[From New Vegetarian and Natural Health, Winter 2010 issue]
By Roger French
If you go to an orthodox doctor with heartburn, you will probably be offered drugs that either reduce gastric acid secretion or partly neutralise stomach acid. Another option is alginic acid which coats the mucous lining and also reduces the acidity. The medical last resort is surgical treatment.
The most effective drugs for reducing gastric acid secretion are proton pump inhibitors, which are among the most widely-selling drugs in the world. They are medically considered to be generally safe and effective. However, stomach acid is produced for a purpose, namely, the digestion of protein, and suppressing natural acid production would be expected to impair protein digestion. Some brand names of proton pump inhibitors are: Losec, Prilosec, Zegerid, ocid, Lomac, Omepral, Omez, Prevacid, Zoton, Inhibitol, Levant, Lupizole, Dexlansoprazole, Kapidex, Nexium, Esotrex and Protonix.
Antacids – taken before meals – are alkaline compounds that reduce gastric acidity, the common ones and their brand names being: aluminium hydroxide (Amphojel, AlternaGEL), magnesium hydroxide (Phillips’ Milk of Magnesia), aluminum hydroxide with magnesium hydroxide (Maalox, Mylanta, Diovol), aluminum carbonate gel (Basaljel), calcium carbonate (Alcalak, TUMS, Quick-Eze, Rennie, Titralac, Rolaids) and sodium bicarbonate (‘bicarb soda’, Alka-Seltzer).
The trouble with antacids is that when stomach acid is neutralised, the body responds by producing more, starting a vicious circle of too much acid followed by too little acid, and so on.
What's more, antacid medications are a major source of aluminium for elderly people, and in view of its strongly suspected association with dementia, particularly Alzheimer's Disease, the long-term harm to the mind could be far worse than the original heartburn problem.
Instead of merely treating the symptoms, it is possible to deal with the causes of heartburn with the prospect of solving the problem without side-effects.
WHAT IS HEARTBURN?
Heartburn, also commonly referred to as 'acid stomach', is medically named gastric reflux or gastro-oesophageal reflux disease (GORD). It refers to the acidic contents of the stomach squeezing or ‘sloshing’ back through the stomach valve into the lower part of the throat (called the oesophagus, and the valve is called the gastro-oesophageal sphincter). The reflux of gastric contents is spontaneous and involuntary.
The lower part of the oesophagus is sensitive to acid and is irritated by it and can become inflamed, which is what produces the so-called ‘heartburn’ pain, a burning sensation under the breastbone. This symptom is often accompanied by burping and sometimes the feeling that food is getting stuck in the lower throat. If a large amount of gas happens to form in the stomach, the burping can carry acid into the throat and increase the burning.
Less common symptoms include pain on swallowing, excessive salivation (saliva is slightly alkaline and acts as a natural antacid), nausea, regurgitation and chest pain.
Acid reflux is extremely common – as many as one in five people experience symptoms at least once a week.
It also occurs in infants and children, although relatively rarely. It is important to distinguish between gastric reflux and physiological reflux, which is quite common in infants. Parents are all too familiar with irritability and vomiting during the first year of life, which soon resolves without treatment and with no long-term effects. However, in rare cases, it progresses to true gastric reflux.
If gastric reflux persists for more than about five years, there is a risk of developing Barrett’s oesophagus, in which the lining of the lower oesophagus changes in appearance to resemble the linings of the stomach and intestine. These changes are caused by the chronic irritation due to the gastric juices, and the cells may eventually turn cancerous.
Symptoms of Barrett’s oesophagus tend to be similar to those of regular heartburn and may seem fairly trivial, so that the condition is often not diagnosed until it is well advanced. Barrett’s oesophagus occurs more often in men than in women.
Other possible harm from long-term acid reflux is the development of tight bands around the oesophagus (strictures), which may make swallowing difficult (called dysphagia), and ulceration of the stomach, which may lead to bleeding into the gut. These are more likely to occur in people who have developed Barrett's oesophagus.
