Heartburn is a very common condition that I see as a Naturopath. In fact, I think acid-reflux has become so common that most people do not think it is an issue or a sign that body is communicating something is “off”.
Sometimes patients even forget to tell me, until I do deeper digging, that they are taking heartburn medication (usually a PPI which stands for proton-pump-inhibitor) or popping an antacid before or after meals.
I think this is linked to the fact that a lot of our North American diet of processed foods/drinks and lifestyle has been normalized, and so with it comes the normalization of taking “something” to alleviate the symptoms our body is expressing.
My approach is that when the body communicates it is telling us something is out of alignment and there needs to be deeper change: both in our lifestyle and nutrition.
Also, research is now showing that long-term use of acid-suppressing medication has harmful side effects – let’s look at why.
The stomach is supposed to be an acidic environment. This is the place where outside materials meet our insides! Stomach acid kills harmful bacteria and prevents us from getting sick. It also helps with the breakdown of food into its nutrients. Low stomach acid means we cannot properly extract vitamins/minerals from our food. It should come as no surprise then, that one of the side effects of long term PPI use is vitamin B12 deficiency (1,2). The FDA has even warned against potential risk of fracture, kidney disorders, low magnesium, C. diff diarrhea, pneumonia, and even dementia just to name as few (2).
Some of the factors that predispose individuals to heartburn include: being overweight, smoking, a hiatial hernia, eating large meals or right before sleep, eating spicy food, alcohol, and low stomach acid. While most of these make sense, you may be wondering how low stomach acid can cause heartburn.
At the end of our esophagus and the beginning of our stomach there is a valve named the LES: lower esophageal sphincter. It separates the stomach and acidic environment) from your esophagus. In an ideal situation the LES relaxes when we are eating and closes shut at all other times and during digestion. However, LES tone can weaken overtime due to: smoking, stress and even coffee! One of the reflexes of the LES is to close when stomach acid is optimal (pH of 2-4). However, if stomach acid is low (a higher pH) then it doesn’t close or respond properly. Instead it relaxes allowing the acid that is there to regurgitate up into the esophagus. This is what causes that sensation of burning. Low stomach acid will also equate with improper digestion of nutrients that are key for the digestive mucosa to produce more stomach acid: zinc being a major factor.
For a lot of people what is actually occurring is that they have an imbalance in lifestyle factors (smoking, eating before bed, high stress) and diet (processed foods, too much coffee/alcohol) – that leads to lower stomach acid and a loss of stomach and LES tone. They then start to experience heartburn and are often given acid suppressing medications, which as you can understand don’t really get to the root of the issue but just mask the symptoms. In fact, over time they can just make the situation worse by suppressing stomach acid even more, leading to nutrient deficiencies and the other risks mentioned above.
My Naturopathic approach to GERD (gastroesophageal reflux disease) or heartburn has a few components:
1. Slowly increase the stomach’s ability to produce acid (especially if there has been long-term suppression): this can be done through changing the diet, incorporating something mild such as apple cider vinegar, and slowly weaning off of PPIs, supplementing with HCL and digestive enzymes in cases where it is needed.
2. Soothe the esophagus (manage acute symptoms of heartburn): there are some great herbs that help with this: marshmallow and deglycerized licorice are commonly used.
3. Strengthen the LES tone: acupuncture has been studied and shown to significantly strengthen LES tone, apple cider vinegar can help, but the biggest effects come from building on foundations.
4. Correct any underlying nutrient deficiencies such as zinc or B12
5. Work on foundations of health and prevention: getting a proper nights rest, managing stress, eating well and moving your body are all part of the foundation of health. Quitting smoking and making lifestyle changes to not eat on the run, before bed, or over eat are really important. Decreasing consumption of coffee/alcohol, as well as citrus foods and chocolate have been beneficial for patients struggling with acid-reflux.
Fundamentally, you want to start seeing your heart burn as a message from your body that something is off! Examine when it happens and what you are consuming. If you have been taking PPIs for a long time you may also want to consider an alternative approach. Our digestion is one of the most integral parts of health: it is through digestion that we receive what we need from our food to build good health. I hope that this summary has been informative and helpful.
Yours in health,
Spomenka
1. 4. Wilhelm SM, Rjater RG, Kale-Pradhan PB. Perils and pitfalls of long-term effects of proton pump inhibitors. Expert Rev Clin Pharmacol. 2013;6(4):443-451.
2. Maes ML, Fixen DR, Linnebur SA. Adverse effects of proton-pump inhibitor use in older adults: a review of the evidence. Ther Adv Drug Saf. 2017;8(9):273–297. doi:10.1177/2042098617715381