Acid Indigestion: Myth & Mysteries

Among the commonest ills of man, ranking close to constipation and headaches, is the wide range of supposed digestive upsets mistakenly described as "acid indigestion." Every day, millions of Americans complain of "heartburn" or "sour stomach." TV commercials spiel endlessly about "acid upset." Some sufferers try to dignify their complaints with such technical terms as hyperacidity and acidosis. By whatever name, the problem is a high-up bellyache, and those who suffer from it in the U.S. lay out $90 million each year for antacids and alkalizers.

Haunting Danger. Medically both heartburn and acid indigestion are vague terms, as hard to define precisely as to treat effectively. Heartburn ("pyrosis" in medical jargon) is a burning sensation felt somewhere behind the breastbone. In the vast majority of cases, the pain means only that the victim cannot digest food properly because he is emotionally upset, and he may have the pain without food. But there is always the haunting danger that what feels like heartburn may be nature's warning that the coronary arteries are shutting down. Many a man has died of a heart attack soon after asking for a glass of sodium bicarbonate.

Another serious condition that can be mistaken for simple heartburn is a hiatus hernia--a defect in the diaphragm where the gullet (esophagus) passes through, just above the stomach. This permits part of the stomach to poke upward into the chest cavity and spill digestive juices into the gullet. Pope Pius XII suffered from a hiatus hernia for a long time before it was correctly diagnosed and treated, and the condition is by no means rare.

Often, however, heartburn comes with a backflow of partly digested food from the stomach into the esophagus. The victim may then belch up a little of this undigested food or its juices, and be concerned by the sharp taste of his "sour stomach." In most cases, this is a minor matter, and the result of gulping food while under emotional tension. A classic case is that of Wall Street brokers, who eat on their feet during midday trading. The cure is to stop eating, which is easy, and to calm down, which is not. Antacids may speed relief.

Flowing Juices. What seems to be acid indigestion, usually with nausea and belching, has the same causes as heartburn. An antacid tablet may help. The catch is that the layman usually cannot tell the difference between this and a medically significant form of indigestion. This inflammation of the stomach (gastritis) is part of the pattern of peptic ulcer. Then the trouble is not a simple backup of the evening's Scotch, steak and potato but a too-free flow of hydrochloric acid and other digestive juices from the stomach walls into the stomach itself and the duodenum. The excess juices find a vulnerable spot in the stomach wall or duodenum and, in effect, digest that. The result is an ulcer.

Whether caused by an ulcer or by the occasional food upheaval, indigestion has led to a variety of diet fads and home remedies. The faddists include finicky types who do not eat certain foods, especially fruits, "because they're too acid." Or they do eat mildly acid citrus fruits because they have convinced themselves that orange juice, for example, produces an alkaline reaction in the stomach. Some drinkers avoid highballs with a soda mix, claiming that the carbon dioxide that turns the stuff fizzy also turns their stomachs acid. Contrariwise, others take a glass of plain soda to settle their acid stomachs. Many sufferers gulp black coffee, which actually stimulates an empty stomach to produce more acid, and may be irritating; coffee with cream is "buffered."

As people get older, their ability to digest certain components of everyday foods seems to change (there may be a decrease in certain enzymes, but no one is sure). So some make a fetish of avoiding chocolate, or uncooked cucumbers, or all cucumbers, or uncooked cabbage, or all cabbage. Then there is the fellow who loudly proclaims, "I can eat anything"--and then slips off to the bathroom for a dollop of soda bicarb.

Faltering Kidneys. Sodium bicarbonate is at once the commonest, cheapest, most misused and most dangerous of antacids. In normal people, an occasional half-teaspoon in half a glass of water will probably do no harm. But a teaspoonful of bicarb in half a glass of water is enough to neutralize highly acid stomach contents, with some bicarb left over. The leftover can be dangerous, particularly to a person with an unsuspected kidney ailment. The excess bicarb is absorbed into the bloodstream through the walls of the small bowel, causing excessive alkalinity in the blood. It is the kidneys' job to remove this excess, but diseased kidneys may not be up to it, introducing the danger of death from alkalosis.

Though most laymen have never heard of alkalosis, it may be more dangerous than acidity, because doctors are not on the alert for it. And even when they suspect it, it is hard to diagnose. Its symptoms are the same as those for which the patient was taking antacids--nausea, vomiting, abdominal pain. In its later stages, alkalosis may bring on muscle spasms, fever, coma, and finally death.

Helping Steak. Nearly all physicians now avoid sodium bicarbonate. The most up-to-date thinkers among them are coming to the conclusion that the best neutralizer for excess stomach acid is nature's neutralizer--food. They prescribe small meals about every three hours. It matters little, they say, what the ulcer patient eats--he may have steak and French fries with catchup and a cucumber salad with vinegar dressing--provided only that he eats a little at a time and often. The tide has turned against the insipid Sippy diet of milk and light cream: doctors are beginning to find that for some ulcer patients this "cure" is worse than the disease--like bicarb it throws them far enough over on the alkaline side that they can develop alkalosis.

Since many ulcer and recurrent indigestion patients refuse to eat often enough, or do not get complete relief even when they do, doctors still prescribe antacids. But nowadays these are nearly all of the nonsystemic kind--unlike bicarb, they are never absorbed into the bloodstream and are far safer. The body processes them more slowly, so they do not give such quick relief. The most familiar, in the form of milk of magnesia, is magnesium hydroxide, and this is the main ingredient in many brand-name preparations. Since it has laxative properties, some manufacturers combine it with aluminum hydroxide, which is also antacid but, taken alone, is slightly constipating. Several proprietary preparations contain magnesium trisilicate, which neutralizes acid by both chemical and physical reactions and forms a gelatinous lining in the stomach and duodenum that may protect the crater of an ulcer.

Between the devil of alkalosis and the deep blue sea of uncertain acidity, the average man should prescribe nothing for himself except to eat and drink moderately, and should try to do neither when he is too angry or too anxious to enjoy his food. If he feels he must have antacids, he should take them only on a doctor's advice--and be sure the doctor checks to see whether the "acid stomach" is covering up a more serious condition.

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