WHY PEOPLE GET GASTRIC REFLUX
For heartburn to occur, some of the stomach contents must pass back into the lower part of the throat. Either some abnormality is causing the valve to not work properly or pressure in the stomach or abdomen is forcing the fluid through the valve.
Above-normal pressure in the abdomen can be the result of obesity, pregnancy, chronic constipation or tight clothing.
The increased pressure in the abdomen may result in regurgitation of stomach juices into the lower oesophagus, especially if the sphincter is weak, or when the person is lying down or wearing tight clothing.
Over-eating and/or over-drinking cause excessive pressure in the stomach. Eating large meals late at night can cause heartburn after retiring to bed.
Too much rich or spicy food, especially accompanied by alcohol.
Carbonated drinks or any foods or fluid consumed rapidly are likely to cause burping, with resulting heartburn.
Weak or stretched sphincter muscles. Poor muscle tone, which will most likely apply to the entire gut, is a common cause of reflux, and is often due to deficiencies of vitamin B1, magnesium and/or calcium.
Lack of fibre can cause heartburn after a single meal, or many years of fibre deficiency can cause chronic constipation, with the resulting increased pressure in the abdomen.
One of the many functions of fibre is to stimulate the production of a hormone called gastrin which causes the sphincter at the top of the stomach to close after the stomach fills with food. If a meal lacks fibre, the valve can remain partly open or be only loosely closed, allowing reflux to occur.
High intakes of coffee, tea, chocolate and alcohol tend to suppress the production of gastrin, allowing reflux to occur.
Smoking also tends to suppress the production of gastrin.
Meals high in fat. Fat tends to hold food in the stomach for a longer time and also reduces the competence of the oesophageal sphincter.
Tight, restrictive clothing increases the pressure on the abdomen and/or stomach.
Lying down or bending over too soon after eating can be triggers to heartburn if the sphincter is already weak or there is abnormal pressure in the abdomen.
Physical exertion too soon after eating can cause reflux.
Stress can contribute to heartburn. An immediate effect can be indigestion. In the long term, stress can weaken muscle tone and impair organ function in general.
Hiatus hernia. Not everyone with hiatus hernia experiences heartburn; it is more likely to occur when the person bends forward or lies down. With this kind of hernia, the top extremity of the stomach protrudes through the diaphragm (which separates chest from abdomen) and into the chest cavity, often rendering the sphincter ineffective.
The causes of hiatus hernia include: Lack of fibre, which may result in constipation and straining on the toilet causing pressure in the abdomen and eventually hiatus hernia; Obesity can cause pressure in the abdomen; Pregnancy has the same effect; Weight lifting can involve great strain and sudden pressure; Chronic cough can cause repeated strain and have a 'jarring' effect.
Scleroderma and systemic sclerosis can involve hardening of the oesophagus.
Some drugs – such as prednisolone and those used to treat high blood pressure and angina.
Family history. As with most conditions, there can be a genetic predisposition to reflux. One form of predisposition is when the angle at which the oesophagus meets the stomach is abnormal. In the normal case, this angle is such that it creates a valve that prevents the stomach contents from traveling back into the esophagus.
SELF-HELP AND PREVENTION
The heartburn sufferer can do a lot to help themselves through preventing the problem recurring, or dealing with the underlying causes, or taking advantage of appropriate herbs.
First and foremost, attempt to identify the cause or causes and take the necessary steps to deal with them.
Consider the short-term causes.
Decide whether the over-eating or over-drinking are worth the suffering afterwards. Remember that drinking with meals impedes digestion, so take fluids at least half an hour before a meal or two to three hours afterwards.
Have smaller, more frequent meals so that there is less food in the stomach at any one time. Make the evening meal small enough to avoid heartburn when you retire to bed. To ensure that the stomach will be empty or close to empty at bed time, have the evening meal at least three hours before retiring to bed.
Are you consuming enough fibre? Remember that it occurs only in plant foods, and to ensure abundant fibre, we need a balance of vegetables, fruits, wholegrain foods, legumes, nuts and seeds.
At least initially, drastically reduce fatty foods, especially fried protein foods, as these tend to remain in the stomach for a long time.
