This is my very first article here on Commonwealth Herbs!

To mark the occasion, I’ve decided to set a goal for myself.
I love anatomy. I love anatomical relationships. If you get me going, I can talk forever. My goal here is to keep it fairly simple (as simple as talking about a piece of a complex system can be!) and understandable and useful.
And under 50 pages.
Let’s go!

Joanna

Setting the Stage
We tend to think of ourselves as made of individual parts – if there’s a problem with my stomach, its the fault of the stomach. If there’s something wrong with my knee, it might need to be replaced. But something you’ll hear from me in this article (and every time you talk to me…and from Katja and Ryn…) is that the body is interconnected. Its extremely common that if you feel discomfort or pain, the “part” that’s complaining is relatively fine – its just being asked to do more than it was designed to do.

For Example
You build a bridge to support 10,000 pounds.
No one is informed of the weight limit.
Then 20,000 pounds of elephants are paraded across it in high winds.
The bridge falls.

You could:

  1. blame the bridge when it breaks and replace the part of the bridge that physically broke
  2. look at the plans, realize that you asked too much of this particular bridge, then go back to the original plans and figure out a different solution

The latter is more of what I do, and the lens through which we’ll take a look at heartburn.

Acid Reflux : Pyrosis : Heartburn
These are all names for the same uncomfortable experience. But one of these names is not like the others!
The name “Heartburn” is so viscerally descriptive. It really does feel like a burning sensation in the heart.
But its more than that. It teaches us something important about our anatomy.

There are a lot of things in the body that are programmed to be symmetrical. You have two arms, two eyes, two legs.
But at the heart of it all (oh the pun!), your organs are not symmetrical.
You have only one stomach and only one heart. They are both on the left side – one right above the diaphragm and one right below it.

The muscle of the diaphragm is the main muscle of breathing. It divides the chest cavity from the abdomen. Above the diaphragm, things are protected by the rib cage. Below the diaphragm, things are mostly not protected by the rib cage.

So it makes perfect sense that when stomach acid ends up higher than it should, into the esophagus (which passes through the diaphragm), that burning sensation would seem to come from the heart.

What is causing heartburn?
The cause is fairly simple.
The sphincter at the junction of the esophagus and the stomach is not able to do its job properly. Its job, as you might already guess, is to keep the stomach acid out of the unprotected esophagus, and in the stomach which is designed to contain it.
WHY this is happening is a more complex story that will vary from person to person, and can touch on a lot of factors – diet, stress, movement patterns, etc.
If you haven’t guessed already, I’ll be talking about the movement patterns piece!

Why is this such a problem for people?
Areas of transition are places where different forces meet. The diaphragm is just such a place. If the balance of forces is off for any reason, this can cause problems.
There are many forces at work here. Let’s take a closer look at a couple of them.

Pressures
The area below the diaphragm and the area above the diaphragm are very different. One is designed to expand and contract thousands of times per day. In order to pull in air for breathing, the thorax needs to be at a lower pressure than the abdomen. Since everything in the known universe flows from high pressure to low pressure – great for pulling in air from the outside world – there is a built-in tendency for the structures under the diaphragm to be pulled up towards it.
This is actually a helpful phenomenon. When its working properly, this “attraction” of the diaphragm prevents all the organs from just sitting on top of one another, and eventually transferring all that weight directly down onto the pelvic floor.
But.
When the pressures aren’t in balance, abdominal organs can get pulled up around and even sometimes through the diaphragm.
Whoops! Not the original intention!
The ability to deal with crowding near the diaphragm, or even herniation through it, is not what the gastro-esophageal junction is designed for.

The esophagus is not the only tube that passes through the diaphragm, but it seems to be the only one we have widespread problems with. The aorta and vena cava also run through the diaphragm (plus a few nerves), but there is relatively little movement in these tubes. The esophagus on the other hand, has to be able to accommodate the movement of swallowing. Because of this, it it less firmly connected to the diaphragm. Since it can move up and down with each swallow, there is more play in that relationship. This leaves it open for potential problems.

