Heartburn

Struggling with heartburn? Here’s what you need to know to find relief.

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What is heartburn?

Heartburn is a burning pain in your chest. This pain is caused by stomach acid rising from your stomach into your oesophagus (the pipe that takes food from your mouth to your stomach).

This can cause:

- Burning pain in the middle of your chest

- Pain which is worse when you bend over or lie down

- Burning pain that radiates into your back

By learning more about the causes of, tests for, and treatment for heartburn, you can understand it better and make informed decisions to get back on track.

Why does heartburn happen?

There are several possible causes of heartburn, and it’s important to find out what’s causing yours.

Here are the main causes of heartburn:

  • Gastroesophageal reflux disease (GORD)

  • Hiatus hernia, when part of your stomach moves up into your chest

  • Surgery you’ve had in the past (especially bariatric surgery)

  • Certain foods and drinks, such as alcohol, coffee, chocolate, and fatty or spicy foods

  • Being overweight

  • Smoking

  • Pregnancy

  • Stress or anxiety

  • Medication, such as anti-inflammatory painkillers

  • Overgrowth of bacteria in your small intestine (this is called SIBO)

Diagnosing heartburn

Diagnostic testing allows us to pinpoint the exact cause so we can recommend the right solution.

Oesophageal manometry, 24-hour pH, malabsorption breath tests, SIBO & gastric emptying

At the Functional Gut Clinic, we use the following highly accurate and trusted diagnostic tools, to identify the underlying cause of your heartburn:

  • Oesophageal manometry – which measures the function of your oesophagus (food pipe)

  • 24-hour pH impedance monitoring – which looks at whether you have any reflux

  • Carbohydrate malabsorption breath test – which finds out if you have certain food intolerances (lactose or fructose)

  • Small intestinal bacterial overgrowth (SIBO) breath test – which finds out if you have an overgrowth of bacteria in your small intestine (called SIBO)

  • Gastric emptying test – which measures how quickly food leaves your stomach

Learn more about heartburn

How Your Gut Bacteria Can Influence Your Weight

How Your Gut Bacteria Can Influence Your Weight

April 13, 20264 min read

What you eat determines what you weigh. That’s a basic fact everyone understands. But it’s not quite that simple. While there’s a certain logic to “calories in calories out,” how your body processes what you eat is determined by your gut microbiome.

Your gut is home to trillions of bacteria and other microorganisms which are collectively known as the gut microbiome. Increasingly recognised as a pillar of health, your microbiome influences how your body digests food, processes calories, and therefore your weight.

Below, we cover how gut microbes and weight loss may be connected, how this affects obesity, and what you can do to support your gut microbiome during weight loss.

What the Gut Microbiome Is

The gut microbiome was first discovered decades ago. However, it was only in recent years that its importance was finally understood.

It refers to the community of bacteria, fungi, viruses, and other microorganisms that live inside your gut. Most of these microbes aren’t harmful. In fact, they’ve been with you from the moment you were born, producing essential nutrients, supporting digestion, and even boosting your mood.

But eating the wrong thing, taking antibiotics, or experiencing prolonged stress can take a toll on your gut microbiome. Get the wrong composition of species, and it can increase your risk of weight gain.

The Link Between Gut Bacteria and Obesity

People with obesity often have different gut bacteria inside their guts. Not only that, but they’ve typically got a lot fewer species of bacteria compared to people of moderate weight.

The effects can be pretty startling.

When scientists transferred a collection of microbes from people with obesity to mice, the mice immediately gained weight. The microbes shifted the entire metabolism.

How Gut Bacteria May Affect Weight

What’s going on? Well, it seems to be down to the specific species. If you’ve got certain groups of bacteria, they can increase your risk of obesity. But there are also beneficial bacteria that can aid weight loss.

One 2018 study examined the ratio between two bacterial groups: Prevotella and Bacteroides. People who had more Prevotella than Bacteroides lost more weight and body fat than those with roughly equal amounts of these bacteria.

Prevotella copri, in particular, was linked to lower insulin levels. Higher insulin is associated with type II diabetes, so keeping levels low can offset one potential risk of obesity.

The Role of Short-Chain Fatty Acids

But how are the bacteria actually influencing your weight? Some bacteria simply extract more calories from the same food, leaving less leftover for you. Signalling is another factor. Certain bacterial compounds influence hunger hormones, fat storage, and inflammation.

One group of compounds are known as short-chain fatty acids (SCFAs). They can help support:

  • Gut lining health – strengthening the intestinal barrier and reducing inflammation

  • Appetite regulation – influencing hormones involved in hunger and satiety

  • Metabolic signalling – helping regulate how the body processes energy and stores fat

Diets rich in fibre from vegetables, legumes, and whole grains help feed beneficial bacteria and promote healthy SCFA production.