It may be found necessary to avoid consuming acidic fruits and tomatoes and their juices.
Acknowledging that it is easier said than done, cut out or at least cut down the intake of caffeine in the form of coffee, tea, chocolate and cola drinks, and also avoid alcohol, sugar, carbonated drinks, very rich foods and strongly-spiced foods.
Avoid a large amount of protein in the one meal as it stimulates acid production. Protein-rich foods are nuts, legumes, seeds, eggs, cheese and flesh foods. Animal proteins require much more acid, which is just one of many arguments in favour of vegetarian eating.
Avoiding wearing tight-fitting clothing, especially if there is abdominal obesity. Check that clothing is loose.
Avoid lying down immediately after a meal; take an easy walk instead.
For Persistent Heartburn
To minimise the intensity of persistent heartburn, the diet needs to be fibrous and lubricating: salads, lightly-cooked vegetables, well-cooked rice and other whole grains, well-cooked potato, grated apple, banana, yoghurt, pawpaw and green vegetable juices, the last being mildly astringent.
Because protein is essential in the normal diet, there must also be some protein foods. Plant proteins will help because they tend to require less acid. A good one is ‘almond milk’, made by blending almonds in water and straining off the ‘milk’ containing easily digested protein.
Good, old-fashioned slippery elm is mucilaginous, tending to protect and soothe the mucus lining of the throat. It can be taken either in tablet form or as one or two teaspoons of the bark powder dissolved in a cup of hot water.
Allow plenty of time for meals so that you can relax before and during each meal. Eat slowly and chew each mouthful thoroughly – grandma had the right idea when she said 28 chews each mouthful!
If the burning pain after a meal is too distressing, it may be worth the trouble to apply a hot compress over the stomach, its purpose being to improve the blood supply in the area and relax the muscles.
To strengthen the gut muscle, in particular the oesophageal sphincter, ensure adequate B vitamins, especially B1 and the minerals magnesium and calcium. These are all supplied in a diet of legumes, seeds, nuts, whole grains and fresh vegetables, as mentioned above. Topping up with a B-complex could be helpful. A homeopathic remedy may also help tighten slack muscles – it is 'calc fluor' biochemic tissue salt (originally designed by Dr Schuessler).
Use of Herbs
There are herbs for providing relief and herbs that are preventive. Before using them, it is always wise to consult a professional herbalist for best results and to check for any contra-indications.
Ginger can be taken in capsule form or as a 'decoction': add 1½ teaspoons of freshly-grated root to a cup of water, boil, simmer for 10 minutes, strain, allow to cool and drink as needed.
Meadowsweet soothes the mucous membranes. Add 1 or 2 teaspoons of dried herb to a cup of boiling water, infuse for 15 minutes, cool and drink 3 times daily.
Marshmallow root and slippery elm (mentioned above) reduce irritation and inflammation of digestive organs. Common pigweed (purslane) may also be recommended by a herbalist. Marshmallow and pigweed would be taken as decoctions.
Herbs that tone and heal the digestive system may be recommended. They include hops, rue, gentian and golden seal. These can have toxic effects if taken in large amounts and should not be taken for long periods, particularly during pregnancy. This highlights the importance of consulting a practitioner before taking any form of remedy.
Deal with Obesity
Easier said than done, but it can be done. For the large majority of people, it boils down to food and physical activity.
Whereas low-calorie dieting lowers the rate at which we burn energy (metabolic rate), regular physical activity raises the metabolic rate to persistently higher levels. It is very encouraging to know that people who regularly run, play tennis or have other strenuous activity have been found on average to be lean and trim, even when they are eating far more calories than people who have no exercise and are relatively obese.
Regular physical activity replaces fat with muscle which burns energy during activity 20 to 100 times faster than normal. Daily brisk walking or light bouncing or running on a rebounder can make a significant difference to metabolic rate. [The NHS shop stocks a quality rebounder.]
