With Thanksgiving approaching, millions of us will soon be stuffed like a turkey — and suffering from heartburn as a result.
I find heartburn to be one of the most misunderstood symptoms. Most people, including doctors, believe that heartburn is caused by excess stomach acid.
As I’ve explained to thousands of doctors, it's actually a disorder of flow, or motility. Heartburn happens when the contents of your stomach travel backward up the esophagus, causing pain and inflammation.
This condition is technically called GERD (gastroesophageal reflux disease) or just simply “reflux," and the inflammation is called “esophagitis." But acid is not the main cause of pain or inflammation. There are many irritants in stomach juice, including bile and the enzyme pepsin, which breaks down protein and can damage your esophageal lining.
The Problem with Heartburn Drugs
The standard treatment of GERD is the use of drugs that suppress stomach acid. But I don't recommend relying on them to treat your heartburn for four main reasons:
1. They don’t prevent reflux. They merely convert acid reflux into non-acid reflux, which can still cause damage.
2. They may have serious side effects. With long-term use, acid-suppressing drugs increase your risk of bone loss, fractures, and nutritional deficiencies. And with any use, they can increase your risk of pneumonia, food-borne infection, and Clostridium difficile colitis, a life-threatening infection of the large intestine.
3. They can cause weight gain. As many as three in four people who use acid-suppressing drugs for longer than a year develop undesirable increases in body weight.
4. They increase development of food allergies. Just three months of acid suppression increases levels of allergic antibodies to foods and the risk of a clinically diagnosed food allergy. The reason: You need stomach acid to digest protein, and poor digestion of protein makes food much more allergenic. I discuss this problem further in my new book, The Allergy Solution.
How to Fight Heartburn Naturally
I’ve used the following methods successfully with thousands of my patients dealing with GERD.
The program is based on a few simple facts: First, GERD is caused by malfunction of the LES valve (the lower esophageal sphincter), which separates the esophagus from the stomach. The main trigger for GERD is a full, distended stomach. The natural treatment for GERD, then, is not acid suppression — but avoidance of stomach distension and tightening of the LES valve.
So here's what to do:
1. Never stuff yourself.
Chew your food well, eat relatively small meals, and stop eating before you are full. This can help prevent distension of your stomach, which is the main trigger for GERD.
2. Relax while you eat.
Make mealtime a quiet, relaxing time to focus on your food. This enhances normal esophageal motility.
3. Don’t lie down within two hours of eating.
This gives your stomach a chance to empty while gravity is helping prevent reflux.
4. Drink alkaline water, with a pH of 8.5 to 9.
I recommend this as your main source of drinking water. Iceland Spring and Evamor are two brands of naturally formed waters made alkaline by their contact with limestone.
Drinking alkaline water is very different from suppressing stomach acid. Alkaline water isn't strong enough to reverse acidity in your stomach, but it is strong enough to inactivate pepsin outside your stomach, in your throat and esophagus.
5. Take calcium citrate powder after eating.
You should take about 150 mg, dissolved in a small amount of water, after each meal and at bedtime.
Most people, including doctors, misunderstand the role of calcium in preventing GERD. They think of calcium preparations like Tums and Rolaids as antacids. In fact, these products, which consist of calcium carbonate, have no significant effect on the acidity of the stomach or esophagus.
In my clinical experience, I have found that calcium citrate, which is a mildly acidic form of calcium, works even better than calcium carbonate. The reason: calcium citrate is more soluble than calcium carbonate, so the calcium gets into the cells of the esophagus faster.
A key point: Calcium pills do not work for this purpose. The calcium must be chewed or swallowed as a powder or liquid, because it must be available in solution in the lower esophagus, where it prevents reflux without decreasing stomach acid.
6. Take digestive enzymes with each meal.
This will help to decrease distension of the stomach. In my experience, I’ve seen excellent results with several enzyme preparations, taken as pills or powder.
7. Try melatonin, if you suffer from nocturnal reflux or cough.
Most people think of melatonin as a sleep aid, but melatonin is the only product, aside from calcium, that directly tightens the LES. The dose needed is 3 to 6 mg, which should be taken at bedtime.
One caution: Some people cannot take melatonin because they feel hungover the next day. This sensitivity doesn't improve with time, so if you feel drugged by melatonin, stop right away.
9. Take a form of licorice called DGL in a chewable wafer, before each meal.
Be very wary of DGL supplements containing glutamine, however. Glutamine is an amino acid that is widely used for relief of GI disorders. Despite its benefits, glutamine can enhance the activity of pepsin, which may then increase the inflammation that accompanies GERD.
9. Try a gluten-free diet.
People with gluten-sensitivity or celiac disease may experience heartburn as their primary symptom. If heartburn continues, ask your doctor to test you for celiac disease.
10. Increase your acid, instead of reducing it.
Some people find that heartburn improves if they take pills of betaine hydrochloride, or if they drink a solution of vinegar in water with their meals.
There are two reasons acid may actually protect against GERD. First, acid may speed the emptying of the stomach, preventing distension.
Second, it may change the bacteria living in your stomach or esophagus. Recent research has shown that both GERD and acid suppression are associated with abnormalities in the microbes that inhabit your upper GI tract. These changes in the microbiome contribute to the inflammation of esophagitis. Acid may help to correct this disturbance.
This article is provided for general educational purposes only and is not intended to constitute medical advice or counseling, the practice of medicine or the provision of health care diagnosis or treatment, the creation of a physician-patient relationship, or an endorsement, recommendation, or sponsorship of any third-party product or service by the sender or the sender's affiliates, agents, employees, or service providers. If you have or suspect that you have a medical problem, contact your doctor promptly.
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