Signs Your Microbiome May Be Affecting Your Weight

An unbalanced gut microbiome isn’t the only cause of weight gain or obesity. So, how do you know if it’s a factor in your weight troubles?

Often, you’ll notice a persistent difficulty losing weight. Maybe you’re following the same diet as a friend (adjusted for body size), but you’re still not losing any weight, or not as much.

You might also notice sugar cravings, as the bacteria influence your hunger signals to get you to eat more. Sometimes, these signs occur alongside digestive symptoms like bloating, constipation, or stomach discomfort.

Support a Healthy Microbiome for Weight Management

There’s good news. Fixing your gut microbiome involves a lot of the same habits that will help you lose weight. You don’t need to worry about a dozen different things. Simply focus on:

  • Fibre-rich foods (vegetables, legumes, whole grains)

  • Fermented foods (yoghurt, kefir, kimchi, sauerkraut)

  • Diverse plant-based diet

  • Reducing ultra-processed foods

  • Regular sleep and stress management.

Your gut microbiome won’t change overnight. However, if you stick to the recommendations above, beneficial bacteria can gradually increase over the following weeks.

When Microbiome Testing Can Help

While the advice above will benefit your gut, it’s not specific to you. The only way to understand what’s going on in your gut is to perform a gut microbiome test.

The Functional Gut Clinic offers microbiome testing to determine the microbial diversity and composition of your gut microbiome. We can provide personalised dietary and lifestyle recommendations based on your results to help you restore your gut microbiome and support a healthy weight.

Learn more about our gut microbiome testing to discover what your microbiome is telling you and how to support healthier weight management.

Read the following engaging article: Eosinophilic Oesophagitis (EoE): When Your Symptoms Aren't Just Acid Reflux

gut microbes and weight lossmicrobiome and weightweight loss microbiomegut bacteria obesitymicrobiome and weight management
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Heartburn is a burning pain in your chest.

Heartburn is often experienced after eating and can last anywhere from a few minutes to several hours. The stomach releases more acid after eating certain foods, including spicy dishes, fatty foods, citrus fruits, tomato-based products, garlic, and caffeinated drinks. The more acid that is produced, the greater the risk of heartburn.

Other factors include obesity, smoking, stress, pregnancy, and eating too close to bedtime.

What are the symptoms of heartburn?

Heartburn primarily causes an uncomfortable or burning sensation in the middle of your chest. You may also experience:

  • A burning sensation in your throat

  • A strong acidic or sour taste in your mouth

  • Difficulty swallowing (dysphagia)

  • A feeling of pressure or pain behind your breastbone

  • Repeated coughing

  • Hoarse voice

In addition to these symptoms, the pain from the acid can get worse when lying down or bending over. This is because the acid flows out of the stomach and into the oesophagus. Whenever you lie down, you increase the risk of heartburn-related symptoms.

Constant heartburn is a sign of a severe underlying condition. Most people experience heartburn in episodic attacks – usually after consuming certain foods. If the heartburn is persistent, it’s crucial to speak to a medical professional. You can also consider organising a test via The Functional Gut Clinic (see below).

What causes heartburn?

Heartburn occurs when the contents of the stomach enter the oesophagus (the food pipe connecting your stomach to your throat). Usually, the stomach contents are prevented from going back into the oesophagus by a juncture called the lower oesophageal sphincter. However, in some people, this sphincter doesn’t function properly.

Heartburn is a symptom of gastroesophageal reflux disease (GORD). GORD simply refers to the backflow of acid from the stomach into the oesophagus. GORD is the condition; heartburn is the symptom.

Several factors increase the risk of heartburn. The causes of heartburn and GORD either increase acid production within the stomach or affect the functioning of the lower oesophageal sphincter. These include:

  • Hiatal hernia. A hiatus hernia involves a part of your upper stomach penetrating through the diaphragm (the layer of muscle separating your chest from your stomach). This usually occurs due to a weakness or tear.

  • Pregnancy. If you become pregnant, the increased pressure during the third trimester (and sometimes earlier) forces the stomach contents backwards, causing heartburn.

  • Surgery. Previous surgery, especially bariatric surgery, increases the risk of not only heartburn but also a hiatus hernia.

  • Smoking. Smoking is closely linked to heartburn and GORD. People who quit smoking notice a significant reduction in heartburn symptoms.

  • Overweight or obesity. Being overweight or obese is a major risk factor for GORD. This is likely due to the increased pressure in the stomach alongside a diet high in fatty, processed foods.

