Heartburn, sometimes referred to as acid reflux, or GERD (gastrointestinal esophageal reflux disease), is one of the most common digestive disorder affecting North Americans. After Lipitor (a cholesterol reducing medication), acid suppressing medications are the most common medication prescribed for this condition.
Problems with taking acid suppressing drugs (e.g. nexium, zantac, prilosec):
From The Journal of Gastroenterology (2):
“Treating GERD with acid inhibition will not work because acid secretion is NOT the primary underlying defect.”
The primary underlying defect; Not too much acid, but too little acid.
Most people assume heartburn is caused by too much stomach acid production. This is a common misconception due to the fact that GERD prevalence increases with age, while stomach (hydrochloric) acid production decreases with age (3). In fact, 40% of women over 80 years of age do not produce stomach acid at all. If GERD was caused by excess acid, more children and teenagers would have GERD than the elderly.
Heartburn is caused by stomach acid coming into the esophagus (see image above). The esophagus does not contain a lining that protects it from stomach acid, like the stomach does, and the presence of this acid in the esophagus causes the acid reflux and burning sensations associated with heartburn or GERD.
The esophagus is separated from the stomach by a muscular valve or sphincter known as the LES (lower esophageal sphincter). This LES should only open when swallowing foods/liquids to allow them in the stomach for digestion. GERD is caused by a dysfunction of this LES, which opens when it shouldn’t, allowing stomach acid into the esophagus from the stomach.
Low Stomach Acid
Stomach acid is required for maintaining a low pH in the stomach which prevents bacteria from overgrowing. Thus, low stomach acid causes bacterial overgrowth in the stomach as well as further down to parts of the intestine. Bacterial overgrowth causes maldigestion of carbohydrates, which leads to gas production. This gas increases the pressure in the abdomen and stomach, causing the lower esophageal sphincter (LES) to malfunction (4). The malfunction of the LES allows acid from the stomach to enter the esophagus, thus producing the symptoms of heartburn and GERD (5).
Summary of the Mechanism of Heartburn
Low Stomach Acid —> Maldigested Carbohydrates —> Gas —> Increased Abdominal Pressure —> LES Malfunction —> Heartburn
Other contributing factors to heartburn:
Healing from Heartburn
GERD and heartburn are easily prevented and cured by addressing this underlying defect using dietary and lifestyle changes. There are three steps I use to treat without medications, applied in the following order:
CALM Inflammation of the esophageal lining caused by stomach acid
As stated above, the reason people feel heartburn or acid reflux is because of the presence of stomach acid in their esophagus. The esophagus is not meant to store stomach acid as it does not contain the protective lining that the stomach does. Thus the presence of stomach acid in the esophagus causes inflammation in the esophagus leading to symptoms of heartburn. The first objective is thus to calm the inflammation to help alleviate symptoms, so that steps 2 and 3 can be addressed as well. The following supplement and dietary suggestions are recommended:
Deglycyrrhizinated Licorice (DGL) (6)
DGL has been shown to be effective in treating gastric and duodenal ulcers and works as well as zantac with no undesirable acid suppression or side effects. It works by promoting mucous secretion, and stimulating new cell growth which contribute to a health gut lining.
Zinc Carnosine (7)
Zinc carnosine benefits by restoring the gastrointestinal lining through it’s anti-inflammatory and antioxidant functions. Evidence supports the safety and efficacy of zinc carnosine for maintenance, prevention and treatment of the mucosal lining. It is approved for use of treating gastric ulcers in Japan and most conditions of the upper GI tract.
Mastic Gum (8)
Mastic gum has been used for more than 2500 years in traditional Greek medicine for treating several diseases such as peptic ulcers and gastritis. Modern science has justified it’s benefits by revealing its activity against bacteria such as H Pylori, which is the main cause of gastric ulcers. Studies confirm its anti-inflammatory, antioxidant and anti-microbial actions which makes it a valuable treatment tool for heartburn.
Reduce inflammatory foods
It is suggested to avoid the following foods to calm the inflammation from GERD:
gluten, dairy, spicy foods, citrus foods, tomatoes, coffee, peppermint, chocolate, alcohol
REMOVE the factors causing low stomach acid and bacterial overgrowth
The factors causing low stomach acid and as a result, bacterial overgrowth, can include: acid-suppressing and antibiotic medications, H pylori bacterial infection, chronic stress and malnutrition. An additional cause, as mentioned above, is age, as production of stomach acid reduces with age (1). Bacterial overgrowth is often a cause of low stomach acid as sufficient stomach acid reduces the pH in the stomach, providing a non-hospitable environment for bacteria to survive. Eradication of bacterial overgrowth often includes the rotation of anti-microbial herbs such as oil of oregano, garlic, berberine, and mastic gum.
REPLACE stomach acid and beneficial bacteria
As low stomach is connected to GERD, the last step is to increase stomach acid levels. If this is done too early on, it can aggravate heartburn symptoms. Increasing stomach acid can be done through:
Due to bacterial overgrowth being a major factor in heartburn and GERD, establishing a beneficial balance of bacteria is an integral part of treatment. After eradication of bacterial overgrowth, replacing beneficial bacteria can involve the use of fermented foods such as kefir and sauerkraut, and/or the use of probiotic supplements. Not all probiotics are created equally, and some can aggravate digestive symptoms if SIBO is present. To be safe, probiotics without acidophilus are recommended.
Heartburn and GERD are easily prevented and cured with a Naturopathic approach as outlined above. The mainstream medical approach of taking acid-suppressing medications unfortunately has its risks and side effects which can be easily avoided by following a more natural approach.
Dr. Lara is a Naturopathic Doctor who is passionate about helping and empowering her patients in their journey towards lifelong health and wellness