It seems like there’s a lot of epidemics out there: diabetes, being overweight, and sleeping issues to name a few. But one of the most common and potentially disabling problems that affects a lot of people is heartburn and gastroesophageal reflux disease, or GERD.
Most of us have experienced this at some point in our life, but many people are bothered by this a lot. The symptoms can range from some mild discomfort in your upper stomach or lower chest after eating, to actually feeling pain in the chest going up into the throat and sometimes even into the mouth. This condition is extremely common, and caused by an excess of acid coming up into the esophagus from the stomach. But why it happens is less clear.
We do usually suspect that there is some sort of a mechanical or physiological component to the symptoms, as there is supposed to be a tight ring-shaped sphincter at the bottom of your esophagus that stops acid from coming up from the stomach. Why somebody might have a problem with this ring is less than clear, but there may be some genetic component. Furthermore, many foods have been implicated in causing this: spicy or acidic foods, particularly tomatoes, and even alcohol. Some people think it’s caused by eating too much, and some people think it’s caused by eating too many carbs. Eating late at night before going to bed is a common contributor as well.
People who suffer with heartburn or reflux frequently reach for antacids like Tums and Gaviscon over-the-counter, or come to us in the family doctor’s office for prescriptions for drugs like Zantac or Pepcid AC (a special type of antihistamine), or, the ultimate drug in this area, the PPI (pantoprazole or lansoprazole, which are known by their brand names of Pantoloc or Tecta, and Prevacid). These drugs often work because they directly act to reduce the amount of acid in the stomach and that therefore leads to less acid being pushed into the lower esophagus. Sounds good, right? However, like many things in life, the simple fix is not really a long-term fix at all.
It turns out that our stomachs are actually meant to be acidic, and on a pH scale from 1 to 14, where the most acidic things have a lower number, our stomach is supposed to have an acidity of one to two on the pH scale. Why? This is the optimal environment in which to absorb the various nutrients that need to get into the body, or at least it’s the optimal pH for helping all the different enzymes to break things down well, which is an essential step in helping us get the building blocks and vitamins and minerals that we need from our food.
So, if the stomach is not as acidic as it is supposed to be, because of daily use of drugs like PPIs to treat reflux, we’re messing with the stomach’s need to be acidic, and we may not digest and extract proper nutrients from our food. This could go on for a long time! There seems to be more and more emphasis, even in the conventional medical community, about the risks of taking these drugs long-term. Risks include vitamin B12 deficiency, osteoporosis from inadequate absorption of calcium and vitamin D, and even early dementia or memory problems.
So, if you have heartburn and need to take these medications, what should you do? Well, for starters we should try to avoid the problem in the first place, and this approach can help people recover even if the problem has been established for a while. My first suggestion is definitely to look for underlying constipation, as dealing with that might actually help your reflux and heartburn.
How might you know if you have constipation? Do you tend to get full pretty quickly after you start eating, or do you even feel nauseous after eating? Waves of stomach pain can also point to constipation, especially if you feel normal in between these waves. I have a whole other video about this, so do watch that if there’s a chance you might be constipated!
I should mention that if you do have stomach pain, you should reach out to our office as soon as possible so that we can evaluate whether or not there might be anything more serious going on.
There’s something else to talk about regarding food and heartburn and reflux, and this is something that I learned from the ancestral food community (how human civilizations around the world all had a few things in common with respect to how they eat). Maybe surprisingly, one of the things that used to help us in this area was eating pickles, or at least some sort of raw and fermented food. This food-type took various forms throughout the world. If you think of sauerkraut or kosher pickles in Europe, it’s quite different from kefir, a fermented yogurt drink in the Middle East, and still very different is kimchi, a spicy, pickled cabbage from Korea. In India, they even pickle vegetables in oil! But what happens with all of these foods is that bacteria in the food naturally goes through a fermentation process that creates acids. These acids help pre-digest the food, and that seems to be a benefit to our digestive system, particularly when eaten before fatty meals. At least, this is the way many human beings have used pickled foods for thousands of years.
It may seem strange to think that if you have too much acid in your stomach, eating an acidic or fermented food would help the situation. But humans may have gotten into the habit of eating these acidic foods to help their stomach get more acidic, in order to aid absorption of nutrients from fattier meals. And perhaps because we now live in a society that does not regularly consume pickled or fermented foods, we are putting too much strain on our stomachs to come up with all of the acid that is needed for good digestion. If our stomachs have trouble controlling the amount of acid that gets released, then it would make sense that we are overwhelming our systems when we could have gotten help from pickled and fermented foods instead.
So try to find a pickled food that you like, or at least that you can tolerate, and try eating those within 15 to 30 minutes ahead of eating any meal that has a good amount of fat in it. And if you are going to choose pickles from the grocery store, try to choose pickles that are in the refrigerated section, and, even better, do not include vinegar, as truly fermented pickles will have been naturally fermented without added vinegar. And if you can’t find any pickled foods that you like, some people even resort to up to a tablespoon of apple-cider vinegar in their mouth as a workaround!
So, to summarize, lots of people get heartburn and reflux symptoms, and some of them may be able to find some strategies in their food choices to help manage those symptoms. Many people will at certain times in their life need medications, but they should be aware that the medications taken long-term might have some unintended consequences.
We are always happy at the office to have a further conversation with anybody who is not sure how to best manage these troublesome symptoms.
