Because conventional physicians are becoming more skilled at diagnosing and treating heartburn, a condition in which stomach acid splashes upward into the esophagus, this common problem is undergoing some name changes. Strictly speaking, when you used to feel as though Mount St. Helens was erupting beneath your breastbone, it was called “heartburn.” After doctors developed gastroscopes to actually see the irritated esophagus, your heartburn grew into the more respectable “reflux esophagitis,” or “reflux” for short.
Now, as more effective (but very expensive) drugs have been developed, heartburn has matured to GERD, or gastroesophageal reflux disorder. (When the price of diagnosing and treating a condition has increased by a thousandfold, it’s only appropriate to select a name worth the price.)
Although conventional medicine does a nice job with whatever you want to call it–heartburn, reflux, or GERD–our integrated approach at WholeHealth Chicago is far less costly and actually addresses some of the basic causes that conventional medicine may overlook.
What is Heartburn?
An estimated 60 million Americans experience this common digestive problem each year, and as many as 25 million may be affected on any given day. Heartburn is the informal name for this stomach complaint whose chief symptom is a burning sensation behind the breastbone. The discomfort most often occurs after meals and lasts from a few minutes to several hours. Heartburn is especially prevalent among pregnant women: More than 25% of them routinely experience its fiery flashes every day.
Despite its name, heartburn has nothing to do with the heart. It occurs when stomach acid backs up from the gastrointestinal tract into the esophagus, a process reflected in the medical name for this condition: gastroesophageal reflux. The corrosive stomach acid, used to digest food, irritates the delicate lining of the esophagus and produces the distinctively unpleasant experience of heartburn.
Key Symptoms
- Burning sensation in the upper abdomen and chest, sometimes extending to the throat; usually occurs after eating
- Bloated feeling; belching; occasional nausea
- Regurgitation of sour liquid into back of throat
- Discomfort often made worse by lying down
What Causes Heartburn?
The stomach secretes about a quart of hydrochloric acid each day to aid in digestion. As long as it remains in the gastrointestinal tract (which is lined with protective mucus) the caustic acid poses no problem. A muscle called the lower esophageal sphincter (LES) acts as gatekeeper, opening to let food into the stomach and then closing to keep acid out of the esophagus. When the LES does not close tightly, however, acid can quickly escape to trigger an episode of heartburn. Age is often a factor, because after age 40 the LES tends to grow gradually weaker.
Numerous other factors may also be involved:
Being overweight or pregnant creates pressure on the abdomen that weakens the LES.
Smoking weakens the LES and in addition dries up saliva that helps dilute the stomach acid.
Chocolate, alcohol, onions, garlic, and other dietary items cause the LES to relax.
Fatty foods have the same effect.
Acidic foods like citrus fruits, tomatoes, and coffee increase production of stomach acid.
Overeating increases the production of acid, and a large quantity of food creates extra pressure on the abdomen.
Tight clothing squeezes the midsection and tends to push stomach contents upward.
Lying down after eating allows acid to flow more easily into the esophagus.
Treatment and Prevention
In many cases, the discomfort of heartburn can be prevented with simple dietary adjustments and other lifestyle changes. When symptoms do flare up, they can usually be treated successfully with supplements, over-the-counter remedies, and other self-care methods.
Persistent heartburn, however, should be brought to the attention of your doctor, who may do some diagnostic testing. A number of medications are currently available to treat severe heartburn. For a routine case of mild heartburn, a reasonable start would be to use an over-the-counter antacid.
Gaviscon antacids, with special foaming properties, are especially designed to treat heartburn. Taken with water, they actually foam in the stomach and coat the lower esophagus with an acid-neutralizing material. Taking an OTC antacid (liquid or chewable tablet) up to three hours after eating should provide some relief almost immediately. It is not advisable, however, to exceed the recommended dose or frequency.
For mild cases of heartburn, physicians usually prescribe H-2 blocking drugs, which reduce the production of stomach acid. These include cimetidine, nizatidine, ranitidine, or famotidine. If symptoms are severe, doctors often simply increase the doses of these medications. Or they may add a “prokinetic,” a medicine that improves the movement of food through the stomach and increases closure of the LES. Metoclopramide may be recommended, to be taken 30 minutes before a meal and at bedtime.
Finally, your doctor may prescribe omeprazole, one of a new type of drugs called proton pump inhibitors, which turns off the system responsible for acid secretion. Although omeprazole is the most effective medication available for severe GERD, it is so expensive that even some health insurance companies are refusing to pay for it, requesting that physicians prescribe less-expensive alternatives.
In addition, there are various lifestyle changes you can make and beneficial supplements you can use to help reduce your heartburn. And actually, many of the conventional medications work best in conjunction with complementary therapies.
Just a reminder: If you have a serious medical condition or are taking medication, it’s a good idea to talk to your physician before starting a supplement program.
How Supplements Can Help
Calcium carbonate, a well-established short-term remedy for heartburn, is the main ingredient in several popular antacids. Some supplement manufacturers combine calcium carbonate with DGL (see below).
Deglycyrrhizinated licorice (DGL) is a highly regarded herb used as a demulcent (an agent that soothes and coats mucous membranes) and has been shown to be as effective as the drug cimetidine (Tagamet) in the treatment of peptic ulcer disease. DGL can help restore the vital mucous lining that protects the stomach itself from hydrochloric acid.
