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Heartburn has long plagued mankind. Three thousand years ago, the ancient Sumerians of Mesopotamia even had a word to describe it. Yes, ancient civilizations suffered from heartburn, too. Heartburn, or acid reflux, is an all too common condition caused when stomach acid regurgitates, or backs up, into the esophagus.[i] These days 20 percent of people in the U.S. suffer from gastroesophageal reflux disease (GERD), severe or chronic acid reflux that can have more serious implications.
Almost everyone experiences heartburn at one time or another. However, people who are overweight have a higher risk of experiencing GERD, and that risk increases with the amount of excess weight.[ii] Hiatal hernia, an anatomical defect, can cause GERD. But all too often, GERD results from routinely eating too much food at mealtime—not an uncommon situation in a country in which two-thirds of adults are overweight or obese. A large study at the University of Arizona medical school found that the consumption of soft drinks was also strongly associated with nighttime GERD and heartburn.[iii] Food sensitivities likely play a role as well.
In the 1990s, pharmaceutical companies began an aggressive push to sell drugs to treat heartburn and GERD. Each year, they rake in billions of dollars selling prescription and over-the-counter versions of acid-blocking drugs. One group of drugs consists of proton-pump inhibitors, which include omeprazole (Prilosec), lansoprazole (Prevacid), and esomeprazole (Nexium). The other group consists of H2 blockers, such as cimetidine (Tagamet), famotidine (Pepcid), and ranitidine (Zantac). These drugs suppress acid production in the stomach through different mechanisms. None of them are intended for long-term use, but many people do take them for years.
Using these drugs becomes a slippery slope. That’s because acid-blocking drugs set the stage for a host of problems. People who use Prilosec and Nexium have almost a 50 percent increased risk of hip fracture after just one year, and two and one-half times greater risk of fracture after long-term use of the drug.[iv] Regularly using any type of acid-suppressing drug almost doubles the risk of contracting pneumonia.[v] Acid-blocking drugs can increase susceptibility to food-borne illnesses, largely because a weakly acidic stomach may fail to destroy infectious bacteria. Prilosec and other acid-blocking drugs can also lead to an overgrowth of Clostridium difficile and other undesirable gut bacteria, which can have a damaging effect on digestion, immunity, and overall health. [vi] [vii]
And there’s more. Acid-suppressing drugs increase the risk of atrophic gastritis, which interferes with the absorption of vitamin B12, vitamin C, magnesium, and likely many other nutrients.[viii] In one recent study, published in the Journal of the American Medical Association, doctors reported that people who had taken proton-pump inhibitors for longer than two years were 65 percent more likely to be deficient in vitamin B12. Those who had been taking H2 blocker drugs were 25 percent more likely to develop a vitamin B12 deficiency.[ix]
One would think, when it comes to gastrointestinal tract problems, that doctors would pay more attention to the obvious—i.e., what people are eating. Consumers are often left on their own to take the time and effort to identify the specific cause of GERD and heartburn, as well as to muster the personal fortitude to resist a doctor’s pressure to take acid-blocking drugs. It’s also best to treat GERD sooner rather than years later, before acid-damage to the esophagus or the use of drugs leads to still other problems, such as Barrett’s esophagus.
The most overlooked cause of GERD and heartburn may very well be incomplete digestion, which can happen in people who eat food too quickly, don’t adequately chew their food, or simply eat too much. To explain, each step in the digestive process contributes digestive enzymes, acids, or other substances (e.g. bile), and prepares food for the next step in digestion. Digestive enzymes in saliva serve as the first step in breaking down food; it’s here that amylase starts breaking down carbohydrates. Adequate chewing reduces the size of food particles and allows them to be better coated with amylase. In the stomach and small intestine, still other digestive enzymes break down food, but the entire process starts in the mouth.
Additionally, try to identify whether food sensitivities might be causing GERD. Processed foods are more likely than wholesome foods to cause GERD and heartburn, and processed sauces (think barbecue sauce) are especially suspect. One possible reason is that processed foods are highly refined and typically contain added sugars, processed fats, and artificial colors and flavorings—all substances that our digestive tracts were not meant to process.
You can self-test for many food sensitivities. Start by keeping a food diary of what you eat and drink for meals and snacks each day, and note the time you develop symptoms of GERD or heartburn. There is a good chance that you will quickly see associations between certain foods (or types of meals) and symptoms.
