NATURAL SOLUTIONS FOR HEARTBURN

Q. I suffer from heartburn a least a few times a week. I can't put a finger on specific food triggers. My heartburn generally occurs at night either preventing me from sleeping or waking me up in the middle of the night. Over the counter treatments do work, but I question how good they are for me. Can you suggest some natural alternatives?

A. Heartburn is unfortunately a way of life for many men and women. It happens on a such a regular basis and because over the counter treatments seem to work, we all assume it's no big deal, often failing to mention the chronic condition to our doctors.

Common Problem
Heartburn CAN be a benign and rare problem for all of us from time to time, particularly with certain foods. That being said, if you have chronic heartburn, severe enough to affect sleep on a weekly basis, or more, you could be looking at a potentially serious problem such as GastroEsophageal Reflux Disease (GERD). It is important for chronic heartburn sufferers to talk to their doctor before it gets to a point where medication is necessary.

What is 'Heartburn?'
Heartburn occurs when acid from the stomach passes back up into the esophagus. Normally, the lower esophageal sphincter (LES) or muscular ring that separates the stomach from the esophagus contracts when the stomach is full and relaxes when eating (so food can easily pass into the stomach). This is meant to be a one-way valve, with contents being transferred from esophagus to stomach but not the other way around. Unfortunately, for a number of reasons, this sphincter can get lazy or malfunction, allowing the acidic contents to splash up and damage the mucous membranes of the esophagus, which is not equipped to handle the acid.

Why it Happens
Two of the more common reasons for the an under active LES are too much food (overeating), leading to a sphincter that can't quite close, or pressure being put on the stomach, leading to a sphincter that is unable to stay closed. The latter is caused by weight or obesity, and also explains why heartburn is so common in pregnancy, where the growing uterus puts pressure on the stomach above. In some cases, GERD or reflux is caused by to little stomach acid. Insufficient amounts of acid fail to signal a closing of the LES (for digestion) and with the sphincter wide open, even a small amount of acid is able to splash up.

Why it can be Dangerous
As I mentioned, the lining of the esophagus is not meant to come in contact with acid and when it happens chronically, the cells of the lining become inflamed and irritated (known as esophagitis). This irritation can then lead to bleeding (or ulcers), which long-term can have its own repercussions. Barrett's esophagus goes one step further in that these cells begin to change. The normal cells of the lining of the esophagus are replaced by other cells (dysplasia). This process leads to a great risk of developing cancer of the esophagus. Strictures occur when damage to the lining of the esophagus causes scarring, which eventually causes narrowing or blockage of the esophagus making both eating and drinking very difficult and dangerous.

How Can I Help?
Caffeine, chocolate, tomato, garlic, citrus fruits, high fat meals, peppermint and often creamy and or spicy foods can all increase symptoms of GERD and decrease lower esophageal sphincter pressure, making it more likely that stomach acid can leak out. Experiment with these foods carefully and stay clear of those that aggravate your symptoms. Avoid tight fitting clothing that put excess pressure on the stomach. More so an issue for women, girdles or 'tummy tucking' underwear can actually cause , or at least worsen GERD symptoms.

OTC
Over the counter antacids are often recommended for treating recurrent heartburn or GERD symptoms, but over use of these type of medications can cause problems, including mineral imbalances and changes in stomach pH, which significantly impairs digestion. Proton pump inhibitors, another class of drug commonly used to prevent reflux, has been linked to increased risk of hip fracture and osteoporosis. More research needs to be done before claims such as these can be verified, but none the less, consumers are looking for less controversial and side effect free solutions, as well as wanting to get to the root of the problem, as opposed to simply addressing the symptoms, which most of these medications fail to do.

Dietary and Lifestyle Interventions
We've talked about the things you should not eat or should avoid doing, now let's get to things we can be eating, supplementing with and changing in terms of lifestyle, to prevent or treat GERD or occasional heartburn before it develops into something more serious. First and foremost, if you are overweight, lose weight. It is just that simple. Weight loss of even 5 to 10 lbs can minimize GERD and heartburn issues significantly. Eating smaller meals throughout the day is another way to minimize pressure on the LES. 5 to 6 smaller meals throughout the day means less chance of overeating. Another bad habit that can worsen LES malfunction is late night eating followed by bed. When we lie down shortly after a moderate to large meal, we are decreasing the pull that gravity itself has on the LES and keeping this sphincter closed during digestion. Try to give yourself 3 hours between eating and bed to make sure your food has been adequately digested before lying down. Also, consider raising the head of your bed by just a few inches (thick books work well). Again, this may help those that often wake with symptoms during the middle of the night. Talk to your Naturopath or MD about exercises you can do to strengthen your lower esophageal sphincter. It sounds odd, but being a muscle, there are ways to strengthen it.

Supplementation
In terms of supplements, probably the most important to consider are deglycerhizinated licorice (DGL), aloe or glutamine (or a combination) to repair an irritated mucous membrane. They can be taken as a powder or DGL is also available in a chewable tablet for fast relief. Probiotics are also a great way to ensure that you are maintaining a healthy gastrointestinal flora and ensure proper food breakdown with healthy bacteria. Ginger, in the form of the raw root or tea has also been shown to be very effective in treating GERD symptoms and preventing inflammation of the mucous membranes. To make an easy ginger tea, simply peel a small chunk of the root, slice it and let it steep in hot water for 5 minutes. You can add a small amount of honey for taste. Try a cup before bed. For individuals with low stomach acid, apple cider vinegar shortly before each meal can work to both increase stomach acid and therefore also signal the LES to close allowing for less reflux of acid.

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