by Stephanie Bristow, ND
Dr. Stephanie is a Naturopathic Doctor at Calgary WOW Centre. She received her Doctorate of Naturopathic Medicine from the Canadian College of Naturopathic Medicine in Toronto and is a licensed Naturopath in the province of Alberta. Dr. Stephanie has a family practice supporting patients of all ages. She has a special interest in digestion, thyroid, mood & stress, hormonal balance, pregnancy/postpartum, infants and children.
Heartburn is one of the most common digestive complaints that brings patients to my office. Those with chronic heartburn symptoms tend to also notice bloating, gas, excessive burping or issues with constipation or loose stools. In this blog we will discuss the ins and outs of heartburn, how it influences your digestive health and what to do about it.
Gastroesophageal reflux disease (GERD), more widely known as ‘heartburn’ or indigestion is the symptom you experience when stomach acid moves up into the esophagus and irritates the lining. Its common name heartburn is
quite deceiving as it has nothing to do with the heart. It gets its name from the burning feeling that can be felt in the upper chest. Most people describe ‘heartburn’ as burning pain in their chest following a meal, however there are several ways it can be felt. Some people experience burning in their throat, change in voice or hoarseness, sour taste in the mouth, discomfort or bloating in the upper abdomen. Long term GERD may cause lung concerns such as asthma, tooth enamel decay, gingivitis and Barrett’s Esophagus (over time stomach acid damages the esophageal cells and they
become pre-cancerous).
GERD is a very common condition, whether you suffer from it on a daily basis or have experienced it occasionally after large meals. The most popular acute over-the-counter remedy is Tums while the most commonly prescribed pharmaceuticals are proton pump inhibitors and H2 blockers such as Nexium, Prevacid, and Zantac. The pharmaceuticals work by blocking the stomach’s ability to produce acid: if there is no acid, there are no symptoms. Because this is not a solution to the problem most people who are prescribed these medications have to stay on it for the rest their lives
otherwise the symptom returns. In fact, stopping these drugs cold turkey causes rebound heartburn often much worse than the original symptom.
This is where Naturopathic Medicine differs, my goal in working with patients is to understand why the symptoms are present as they are clues to the underlying problem. Rather than eliminate a very crucial digestive function, Naturopath’s work to improve digestion and health with individualized care to find the solution. Here are some common
reasons people experience GERD:
- Eating too much too quickly: it’s important to leave space in your stomach to churn the food. The 80/20 rule is a good place to start, eat until you’re 80% full and leave 20% space. Don’t forget to chew your food well!
- Drinking with meals. It’s fine to sip on warm or room temperature liquids while you eat to moisten your mouth and food, but too much liquid will dilute the stomach acid making it less effective.
- Lying down after eating (gravity!).
- Eating foods that cause the lower esophageal sphincter (LES) to relax. This is a small sphincter which separates the stomach from the esophagus which should be tightly closed, but certain foods and activities can trigger it to relax. The LES can be triggered to relax by: mint, spicy foods, chocolate, coffee, tea, cow’s milk, tomatoes, oranges and saturated fats.
- Food triggers. Besides the common foods above that cause relaxation of the LES, there can also be food sensitivities or allergies that contribute to GERD. Food sensitivity tests or elimination diets can be helpful in identifying what those specific foods are for you.
- Smoking: cigarettes can weaken the muscular reflex of the LES, causing it to relax. Smoking also damages the mucus lining which protects our cells from being damaged by stomach acid, intensifying the burning feeling.
- Insufficient stomach acid production (not enough stomach acid). This can be a difficult concept to wrap your head around as we tend to assume the burning feeling must mean there is too much stomach acid, however the
opposite is true most of the time. As we age the production of digestive enzymes and stomach acid declines resulting in a weakening of our digestive function and an insufficient amount of stomach acid. This brings up the question: If my stomach acid is insufficient, why am I experiencing GERD? Let’s take a look…
Stomach acid and the lower esophageal sphincter
Remember the LES? The small sphincter between the stomach and the esophagus, as it turns out this sphincter is sensitive and perhaps even triggered to close by the degree of acidity in your stomach. Researchers have found that the sphincter closes the tightest at a pH of 3. What else has a pH of 3? Stomach acid! Technically the stomach fluid may range from 1.5-3.5, 1.5 more commonly on an empty stomach but as food is added to the fluid the pH raises to closer to the 3-3.5 mark. By using drugs like Zantac or Prevacid we inhibit the production of stomach acid so the burning will no longer be felt, however the LES may still be relaxed leaving the why unaddressed.
Often times solutions to GERD can be as simple as increasing the acidity in the stomach to help the LES close tightly. A teaspoon of apple cider vinegar or a capsule of betaine hydrochloric acid capsules are great solutions to increase acidity when production has begun to naturally decrease. The Betaine HCL test is a good way to figure out how deficient you are in stomach acid, but it’s best done under the guidance of a Naturopathic Doctor. Individuals with gastritis, ulcers, pregnant or on PPI’s or H2 blockers should not do this test.
Regardless of the medication you are using to manage heartburn symptoms, working with an ND to figure out the root cause of GERD is critical to the healing process. If you are taking a prescription drug to prevent symptoms, ND’s collaborate with MD’s to slowly reduce your dose while the root causes are uncovered and a plan is set in place to manage the rebound symptoms (herbs like licorice and slippery elm are great for this).
Our health is incredibly dependent on our digestive system, disease either starts or is prevented here. Stomach acid plays an integral role in this process, not something you’d want to go without!
Take a look at some of the functions of stomach acid:
- Breaks down food! Without adequate stomach acid we can’t adequately breakdown protein and absorb essential nutrients. Several vitamins and minerals are bound to proteins, stomach acid is a necessary step to breaking down protein to release the minerals like iron and calcium making it essential for people with anemia, osteoporosis or osteopenia.
- Helps to digest carbohydrates and fats, especially fat-soluble vitamins A & E by stimulating the release of pancreatic enzymes.
- Protects us from bugs. A key component of our immune system, stomach acid kills bacteria and parasites that we consume, preventing us from getting sick.
- Helps neutralize harmful candida infections by taking care of proliferating negative yeast organisms.
- Initiates peristalsis, the rhythmic movement of that propels food through our digestive system – crucial for those with chronic constipation and Small Intestinal Bacterial Overgrowth (SIBO).
- Essential for the absorption of vitamin B12
Having a healthy stomach is essential to a healthy digestive system and body. Take care of your stomach and your stomach will take care of you! If you have any questions or are interested in a consultation I offer complimentary Meet & Greet appointments to ensure we would be a good fit before getting started.