Getting to the heart of the matter

Many people experience the occasional bout of heartburn as a common digestive complaint. Despite the name, heartburn has nothing to do with the heart. It often presents first as a sensation of a tickle or irritation in the chest and throat often accompanied by a sour taste that is caused by the contents of the stomach pressing back up the esophagus. This can lead to extreme discomfort and many turn to over the counter (OTC) drugs such as the antacid, Tums, to alleviate the symptoms. If acid reflux becomes chronic and persistent, such as in gastro-esophageal reflux disease (GERD), sufferers often look to their doctors for prescription drugs such as Histamine Type 2 (H2) receptor blockers or Proton Pump Inhibitors (PPI’s) to manage their symptoms. Unfortunately, long term use of these drugs can have side effects of their own and lose effectiveness over time without addressing the root cause of the reflux. Often the primary cause is diet and lifestyle driven. For many, heartburn can be managed by mindfully shifting food habits, identifying triggers and limiting stress.

Basic anatomy:

The digestive tract is a complex system in the body physically starting at the mouth where food and liquids enter and is completed with the elimination of the waste materials through the anus. Digestion occurs every step of the way. Matter travels from the mouth through a tube called the oesophagus and passes through a one way valve made of a taut circular muscle into the stomach. This valve is referred to as the lower esophageal sphincter (LES) and should act as a one way door, allowing passage of anything ingested. Once in the stomach, gastric juice, primarily of hydro chloric acid, begins the breakdown of the contents for digestion. As the bolus is churning in the stomach, the pyloric sphincter, found between the stomach and the small intestine, allows the emptying of the stomach into the intestinal tract to make the lengthy journey for processing. On average, the GI tract measures about 5 meters in length.

What causes heartburn?

Acid reflux occurs when the acidic contents, normally safely contained within the stomach lining, pushes  back into the less protected esophagus. The stomach lining is armoured against the incredibly low PH environment needed to begin the break down of ingested materials but the mucosa lining of the esophagus is not, therefore, when stomach acid leaks through a compromised LES it becomes highly irritating to the sensitive esophagus. Long term reflux can lead to chronic inflammation, injury and even cancerous changes. Causes can include:

• Diet and lifestyle habits
• Excess stress
• Stomach acid imbalances
• Food sensitivities
• Tight clothing
• Obesity
• Pregnancy
• Alcohol
• Nicotine
• Medications
• Underlying medical conditions

Symptoms of acid reflux

• Burning pain in throat
• Sharp pain in chest and back
• Bitter or sour taste in mouth
• Belching or verbing
• Feeling a tickle and the need to cough or clear throat
• Difficulty or pain on swallowing
• Food regurgitation
• Increased salivation
• Worsening when laying down.
• Worsening with more food or liquid entering the stomach, especially trigger foods.

*Note: If any of these symptoms are intensely persistent or experienced along with shortness of breath, confusion, dizziness, tingling and numbness, light headedness, loss of appetite, vomiting blood, bloody or black stool or unexplained weight loss, consult a doctor immediately.

The worst offenders

Getting to know your triggers is key in managing acid reflux. Certain foods and beverages increase the incidence of heartburn and eliminating them is critical in preventing symptoms. Keeping a tracking journal can be helpful to note what causes an increase in reflux. Certain foods are heavily indicated but some other major factors, like stress and anxiety, can also play a significant role. Here are some of the top culprits:

• Fatty foods such as deep fried foods or saturated fats from animal sources are one of the top triggers. Heavy fats slow down the emptying of the stomach through the pyloric sphincter and can cause a back up against the LES and an over production of stomach acid.
• Inflammatory and acid forming foods such as refined carbohydrates, sugars, gluten, dairy and processed meats.
• Over eating pushes and excess of food against the LES and is often a significant factor.
• Citrus fruits such as oranges and grapefruits.
• Undiluted vinegars.
• Tomatoes including sauces, soups and fresh tomatoes.
• Spicy foods including hot peppers, Onions and garlic.
• Chocolate (say it isn’t so!).
• Peppermint, although can aid digestion, may have a relaxing effect on the LES and increase heart burn symptoms for some.
• Alcohol creates inflammation through out the entire digestive tract and can also have a relaxing effect on the LES.
• Carbonated beverages can add to gas in the stomach creating pressure build up on the LES. Sugary carbonated beverages are a double whammy.
• Caffeinated beverages such as black tea and coffee can increase the acid environment.
• Tight clothing, pregnancy and excess abdominal fat can place excess pressure on the stomach.
• Inconsistent eating schedules.
• Medications such as aspirin, some high blood pressure meds, certain antibiotics, bone building meds, iron tablets, estrogen, sedatives and some anti depressants can all affect the LES and acid balance in the stomach.
• Nicotine, such as in cigarettes or vapes, can relax the LES increasing incidence of reflux.

