One in ten Americans experiences heartburn at least once a week. Heartburn is a burning sensation experienced in the upper abdomen often just behind the breastbone. Heartburn tends to be worse when lying down or bending over. Signs of heartburn can include hoarseness, a chronic cough, asthma and eroding teeth. Heartburn is more common among the elderly and pregnant women. Because the pain of heartburn can mimic heart disease, it is important to get a prompt medical evaluation when you experience any new chest symptoms.
Heartburn is most typically caused by acid reflux which happens when stomach acid leaks back up into your esophagus. Occasional heartburn is common and is not necessarily a cause for alarm. It can often be managed by dietary changes and over the counter medications or supplements.
Heartburn that occurs frequently and interferes with your daily routine is called GERD (gastroesophageal reflux disease). Untreated GERD can eventually damage the esophagus and cause serious medical complications. Barrett's esophagus is a complication of GERD where the tissue lining the esophagus eventually starts to resemble the tissue that lines the intestines. This condition raises the risk for esophageal cancer. One cause of chronic heartburn can be Helicobactor pylori ("H pylori") which is a bacteria that can settle into the lining of your upper digestive tract. Eventually, this bacteria can erode the lining and cause bleeding ulcers. Chronic heartburn accompanied by dark stools can be an indication of bleeding and is always a cause for concern. Fortunately, H pylori infections are treatable, but they should be addressed promptly.
Heartburn can have a number of triggers including food, medications, ulcers, exercise, obesity and stress. Foods that commonly trigger heartburn include alcohol, chocolate, fried or fatty foods, coffee, citrus, tomatoes, other spicy foods and soft drinks. In our experience, high carbohydrate diets tend to worsen heartburn because they likely promote overgrowth of undesirable bacteria and yeast.
In naturopathic medicine, our initial treatment goal is always to find the underlying cause of heartburn. A conventional medical work up for heartburn can include an x-ray of your upper abdomen, an endoscopy (where a flexible tube is passed down your throat to view the esophagus) or other tests based upon your symptoms. The specialist that performs these types of tests is usually a gastroenterologist. In addition to conventional testing, we often run food sensitivity testing to identify trigger foods for heartburn. We frequently find that patients have food triggers beyond the typical culprits. A thorough health history helps determine if you also have diet and lifestyle factors that may be contributing to your condition.
It is important to treat heartburn to keep symptoms from worsening and from preventing permanent damage to your digestive tract. Treatments may include medication, diet and lifestyle changes and supplements. Over the counter medications for heartburn are typically antacids or H2 blockers. H2 blockers block the action of histamine on certain cells in the stomach, which in turn lowers the stomach's production of stomach acid. H2 blockers are not designed for long term use.
Here are our top ten diet and lifestyle recommendations that may be helpful for heartburn:
- Sleep with your head elevated several inches.
- Eat smaller, more frequent meals.
- Do not eat within two to three hours of bedtime.
- Avoid known trigger foods.
- Stop smoking.
- Avoid wearing belts or clothing that are tight fitting around the waist.
- Lose weight if you are overweight. Weight gain around the middle often contributes to worsening heartburn symptoms.
- Avoid alcohol.
- Keep a heartburn diary. Outline when heartburn episodes occur along with the severity. Also, note what gives you relief. This information can be especially helpful to give to your doctor.
- Reduce the amount of stress in your life.
Some of the more common supplements that we use for heartburn are:
- Probiotics: Restoring beneficial bacteria in the digestive tract with a daily dose of probiotics can be helpful for many who suffer from heartburn. Healthy bacteria aid digestion which also helps prevent heartburn. Probiotics are conveniently offered in capsule, chewable tablet and powder forms.
- Intestinal Repair Supplements: Products that aim to repair the mucosal lining of the gastrointestinal system can be beneficial.
- Digestive Enzymes: Enzymes that break down food to aid in digestion and absorption can be an important piece of treating GERD.
- Acute Care: Deglycyrrhizinated licorice (DGL) is an herb that has been used for heartburn and other digestive ailments. It may help coat the stomach and reduce acidity.