8 Surprising Heartburn Causes You Need to Take Seriously

Most of us will suffer from the telltale burning at some point, but many things can cause heartburn other than that extra-spicy chili you just ate.

Yes, heartburn is common

At some point, you’ll probably feel the burn—heartburn, that is. About 60 million Americans experience heartburn at least once a month, according to the American College of Gastroenterology. In fact, the organization points out that one-quarter of people of those people may have it daily. But although heartburn is common, it’s causes can be tricky to understand, experts say. Here’s what you need to know about heartburn.

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It’s on the rise

If it seems as if more people are dealing with heartburn, it’s because they are. “Heartburn has become extremely common, especially in the U.S. in recent years with a growing number of people who are obese,” says Kristle Lynch, MD, assistant professor of clinical medicine at Perelman School of Medicine at the University of Pennsylvania. One of the primary heartburn causes is obesity, which increases gastric pressure so that stomach contents flow back up into the esophagus. 

Do you have heartburn?

The term may sound self-explanatory, but you’ll know it’s happening to you if “you feel a burning midline chest pain or experience some liquid regurgitation (acid reflux),” says Dr. Lynch. Turns out that heartburn, acid reflux, and GERD are not the same thing

When to see a doctor

Heartburn may be common, but it’s not something you can brush off. If you try over-the-counter medication (like OTC proton-pump inhibitors) and symptoms don’t improve, that’s not typical. “It may not be heartburn, or it’s heartburn that’s not responding to medication,” says Dr. Lynch. Choking on food, vomiting, and unexplained weight loss are also worrisome; talk to your doctor. If it’s severe and you suspect it may be a heart attack, head to the ER. 

Why you should take it seriously

Yes, it’s easy to throw heartburn medication at the problem and wait to feel better. Some people just live with the pain, thinking this is something that just happens after eating. That’s unwise, says Dr. Lynch: Over time, acid reflux causes damage to the lining of the esophagus and can lead to Barrett’s esophagus, a condition in which cells of the lining of the esophagus develop abnormalities. “Barrett’s can eventually turn into esophageal cancer. Though most patients will never develop cancer, it’s so scary and morbid that it’s a high concern,” says Dr. Lynch.

Heartburn cause: Mint chewing gum

Although some research suggests that chewing sugar-free gum for a half-hour after a meal can decrease reflux, mint can have the opposite effect. In general, peppermint is a trigger for some people because it relaxes the lower esophageal sphincter, allowing juices to bubble back up. If you’re going to try the chewing-gum trick, start with a non-mint flavor.

Heartburn cause: High-fiber meals

You thought you were being healthy with your brown-rice bowl packed with broccoli and black beans, so why do you feel awful now? Although it’s a rarer trigger, “a high-fiber meal empties more slowly out of the stomach,” says Dr. Lynch. And one of the more common heartburn causes is food that sits around longer in the digestive tract.

Heartburn cause: Ketchup

You’ve likely heard that acidic foods like tomato sauce, tomato juice, and raw tomatoes can be common heartburn causes for some people. But you may not have realized that ketchup is also a potential culprit, says Dr. Lynch. Even the smaller amounts that are typically eaten with a meal could be a problem.

Heartburn cause: Gravity

Or, rather, it’s the loss of gravity’s assistance when you lie down after you eat that is among the heartburn causes, according to Dr. Lynch. Sitting up allows food and digestive juices to move the correct way; lie back and they can move upward, leading to heartburn. Finish your last meal two to three hours before bed, the American College of Gastroenterology advises.

Heartburn cause: Nighttime

It’s like a heartburn trifecta. In the U.S., dinner is traditionally the biggest meal, and eating heavy loads of food slows digestion (trigger one). Then we lie down to go to sleep (trigger two). And people are generally more sensitive to pain at night (trigger three). “Everything is quiet, and you’re more aware of the sensation of pain,” says Dr. Lynch. Big, late dinners are like three heartburn causes in one. What can help is eating smaller meals, finishing up eating a few hours before bed, and using a wedge pillow or risers for the head of your bed to keep gravity’s pull working for you while you snooze, she says.

Heartburn cause: Too tight belt

Anything that’s too tight—a bra, compression tights, belt—will put pressure on the stomach, encouraging the upward flow of stomach acid, says Dr. Lynch. If you notice that symptoms increase when you’re wearing constricting clothing, it’s time to loosen up. 

Heartburn cause: Old pants

Weight gain also increases this intra-abdominal pressure, but then there’s this double whammy: “Sometimes people will gain weight, but they don’t go up in pants size,” says Dr. Lynch. The constriction only serves to exacerbate symptoms. Buying new pants is one way to find comfort. It’s also worth talking to your doctor about starting a weight-loss program. 

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Heartburn cause: Hiatal hernia

Obesity is one factor that can predispose people to a condition called a hiatal hernia, says Dr. Lynch: Part of the stomach moves into the chest through the opening in the diaphragm, which can cause or worsen symptoms, Dr. Lynch says. (The treatment for heartburn in patients with a hiatal hernia is the same—unless they’re showing signs of complications of reflux, like bleeding or ulcers, she adds.)