*Note: Triple trouble is a meal high in fat, calories and over consumption. Include a few alcoholic beverages after a stressful day and  it all may come up to haunt you!

Prevention

• Identify your worst triggers and avoid them.
• Try natural digestive enzymes of pineapple and papaya before eating.
• Try small amounts of apple cider vinegar diluted in water to balance stomach acid.
• Know your limit and Don’t over eat.
• Chew your food well, slow down and eat mindfully.
• Consider eating smaller meals more frequently through the day and avoid over snacking on processed packaged foods.
• Eat at least 2-3 hours before retiring to bed and don’t lay down after eating. Limit late night snacks.
• Moderate caffeinated drinks and carbonated beverages if they are a known trigger.
• Drink water with your meals which will create a sense of fullness and slow down over eating plus dilute stomach acid.
• Limit alcohol.
• Quit smoking.
• Adopt a higher fiber and more alkaline diet by adding more whole plant foods such as fruits, veggies, whole grains, beans, nuts and seeds. Vegetarian and vegan diets are significantly less likely to cause acid reflux.
• Choose to grill, bake or broil lean meats and remove skins.
• Consider long term weight loss goals.
• Practice stress management techniques such as meditation, visualization, self care, nature, exercise and emotional outlets.
• Practice good sleeping habits, melatonin may help tighten the LES through the sleep cycle.
• If the use of other medications are problematic, follow the instructions for use but try and remain upright for at least 30 minutes, take with water and avoid known triggers that increase symptoms.
• Try 1/4 tsp baking soda in 1/4 cup water, repeat after 5 minutes if little change.
• Prop up head and shoulders if heartburn comes on while sleeping.

Include these foods in your diet

• Brown rice
• rolled Oats
• Miso soup
• Ferments such as sauerkraut and kefir
• Melons such as watermelon, honeydew and cantaloupe
• Bananas
• Cilantro
• celery
• artichokes
• sweet bell peppers
• cucumbers
• sweet potatoes and winter squash
• Coconut milk and water
• Aloe vera juice
• Lemon water
• Teas such as chamomile, ginger, fennel and licorice root.

*Note: If nothing changes after making modifications, consult a physician, whether allopathic or Naturopathic doctor.

Possible side effects of OTC and prescription medications

Prescription medications and OTC remedies can provide temporary relief but long term dependency can become problematic. These drugs are intended to lower the stomach acid but we need an acidic environment to properly digest our food. The PH of the stomach is also the first line of defence against pathogens and promotes immunity from foreign invaders. Here are some possible long term effects:

• Digestive inadequacies including vitamin and mineral absorption.
• Decrease immunity.
• Acid rebound, the body’s attempt to over compensate for the reduced acid by over producing more of it.
• Calcium carbonate in antacids may increase flatulence, constipation, cramping and nausea.
• Calcium carbonate can also add unnecessary calcium into the blood stream which can affect the heart and cardio-vascular system if used excessively.
• Prescription medications like histamine type 2 (H2) receptor  blockers and proton pump inhibitors (PPIs) are stronger than the OCT’s and may eventually affect kidney, liver and cardio vascular health.
• Prescription medications may also increase incidence of migraines.
• May lose effectiveness over time.

Conclusion

Acid reflux is a common digestive complaint that is primarily a result of diet and lifestyle choices. Adopting a more alkaline diet with whole plant foods and limiting high fat, processed foods and the tendency to over eat can dramatically reduce the symptoms of heartburn. Making the necessary changes to diet and lifestyle takes commitment and time but the effort also improves overall gut health and physical well-being. With mindful adjustments to eating habits, managing stress, reducing alcohol and nicotine dependency and practicing good sleeping patterns, it is possible to avoid OTC’s and prescription medicines and leave the reflux behind for good.

Give these soothing recipes a try:

Immune Support Lemon Chicken Soup (Vegetarian Option)

Oatmeal Blend for Over Night Oats or Porridge

Refreshing Apple and Turnip Slaw