Heartburn is a common symptom that many people will experience. It is diagnosed as GERD or Gastrointestinal Esophageal Reflux Disease when it becomes a recurrent or chronic problem. It may occur with or without known triggers. Some commonly known triggers such as coffee, spicy foods, citrus fruits, tomatoes are often avoided by patients who are suffering. Interestingly, as a Doctor of Naturopathy, I find that the considered known problems are rarely the root cause of the problem. Yes they can create irritation once the problem has evolved, but we rarely find spicy foods or tomatoes, for example, to be the causative factor.
There are many long term health risks to having GERD, with the most common ones being gastric ulcers and Barrett’s esophagus. Barrett’s esophagus is a pre-cancerous condition of the lower esophageal cells caused by long term exposure to stomach acid.
An ulcer is caused by constant irritation to the lining of the stomach leading to inflammation that may or may not bleed, but will cause pain once contact with food and liquids occurs. If ulcers are not properly treated, they can develop into cancers.
Being pre-cancerous, both these conditions have to be monitored closely.
Prevention is Always Better!
My advice to patients is always to “nip it in the bud” – i.e. take the preventive approach. Many simple changes to your diet and lifestyle can prevent development of heartburn into GERD, not to mention avoiding any further complications.
The most common culprit I find as a Naturopathic Doctor is food sensitivities. These often turn out to be the root cause of the problem. As I mentioned above, you may be reacting to foods that are not usually associated with heartburn. These can include common sensitivities such as gluten containing grains and dairy products, as well as unhealthy foods such as those containing high sugar or preservatives. It is important you work with your Naturopathic Doctor or Clinical Nutritionist to diagnose and eliminate any foods creating sensitivities as removal of triggers is the first step in healing.
5 Rules for Dealing with Heartburn
While diagnosing and treating the root cause is the only ‘cure’ for hearburn, there are some lifestyle factors to consider while this journey is taking place.
Adhere as strictly as possible to the following to prevent recurrent symptoms:
1) Never leave your stomach empty! – This is not a pass to overeat but a golden rule to avoid heartburn. It is important to ensure that you do not have stomach acid floating around with no food to digest. Eat a small meal/snack every 3-4 hours. Having only 2 or 3 large meals with long hours in between can worsen your heartburn and increase risk of ulcers.
2) Eat breakfast within the first hour of waking up – this is in line with rule #1 since technically you have been ‘fasting’ through the night. Unless you are in the habit of having a 3 AM snack!
3) Avoid caffeine drinks in the morning without adequate food -the worst thing to do first thing in the morning would be to pour coffee or tea (acidic foods) into your empty stomach. If you insist on having some tea or coffee, have it with your breakfast. Green tea is your best option in terms of least amount of caffeine and high amounts of healthy anti-oxidants.
4) All your meals and snacks should include proteins and good fats. Examples include nuts, seeds, beans & lentils, eggs, organic cold cuts, tuna salads. Again, be mindful of your individual triggers.
5) Drink plenty of water. Sipping water throughout the day rather than just gulping a glassful every few hours is recommended. Try to drink half your weight in ounces of water each day.
All of the above rules are in addition to two general rules that most doctors will relay to their patients. These are:
• avoid overeating
• don’t lie down immediately after meals, wait at least 1/2 hour
What can I do if my Heartburn is Giving me a lot of Pain?
Most patients who complain of heartburn will at some time need to take something for immediate relief. Besides the common over-the-counter antacids like Tums, Rolaids, Prilosec and Pepcid, there are herbal and natural alternatives available. Deglycerrhized Licorice (DGL) is most commonly recommended by Naturopathic Doctors as it has the most soothing effect and is easily available. It is also a safe form of licorice for patients with high blood pressure.
Based on your case history and other symptoms, your Naturopathic Doctor or clinical nutritionist might recommend other herbs such as Slippery Elm, Brassica extract, Plantain extract, Marshmallow extract or aloe vera. Each herb has soothing properties with additional functions such as being an astringent or tonifier for your gut. The form of the herb is usually selected based on individual patient needs – tea, tincture, capsule or tablets.
Note: Heartburn is Not Always Due to Excess Acid
Intuitively it would seem obvious that heartburn is caused by excessive acid. However, there are a group of patients who experience heartburn due to inadequate acid production rather than excessive acid.
This can be due to inappropriate eating patterns and excessive stress. Working with your Naturopathic Doctor can assist you to figure out if this is your problem. For example, if you have a history of infections or parasites, abnormal bowel movements and symptoms such as bloating and gas, you may belong to this category.
When there is inadequate acid in the stomach, any food that makes contact with its irritated lining will cause pain. In addition, such patients often have spurts of excess acid production as the body tries to recover from the stress – high amounts of acid when there is no food available can cause that intense burn and chest pain. Appropriate snacking and adequate acid with meals is key for these patients. As always, it is important to find the root cause underlying the problem of low stomach acid.
A simple ‘BURP TEST’ is what I recommend to my patients which you can try at home: First thing in the morning even before you brush your teeth, add 2 tsps of baking soda to 4 oz of water. Stir and drink it down. Ignore the initial burp you get right after you have gulped down the water. Then, monitor yourself for the next 3 minutes. If you get one or more large burps (like the one that can embarrass you when you are around friends!) during these 3 minutes, you probably make adequate stomach acid. If you do not get any significant burps or just a few short unnoticeable ones, you need to talk to your Naturopathic Doctor about how to balance your stomach acid.
I hope you found this helpful. Heartburn and GERD are extremely common but very treatable. Simply masking the symptom with a medication is not only temporary but can result, long term, in more serious diseases. We have excellent success in this area and are more than happy to assist you, your friends and family.
Please let me know if you have any questions. I am happy to help!
Dr Preeti Kulkarni, ND
Doctor of Naturopathy
HealthNOW Medical Center