One ongoing controversy is whether infection with H. pylori can cause GERD and/or heartburn—or if the GERD/heartburn is a consequence of H. pylori treatment. H. pylori is a bacterium found in the stomachs of half the world’s population. In some people, but not everyone, H. pylori can cause indigestion, gastritis (stomach inflammation), and peptic and duodenal ulcers. Some doctors believe that H. pylori can increase stomach acidity and cause GERD. The conventional medical treatment for H. pylori-caused ulcers is either a two-antibiotic regimen for up to two weeks or the use of proton-pump inhibitors, such as Prilosec or Nexium. But those treatments can damage the gut in other ways.
GERD and heartburn are clear signs of an unhealthy digestive tract, and it is important to restore its health and improve digestion. A number of supplements can help, although the healing process may take weeks or months, depending on previous eating habits and use of acid-blocking drugs. It is also important to restrict the use of alcohol and non-steroidal anti-inflammatory drugs (NSAIDS), such as aspirin and ibuprofen.
DGL Licorice Root. Licorice root (Glycyrrhiza glabra) is a time-honored herbal remedy for heartburn. The deglycyrrhizinated (DGL) form has a constituent removed because it can elevate blood pressure in some people. The herb’s digestive tract benefits have been attributed to anti-inflammatory properties. Dose: 300-500 mg of the standardized extract daily.
Slippery Elm. This herbal extract of Ulmus rubra uses the tree’s inner bark. It contains mucilage, which coats the esophagus and reduces GERD-related pain. Years ago slippery elm was a popular drugstore remedy for heartburn. Dose: 400 mg in capsule form or 40 drops of the tincture in water daily.
Bitters. Bitters are a traditional herbal remedy, usually taken in liquid form, to promote better digestion. Almost all bitters contain the herb gentian as a key ingredient, but they often contain a variety of other herbs, such as angelica root, aloe vera leaf, rhubarb root, valerian root, cinnamon bark, cardamom seed, and saffron. Dose: Because products vary, follow label directions.
L-glutamine. L-glutamine is the most abundant amino acid in the human body. It was first reported to help heal stomach ulcers almost 60 years ago,[x] and it’s now widely used by alternative health care practitioners. Glutamine is useful because it contains an extra nitrogen atom that helps the body create other amino acids for healing. Its benefits may be enhanced when combined with bovine colostrum.[xi] Dose: Up to 400 mg four times daily of L-glutamine and 500 mg daily of colostrum.
Marshmallow. This herb—not the candy—has been used for more than 2,000 years to treat indigestion and ulcers. The German Commission E herbal monograph recommends the use of marshmallow root (Althea officinalis) to treat pharyngeal and esophageal irritation. It is generally safe, but it might lower blood sugar levels and increase absorption of the drug lithium.[xii] Dose: The tincture may be preferred over capsules. Follow label directions.
Ginger. This herb (Zingiber officinale) is one of the most widely used digestive aids. It can be taken as a supplement or used as a spice or condiment. It has potent anti-inflammatory benefits. Dose: Dosages will vary among supplement brands. As a general guideline take approximately 300 mg of ginger extract.
Probiotics. These good bacteria are essential for restoring and maintaining a healthy gut. Granted, the majority of our gut bacteria live in our intestine (relatively few are found in the acidic environment of the stomach), but their diverse roles in gut health and immunity cannot be underestimated. Probiotics may be especially helpful in reversing an overgrowth of pathogenic bacteria in the gut.[xiii] Dose: Opt for formulas containing several species of bacteria, particularly Lactobacillus and Bifidobacteria.
Digestive Enzymes. Our bodies’ ability to secrete adequate amounts of digestive enzymes might be compromised by the use of acid-blocking drugs, NSAIDS, and many other medications. Because we don’t know exactly which enzymes we need, it might be best to take a formula containing six or more digestive enzymes that help break down sugars and other carbohydrates, proteins, and fats. Dose: Products vary greatly, so follow label directions.
Mastic Gum. This extract of Pistacia lentiscus has a 2,000-year history of being used to treat stomach ulcers. Some research indicates that it might reduce (though not eliminate) H. pylori in the stomach.[xiv] DGL licorice and oregano might help as well. Dose: Follow label directions.
Although common, GERD and heartburn don’t have to be a way of life. Being more mindful of your eating habits, avoiding the use of acid-blocking drugs, and taking steps to heal the gut can help you avoid both of these conditions.
HCl is the chemical abbreviation for hydrochloric acid, which is normally produced in the stomach, and pepsin is a digestive enzyme. As counterintuitive as it might sound, many people with heartburn or GERD benefit from taking HCl and pepsin.
I recently consulted for a person who had suddenly developed GERD symptoms. It turned out that he had been taking an HCl and pepsin supplement, but had finished the bottle. His doctor suggested that he take omeprazole (Prilosec), which he was reluctant to do. As soon as he started taking his HCl and pepsin supplements again, his GERD symptoms went away. The benefits of HCl and pepsin suggest that GERD might often have less to do with excess stomach acid and far more to do with incomplete digestion. For dosage, follow label directions or the advice of a health care practitioner.
