, 1997). Using antacids may not help ameliorate the burning sensation associated with indigestion, although some people say that they get relief from taking antacids (see NIDDK, 2004).
Symptoms of Acid Indigestion
Symptoms of acid indigestion include a burning, distressing feeling in the pit of the stomach, nausea or upset stomach, burping, vomiting and heartburn. It was pointed out earlier that acid indigestion and GERD/heartburn are separate digestive disorders. If you are uncertain as to whether you are suffering from either acid indigestion or GERD/heartburn and the condition is persistent, it is recommended that you consult with a healthcare practitioner.
Prevention of Acid Indigestion
To help prevent acid indigestion and its symptoms, especially the burning pain in the pit of the stomach, there are a number of things which can be done involving lifestyle, eating behaviors, daily diet, nutritional supplementation (i.e., vitamins and minerals), kitchen spices when cooking, herbs supporting the digestive system and how best to take those herbs.
Our lifestyle, how people live in terms of the actual behaviors of their day-to-day lives, has a profound effect upon on overall health, generally, and digestive health, specifically. The following lifestyle strategies might prove useful in preventing acid indigestion or at least modulating the symptoms associated with it:
- Eliminate or limit intake of alcohol
- Eliminate or limit use of smoking and tobacco products
- Get sufficient amount of rest and sleep
- Learn about how to manage stress and anxiety
- Exercise or stay physically active on a regular basis
- Lose excess weight
It is not only what we eat but how and when we eat which affects maintaining overall health, healing of the body and keeping the digestive system healthy. The following eating behaviors might prove useful in preventing acid indigestion or at least modulating the symptoms associated with it:
- Eat smaller meals throughout the day
- Eat at regular, scheduled intervals
- Eat slowly
- Chew food thoroughly
- Do not eat standing up
- Do not eat when emotionally upset or stressed
- Do not eat two to three hours before going to sleep
- Do not eat and then lie down
Diet and nutrition are fundamental to overall health and healing of the body. The following dietary suggestions involving either the elimination or moderation of certain foods can go a long way in preventing acid indigestion and its symptoms:
- Eliminate or moderate intake of spicy foods
- Eliminate or moderate intake of saturated and trans-fatty acids
- Eliminate or moderate intake of refined, processed, white sugar/sucrose (i.e., refined carbohydrates)
- Eliminate or moderate intake of refined grains and foods derived from milled flour (i.e., refined carbohydrates)
- Moderate intake of animal meat
- Moderate intake of mucous building and congesting foods such as milk
- Eliminate or moderate intake of caffeine
- Eliminate or moderate intake of carbonated soft drinks
In addition, eat a balanced diet of primary, secondary and tertiary foods. Primary foods include whole grains and protein. Secondary foods consist of fresh, local, seasonal vegetables, which should be mostly lightly cooked. Tertiary foods are constituted of dairy, eggs and fruits (see Tierra, 1998).
Tierra (1998) recommends the following daily percentages for primary, secondary and tertiary foods:
- Primary foods – Eat 20%-30% of whole grains and 20%-30% of protein such as animal protein, tofu, tempeh and beans
- Secondary foods – Eat 30%-40% of mostly lightly cooked fresh, local, seasonal vegetables
- Tertiary foods – Eat 5%-10% of dairy, eggs, fruits, fats and oils such as olive oil, sesame oil and 2% of ghee (see Tierra, 1998).
An important step in eliminating acid indigestion or at least modulating its effects is to establish and maintain an optimal nutritional status. Proper nutritional supplementation can help keep a person’s nutritional status optimal.
