3 Ways To Manage Heartburn Naturally
When we typically think of heartburn, we assume that we have an excess amount of acid in our stomach that's causing this acidic, burning sensation. Makes sense, right? Going along with this theory, then, the treatment option is to use medications that turn off or suppress the acid production in our stomach using medications called proton pump inhibitors or PPIs to get relief.
The really interesting thing about stomach acid is that most of us don't actually have this crazy, huge, overproduction of it as we are led to believe. Contrary to popular belief, many cases of heartburn or acid reflux are not caused by the overproduction of stomach acid but rather from having too little stomach acid. The current literature shows that gastroesophageal reflux disease (GERD) is caused by a dysfunction of the muscular valve that separates the lower end of the esophagus and the stomach. This is known as the lower esophageal valve, or LES [1].
So what causes dysfunction of the LES? One major factor is having too little stomach acid. Insufficient stomach acid can lead to a host of different conditions that encourage the increase in intra-abdominal pressure (IAP). As IAP increases, it pushes against the LES. When the LES opens because of the pressure and even a microscopic amount of acid touches the inside of your esophagus it can produce large amounts of pain and burning. This is because the esophagus is not protected like the stomach from high acid levels.
We actually want our stomach environment to be really acidic for proper digestion to occur. When we take PPIs we completely turn of the production of this stomach acid. For some people experiencing acute digestive issues that's the desired effect. But long term misuse of these acid suppressing drugs can cause issues overtime and alter our ability to properly digest our food which is a BIG deal.
If you experience symptoms like:
Acid reflux
Heartburn
Burping
Gas or bloating
Excessive feelings of fullness or desire to skip breakfast
Nausea after eating
…you might be experiencing symptoms as a result of low stomach acid. The pH or level of acidity in our stomach is meant to be between 1.5 and 1.7, which is very acidic because we need to break down all of the food we eat into a form that can be absorbed by our small intestines [1].
I work as a holistic health coach, but I'm also a cardiac RN and the majority of patients that come into my clinic are on a PPI like Pravacid, Nexium, or Prilosec. They’re everywhere! These medications are typically intended to be used if you are experiencing really severe stomach acid issues and inflammation or a gastric ulcer. Additionally, there are studies that show that timely use of PPIs can protect people from getting ulcers that can develop as the result of non-steroidal anti-inflammatory (NSAID) use [2]. There are definitely indications for these drugs to resolve acute gastrointestinal issues if used in an appropriate manner. If your gut is highly inflamed you may need this type of support in addition to changing your diet and using holistic methods, and it’s best to work with a doctor to get you on the right medication for your needs.
These drugs, however, are highly over-prescribed. More than 60 million prescriptions for GERD were filled in 2004 and Americans spent $13 billion on acid stopping medications in 2006 to give you an idea of the magnitude [3, 4]. These medications are actually available for over the counter purchase as well which allows patients to self-medicate without reporting their condition to a doctor. It’s important to note that these medications were only approved by the FDA for 8 weeks of use. They were never intended to be prescribed for years or even decades, as is often done today. Many people I see as private health coaching clients who are experiencing symptoms of heartburn have been on these acid suppressing drugs for 10 to 20 years! Since these drugs aren’t getting to the root cause of the issue (and are often times making things worse overtime), people become reliant on them to control their symptoms and get stuck in a vicious cycle.
In fact, the FDA has issued a series of reports cautioning against the prolonged use of PPIs, citing increased risk of infection, bone fractures, and life-threatening infections (clostridium difficile). [5, 6] As with any medication, it’s really important to take a critical look at what they are really doing and how they are affecting our digestion and whole person health.
Why is stomach acid important?
When we take medications that turn off our ability to produce stomach acid we have to consider how this is impacting our overall digestion and then, downstream, our overall health. Proper levels of stomach acid are needed to adequately absorb many nutrients, including minerals (iron, copper, zinc and calcium), vitamin B12, folic acid and proteins. Stomach acid is also a crucial part of the immune system. The acid barrier of the stomach during normal states of health easily and quickly kills bacteria and other bugs that enter the body. It also prevents bacteria in the intestines from migrating up and colonizing the stomach [7]. When we don’t have adequate levels we are more susceptible to these types of infections, nutrient deficiencies, increased bacterial overgrowth in the intestines and more.