Untreated, chronic heartburn and GERD severely irritate the esophagus and may develop into “Barrett’s esophagus,” a precancerous condition. However, several nutrients appear to impact the risk of developing this condition.
In a study of 103 subjects, Welsh researchers reported that people with Barrett’s esophagus had significantly lower blood levels of antioxidants, including selenium, vitamin C, and carotenoids.[xv] Other research suggests that selenium might offer some protection.[xvi] [xvii] [xviii] Meanwhile, an Irish study found that taking 1,000 mg of vitamin C daily reduced several markers of inflammation in people with Barrett’s esophagus.[xix]
[ii] Jacobson BC, Somers SC, Fuchs CS, et al. Body-mass index and symptoms of gastroesophageal reflux in women. New England Journal of Medicine, 2006;354:2340-2348.
[iii] Fass R, Quan SF, O’Connor GT, et al. Predictors of heartburn during sleep in a large prospective cohort study. Chest, 2005;127:1658-1666.
[iv] Yang YX, Lewis JD, Epstein S, et al. Long-term proton pump inhbitor therapy and risk of hip fracture. JAMA, 2006;292:2947-2953.
[v] Laheij RJ, Sturkenboom MC, Hassing RJ, et al. Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. JAMA, 2004;292:1955-1960.
[vi] Dial S, Alrasadi K, Manoukian C, Huang A, Menzies D. Risk of Clostridium
difficile diarrhea among hospital inpatients prescribed proton pump inhibitors:
cohort and case-control studies. Canadian Medical Association Journal, 2004;171:33-38.
[vii] Del Piano M, Anderloni A, Balzarini M, et al. The innovative potential of Lactobacillus rhamnosus LR06, Lactobacillus pentosus LPS01, Lactobacillus plantarum LP01, and Lactobacillus delbrueckii Subsp. delbrueckii LDD01 to restore the “gastric barrier effect” in patients chronically treated with PPI: a pilot study. J Clin Gastroenterol, 2012;46 Suppl:S18-26
[viii] Henry EB, Carswell A, Wirz A, et al. Proton pump inhibitors reduce the bioavailability of dietary vitamin C. Alimentary Pharmacology & Therapeutics, 2005;22:539-545.
[ix] Lam JR, Schneider JL, Zhao W, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA, 2013;310:2435-2442.
[x] Shive W, Snider RN, Dubilier B, et al. Glutamine in treatment of peptic ulcer; preliminary report. Texas State Journal of Medicine, 1957Nov;53(11):840-842.
[xi] Ann JY, Kim SJ, Han SP, et al. Effect of glutamine on the non-steroidal anti-inflammatory drug-induced bacterial translocation. Korean J Gastroenterol, 2004;44:252-258.
[xiii] Del Piano M, Anderloni A, Balzarini M, et al. The innovative potential of Lactobacillus rhamnosus LR06, Lactobacillus pentosus LPS01, Lactobacillus plantarum LP01, and Lactobacillus delbrueckii Subsp. delbrueckii LDD01 to restore the “gastric barrier effect” in patients chronically treated with PPI: a pilot study. J Clin Gastroenterol, 2012;46 Suppl:S18-26
[xiv] Paraschos S, Magiatis P, Mitakou S, et al. In vitro and in vivo activities of Chios mastic gum extracts and constituents against Helicobacter pylori. Antimicrob Agents Chemother, 2007;51:551-559.
[xv] Clements DM, Oleesky DA, Smith SC, et al. A study to determine plasma antioxidant concentrations in patients with Barrett’s oesophagus. J Clin Pathol, 2005;58:490-492.
[xvi] Bjelakovic G, Nikolova D, Simonetti RG, et al. Antioxidant supplements for preventing gastrointestinal cancers. The Cochrane Database of Systematic Reviews. 2004, Issue 4.
[xvii] Moe GL, Kristal AR, Levine DS, et al. Waist-to-hip ratio, weight gain, and dietary and serum selenium are associated with DNA content flow cytometry in Barrett’s esophagus. Nutr Cancer, 2000;36:7–13.
[xviii] Rudolph RE, Vaughan TL, Kristal AR, et al. Serum selenium levels in relation to markers of neoplastic progression among persons with Barrett’s esophagus. J Natl Cancer Inst, 2003;95:750–757.
[xix] Babar M, Abdel-Latif MM, Ravi N, et al. Pilot translational study of dietary vitamin C supplementation in Barrett’s esophagus. Dis Esophagus, 2010;23:271-276.
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