Basic supplement protocol. A daily supplement protocol would include the following:
- Multiple vitamin and mineral
- Greens product (a brand containing protein to help modulate release of glucose)
- Omega-e fish oil
- Dietary fiber supplement (50% soluble fiber and 50% insoluble fiber)
- Digestive enzymes (a brand containing a spectrum of enzymes to help digest carbohydrates, protein and fat)
Hydrochloric acid. Mowrey (1986) recommends that hydrochloric acid (HCL) be considered in remedying acid indigestion. Murray (2008) also recommends supplementing with HCL. He states that “in the person with chronic heartburn or indigestion, rather than focus on blocking the digestive process with antacids, I have found most people respond better if we focus on aiding digestion. One of the most useful digestive aids is hydrochloric acid” (Murray, 2008, p.1). Murray (2008) specifically recommends a product by Natural Factors called Betaine HCL. He recognizes that “not everyone can have detailed gastric acid analysis to determine the need for hydrochloric acid supplementation” (Murray, 2008, p. 1) and offers the following practical method of determination:
- Begin by taking one tablet or capsule containing 10 grains (600 mg) of hydrochloric acid at your next large meal. If this does not aggravate your symptoms, at every meal after that of the same size take one more tablet or capsule. (One at the next meal, two at the meal after that, then three at the next meal.)
- Continue to increase the dose until you reach 7 tablets or when you feel warmth in your stomach whichever occurs first. A feeling of warmth in the stomach means that you have taken too many tablets for that meal, and you need to take one less tablet for that meal size. It is a good idea to try the larger dose again at another meal to make sure that it was the HCl that caused the warmth and not something else.
- After you have found that the largest dose that you can take at your large meals without feeling any warmth, maintain that dose at all of meals of similar size. You will need to take less at smaller meals.
- When taking a number of tablets or capsules it is best to take them throughout the meal.
- As your stomach begins to regain the ability to produce the amount of HCl needed to properly digest your food, you will notice the warm feeling again and will have to cut down the dose level (Murray, 2008, p. 1).
Before taking any nutritional supplement always consult with your physician.
Herbs. The key to holistic health is total nutrition and the key total nutrition is a balanced diet. Supplementing your daily diet with herbs can play an important role in creating a balanced diet so at to remedy nutritional deficiency and help the body to heal itself holistically of various diseases and disorders such as acid indigestion.
Mowrey (1986) recommends the following herbal blend as a digestive aid to relieve indigestion (dyspepsia) and other related digestive problems such intestinal gas, enteritis, colic and heartburn: Papaya leaves, peppermint leaves, ginger root, fennel seed and saw palmetto berries. He recommends taking the blend in capsule form or as an infusion (i.e., tea). A good herbalist can create the blend or you might be able to find a nutritional supplement product at a health store containing most if not all of the herbs in Mowrey’s blend.
Tierra (1998) recommends the following blend of herbs for acid indigestion: Dandelion root, calamus root, gentian, angelica, valerian and ginger root. He specifies the exact proportions. Unless you have expertise in formulating and making herbal blends, you would most likely need to have an herbalist create the blend for you.
Finally, Murray (2008) recommends a product (i.e., Peppermint Oil Complex with Oregano Oil) made by Natural Factors containing volatile oils from peppermint, oregano, and caraway seed oil in an enteric-coated capsule. Using this sort of delivery system prohibits the break down of the supplement in the stomach and allows it to be delivered to the small and large intestine. According to Murray (2008), research has demonstrated that preparations containing peppermint oil in enteric-coated capsules are effective and safe in treating non-ulcer dyspepsia (NUD) and GERD.
Kitchen spices/medicines. There are herbal spices used in cooking that can help with digestive system issues such as acid indigestion. These kitchen spices are classified as carminatives, a class of herbs and spices for relieving symptoms associated with digestive problems. Some of these kitchen spices include:
- Anise (helps with gas)
- Bay (helps prevent indigestion and gas)
- Caraway (excellent digestive aid)
- Cloves (improves digestion and helps prevent gas)
- Fennel (helps with gas)
- Ginger (helps with indigestion) (See Tierra, 1998)
Acid indigestion is digestive fact of modern life. The most common causes of acid indigestion are related to eating unhealthy foods, unhealthy ways of eating and unhealthy lifestyle behaviors, although it can be caused by peptic ulcers, GERD and gastric or pancreatic cancer.
