I've always thought it sounded counterintuitive to use an acid to alleviate indigestion, but the number of times I've heard people treat their symptoms of heartburn with apple cider vinegar is too large to count. So I decided to look into whether this strategy works, and to do some investigation about the idea behind its use. To my surprise, there is no research published in medical journals that addresses using raw apple cider vinegar to treat heartburn, despite widespread use and recommendations from blogs and websites.
What is heartburn?
Heartburn is most commonly caused by stomach acid contents traveling up into the esophagus, the pipe that connects the mouth to the stomach. Unlike the stomach, the esophagus is not used to the presence of acid. The stomach acid irritates the esophagus, leading to several symptoms including throat clearing, burning sensation in the chest and neck, sour sensation in the mouth, cough, and bloating. It is not a pleasant feeling. It's what we call GERD, or gastroesophageal reflux disease.
There are several reasons why gastric contents move up into the esophagus instead of going down to the bowel. The relaxation of the lower esophageal sphincter (LES), a valve that sits between the esophagus and the stomach, is the most common culprit. The LES is usually closed, creating a contained system to digest food. But it opens from time to time, to let air out in the form of belching. Reflux mostly happens when the valve relaxes too much, or too often. It allows not only gas but also gastric acid to move up, causing the discomfort.
There is a theory stating that what controls the LES is the stomach's acidity. If for some reason the stomach is not producing enough acid, the muscles around the LES would relax, resulting in more reflux. However, the mechanism that controls this valve is much more complex than the level of gastric acidity. It involves a complex network of involuntary muscles and several different hormones and neurotransmitters.
Medications for heartburn
The gold standard to treat heartburn is to take an over-the-counter class of medications called proton pump inhibitors (PPIs) that reduce stomach acidity. Using these drugs will not prevent reflux, but can reduce inflammation in the esophagus, allowing it to heal. Avoid taking these medications for more than a month, unless recommended by your doctor. It is not unusual to become used to PPIs. After taking them for a few weeks it may be hard to wean off of them, because stopping can cause rebound symptoms. PPI side effects are minimal, but long-term use can cause osteoporosis, infections, and a decrease in the absorption of nutrients.
Antacids and medications such as ranitidine and famotidine (H2 blockers) may work well and have fewer side effects, but if these strategies do not make you feel better within a few weeks, it is a good idea to consult with your doctor. Although rare, heartburn could be a sign of other serious illnesses.
Self-help measures for heartburn
Another approach that may be quite effective and free of side effects is to change specific behaviors:
- Avoid foods known to cause heartburn: coffee, chocolate, alcohol, fatty foods, tomato, spicy foods, and acidic foods.
- Avoid lying down for at least two to three hours after a meal.
- Eat small meals.
- Lose weight if you need to.
- Don't smoke, and if you already do, try to quit.
But what about taking apple cider vinegar for heartburn? Since we have no data to support the effectiveness or safety of its use for heartburn, it's probably a good idea to stick to drizzling this deliciousness on colorful salads for now.