Update on heartburn: You’ll be surprised at the new findings … I was!

You are what you eat, but sometimes no matter how well you eat, you may experience heartburn.

What is the difference between heartburn and GERD?

Like so many other diseases, health experts link GERD (gastroesophageal reflux) in part to diet, but most certainly the increasing rate of obesity is the primary cause: extra body fat puts pressure on the lower esophageal sphincter (LES) and may also relax the LES.  Age can also be a contributing factor toward higher risk.

As reported by MayoClinic.org, “Acid reflux and gastroesophageal reflux disease are closely related, but the terms don’t necessarily mean the same thing.”

“Acid reflux is the backward flow of stomach acid into the esophagus — the tube that connects the throat and stomach. During an episode of acid reflux, you may taste regurgitated food or sour liquid at the back of your mouth or feel a burning sensation in your chest (heartburn).”

You may have difficulty swallowing, coughing, wheezing, and chest pain — especially while lying down at night.

Sometimes acid reflux progresses to GERD, a more severe form of reflux.

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Dr. Joel Richter, a gastroenterologist and chairman of medicine at Temple University in Philadelphia defines GERD:

• Heartburn becomes chronic, occurring two or three times a week or more
• It interferes with your lifestyle so that you’re avoiding eating various foods
• You’re not exercising because you get heartburn when you do
• It interferes with sleep
• It interferes with swallowing

Untreated, GERD can lead to Barrett’s esophagus: when cells that line the esophagus become abnormal, which boosts the risk of esophageal cancer.

Your doctor can diagnose based on your symptoms or may perform tests to confirm GERD. They may want to rule out H. pylori, a bacteria that can lead to stomach ulcers, which can also cause symptoms.

GERD can also be related to our environment. Air pollution can cause hoarseness and cough, throat clearing, post-nasal drip, sinusitis, sore or burning throat, along with reflux.

A Billon Dollar Treatment

The American Gastroenterological Association reports that studies suggest that about 33% of Americans have GERD, with heartburn the most common symptom. Research also shows that while 18 – 27% of North Americans have GERD, in Latin America it is also as high as 23%.

As reported by ConsumerHealthChoices.org, “If you suffer from occasional heartburn and have not been diagnosed with GERD, nonprescription antacids such as Maalox, Mylanta, Rolaids, and Tums, or acid-reducing drugs known as H2 blockers, such as cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), and ranitidine (Zantac) will very likely provide relief. All of those products are available without a prescription as low-cost generics.”

More than 113 million prescriptions are filled each year worldwide for proton pump inhibitors (PPIs ­— the strongest of acid-reducing medications).  At $14 billion, PPIs are the third largest-selling drug category in the world.

There are several types of PPIs including Prilosec (available in prescription-strength and over-the-counter), Prevacid, and Nexium.  Read more here.

Evidence emphasizes that that PPIs are supposed to be taken for two to eight weeks to relieve symptoms of GERD — and appear safe when taken as recommended.

However, they’re not meant to be used long-term, and can have some nasty side effects.

Chronic use can backfire if you stop — a rebound-effect can mean pain even worse than before starting. PPIs function to decrease stomach acid, but stomach acid is essential for digesting certain foods.

Without proper digestion, important nutrients can become deficient. An article in Therapeutic Advances in Drug Safety notes that overuse of PPIs can lead to deficiencies of vitamin B12, vitamin C, calcium, iron, and magnesium metabolism.

Chronic use can also increase the risk for infection —as reported on NPR’s Morning Edition; stomach acid serves “as a barrier against different pathogens.”  With less stomach acid, there’s less protection against food poisoning like salmonella, a sometimes life-threatening digestive system infection bug Clostridium difficile, and even pneumonia.

PPIs may even increase the risk for dementia.  The NPR report cites a recent editorial in the online journal JAMA Neurology about a study that shows a significant association between chronic use of PPIs and dementia in people 75 and older.  The researchers emphasize that an association is not causation, and say that further research is needed, but also caution that their findings are strong enough to recommend avoiding PPIs to lower risk if possible. Speak with your prescribing physician.

New research adds another note of caution.  Data on more than 125,000 new users of PPIs found that half of patients who develop chronic kidney damage while taking PPIs don’t experience acute kidney problems beforehand. They recommend that doctors … “evaluate whether PPI use is medically necessary in the first place because the drugs carry significant risks, including a deterioration of kidney function.”

