Enduring heartburn is far from enjoyable but reaching for the over the counter antacid may cause more harm than good when used on a long term basis to manage the incessant attacks that many people experience.
I was very surprised to see these medications moved from prescription only to over the counter a few years ago untill I came across the data that indicated up to 30% of adults grapple with some form of heartburn on a daily basis. I think this number is a lot higher as I am seeing far more in my patients these days.
What we need to be asking is, what is the driving cause of Heartburn and how best do we treat it.
Understanding Heartburn
Heartburn occurs when stomach acid travels into the esophagus, where it shouldn’t be. The esophagus, responsible for transporting food from the mouth to the stomach, lies near the heart, behind the sternum. Hence, the pain typically felt in the chest region lends this digestive issue its name, and explains why it can provoke anxiety as well as reflux symptoms.
Although burning sensations and chest pain are primary indicators of heartburn, some individuals experience subtler symptoms. For instance, a chronic cough during meals could signal "silent acid reflux," while post-nasal drip or frequent throat clearing may also be signs.
What Triggers Heartburn?
Many associate heartburn with excess stomach acid, often resorting to antacids for relief. However, surprisingly, heartburn commonly stems from insufficient stomach acid. Paradoxically, using acid-blocking medications can exacerbate the issue.
When the body produces inadequate stomach acid, it impacts the upper esophageal sphincter that fails to close properly. This deficiency also hampers efficient food breakdown, causing food to linger in the stomach longer and increasing the likelihood of acid reflux.
Why Does Heartburn Recur?
Repeated exposure to stomach acid can damage the esophageal lining over time, heightening sensitivity. Eventually, even minor amounts of stomach acid can trigger discomfort. Highly acidic foods such as tomatoes, strawberries, citrus fruits, coffee, and chocolate can exacerbate irritation, perpetuating the cycle of heartburn until the underlying cause – low stomach acid – is addressed and the esophageal lining begins to heal.
How Can Heartburn Be Managed?
Traditionally, heartburn has been managed with quick fixes like acid-blocking medications (PPPIs - Proton Pump Inhibitors), that reduce stomach acid. While these may offer temporary relief, they set the stage for prolonged struggles with heartburn and potential development of more severe health issues down the line.
Furthermore, acid-blocking medications can lead to nutritional deficiencies, as stomach acid aids in the absorption of vital nutrients like iron, calcium, zinc, and certain vitamins that are essential in the body. Deficiency of these minerals can lead to increased fatigue, long term bone loss & weakened immune health.
Long-term use of PPIs has also been associated with chronic bowel infections such as C. difficile over growth and Sibo as well as increased risk of pneumonia infections. New research is now looking at the association of these medications in severe clinical outcomes with COVID-virus infections.
Addressing the root cause of heartburn, often low stomach acid, is the most effective approach.
Improving Stomach Acid Levels
Enhancing stomach acid levels can be achieved through simple lifestyle adjustments:
Adopt a balanced diet rich in fruits, vegetables, and adequate protein, while minimizing processed foods and sugar intake.
Embrace a leisurely approach to meals, akin to the French dining ethos, ensuring thorough chewing.
Limit water consumption during meals but maintain hydration between meals.
Consider utilizing digestive enzymes with each meal to support digestion.
Incorporate diluted apple cider vinegar into your routine by mixing it with water and consuming it before meals.
Enhancing Digestive Health
In addition to restoring healthy stomach acid levels, focus on healing any esophageal or gut lining damage to prevent symptom recurrence.
Beneficial nutrients and botanical medicines include:
Quercetin, aloe, and marshmallow soothe irritated mucous layers.
Deglycyrrhizinated Licorice (DGL) and zinc carnosine to promote healing of tight junctions in the gastrointestinal tract.
Herbal bitters like gentian, yellow dock, dandelion, and burdock to support optimal digestion.
Probiotics to foster a balanced gut microbiome.
By addressing the underlying causes of heartburn and adopting these natural strategies, you can achieve long-lasting relief and promote overall digestive wellness.
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