Heartburn is a common concern and the medicine used to treat it was thought to have few adverse effects. New research shows however that, while this medicine decreases immediate symptoms for many sufferers, there is an increased risk of other harmful conditions.
In this article we explore why heartburn happens and how to get rid of it, naturally.
Since the 1990s the number of people diagnosed with Gastroesophageal Reflux Disorder (GERD), or more commonly known as heartburn, has risen dramatically. Between 1998 and 2005 alone, there was an increase of 216% of the number of GERD diagnosis. Today, one in five Canadians1 report suffering from heartburn. As a result, millions of people are taking prescription medication in an attempt to manage their symptoms. This class of drugs, called proton-pump inhibitors (PPI), is now one of the top five prescriptions given by medical doctors in Canada.
When PPIs came on the market in the 1980s they were considered very safe drugs with minimal side effects. Their effectiveness meant that doctors could more easily and quickly treat the symptoms of GERD without having to spend time in each short clinic appointment exploring the cause or explaining how nutrition, diet, and lifestyle changes could produce relief without the option of medication.
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PPIs became a quick-fix for many doctors and while they were initially prescribed for 6-week courses, they are now regularly prescribed as long-term solutions. Over the last several years, however, an increasing amount of evidence has suggested that these drugs may not be as risk free as once thought.
Studies published in several leading medical journals show long-term use of these medications can lead to the following significant risks:
In this era of grab and go food, eating in front of the TV, or quickly reheating leftovers, we often don’t get a full cephalic response before we eat. We quickly eat at our desk between meetings, snack in the car, or chow down while watching the latest episode of our favourite Netflix show. Fast-forward 30 minutes, and that food feels like it’s sitting like a rock. Lay down to try to ease the stomach and there is it, heartburn.
Acute and chronic kidney disease: up to a 50% increase in risk5, 6
Dementia: up to a 44% increased risk in regular PPI users7
Bacterial infections: up to a 74% increased risk of getting C.difficile infection
Fractures: up to a 58% increased risk in spine fractures
With these risks adding up, many Canadians are starting to ask their doctors, “Do I really need this prescription or is there something I can do naturally?”
Why do we get Heartburn?
As a doctor, I believe that the questions we should be asking are “What is the root cause of this patient’s symptoms, and how should we treat this?” The widely held belief is that heartburn is created by having too much acid in the stomach, which isn’t always true. In fact, as we age, our ability to produce stomach acid decreases but the number of times we experience heartburn will actually increase.
With the belief that high stomach acid creates GERD, we should expect to see teenagers chewing on TUMs while the elderly down spicy pepperoni pizza. In fact, one of the main reasons GERD is such an issue in our modern society is not what we eat, but the way that we eat.
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How We Eat
The very first part of digestion is called the “cephalic phase.” When you smell food, or think of food (think of lemons and you’ll start to salivate), you are triggering your cephalic response. This response sends a message down the length of the vagus nerve, reaching the stomach and organs of digestion, triggering the cells in the lining of the stomach to release hydrochloric acid (HCl). HCl plays an important role in breaking down food, killing bacteria, and helping certain vitamins (such as Vitamin B12) be accessible for later absorption.
At the top of the stomach is a sphincter called the lower esophageal sphincter (LES). It acts like a lid on the container of the stomach. When food is swallowed, it pushes past this sphincter and then it closes behind, ensuring stomach acid and the food it is mixing with does not come back up into the esophagus. The LES is signalled to close when there is an adequate amount of HCl in the stomach. Remember that cephalic phase? This is where it’s so important, because if we haven’t had the time to get into our cephalic phase before eating, then the stomach doesn’t release as much HCl. This, in turn, doesn’t properly signal the LES to close as it should, allowing for food and some stomach acid to start to move up into the lower esophagus, leading to heartburn.When we add in chewable tablets to relieve stomach acid, or take prescription medicine, we are getting rid of the symptoms by lowering the stomach acid; however, we aren’t addressing the problem, we are actually making it worse! When we repeat this time and again, the body starts to adapt and the GERD symptoms become chronic.
Other causative factors in this painful condition are the growing rates of obesity, larger meals, and restrictive clothing. These factors increase the amount of pressure on and within the abdomen, which makes it even harder for the LES to close. Research shows there is a 1.5 to 2-fold increase in the incidences of GERD with increase body mass index (BMI).8
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There is certainly a time and place for GERD medications as long-term GERD can lead to cellular changes in the esophagus, which can predispose a person to Barrett’s Esophagitis, esophageal cancer, varicosities, and other disorders that can have dire consequences. It is important to consult with a licensed healthcare provider to have appropriate testing and sometimes imaging, conducted. However, if GERD is a newer symptom to you, or you would like to try to address things naturally before trying a prescription medication, here are some tips to consider:
Getting to the Root of Heartburn:
Get cephalic:
Slow down. Take a few deep breaths before eating. Take a few moments to think about how delicious your food is going to be and how good it smells. It sounds silly, but this can be extremely effective. Challenge yourself to take 5 deep breaths before eating.
Bump up your acid
Try adding a bit of apple cider vinegar (between 1tsp to 1 tbsp) in some water before a meal to stimulate your vagus nerve and give your stomach a little boost.
Eat something bitter
Similar to the apple cider vinegar, bitter foods stimulate the digestive reflexes. This is why a salad with bitter greens is traditionally served in many European multi-course meals. Bitter vegetables include: arugula, radicchio, endives, chicory and artichokes.
Take off the pressure
If you have gained some weight, your GERD symptoms might be the cry from body to take a closer look at your diet and fitness levels. You might also consider your clothing. If you wear belts or restrictive clothing, can you loosen these before eating and while you are digesting.
Address nutritional deficiencies
Stomach acid needs zinc and Vitamin B6 as co-factors for production. If you are low in these key nutrients, then you may be getting GERD-symptoms.
Look deeper
In my practice, I have seen multiple cases of GERD resolve after taking a closer look at diet, eliminating food allergies and sensitivities, and ensuring the digestive tract has a healthy colony of bacteria. Working with a licensed naturopathic doctor or a holistic nutritionist will help you get to the root of your GERD.
Dr. Robyn Land is a licensed Naturopathic Physician with the College of Naturopathic Physicians of BC, the BC Naturopathic Association and the Canadian Association of Naturopathic Doctors. She is the owner of Local Health Integrative Clinic in Vancouver, BC and a faculty member at the Boucher Institute of Naturopathic Medicine, one of two accredited Naturopathic schools in Canada.
Data sources include: Canadian Journal of Gastroenterology, and StatsCan.
Publisher’s Notes: Dr Robyn Land is a general practitioner of naturopathic medicine at the Local Health Integrative Clinic and Yoga Alliance certified instructor.
