7 Burning Questions Answered: Your Guide to Understanding Acidity

If you've ever experienced that burning sensation in your chest and sour after-taste in your mouth post a meal, you know how disruptive acidity can be to your daily life. But what exactly causes this feeling, and how can you manage it effectively? We will answer seven important questions about acidity that will arm you with the information you need to keep your digestive system in check.

Acidity and indigestion are common complaints worldwide, but they seem particularly prevalent in India. An estimated 32% of adults aged 30-44 in India report experiencing these issues. 

The stomach lining has millions of tiny glands that secrete gastric juice, a mixture of chemicals like hydrochloric acid (HCl) and digestive enzymes. This breaks down complex food molecules, particularly proteins, into smaller units so that the body can better absorb nutrients used for energy or other body functions. 

To protect itself from this potent acid, the stomach lining produces a layer of mucus. This mucus acts like a shield, allowing HCl to break down food without damaging the stomach itself. It also releases bicarbonate, an alkaline substance (opposite of acid), which helps neutralise excess acid produced by the stomach. Our bodies usually maintain this delicate balance — until our diet and lifestyles get in the way. 

Certain foods and habits can spike stomach acid release or weaken the stomach's protective barrier, causing acidity. Let’s understand why this happens.

While stomach acid is necessary for digestion, an imbalance can lead to discomfort. Here are some common risk factors for acidity. 

• Spicy foods: Chilies and other spicy ingredients can irritate the stomach lining, increasing acid production and symptoms of acidity. 
• Fatty and fried foods: Fatty meals slow digestion and can pressure the lower oesophageal sphincter (LES) — the muscular valve (stop-gap) between the oesophagus and stomach. This pressure allows stomach acid to flow back up, which, over time, damages the lining of the food pipe. 
• Acidic foods: Citrus fruits, tomatoes, and certain processed foods can increase stomach acidity.

• Large meals can overwhelm the stomach's ability to handle them efficiently, increasing acid production and discomfort.
• When stressed, the body releases hormones that stimulate acid production while weakening the stomach lining, making it more susceptible to irritation.
• Alcohol relaxes the LES, allowing acid to back up into the oesophagus. Carbonated or gas-filled beverages can irritate the stomach lining and cause bloating, worsening acidity symptoms.
• Smoking weakens the LES and irritates the stomach lining, increasing the risk of acidity.

• Frequent intake of medications can damage the stomach lining and increase acid production.
• A hiatal hernia is said to happen when part of the stomach moves up through the diaphragm, which is the muscle that divides the chest from the abdominal area. This condition can cause the LES to weaken and result in acid reflux.
• Pregnant women are more prone to acid reflux because of the relaxation of the LES, which is often due to hormonal shifts during pregnancy.
• When you gobble down your food, you swallow more air. This air can get trapped in your stomach, putting pressure on the LES and causing it to relax momentarily, allowing stomach acid to rise.
• Gravity ensures that stomach acid remains in its proper place. Lying down soon after a meal can allow acid to flow back up into the oesophagus more easily. This is why nighttime heartburn is a common complaint.
• Wearing tight clothing around the waist can put pressure on your abdomen and stomach, pushing up on the LES and potentially causing heartburn.

You can recognise acidity after experiencing a range of uncomfortable symptoms. Some of the causes of acidity are:

• Heartburn: Stomach acid flowing back into the oesophagus frequently causes a burning sensation in the chest — the area behind the breastbone or sternum. “It makes it hard to enjoy a meal or even get a good night's sleep because the burning wakes me up,” says Amit, a 22-year-old engineer from Mumbai, who has been dealing with acidity since his eating habits changed after moving into his college hostel. 
• Indigestion: A feeling of fullness, discomfort, or burning in the upper abdomen after eating.
• Regurgitation: The uncomfortable flow of stomach contents back up into the mouth (often described as a sour taste).
• Nausea: Feeling like you might vomit.
• Bloating: A feeling of tightness or fullness in the abdomen due to gas buildup.
• Sore throat: Stomach acid rising up the oesophagus can irritate the throat.

Acidity can directly or indirectly affect other digestive conditions, which include the following:

A chronic condition, Gastroesophageal Reflux Disease (GERD) is characterised by the frequent upward flow of stomach acid into the oesophagus. This often occurs because of a weak lower oesophageal sphincter (LES), which is the muscle ring that separates the stomach and oesophagus. GERD doesn't necessarily involve excessive acid production but rather the inability of the stomach to properly contain the acid it produces. The primary indicator of GERD is often heartburn, though it may also lead to feelings of chest pain, regurgitation, a sour taste in the mouth, and challenges with swallowing.

“Barrett’s oesophagus is a disorder where the lining of the lower oesophagus becomes damaged primarily because of acid reflux. In a patient suffering from Barrett’s oesophagus, this lining will turn red, which is otherwise flat and pink,” says Dr Harsh Sheth, a gastroenterologist in Mumbai.

Gastritis occurs when the stomach's lining is inflamed. While it can involve increased acid production, it's not always the primary cause. Instead, it is usually due to bacterial infection (H. pylori), excessive pain medications, or autoimmune reactions. Like acidity, gastritis can cause heartburn, indigestion, nausea, and vomiting. It may also lead to belly pain, loss of appetite, and a feeling of fullness.

Healthcare professionals diagnose acidity by considering your symptoms and medical history. In some cases, depending on the complexity of your situation, the doctor might recommend additional non-surgical and imaging tests to present a clearer diagnosis.

There are two primary types of over-the-counter (OTC) medications that can help control acidity:

• Fast-acting relief medications quickly neutralise stomach acid, providing prompt relief from heartburn and indigestion.
• Acid-reducing medications reduce the overall production of stomach acid, offering longer-lasting relief compared to other fast-acting options. They are suitable for occasional heartburn.

Sometimes, your doctor might recommend stronger prescription medications for more severe or persistent acidity. In either case, it is important to consult your doctor before taking any OTC medication to avoid side effects.

While medications can offer relief, simple lifestyle adjustments are surprisingly effective in managing acidity and preventing discomfort in the long run.

• You should identify and avoid trigger foods that worsen acidity. These might include spicy, fatty, acidic foods and even certain beverages like coffee and alcohol.
• Overeating can overwhelm your digestive system. Consuming smaller meals more often can help avoid the accumulation of stomach acid.
• Proper chewing breaks down food particles more effectively, making digestion smoother and reducing the workload on your stomach.
• Excess weight can pressure your abdomen and weaken the lower oesophagal sphincter (LES), leading to increased acid reflux.
• Stress can exacerbate digestive issues like acidity. Stress levels can be managed by practising yoga and meditation. 
• Take a gap of at least a couple of hours between your meals and bedtime. Go for short walks after meals. Place pillows underneath your head to support it during sleep.

“Raising the head of your bed approximately 6-8 inches can aid in stopping stomach acid from returning to the oesophagus during sleep. This simple change can significantly reduce nighttime acid reflux,” says Dr Avinash Tank, a gastroenterologist in Ahmedabad. 

Understanding acidity is the first step toward managing and preventing it. Don’t let the fear of experiencing acidity get in the way of trying out and enjoying a hearty meal.