Heartburn/GERD: Symptoms, Causes and Treatments
Heartburn is a common condition that affects between 20-30% of adult Americans who experience acid reflux symptoms every week. Heartburn occurs when the acid from your stomach regurgitates back up into the esophagus. This acid causes symptoms of burning, pain and pressure in the upper part of the abdomen, chest or throat. Another name for heartburn is ‘GERD: Gastroesophageal Reflux Disease’. More than 60 million Americans experience heartburn at least once a month. Some studies suggest that more than 15 million Americans experience heartburn symptoms each day.
What are the symptoms of heartburn?
- A burning pain in the upper part of the abdomen, throat or chest which often occurs after eating.
- A bitter or acidic taste in the mouth.
- Chronic, dry cough or a hoarse voice due to irritation in the throat from acid regurgitation.
- Chronic phlegm/clearing of the throat.
- Difficulty swallowing: pain or stricture.
What are the risk factors for developing heartburn?
- Older age (> 50 years old).
- Males are at higher risk.
- Chronic use of NSAIDS (pain medications).
- Smoking.
- High Body Mass Index (BMI)/Obesity.
- Hiatal hernia.
- Family History.
What are the common triggers of heartburn?
- Diet: fatty foods, spicy foods, coffee/black tea, chocolate, alcohol, tomato sauce, citrus, sodas/carbonated beverages and peppermint.
- Stress.
- Eating too quickly or inadequate digestion.
- Eating too late (too close to bedtime).
- Smoking.
- Obesity.
- Medications: antibiotics, pain medications like Ibuprofen and Aspirin, blood pressure medications like calcium channel blockers and beta blockers.
What are the possible complications of heartburn/GERD?
- Esophagitis: inflammation or the esophagus.
- Ulcerations and bleeding.
- Barrett’s esophagus: changes in the cells in the esophagus due to acid irritation. This is a pre-cancerous condition that requires close monitoring and can lead to esophageal cancer.
- Gastric/stomach cancer.
How is heartburn treated with conventional medicine?
- Antacids: TUMS, Alka Seltzer, Milk of Magnesia, Pepto-bismol.
- H2 blockers (Histamine antagonists): Pepcid AC, Tagamet, Zantac.
- Proton pump inhibitors (PPIs): Prilosec, Prevacid, Nexium, Protonix, Aciphex. These are over the counter but can be prescribed in higher doses by a doctor. More effective than H2 blockers at treating esophagitis.
- Motility agents: help move stomach contents through faster to prevent acid from regurgitating back into the esophagus: Reglan.
What are the side effects of heartburn medications?
- Side effects of H2 blockers: headache, abdominal pain, diarrhea, nausea, gas, sore throat, runny nose and dizziness.
- Side effects of Proton pump inhibitors (PPIs): headache, abdominal pain, diarrhea, bloating, constipation, nausea and gas.
- Side effects of Reglan: Can be serious and may include drowsiness, fatigue, diarrhea, restlessness and movement problems.
- Side effects of blocking stomach acid:
- Decreases absorption of important nutrients: Vitamin B12, Folate, Magnesium. Calcium, Iron, Vitamin C, Vitamin D.
- Less acid protection against viruses and bacteria: C. Diff, H. Pylori.
- Gastric cancer: 8 fold increase after 3 years of PPI medication use.
How long should heartburn medications be used?
- Recommended for 2-8 weeks.
- OTC: recommend no longer than 2 weeks and then consult with a doctor if symptoms persist.
- GI doctor: typically recommend an 8 week protocol.
- Often people are put on these medications and they continue to take them for years.
How do I get off of heartburn medications?
- Antacids and H2 blockers can be stopped abruptly but symptoms may return.
- PPIs need to be slowly weaned down.
- It is very common to have rebound heartburn (that is even worse than the initial symptoms) with abrupt discontinuation of these medications.
- Work on diet and use natural treatments to treat heartburn and support digestion.
Are there natural treatments that can help with heartburn?
- Diet: Avoid triggers, plenty of fiber, well-balanced whole foods plant based diet.
- DGL (Deglycyrrhizinated licorice) chewable tablets.
- GI repair powders: DGL, Aloe vera, Slippery elm, Glutamine etc.
- Liquid Calcium/Magnesium.
- Baking soda: 1 tsp in a cup of water.
- Apple cider vinegar: 1 TBSP in a cup of water before meals.
- Elevate the upper part of your body during rest or sleep.
What are the dietary recommendations for heartburn?
- Lots of fiber: whole grains, fruits, vegetables, oatmeal, flax and chia seeds.
- Alkaline foods: fruits and vegetables: bananas, melons and cauliflower.
- Foods that contain a lot of water: Celery, cucumbers, watermelon and lettuce.
How can I prevent heartburn for good?
- Permanently avoid obvious triggers.
- Eat a healthy diet: GERD diet.
- The Mediterranean diet: plant and whole foods-based: it focuses on eating lots of fruits, vegetables, whole grains, nuts and seafood.
- Eat five to six small meals per day rather than three larger ones.
Heartburn is common but is often treatable without medication in most cases. Natural treatments including dietary changes are very effective at treating and preventing heartburn.
