If you are one of the millions of Americans who suffer from heartburn, you are in good company. At least one third of Americans suffer from heartburn at least once per month. This article will cover the cause of heartburn, why you need to get off your little purple pill (or other heartburn medication) and how to treat heartburn naturally.
What is heartburn and why is potentially dangerous?
The word “heartburn” is a bit of a misnomer since heartburn is not a disease of the heart. It is due to an irritation of the esophagus caused by stomach acid. The lower esophageal sphincter (LES) is a muscle that divides the esophagus from the stomach and it operates like a valve – allowing food into the stomach and then closing tightly to prevent stomach acid from going back into the esophagus or refluxing. If the LES is not tight enough or it opens too frequently, stomach acids from the stomach (such as acid, pepsin, and bile) can go backwards up the esophagus causing the burning sensation we call heartburn. Refluxing acid can also cause cough or hoarseness. If reflux occurs frequently, this is referred to as Gastroesophageal reflux disease (GERD). Over time, GERD can lead to esophagitis, an inflammation of the esophagus or to a more serious illness called Barrett’s Esophagus. In Barrett’s Esophagus, the presence of gastric acid in a place where it is not supposed to be (the esophagus) can cause the cells that line the esophagus to change their structure and sometimes this progresses to cancer.
A few of the more common symptoms of heartburn:
- Chest pain
- Cough and hoarseness
- Burning sensation in throat and/or chest
- Sour taste
- Nausea and vomiting
Certain substances can relax or trigger the LES including:
- Citrus fruits
- Garlic and onion
- Products containing caffeine
- Fried foods
- Spicy foods
- Processed foods
- Certain medications including, anticholinergic drugs (like scopolamine), iron pills, non steroidal anti-inflammatory drugs (like aspirin, ibuprofen, naproxen etc.), potassium, sedative, bisphosphonates (used to treat osteoporosis), beta blockers and calcium channel blockers (blood pressure pills)
Other potential causes
- Eating right before bed or reclining on a full stomach
- Magnesium deficiency (magnesium is necessary for relaxing the LES)
- Food sensitivities – gluten and dairy are big offenders
- An overgrowth of yeast (like candida) or bacteria (like H. Pylori)
- Lack of sleep.( For more information on sleep hygiene and techniques for better sleep, check out my blog and my podcast on New Jersey Women’s Health Summit.
- Hiatal hernia, where a portion of the stomach protrudes through an opening in the diaphragm where the esophagus normally fits snugly
- Celiac disease
- Esophageal stricture (narrowing of the esophagus)
- Chronic Obstructive Pulmonary Disease (COPD)
- History of GERD as a child
- Lack of stomach acid
The Little Purple Pill
Many of my patients have been using Proton Pump Inhibitors (PPI) to manage their symptoms of heartburn for years . In fact, across the US, approximately 15 million Americans rely on these medications daily to control the discomfort of their heartburn. Examples of PPI’s include Esomeprazole (Nexium) Omeprazole (Prilosec), Pantoprazole (Protonix) or Lansoprazole (Prevacid).
How PPI’s work and their potential risks
These medications work by suppressing molecules responsible for the release of stomach acid. They medications may give symptomatic relief but there are problems with these drugs. As a result of long-term use, the body fights back and produces MORE acid and, suppressing the stomach acid regularly appears to weaken the LES.
Here are some of the potential risks of PPI use:
- Risk of heart attack
- Risk of pneumonia
- Overgrowth of bad bugs leading to bloating
- Vitamin and mineral deficiencies notably B12, magnesium and zinc. * Vitamin deficiencies themselves can cause a whole host of issues such as fatigue, neuropathies, depression, memory problems, osteoporosis and more.
- Risk of anemia (since iron absorption is affected)
- Risk for hip fracture in patients with osteoporosis
* This is because PPI’s deplete the stomach of acid stomach necessary for the digestion of foods and for nutrient absorbing.
Stopping your PPI
Don’t stop your PPI cold turkey as this may cause severe rebound of symptoms. Gradually begin to lower your dose and spread the dosage out over time (once ever other day, then every three days, etc.). Once you are down to the lowest dose, you can start substituting with an over-the-counter H2 blocker like Tagamet or Zantac. Then wean off the H2 blocker over the next several weeks.
Alternative ways to treat your heartburn
- Eat real whole, unprocessed foods – lots of fruits and veggies. Eat your foods cooked, avoid a lot of raw foods for a week or so. Avoid refined sugars, white flour, junk food and alcohol.
- Eat smaller, more frequent meals. Eat approx every 3 hours and stop eating at least 3 hours before bed.
- Reduce or eliminate potential triggers like nicotine, tomato, coffee and spicy foods. Consider a 21 day trial of eliminating gluten and dairy.
- Breathe before you eat. Eating while stressed is a recipe for disaster…your food might even go up instead of down. Dr. Mark Hyman suggests the “Take 5 Method.” Take five breaths before each meal. Count in for 5, count out for 5 and breathe deeply.
- Acid Supplementation with apple cider vinegar. This may seem counterintuitive but acid replacement can be extremely effective in reducing incidence of GERD. Adding a weak acid like apple cider vinegar can help tone the LES. Try: 1-2 teaspoons of apple cider vinegar (1-2 teaspoons daily –can put in warm water)
- Take a betaine hydrochloric acid supplement. Start with 1-2 capsules prior to a meal or snack. This will help with digestion and also works to eliminate the helicobacter.
- Try a digestive enzyme. Take 2-3 before a meal. Some come packaged with betaine hydrochloric acid.
- Deglycerized Licorice (DGL). Chew 2-3 tablets before a meal or snack.
- Probiotics and Prebiotic supplementation. Probiotics come in many forms. I recommend a supplement with at least a 15 billion colonies. Prebiotics are non-digestible plant fibers.
- Vitamin D. Get your levels checked. Aim for 40-60 ng/mL
- Other helpful supplements: 75–100 grams zinc carnosine 2x per day between meals, 3-5 grams glutamine powder in water 2x per day, 400-500 mg of magnesium glycate per day.
I hope you find these suggestions useful for getting letting go of your dependence on medications and helping you feel better.
Until next time,
Jenny Kalina PA-C
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