When to see the doctor for GERD?

• When heartburn symptoms are more than once weekly for six months or more.
• To diagnose, your MD may order an EKG to rule out heart-related conditions. Why an EKG? Along with symptoms of heartburn, if you experience sweating, palpitations or shortness of breath, org warns that severe heartburn and heart attack or gallbladder attack can be hard to tell apart.  If you’re not sure contact your physician right away and go straight to the emergency room.
• Rule out hiatal hernia. This common condition doesn’t always cause acid reflux, but it may.

Read more here.

Change Your Lifestyle, Stave Off Heartburn — New Information on Trigger Foods

Health experts including registered dietitians formerly recommended that patients with GERD avoid “known trigger foods” but research has discounted this as unsubstantiated.

Based on a 2013 systematic review of lifestyle modifications for GERD, it was found that after cessation of tobacco, alcohol, and other dietary recommendations, the evidence was not strong enough to solidly make blanket dietary exclusion recommendations. It was found that there are no studies to back up the elimination of the foods thought to “relax” the stomach sphincter muscle, allowing stomach acids to back up into your esophagus, such as peppermint, chocolate, or other acidic foods like citrus and tomatoes.

But, there’s strong research that heartburn and GERD are weight related. Losing weight if you’re overweight is the first course of action to relieve symptom.  We know that this isn’t as simple as taking a “little purple pill.”

Adopt some diet strategies to prevent GERD and symptoms of heartburn

Although the blanket recommendations to avoid certain foods isn’t protocol, each person needs to investigate if they have their own personal trigger foods.

How to determine these?  Create your own forensic food diary!  Whenever you have symptoms of heartburn, note what you ate, how much you ate, and when you ate it. Then eliminate the food for 2-3 weeks, and then slowly reintroduce it to see if the heartburn returns.

What You Can Do NOW

• Get to a healthy weight for your size: Studies show that weight gain and increased belly size can cause or worsen GERD. How to do that? With a whole foods diet, not necessarily by “going on a diet.”

Find more information on what I mean by “whole foods diet” please read my CuencaHighLife.com column — click here to read. Meanwhile…

• If you smoke, stop.
• Slow it down: make a deliberate attempt to chew your food before swallowing! Most of us are “speed-eaters”, and deliberately savoring more slowly helps digestion.
• Eat smaller meals more frequently and ditch the “three squares” that put pressure on your LES.
• Avoid sleeping on a full stomach: give yourself at least 2-3 hours between eating and lying down.
• Don’t be a fashionista: wear those tummy-hugging clothes a bit loser.
• Keep your head up: Use a foam pillow wedge (click here for more info).
• Note: Pregnancy is often associated with heartburn – especially if you’ve experienced heartburn before getting pregnant.

“Cures”

Some of my clients have asked me what I think about taking aloe vera supplements or drinking the juice. Aloe vera is a succulent cactus plant, belonging to the family Liliaceae. The gel of the plant is a slick substance extracted from the interior of the aloe vera leaf, and latex refers to the yellow part that lies beneath the leaf skin. Drinking the juice can cause an allergic reaction, including skin rash, hives, difficulty breathing, or throat irritation.

The aloe gel is typically used topically to relieve skin conditions like burns and cold sores.  Taking the gel orally can lower blood sugar, and if you’re on medications for diabetes, or if you have Crohn’s disease, ulcerative colitis, or hemorrhoids do not take any product made with the whole aloe leaves. The whole leaves contain aloin, a natural laxative, and can cause cramping and diarrhea.

The only safe aloe vera juice is processed to remove all of the aloin.  Although there is little evidence to support taking it for heartburn, topically it is likely to be safe. Just because it’s “natural” doesn’t mean it’s safe to take internally. Read more here.

Apple cider vinegar has been touted as a digestive remedy.  The theory is that for some people acid reflux may result from too little digestive acid, and drinking it can add beneficial acid to the digestive tract.  However there aren’t clinical studies supporting this.