  • Medications. Certain medications, such as anti-inflammatory painkillers (e.g., ibuprofen or aspirin), sedatives, and blood pressure medications, can increase your risk of heartburn.

  • Stress or anxiety. An increase in stress or anxiety can increase acid production in some people, leading to heartburn. It’s often accompanied by another factor.

  • Small intestine bacterial overgrowth (SIBO). Excessive bacterial growth in the small intestine leads to increased abdominal pressure and subsequent acid reflux, which can cause heartburn. Managing SIBO often reduces these symptoms.

Foods to avoid

Acid production is a normal part of the stomach’s function. The acid helps digest food. Certain foods require more acid to digest, triggering an increased production in the stomach.

For most people, this isn’t an issue as the acid flows into the small intestine. However, if you struggle with heartburn and GORD, then it’s sensible to limit or avoid certain foods. These include:

  • Citrus fruits (like oranges and grapefruits)

  • Tomatoes and tomato-based products

  • Spicy foods

  • Garlic and onions

  • Chocolate

  • Mint

  • Fatty or fried foods

  • Caffeinated beverages (such as coffee and tea)

  • Carbonated drinks

  • Alcohol

It’s not just the food. Eating an excessively large meal, wearing tight clothes, and lying down soon after eating can increase the risk of heartburn. If you’re experiencing persistent heartburn, it’s often linked to diet rather than another factor.

Is heartburn the same as GORD?

No. Heartburn specifically refers to the burning sensation in the chest. GORD is the underlying condition involving the backflow of acid. Heartburn is a symptom of GORD. Acid reflux is sometimes used as shorthand for GORD – however, not every attack of acid reflux is an example of GORD.

Acid reflux refers to any episode of acid backflowing into the oesophagus. If the episodes occur two or more times a week, it is diagnostic for GORD. Most people experience acid reflux episodes occasionally. This can increase in frequency as acid reflux progresses to GORD. You should speak to a doctor if you notice this change.

Does acid reflux always cause heartburn?

Heartburn is always caused by the backflow of acid into the oesophagus. Several other conditions can create a similar sensation. For example:

  • Oesophageal ulcers. Ulcers occur due to erosion of the oesophageal lining. Often associated with acid reflux or overusing anti-inflammatory medications.

  • Oesophagitis. Severe inflammation of the oesophagus is closely linked to GORD. However, it can also be caused by medications and infections. An allergic condition known as eosinophilic oesophagitis can also cause heartburn.

  • Functional heartburn. Unlike the other conditions, this isn’t a problem with your oesophagus or stomach. It’s caused by a disorder of the gut-brain connection. It involves the same heartburn symptoms but without any signs of acid reflux or inflammation. It’s connected to overactive nerves.

How long does heartburn last?

Heartburn is not a permanent condition. It lasts as long as the acid is present to irritate the oesophagus and throat. Most people experience heartburn and GORD for between a few minutes to several hours. The timespan often depends on the underlying cause. For example, if your heartburn is due to your diet, it might go away within a few minutes. In contrast, if you have a hiatus hernia, the heartburn might persist for much longer, even after standing up.

Constant heartburn is a rare symptom. It’s a concerning sign, as the acid can continue to damage your oesophagus. If you’re constantly feeling heartburn (or using lots of antacids), then it’s critical to speak to a doctor.

Is heartburn serious?

Most cases of heartburn aren’t serious. It’s common to experience heartburn after a large meal or eating certain foods. However, if the heartburn becomes repeated or constant, it can cause long-term damage. Usually, the damage caused by acid reflux heals like any injury. If it happens regularly, then the oesophagus lining can become permanently injured.

Potential long-term complications include:

  • Oesophageal strictures. The lining of the oesophagus becomes replaced with scar tissue due to repeated inflammation. This scar tissue causes a narrowing of the oesophagus (stricture), which prevents food from getting through.

  • Intestinal metaplasia. The tissue lining of the oesophagus undergoes a change to look more like the lining of your intestines, protecting it from damage. It is called Barrett’s oesophagus and is a precancerous condition.

  • Oesophageal cancer. Cancer is a rare complication of GORD and heartburn. It occurs due to persistent inflammation and cellular changes. The longer your heartburn persists, the greater the risk of cancer.

Heartburn and GORD can also indicate problems in your stomach. For example, excess acid production can lead to gastritis (stomach inflammation) and stomach ulcers. It may also aggravate preexisting conditions such as asthma.

How do we diagnose the causes of heartburn?