The most common and uncomfortable symptom of acid indigestion is a gnawing, burning pain in the pit of the stomach. However, other symptoms of acid indigestion include gas, nausea/upset stomach, burping and vomiting.
Making the recommended changes in actual lifestyle and eating behaviors and daily diet can help prevent acid indigestion and ameliorate its symptoms. The goal would be to develop a set of lifestyle and eating behaviors, along with a balanced diet of primary, secondary and tertiary foods in proper portions, which would contribute to overall health and support the digestive system so that the body can be given the opportunity to heal itself and make the necessary corrections to inhibit acid indigestion.
Rather than attempting to make all of the recommended changes in lifestyle and eating behaviors and diet all at once, a better approach is to work on one or two (at most) behaviors at a time. Changing behaviors or otherwise replacing one set of behaviors with another can be challenging. There is a greater likelihood of success in focusing on changing only one or two behaviors at a time.
Finally, nutritional supplementation can make a significant contribution in preventing acid indigestion. The recommended basic supplement protocol and the specific supplements, herbs and kitchen spices should be taken in conjunction with a balanced daily diet. Supplements are supplemental. They are not intended to be used as meal replacements for a healthy, nutrient rich, balanced diet. Moreover, dietary supplements are most effective when tailored to fit the dietary, bio-chemical, health and lifestyle related needs of the individual taking them. In short, nutritional supplements need to be integrated into a person’s daily nutrition and lifestyle. Before taking any dietary supplement it is always wise to consult with a healthcare provider who is knowledgeable about nutrition and dietary supplementation.
You do not have to suffer from acid indigestion, especially if it is being caused by lifestyle and dietary factors. Take charge of your health and make the necessary changes to avoid experiencing the burning pain of acid indigestion. It is recommended that you consult with your physician before undertaking any major lifestyle or nutritional changes.
Bazaldua, O.V. & Schneider, F.D. (1999). Evaluation and management of dyspepsia. American Family Physician, 60(6), 1649-1650, 1656. Retrieved November 1, 2008, from http://www.aafp.org/afp/AFPprinter/991015ap/1773.html?print=yes
Kesel, J. (2007). Difference between indigestion and heartburn. Retrieved November 1, 2008, from http://ezinearticles.com/?Difference-Between-Indigestion-and-Heartburn&id=533538&opt=print
Mowrey, D.B. (1986). The scientific validation of herbal medicine: How to remedy and prevent disease with herbs, vitamins, minerals, and other nutrients. Lincolnwood, IL: Keats Publishing.
Murray, M. (n.d.). Gastroesophageal reflux disease (GERD). Retrieved November 1, 2008, from http://www.doctorymurray.com/conditions/GERD.asp
National Institute of Diabetes and Digestive and Kidney Diseases/NIDDK (2007). Heartburn, gastroesophageal reflux (GER), and gastroesophageal reflux disease (GERD). Retrieved November 1, 2008 from http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/
National Institute of Diabetes and Digestive and Kidney Diseases/NIDDK (2004). Indigestion. Retrieved November 1, 2008 from http://digestive.niddk.nih.gov/about/ddnews/win00/6.htm
Protocare Corporation (1997). Heartburn and indigestion. Retrieved November 1, 2008 from http://quickcare.org/gast/heartburn.html
Tierra, M. (1998). The way of herbs. New York, NY: Pocket Books.
Traditional Japanese Healing Arts (n.d.). Acid indigestion and GERD. Retrieved November 1, 2008 from http://www.japanesehealingarts.com/articles/acid_indigestion.html
 Two other sources that treat acid indigestion and GERD/heartburn as different digestive disorders are Protocare Corporation (1997) and Traditional Japanese Healing Arts (2008).