When the esophagus is inflamed by acid reflux, aloe vera juice can provide quick, soothing relief by reducing acid output and soothing and coating the mucous membranes. Aloe vera juice is not the same as the herb aloe, which is a potent laxative.
If you’re troubled by frequent indigestion or if food feels “heavy” on your stomach, consider taking some digestive enzymes with each meal. Double the recommended dose if you’ve eaten an especially large meal.
Get supplement dosages and tips in our WholeHealth Chicago Supplement Recommendations for Heartburn.
Self-Care Remedies
Eat frequent small meals instead of one or two large ones; this will prevent excess production of stomach acid.
Limit problem substances, such as coffee (including decaf), alcohol and fatty foods.
A pleasant alternative to coffee after a meal is a cup of warm herbal tea–chamomile, ginger, peppermint, marshmallow, meadowsweet or slippery elm–which has the added benefit of relieving heartburn discomfort.
Stay up at least three hours after eating your last meal or large snack before going to bed.
Raising the head of your bed several inches will put gravity to use in preventing reflux during the night.
Chewing gum can provide short-term heartburn relief by stimulating the production of saliva, which dilutes and flushes out stomach acid. Drinking a glass of lukewarm water after a meal may produce a similar effect.
When to Call a Doctor
- If heartburn regularly occurs more than once a week in spite of self-treatment
- If you have had trouble swallowing or if you have vomited blood or passed black, tarry stools. These may be signals of an ulcer, a gallbladder problem, or other serious condition.
- If you feel a crushing chest pain–not burning–along with dizziness, sweating, wheezing, or pain radiating to your jaw or arm. These may be warning signs of a heart attack. Don’t take a chance; get medical help immediately.
Supplement Recommendations
From David Edelberg, M.D. at WholeHealth Chicago: To tame the erupting volcano beneath your breastbone following a sausage sandwich (extra peppers, please), try simply washing down the acid with a glass of warm water and some calcium carbonate. Gaviscon Foamtabs, available at drugstores, create a foam that rises up into your esophagus and neutralizes the stomach acid. Envision a fire extinguisher at work.
Recurrent heartburn, or GERD (for gastroesophageal reflux disorder), requires a little more work. The supplements here are used by nutritionally oriented physicians to speed up the healing process. (Make sure your doctor tests you for Helicobacter pylori, a bacterium associated with stomach ulcers that can cause recurrent heartburn as well.) Once you’ve been symptom-free for a month, it’s reasonable to assume things have healed, and you can discontinue everything.
Our suggestions may take some time for their full effects to be felt. If you do need conventional medications to control your symptoms, by all means continue them as long as necessary. And do not replace any of your prescribed medications with nutritional supplements without consulting your doctor first.
How to Take the Supplements
If you’re troubled by a simple case of heartburn, just use the calcium carbonate, aloe vera in its juice form (available at health-food stores), or an over-the-counter foaming antacid tablet.
For recurrent heartburn, start chewing DGL (deglycyrrhizinated licorice) wafers on a daily basis for at least a month. You also add the herb marshmallow and more aloe vera juice, especially during the first week, to promote healing.
After the first week, you can probably reduce the aloe vera and marshmallow to once or twice a day. And maybe you’ll be lucky enough to develop a liking for the marshmallow tea–then you can substitute it for your heartburn-promoting coffee!
This combination of supplements actually heals the lining of your stomach and esophagus and may also inhibit the bacterium H. pylori, found to cause ulcers. Once symptom-free, you may want to try adding digestive enzymes with each meal to improve your digestive process.
If, despite your best efforts, you continue to have symptoms, you can certainly either add or change to conventional medicines at any time. Just practice a little common sense: Avoid large meals, don’t eat late at night, and reduce your consumption of alcohol, caffeine, and fatty foods.
Once you’ve been symptom-free for about a month, it’s reasonable to assume things have healed, and you can just use supplements on an as-needed basis.
For special consideration
If you think stress and emotional tension worsen your heartburn symptoms, consider adding the gentle and nonsedating herb kava at a dose of 250 mg two or three times a day.
Flavonoids are natural anti-inflammatories, antihistamines, and even inhibitors of the bacterium H. pylori Patients with longstanding heartburn symptoms may want to include a quercetin/flavonoids combination (500 mg 3 times a day of quercetin or mixed bioflavonoids, with or without added bromelain) to speed the healing process. Important:
We at WholeHealth Chicago strongly recommend that everyone take a high-potency multivitamin/mineral and well-balanced antioxidant complex every day. It may be necessary to adjust the dosages outlined below to account for your own daily vitamin regimen. All of our supplement recommendations also assume you are eating a healthful diet.
Be aware that certain cautions are associated with taking individual supplements, especially if you have other medical conditions and/or you’re taking medications. Key cautions are given in the listing below, but you need to see the WholeHealth Chicago Reference Library for a comprehensive discussion of each supplement’s cautions and drug/nutrient interactions.
For product recommendations and orders click here for the Natural Apothecary or call 773-296-6700 ext. 2001.
Be well,
David Edelberg, MD