Here’s a simple exercise to feel how the way you move can affect your organs, specifically around the diaphragm:
Sit up tall but without rigidity. Just easy and upright.
Take a few breaths and notice what that feels like.
Slump back into the back of a chair. Classic “bad” posture.
Take a few breaths of about the same volume.
What do you notice?
If you’re anything like me you feel that the breath is harder to take and it increases the pressure in the chest to an uncomfortable degree. There is a sense of crowding and tightness.
This might seem like an overly simple example, but read on!

Anatomical Coordination
Any time two things need to work together, there is the possibility of miscommunication.
The sphincter at the top of the stomach is not considered a true sphincter – it lacks the thickening of smooth muscle tissues that you find at, say, the other end of the stomach.
Hmm.

Turns out that the diaphragm doesn’t just help us breathe, it also helps us keep the esophageal sphincter closed when its supposed to be.
Or, at least, its designed to!

Taking a look at the diaphragm, we can see that contraction along those fibers would help to close the bottom of the esophagus:

image from Gray's Anatomy / Wikipedia
image from Gray’s Anatomy / Wikipedia

But, the diaphragm does not act in isolation.
Nothing acts in isolation, of course!
Its not just responsible for sitting there until we need to take a breath and then flapping its wings.

We’ve probably all experienced lifting something heavier than we’re comfortably capable of lifting.
What happens?
The diaphragm locks and we hold our breath. This is a very adaptive measure – we have this awesome reserve of emergency stabilizing power just when it matters. But what happens if the muscles that should be stabilizing our body day to day aren’t doing what they should be doing?
This core line is going to get locked down and be unable to respond to everything that’s being asked of it. Its doing too many things. Its over burdened. There are way too many elephants on the bridge and the wind is picking up.

What happens as a result will vary from person to person. People will get anything from neck pain, to back pain, to headaches, to heartburn to any of a host of other problems with roots in anatomy. And I ask you this – what about you is NOT rooted in anatomy?

So, what’s the solution?
This is the part where I admit that I can’t give you an easy solution.
When it comes to the complexity of the human body, there are very few easy solutions to be found over the internet.

Quick patches to get you through until next week? Sure.
Sit up straight!
Be calm!

But. That didn’t work, did it?
Because this core line of the body is (to get a little esoteric) a line of truth. You can’t fake it. You can’t just sit up straight and hope all your problems go away. You’ll be slouching back into that chair in no time.
You can’t just put yourself there and call it done. You need to arrive there, as a whole body, growing into a new place of ease.

Here’s the part that gets missed so often – Its supposed to feel easy.

Yes, really!
I know we live in a culture of “no pain no gain” and we’re so wedded to the idea that anything we try to do needs to be hard…or else it somehow doesn’t count or we’re not really trying.
But that’s not how we’re designed. We don’t slump back into our chairs because we’re bad people. We slump because its easy, and we’re programmed to be maximally efficient.

At the risk of trying to make too many points in one article (I would never!), let’s give a little shout out to the abdominal muscles. Let’s talk about how they should support you with one easy example one of my teachers uses, and I find it so helpful.

Think about fully tightening your abdominal muscles and going for a run like that.

The image is actually kind of funny, right?
We would never do that. We know that’s not how its supposed to work.
But as a culture, we’re not quite prepared for the idea that its actually ok to let the belly go. To let things be soft. To let them alone to just do their job. But that’s what we need to do.
We’re accustomed to holding the belly in either to get extra support or for perceived aesthetic reasons. But when we do this, one of the major results is compression of the abdominal organs. Its easier to compress a hollow organ like the stomach than a solid organ like the liver. So it just makes sense that if the belly is in a state of constant compression, the stomach may take the brunt of that, forcing its contents higher up.