Eating the appropriate balance of natural, unprocessed foods according to Natural Health Dietary Guidelines (refer to Natural Health and Vegetarian Life, Spring 2009 issue) provides a daily calorie intake of between 1500 and 1900, with a full stomach three times a day – and the added bonus of being what we in the NHS believe to be the healthiest practicable diet.
Fruit and vegetables are not only low in calories, but, with the exception of avocado and olives, they contain no significant amounts of fat.
Further, the high fibre content demands a lot of chewing and makes us feel full. It is much easier to avoid over-eating on a natural diet like this than when filling ourselves with heavy, processed foods.
If we do overeat on natural foods, it is because we have learned early in life to use food as compensation for suffering, or to console ourselves when we are upset, or because eating can be a sedative for stress, or because meals are eaten according to the clock rather than hunger, and so on.
The antidote is to create diversions, such as making a phone call, going for a walk, writing a letter, working on a hobby or playing golf, etc. An effective technique is to set one-day goals: "Just for today I will eat only at mealtimes and just enough to satisfy hunger."
[For a detailed account of how to overcome overweight and obesity, see NHVL, Winter 2008 issue.]
Rectify Chronic Constipation
The starting point is adequate fibre, for which the Natural Health diet may well do the trick. In addition, regular physical activity – along with all its other benefits – does make us more ‘regular’.
If bowel tone is sluggish, it should respond to the same nutrients that strengthen the stomach sphincter muscles.
Other nutrients in natural foods will stimulate the conversion of cholesterol into bile which acts as a bowel lubricant and natural laxative. At the same time, be sure to drink plenty of pure water to prevent dehydration.
Never ignore a call of nature. Form the habit of going to the loo whenever your body indicates the need. On the loo, squat rather than sit, so that the bowel can evacuate effortlessly and fully. Like many other people, I (Roger French) have for many years used the In Lieu Toilet Converter which enables squatting. The In Lieu is stocked in the Natural Health Society shop.
Finally, because many emotional problems, such as anger, affect the bowel, learn to relax. Find a technique that suits you and practise it regularly. [See the article on stress in this issue.]
[For a detailed account of how to overcome chronic constipation, see this magazine, Autumn 2005 issue.]
Hernias are very difficult to heal naturally and often require surgery. Fortunately, modern keyhole surgery is much less invasive than the standard long-cut method.
The best approach with hernia is to prevent it forming in the first place. This means avoiding obesity or constipation; taking great care when lifting heavy weights, especially by bending the knees rather than the back; and remedying coughing by finding and correcting the lifestyle causes. It is particularly important to learn to relax so as to avoid being constantly tense.
Exercises to prevent or correct hernia may be learned and practised with the guidance of an osteopath or other practitioner.
Elevate the Upper Body
Some easing of night-time reflux may be achieved by sleeping on the left side of the body. Nothing could be easier to trial!
Elevating the head of the bed can be effective – provided the person can still get to sleep all right. Elevation can be achieved by using plastic or wooden bed risers that support the legs of the bed, or by using a therapeutic bed wedge pillow, or an inflatable mattress lifter that sits in between the mattress and the base. If the bed has an innerspring mattress, be aware that back pain might result, so another method would need to be tried.
The head must be elevated least 15 to 20 cm in order to prevent the backflow of gastric fluids into the oesophagus. A higher degree of incline may provide better even results.
Some Background Recommendations
Aim to have plenty of sleep and time for relaxation. Practise a relaxation technique so that you are not continually stressed, which can have a multitude of harmful consequences.
If you smoke, make a big effort to quit. Smoking irritates the stomach lining and other mucous membranes.
There are many benefits to be gained from regular exercise in the form of daily brisk walking or at least three times a week of running, swimming, cycling, etc. Exercise relieves stress, eases constipation, reduces weight, gives tone to muscles and internal organs and improves self-esteem, making it easier to achieve whatever you set out to do – such as improving eating, quitting smoking or having more exercise.
Not only are the above natural methods likely to relieve and prevent heartburn, they can also be expected to improve almost every other aspect of health and wellbeing.
This sure beats antacid medication with the vicious cycle it can create and the possibility of dementia that may eventually be as advanced as Alzheimer's disease.