Heartburn

Feeling the burn? That uncomfortable, achy, burning sensation in your chest or throat that seems to come after meals, when you lie down, or sometimes randomly for no apparent reason? You are likely one of thousands of Canadians suffering from gastroesophageal reflux, or heartburn, as it is commonly known.

Almost everyone will experience heartburn at some point, but many experience it on a regular (even daily) basis. This can be frustrating and painful and can really cut into the ability to enjoy daily activities. 

Chronic heartburn can also indicate gastroesophageal reflux disease (GERD), a condition that can be extremely uncomfortable and cause symptoms such as chest pain, throat pain, and/or a chronic cough.

Because these symptoms can easily be mistaken for heart symptoms, it is best to consult with your doctor if you experience these symptoms to identify the correct cause.

Depending on the severity of the symptoms, heartburn may be treated successfully with dietary and lifestyle changes. Some people may also need intervention with prescription medications, at least for the short term, in order to get their symptoms under control.

Short-term use of acid suppressing medications does not present significant problems for most people, but the long-term use of some of these medications can cause concerns with the levels of certain nutrients such as calcium, iron, and vitamin B₁₂ which require stomach acid for absorption. Focusing on only symptom relief does not address the underlying causes of reflux, which are often diet and lifestyle related.

Heartburn and GERD are very common, and something that I see often in my practice. In a majority of cases, these issues are successfully managed without chronic use of medications by focusing on diet and lifestyle changes.

Many diet and lifestyle interventions are aimed at improving the function of the lower esophageal sphincter, a small ring of muscle that acts as a gate between the esophagus (your “food tube”) and the stomach.

When in good working order, this sphincter should close with enough pressure to prevent stomach acid and contents from rising into the esophagus. When this does not occur, and lower esophageal sphincter pressure is low, the very acidic contents of the stomach can enter the esophagus, causing irritation that presents as pain, cough, and other uncomfortable symptoms. Here are some of the interventions that I have found to be most useful in the treatment of reflux.

Lifestyle changes

Don’t smoke
Smoking is related to an onset or worsening of many health problems, and reflux is no exception. Smoking is believed to contribute to GERD by reducing lower esophageal sphincter pressure, allowing stomach acid to rise into the esophagus.

Avoid overeating
A very full stomach puts additional stress on the lower esophageal sphincter, which can increase the risk of reflux.

Don’t lie down after eating
In a horizontal position, gravity is already working against your lower esophageal sphincter. Adding a full stomach to this equation can bring on the burn.

Weight loss
Being overweight, especially carrying excess weight in the abdomen, is a significant risk factor for reflux; weight loss can help to reduce GERD symptoms.

Sleep
An important factor for overall health, sleep may also help to reduce reflux symptoms. In a vicious cycle, reflux can disturb sleep, and sleep deprivation can increase a person’s sensitivity to reflux, making the symptoms even more uncomfortable.

Following lifestyle changes, such as not eating before bedtime, can help to reduce the chances of being awakened by reflux. However, proper sleep hygiene can also keep the body well rested, possibly reducing sensitivity to reflux.

Interestingly, some researchers have noted a relationship between GERD and melatonin, the “sleep hormone.” Found in significant amounts in the upper digestive tract, melatonin seems to help protect the stomach lining from free radical damage; levels may be reduced in some people with GERD. Early research and case reports have even shown improvements in GERD symptoms when supplementing some patients with melatonin.

Dietary advice

There is a lengthy list of foods that can aggravate reflux. Not all of these foods will be problematic for all people, and figuring out which ones are problematic for you can take some time.

One approach is to remove all potential food triggers for a period of time and then reintroduce them carefully, in a scheduled way, once symptoms have improved.

Patients often find that this helps them to better identify what their food triggers are and therefore make food choices that are less likely to aggravate their GERD.

Here is a list of “usual suspects” that you could consider removing to see if they are triggers for your symptoms:

• tomatoes
• spicy food
• coffee
• fatty or fried foods
• black tea
• carbonated beverages
• alcohol
• mint
• peppers
• onions
• chocolate
• vinegars and condiments with high vinegar content
• citrus fruit

Herbal medicines

There are several herbal medicines that may be helpful for reflux. It is best to consult with a natural heath practitioner to determine which products are best suited for you.

Potentially helpful herbs include:

• marshmallow root
• licorice root
• slippery elm bark

These herbs have a long history of traditional use in inflammation and irritation of the digestive tract and may help to reduce the burn of reflux.