The following tests may be used to diagnose what is causing your heartburn:

  • Oesophageal manometry – which measures the function of your oesophagus (food pipe)

  • 24-hour pH impedance monitoring – which looks at whether you have any reflux

  • Carbohydrate malabsorption breath test – which finds out if you have certain food intolerances (lactose or fructose)

  • Small intestinal bacterial overgrowth (SIBO) breath test – which finds out if you have an overgrowth of bacteria in your small intestine (called SIBO)

  • Gastric emptying test – which measures how quickly food leaves your stomach

    The following tests may be used to diagnose what is causing your heartburn:

  • Oesophageal manometry – which measures the function of your oesophagus (food pipe)

  • 24-hour pH impedance monitoring – which looks at whether you have any reflux

  • Carbohydrate malabsorption breath test – which finds out if you have certain food intolerances (lactose or fructose)

  • Small intestinal bacterial overgrowth (SIBO) breath test – which finds out if you have an overgrowth of bacteria in your small intestine (called SIBO)

  • Gastric emptying test – which measures how quickly food leaves your stomach

Heartburn treatment

Lifestyle changes

Most people who experience occasional heartburn symptoms can benefit from lifestyle changes. This involves limiting exposure to potential triggers. You might want to try:

  • Avoiding trigger foods, such as fatty foods or caffeinated beverages

  • Eating smaller meals

  • Avoiding tight clothing

  • Avoiding lying down immediately after eating

  • Quitting smoking and alcohol consumption.

Often, people find that small changes to their diet can stop or reduce episodes of heartburn. If the heartburn continues, it’s usually a sign that something else is going on. It’s crucial to get to the bottom of your symptoms; otherwise, they will persist.

Medication

As heartburn is caused by acid, neutralising this acid relieves symptoms. The primary treatment for heartburn is an over-the-counter (OTC) antacid, such as Gaviscon or Alka-Seltzer. These medications provide immediate relief from your symptoms – perfect for tackling a sudden acid reflux attack. If you experience constant heartburn, it’s sensible to carry antacids with you. However, excessive use of antacids can cause other problems.

Your doctor may prescribe medications that prevent acid production. This includes:

  • Proton Pump Inhibitors (PPIs). These medications reduce stomach acid production by blocking the enzyme in the stomach lining that produces acid. Common examples include omeprazole, esomeprazole, and pantoprazole. PPIs are used to treat GORD by allowing the oesophagus to heal and preventing further damage.

  • H2 Receptor Antagonists. These drugs work by blocking H2 receptors on stomach cells that signal the production of acid. This results in decreased stomach acid output. Examples include ranitidine, famotidine, and cimetidine. They are effective in relieving GORD symptoms and are generally used for milder cases.

Surgery

In the majority of cases, lifestyle changes and medication are enough to prevent heartburn symptoms. If GORD doesn’t respond to medication, surgery might be a potential option. This can repair a hiatus hernia, strengthening the lower oesophageal sphincter and permanently preventing the backflow of acid.

Procedures include:

  • Nissen fundoplication. This procedure tightens the junction between the stomach and the oesophagus.

  • Transoral incisionless fundoplication. A similar procedure performed non-surgically using an endoscope.

  • LINX device. A tiny ring of magnets is placed around the junction between the stomach and oesophagus to prevent reflux. It’s a type of minimally invasive surgery.

When should you seek medical care for heartburn?

Heartburn is extremely uncomfortable. However, most cases are relatively mild and treatable with antacids. Speak to a medical professional if:

  • You experience heartburn more than once a week

  • You have other associated symptoms

  • You have difficulty swallowing

  • Your heartburn persists despite treatment

  • You’re over the age of 60

  • You have a tight or squeezing chest pain

  • You cough up blood

Remember, occasional heartburn is relatively normal. But if you have constant heartburn, it’s crucial to get tested. The Functional Gut Clinic is highly experienced in diagnosing acid reflux. We’ll organise your test and provide advice on what to do next.

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Are you experiencing any other symptoms

Symptoms are often closely connected. Find out more below.

Reflux

Burning mid-chest, worse when bending or lying down

Constipation

Difficulty going to the toilet, unusual stools, often with stomach ache or intestinal cramps, bloating, nausea or appetite loss

Bloating

Feeling uncomfortably full and tight, excess belching/breaking wind, abdominal pain or gurgling

Regurgitation

Bringing food or drink back up, difficulty swallowing, feeling that food or drink is stuck in your throat, horrible taste in your mouth

Swallowing Issues

Dysphagia - difficulty swallowing, feeling that food or drink is stuck in your throat, horrible taste in your mouth

Diarrhoea

Loose or explosive stools, can’t get to a toilet in time

Abdominal Pain

Cramps; sharp or dull pain, Bloating, Excessive belching, Nausea or vomiting

Faecal Incontinence

Stools leak unexpectedly, Can’t get to a toilet in time

IBS

Abdominal pain or cramping, bloating, changes in bowel habits and urgency, gas