Heartburn and GERD

By Thomas K. Lo, MA, DC

Heartburn, a burning sensation behind the breastbone that can move up into the throat, may affect up to 44% of North Americans at least once a month. Also called acid indigestion, heartburn is the most common symptom of gastroesophageal reflux disease (GERD).

GERD is among the top 10 reasons people seek medical care and the incidence is increasing. Between 25-35% of the U.S. population is affected by GERD; up to 15 million have heartburn every day.

Overweight, overeating, eating rapidly, stomach distention, pregnancy, smoking, poor stomach emptying, food intolerances, gluten sensitivity, celiac disease and other gastrointestinal disorders all increase risk. Stress, overeating or eating too hastily promotes reflux.

Medical Treatment

Heartburn is treated with antacid drugs. GERD is treated with surgery and/or acid-suppressive drugs. One surgical procedure is fundoplication in which the lower part of the stomach is wrapped around the esophagus to supposedly “recreate” the LES. Unpleasant side effects often include an inability to vomit and severe flatulence.

New, less invasive surgeries to tighten the LES include the Stretta procedure (radiofrequency energy delivered to the LES) and Bard technique (stitches placed in the LES). Common complications are bleeding and difficulty swallowing.

The vast majority of people who have surgery continue to have symptoms and keep using acid-suppressing drugs regularly. The surgical procedures do not necessarily prevent esophageal cancer or other potential GERD complications.

Antacids neutralize stomach acid and are often used for long periods of time. Regular and prolonged use tends to produce constipation, inhibit folate absorption, reduce phosphorus levels and lead to fatigue, loss of appetite and calcium deficiency.

H-2 blockers, such as Zantac, Pepcid, Tagamet, etc., block histamine, which stimulates acid production. They reduce HCI production instead of neutralizing it. You should not take them regularly for more than two weeks unless your doctor advises it. They can interact with other drugs.

PPIs such as Prilosec, Nexium, etc., reduce HCI and pepsin production. PPIs decrease mucosal blood flow in esophagus, stomach and duodenum areas, increasing risk of damage and permeability in their linings. Long-term use decreases absorption of iron, calcium, magnesium, zinc and copper and decreases B12 levels by inhibiting intrinsic factor secretion in the stomach.

Alternatives

Lowering the acidity of the stomach may temporarily relieve symptoms but it doesn’t treat the cause. Improving HCI production and function will help.

Increase the body’s natural production of stomach acid by adequate nutrition and avoidance of toxins.
Eliminate food triggers – personal intolerances. Use an elimination diet, then reintroduction.
Consume a natural, real food diet. Avoid refined, processed non-foods; they exacerbate acid reflux, deplete needed nutrients, add toxins, and upset the bacterial balance in the digestive tract.
If needed, temporarily take a hydrochloric acid supplement and possibly digestive enzymes.
Lose excess weight. A diet of healthful foods, portion control and exercise will help.
Don’t eat within three hours of going to bed.
Avoid huge meals. Don’t drink a lot of alcohol as it is an irritant to the GI tract lining. If you smoke, quit.
Sleep on your left side, not your right side or your back to reduce heartburn at night. If needed, elevate the head of your bed.
Wear comfortable, loose-fitting clothes. Tight pants, pantyhose, slenderizing undergarments, and belts put pressure on the stomach.