Unlike supermarket vinegar, the apple cider vinegar that’s suggested for reflux is raw, organic and unfiltered, with the ‘mother’, meaning it’s unpasteurized and contains live cultures. If you try it to relieve acid reflux, never drink it straight…it is acid. Always dilute it with water, and maybe a little honey to make it palatable.  1-2 teaspoons (5-10 mL) to 1-2 tablespoons (15-30 mL) in 8-oz. /1 cup/240 mL of filtered water.  Do not take more than this, and if you are taking medications for heartburn, GERD or diabetes, speak with your doctor before drinking apple cider vinegar.

And changing your diet might help too. Certain foods promote gas and irritable bowel syndrome (IBS) and the low FODMAP diet might help.

FODMAP stands for Fermentable Oligo-, Di-, Monosaccharides and Polyols. These are types of carbohydrates (sugars) naturally present in foods.

FODMAPs are osmotic, which means that they pull water into the digestive tract and for some people, eating foods rich in FODMAPs can lead to the digestive symptoms that may range from just being unpleasant to being severe.

High FODMAP foods include asparagus, onions, cabbage, sweet corn, apples, mango, lactose (cow’s milk and yogurt), legumes, wheat and cashews.

Low FODMAP foods include leafy greens, bell peppers, carrots, bananas, lactose-free dairy, meat, fish, chicken, tofu, and sourdough bread, oats, quinoa, and pumpkin seeds. Read more here.

The American College of Gastroenterology says that over 60 million Americans experience heartburn at least once a month, and at least 15 million have symptoms daily.

What’s your experience here in Cuenca?  Have you experienced an improvement in your symptoms since your arrival in Ecuador?  Have you lost weight and found better health? We’re interested in your comments!

Author’s note: As a registered dietitian, my goal is communicating current scientific and informational advice and is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Sources

CuencaHighLife.com. Low FODMAP Diet. https://www.cuencahighldev.wpengine.com/oh-aching-gut-ibs/

CuencaHighLife.com. New Years Diet? What happens on January 22? http://www.cuencahighldev.wpengine.com/new-years-diet-happens-january-22/

ConsumerHealthChoices.org. Using the Proton Pump Inhibitors to Treat Heartburn and Stomach Acid Reflux. http://consumerhealthchoices.org/wp-content/uploads/2012/01/BBD-PPIs-Full.pdf

JAMANetwork.com. Do Proton Pump Inhibitors Increase the Risk of Dementia? http://jamanetwork.com/journals/jamaneurology/article-abstract/2487375

MayoClinic.org. GERD. http://www.mayoclinic.org/diseases-conditions/gerd/basics/tests-diagnosis/con-20025201

MayoClinic.org. Heartburn or heart attack: When to worry. http://www.mayoclinic.org/diseases-conditions/heartburn/in-depth/heartburn-gerd/art-20046483

MayoClinic.org. Hiatal hernia. http://www.mayoclinic.org/diseases-conditions/hiatal-hernia/basics/definition/con-20030640

Medicine.net. Barrett’s Esophagus. http://www.medicinenet.com/barretts_esophagus/article.htm

Medscape.org. The Global GERD Epidemic: Definitions, Demographics, and the Clinical Implications of Changing Population Trends. http://www.medscape.org/viewarticle/560076

NPR.org. Health-Shots: Popular Heartburn Pills Can Be Hard To Stop, And May Be Risky
http://www.npr.org/sections/health-shots/2016/02/15/465279217/popular-heartburn-pills-can-be-hard-to-stop-and-may-be-risky

NYTimes.com. Health Guide: Gastroesophageal Reflux Disease: Medications.
http://www.nytimes.com/health/guides/disease/gastroesophageal-reflux-disease/medications.html

ObesityActionCoalition.org. Obesity & Heartburn: What is the Link? http://www.obesityaction.org/educational-resources/resource-articles-2/obesity-related-diseases/obesity-heartburn-what-is-the-link

ScienceDaily.com. Popular heartburn drugs linked to gradual yet ‘silent’ kidney damage. https://www.sciencedaily.com/releases/2017/02/170222082252.htm

Therapeutic Advances in Drug Safety. Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110863/

WebMD.com. Is it Heartburn or Gastroesophageal Reflux Disease (GERD)?
http://www.webmd.com/heartburn-gerd/guide/is-it-heartburn-gerd

WebMD.com. Severe Heartburn? It May Be GERD. http://www.webmd.com/heartburn-gerd/features/severe-heartburn-it-may-be-gerd#1
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