Heartburn: Ignorance is Risk
By Dr. Michael Kane
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. Once controlled the investigation stops. Sometimes patients are on these medications for years and years.
Yet 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 acidic environment can cause a population shift in the gut bacteria.
But the question isn’t to medicate or not. The most important question is not being addressed, “What is the Cause of Reflux ?” And one answer does not fit all. My experience has taught me that the answer can be different for each person. In this article, I will present five patients who have had chronic heartburn, each with a different cause.
Case 1 Food Sensitivity
Adam, then 26 years old, 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 learned a few things. First, the long term use of the PPI had 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 avoiding the foods he was sensitive to, Adam was able to stop the PPI medication without a problem. He reports some difficulties adjusting to the diet change but is working at it.
Food sensitivity can certainly be a cause for reflux. 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
At 72 years old, Ethel’s long history of reflux and some recent abnormal cell changes seen on her endoscopy led her to seek an alternative to the PPI medications she had 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 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, a Tums popping 47 year old man, gets heartburn frequently enough that he carries Tums 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.
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-confessed “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 especially 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” syndrome. 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.
Charlie is a 48 year old patient who has been “Pumping Tums” on a regular basis. He can’t remember how long or how his reflux began. “I just want to it to stop”.
After asking a few key questions, he was able to relate that he notices a number of foods that really make him double over with pain, coffee, chocolate, and wine. He also started taking breath mints because his breath was “rank” as he described. The mints helped his breath but didn’t help with his heartburn. Common foods that cause the loosening of the lower esophegeal valve include coffee, mint, chocolate, alcohol (see chart).
Sometimes the bad breath can be a sign of bacterial imbalance, I sent Charlie to get a H.Pylori breath test. Helicobactor Pylori is a bacteria that can cause upper GI issues. Reflux, ulcers, indigestion, are all complications of H.pylori.
His test was positive. At times, eradication of H.pylori can be a challenge. I presented Charlie with options for treatment, i.e. prescription medication or a combination of botanicals. Charlie chose the prescription. After two rounds of treatment he was symptom free.
As H.pylori is a transmissible bacteria, I suggested his family be tested. Luckily, they all were negative.
Relationship between GERD and Diet
|Dietary target||Proposed mechanism of GERD symptoms|
|Acidic foods||Direct esophageal mucosal irritation|
|Carbonation||Increased gastric distention/TLESRs|
|Coffee||Reduction in LES tone|
|Alcohol||Reduction in LES tone|
|Chocolate||Reduction in LES tone|
|Mint||Reduction in LES tone|
|Spicey Foods||Direct esophageal mucosal irritation|
|High Fat Foods||Reduction in LES tone/gastric motility|
|Late night meal||Increased gastric acid production|
|Large Meal||Increased gastric distention/TLESRs|
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 discovering the cause, talk to one of our doctors about getting to the root of your problem.