Heartburn

Acid reflux (also referred to as “heartburn”) is one of the most common digestive complaints we see in practice. In North America, around 20% of people struggle with a diagnosis of gastroesophageal reflux disease (GERD), which is thought to be the major underlying cause of heartburn.

There are many physiological causes to the sensation of heart burn. Impairment of the lower esophageal sphincter that prevents stomach contents from moving up into the esophagus is one of the main issues, but there are also other factors involved in the development of heartburn symptoms, such as poor integrity of the mucosa of the esophagus, which is supposed to protect our tissues against acid, and poor peristalsis of the esophagus, which is supposed to move food downwards towards the stomach. One thing that is not typically part of the pathophysiology of GERD is having “too much stomach acid”. The issue with GERD is that acid is showing up in the wrong places, causing symptoms. Interestingly, a lack of stomach acid can actually cause heartburn symptoms as well.

One of the main conventional treatments for GERD is the inclusion of acid-blocking medications. Some patients start off by taking over-the-counter medications like Tums or Nexium, which can help immediately improve symptoms. Unfortunately, this is only a short-term solution. After this eventually fails, patients consult their medical doctor and often start on a prescription acid-blocking medication, such as omeprazole. These medications are truly indicated under certain conditions. For example, if there are precancerous changes to the esophagus (such as in Barrett’s esophagus), if there is true overproduction of stomach acid (such as in Zollinger Ellison syndrome), or for the management of gastric ulcers, where stomach acid can further the damage. However, more and more patients are coming, having been on PPIs for years and unaware of the risks of using these medications long-term.

While it’s true that these medications can help reduce symptoms, they come with a very long list of side effects. Some of these include:

- Nutrient deficiencies - specifically, vitamin B12 and magnesium

- Increased infection risk of the gastrointestinal tract - because stomach acid is a key component involved in preventing bacteria from colonizing the stomach

- Maldigestion – stomach acid is required for proper digestion, and a lack of it often causes other gastrointestinal symptoms

- Increased chronic disease risk - Kidney disease, dementia and osteoporosis have all been associated with chronic PPI use

There are an abundance of lifestyle changes that should be made before considering the use of acid-blocking medications. Some of these include:

· Keep a healthy body weight.

· Avoid alcohol, coffee, mint, tomato, citrus, carbonated beverages, tea and caffeine.

· Consume a moderate amount of fiber.

· Avoid overeating or eating too close to bedtime.

· Avoid eating on the run or while distracted.

· Elevate the head of your bed 4-8 inches.

· Quitting smoking.

There are also many naturopathic interventions to help you manage symptoms of heartburn, address the root cause of the issue and avoid the adverse effects of acid-blocking medications. Book an appointment today and get rid of your heartburn for good!

References

Antunes C, Aleem A, Curtis SA. Gastroesophageal Reflux Disease. [Updated 2023 Jul 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441938/

Ahmed A, Clarke JO. Proton Pump Inhibitors (PPI) [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557385/

Kines K, Krupczak T. Nutritional Interventions for Gastroesophageal Reflux, Irritable Bowel Syndrome, and Hypochlorhydria: A Case Report. Integr Med (Encinitas). 2016 Aug;15(4):49-53. PMID: 27574495; PMCID: PMC4991651.