If you are someone that’s been on PPIs for a long period of time, it’s worth starting a dialogue with your doctor about your need for these drugs. It’s important to note that if you have been on them long-term, you do need to taper off of them to avoid experiencing a rebound effect. Avoid self-diagnosing and work with your doctor to assess your need and create a plan for tapering while considering the natural ways to optimize your digestion below.
You’ll first want to start by considering your diet. It’s a good idea to remove the following inflammatory foods to aid in gut healing [8]:
Gluten, dairy and sugar (can be very inflammatory to the gut)
Raw vegetables (they are harder to digest and can irritate the gut lining). Focus on more cooked foods temporarily as they are easier to digest.
Caffeine (coffee, tea, soda, chocolate, etc.)
Processed or fried foods
Consider removing all grains temporarily (can impair digestion and add to inflammation in a compromised gut)
Consider removing nightshades temporarily (white potato, eggplant, peppers, tomatoes) or cooking them to reduce the alkaloid content
Individual food sensitivities
Food to include:
Cooked vegetables (especially leafy greens)
Good quality proteins (meat, salmon, etc.)
Easy to digest soups and stews
Gut healing foods like bone broth and collagen
Three simple ways to help optimize your digestion:
These interventions may seem simple or obvious, but it’s amazing how many of us can benefit from putting mindful attention not only to what we are eating, but how we are eating it to improve the process of digestion! I’ve coached many clients through these simple steps along with making dietary changes and I can tell you they have a huge impact.
1) Slow down before meals in order to activate the enzymes necessary for proper digestion. The process of digestion starts in the brain (also known as the cephalic phase of digestion). When you simply look at food or think about food it actives the production of saliva, stomach acid and enzymes needed to properly break it down. So if you're on the go, running, eating in front of the computer (my own hand is raised over here…), your body is not ready to start this process of digestion so it's not going to effectively break things down.
2) Chew your food thoroughly to help break down food so that's it's easy for your stomach and other digestive organs to process and absorb. When we chew, we help break down these bigger food particles into something smaller that our body can further break down and absorb. If you're experiencing issues such as bloating, burping, nausea after meals or heartburn, try chewing your food very well. Aim for 20 chews per mouthful and see how you go!
3) Optimize your stomach acid. Try drinking one of the following before meals:
8oz glass of water with a generous squeeze of lemon
Apple cider vinegar: Start with 1 tablespoon diluted in 1/4 cup water and drink before meals
Digestive bitters: dilute one dropper-full of digestive bitters in a glass of water 15 minutes before meals to help naturally stimulate digestion. I like this brand >>
You may require more stomach acid support (in the form of HCL supplements) but it’s advised to work with a practitioner to help you with this protocol. HCL should never be taken by anyone who is also using any kind of anti-inflammatory medication such as corticosteroids, aspirin, Indocin, ibuprofen (e.g. Motrin, Advil, etc.) or other NSAIDS. These drugs can damage the GI lining that supplementary HCL might aggravate, increasing the risk of gastric bleeding or ulcer.
If you feel burning when drinking lemon or vinegar proceed with caution and consult with a practitioner as it might be a sign you have some irritation and damage and need some soothing supplements or herbs prior to starting.
If you suffer from heartburn and want to talk more about how to optimize digestion I always offer free 30-minute discovery sessions to get clear on your major health concerns and what’s standing in your way. Contact me to set up a consultation and we can create a plan of action specifically for you!
In Health,
Christina Tidwell, MN, RN, CHC
Resources
[1] https://scdlifestyle.com/2012/06/hypochlorhydria-3-common-signs-of-low-stomach-acid/
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1773617/
[3] https://www.forbes.com/2006/02/27/pfizer-merck-genentech-cx_mh_0224topsellingdrugs.html#189668266662
[4] http://www3.niddk.nih.gov/Burden_of_Digestive_Diseases/index.shtml#CHAPTER14
[5] http://www.fda.gov/Drugs/DrugSafety/ucm245011.htm
[6] http://www.fda.gov/Drugs/DrugSafety/ucm290510.htm
[7] https://fxnutrition.com/shore-up-your-stomach/
[8] https://www.ncbi.nlm.nih.gov/pubmed/11712463