Where to Start
So given that, here are my real suggestions:

  1. Cultivate awareness of your body as a whole. Take a “snapshot” of your body a few times a day. How are you feeling as a whole organism? Where do you feel stresses, strains, or lack of support? What can you do to mitigate that? Does that require a large change like setting up a different workstation? Or could you just get a new chair that allows you to support your own body more readily? Or could you think about your sitting patterns and change things at that level? Pick the solution that works for you.
  2. Find ways to encourage length in your body. Everything needs space in order to function well. In some cases, we could have too much space, but this is a rare problem to have in this area! I could write a whole other article on how access “lift” in the spine (and maybe I will!), but in the meantime you are looking for length of the spine – from the bottom all the way up through the back part of the head – WITH ease.
    If you start to feel rigidity, let go of the movement you are doing and start over. Your body is really, really smart. It will not maintain an effortful position over time for no reason.
    Putting yourself there is not the same thing as arriving there. You’ll feel the difference. We’re looking for the latter! And it will take time.
  3. Practice belly breathing – inhaling so that the belly expands forward and there’s a slight sense of the lumbar spine moving backwards.
    This could be done any time, any where.
    Personally, when I’m starting to feel stressed, I take a few breaths allowing my belly to expand and that helps the stress dissipate immediately. You could also make it a daily practice where you take even one minute just for yourself to sit quietly and breathe into the belly. Whatever works for you and your schedule.
    If you’re having trouble feeling that expansion at first, stick with it. It can be very hard to let the body begin to undo this pattern of feeling that we always need to have a tight abdomen.
    My only caution on this is not to do it if you are currently experiencing heartburn symptoms. As this breathing pattern temporarily increases the pressure in the abdomen it can make the symptoms worse.

If you go to regular movement classes, maintain these principles through your class. Keep that length and support and make that the priority, rather then getting into a specific challenging yoga pose, lifting more weight, or going a longer distance. Make sure that whatever you are doing, your breath is flowing.
Have fun exploring!

For an herbalist’s perspective on heartburn, see our recorded class Heartburn: The Root and the Remedy.

3 Comments

  1. Henriette on 27 September, 2012 at 3:29 am

    Another cause is food intolerance. Now, how does that tie into the musculosceletal apparatus? (I wouldn’t have a clue, but if you do get rid of food intolerances, the reflux / heartburn / whatnot goes away). 🙂



  2. joanna on 27 September, 2012 at 12:07 pm

    Yes! Certainly, the body’s posture and movement are not the only way to look at heartburn.
    But I wanted to offer this as another tool, another way to approach the problem, since I know most of the people reading this are already up on the herbal side of things (and I am definitely not an herbalist!) 🙂

    Food intolerance, stress levels, postural compensations, etc are all stress factors that would contribute to some kind of problem (such as heartburn). Exactly how what we take into our bodies relates to movement is an area that could use more exploration. These two aspects of health tend to be separate, but it is wonderful to move towards a model of treating the whole body as one system.

    My inclination as to how the mechanism of interaction would work is this:
    When an organ is repeatedly irritated, it has a greater likelihood of forming adhesions to neighboring structures. So if someone is eating foods they are intolerant to, eliminating those foods would eliminate a primary, or the primary stressor causing the irritation, but leave the adhesions that have already formed as a result. These restrictions alter the normal motions of the organs (and whatever structures they adhere to) and therefore leave the person open to either experiencing that same problem with just a small amount of stress to the system, or to some other problem down the road.

    But it is also possible that posture can cause a baseline of irritation, just like a food intolerance. If someone is, for example, extremely kyphotic, this might crowd the stomach as well as compromise the function of the diaphragm and make it potentially less able to deal with any kind of stress. For this person, addressing the posture would have profound effects on organ health. Addressing food intolerance would be one way to address the issue, and may eliminate the experience of heartburn, but it can also be addressed from a spatial medicine direction. Or both! Which I think would lend the greatest health benefit!



  3. katja on 27 September, 2012 at 12:35 pm

    Hi, Henriette!

    To address this from the herbal/food side: omg yes, food intolerance. We spend a lot of time on that in our class. As well as “why stomach acid is good for you!” and why heartburn usually has more to do with too LITTLE stomach acid, as opposed to too much.
    In the recorded class we have available right now, we also talk about intra-abdominal pressure caused by sucking in (as well as by eating too much fermenty carby/sugar junk which produces gas, which causes pressure), but Joanna can do that part soooo much more justice. I’m looking forward to getting a new recording where we can team about heartburn, though then it’ll probably be twice as long! 🙂



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