Heartburn

Finding the Cause

By Dr. Michael Kane

Many of my patients report they have had heartburn at some point in their lives.  The symptom of heartburn is bothersome for sure, but the true concern is what the symptom could represent.  That irritating and burning pain can be a sign that the tissue in the esophagus is being irritated. Long term irritation could lead to damage and cell changes even cancer.  That is why many doctors are quick to prescribe medication to block acid production. Usually the investigation doesn’t proceed beyond this point. Sometimes patients are on these medications for years and years. 

Recent studies suggest that long term use of these medications could lead to some health problems, increasing the risk for osteoporosis (bone weakness), dementia and low nutrient levels. They also cause changes in the small intestine.  A lower acid can cause a population shift in the gut bacteria.

The most important question is not being addressed,  “What is the Cause of Reflux ?”

In my experience, the cause might be different for each person.  In this article I will present four patients who have had chronic heartburn, each with a different cause. 

Case 1 Food Sensitivity 

Adam is a 26 year old, who started having digestive issues in his teen years.  He would have a sour stomach and nausea, sometimes preventing him from eating and certainly interfering with his life.  His doctor suspected GERD and put Adam on a Protein Pump Inhibitor (PPI). This really helped and as long as he was on the medication, he did well. Any attempt to come off the medication resulted in a return of his symptoms.  Adam came to our office seeking alternatives to this approach.  After doing some blood work, we determined a few things.  First, the long term use of the PPI had an impact on Adam’s nutrient absorption.  He was very low in b12/folate and some of his mineral levels were very low as well.  Second and more importantly, he tested positive for a number of food sensitivities: corn, wheat and egg to name a few. 

After removing the foods he was sensitive to, Adam was able to stop the PPI medication without a problem.  He reports some adjustments to the diet change but is working at it.  Food sensitivity can certainly be a cause for reflux.  The testing for food sensitivity is through a blood test that looks for the production of IgG antibodies to the proteins of foods. This is technically different from a classic food allergy IgE, which is usually an immediate body response.  The IgG reaction can take longer – 2 hours to 2 days and symptoms present in a number of ways. 

Case 2 Low acid

Ethel is a 72 year old woman.  Her long history of reflux and abnormal cell changes seen on her endoscopy led her to seek an alternative to the PPI medications she has been taking for some time without significant improvement.  

In talking with Ethel,  I suspected that the cause of her reflux might actually be low stomach acid.

Acid production is important for the proper digestion of foods and is critical for the absorption of certain nutrients.  Acid is also important for proper closure of the valve between the esophagus and the stomach.  This valve, the cardiac sphincter, gets its signal to close tightly when there is acid in the stomach.  As we age, acid production can decrease and this decrease can cause poor valve function. 

I suggested a trail of a supplement Betaine HCL that would aid her digestion by increasing acid in the stomach.  She tolerated the trial well. She took it before each meal. Her real test came when she tapered off the medication. She did this without a problem. 

I saw her a year after her starting the protocol. She brought in her most recent endoscopy report which showed absolutely no irritation and more importantly, her cells showed no abnormality. 

Case 3 Timing and logistics

Brad is a 47 year old man who is a Tums popper. He is one of those people who will get heartburn frequently enough that they carry Tums in their pockets all the time.  He shared with me his medical history including the endoscopy and ultrasound showing a diagnosis of a hiatial hernia.

A hiatial hernia is a condition where a portion of the stomach is “herniated” above the diaphragm. This pinching can increase pressure in the stomach and can make reflux much worse. 

I suggested a few lifestyle changes. 

Smaller meals- 

No eating after 7 pm

Avoiding all foods that can cause a loosening of the cardiac sphincter. These include:

coffee, mint, chocolate, tomato products and other spicy foods.  Limit alcohol.

Brad reported on a follow up visit that when he follows the above recommendations he has no heartburn.  He did report that late night dinners out with alcohol are still an issue. But he is happy to have the symptoms very infrequently.

Case 4- Anxiety

Mark is a 29 year old very fit athletic man.  He is also a self confessing “Type A” guy.  In review of his daily lifestyle habits, he has a very healthy routine.  He exercises daily and his diet is very healthy.  However, he takes no time to eat. He usually eats on the run or in his car.  This is not ideal for digestion or those with reflux.

He also has some significant sleep issues.  His active mind makes it difficult for him to get a full nights rest. 

This pattern of increased stress is not uncommon for some with reflux.  The digestion process is controlled by the parasympathetic nervous system.  Those “Type A” folks usually have a hot wired sympathetic nervous system ready for that “flight or fight”.  Digestion is often compromised.

Besides making the logical suggestions about taking time to chill out and eat while relaxed. I suggested a protocol of support for his nervous system that includes a few nutrients that can also help with sleep.  Melatonin and 5htp (a form of tryptophan) are a part of this protocol. 

Mark did great on these supplements.  His reflux resolved and his sleep improved.  I also persuaded Mark to take a meditation class to help in the balancing of his parasympathetic and sympathetic nervous systems. I hope that by retraining the body, he will no longer need to take any supplements. 

Don’t settle for not knowing the cause of any of your health concerns.

As you can see from the variety of the cases here, there is not one cause for the symptoms of reflux.  If you are taking anything to treat the symptoms rather than the cause, talk to one of our doctors about getting to the root of your concern.