Heartburn

by Mark Whalen

Heartburn is the most common symptom associated with Gastroespohageal Reflux Disorder (GERD).  Heartburn associated with GERD typically occurs 30-60 minutes after a meal. Sixty million people will experience heartburn at least one time a month. Approximately 7% of the US population, roughly 15 million people, will experience heartburn daily.(1) Fifty percent of diagnoses occur in patients between 45 and 64 years old.(2)

For some, heartburn is an occasional nuisance, for others it is a chronic, life changing condition that can have serious consequences. Chronic heartburn can lead to problems eating and sleeping, which can diminish a patient’s quality of life.

Anatomy of the Digestive Tract

Before we dive into the details, let’s review some anatomy. When we eat, the food travels down the esophagus, through the Lower Esophageal Sphincter-the flap that connects the Esophagus and Stomach.canstockphoto14028646

The Parietal Cells in the stomach produce Hydrochloric Acid(HCl) to break down the food we eat. The stomach is lined with a mucous coating to protect it from the acid. When this lining breaks down, you can get ulcers- the acid burning a hole in your stomach lining. Fun stuff.

In patients with chronic heartburn, the Lower Esophageal Sphincter is weak, and doesn’t close properly. This leads the acid from the stomach spilling up in to the esophagus. The acid causes a burning sensation- hence the term ‘heartburn’ because it is typically felt in the chest area. The pain can be so intense that patients may initially confuse the pain for a heart attack.

One major complication of Heartburn is a condition known as Barrett’s Esophagus. The esophagus lacks the protective coating of the stomach, so the HCl can eat away the lining of the esophagus leading to pre-cancerous changes.

Current Treatment Options

H2 antagonists (Zantac and Pepcid) target histamine. Histamine is what stimulates the Parietal Cells to release HCl. H2 antagonists produce quick results; a patient can get symptomatic relief within 1 hour. They are better used for acute, mild cases of reflux.

The Proton Pump Inhibitors (Nexium, Prilosec, Prevacid, Ompeprazole, Protonix) are prescribed for more severe Heartburn. While they may take longer to work initially, they are best for long-term cases of Reflux as they provide more relief over time. The Proton Pump Inhibitors block the production of stomach acid from the Parietal Cells.

While the two classes of medications are treating the same condition, they work on different areas in the stomach, which helps explain their different response times and usefulness in chronic vs. acute cases.

A recent article in the Washington Post discussed a data-mining project that indicated a possible correlation between use of Proton Pump Inhibitors and a 21% greater risk of heart attack. This was not a cause-effect connection and the project did not account for the state of the participant’s health prior to going on medication.(3)

Despite the lack of a direct cause-effect mechanism, I thought it was worth mentioning. You can read the article here: Washington Post

Common Causes

Aside from any physical causes (hiatal hernia, pregnancy), there are many common causes of heartburn.  If you suffer from heartburn, take a look and see if there are any items here you could modify.

• Reclining after a meal

• Overeating

• Trigger Foods: spicy foods, acidic foods-coffee tomatoes, alcohol, greasy foods, citrus, garlic, onion, chocolate

• Obesity: causes an increase in intra abdominal pressure

• Stress: Chronic stress can lengthen the amount of time food stays in the stomach; acute stress shortens it

• Some medications—calcium channel blockers, beta blockers, nitrates

• Overuse of Antacids: Antacids initially trigger the Parietal cells to make hcl but over the long term they become less productive and produce less acid over time. Antacids also decrease body’s ability to digest protein.

• Age: Hcl decreases as we age making it harder to break down food

Is treatment misguided?

It’s seems to be a common assumption that Reflux is caused by too much stomach acid. Since drugs like H2 antagonists and Proton Pump Inhibitors relieve symptoms, its assumed they decrease stomach acid, so too much acid must be the answer.

BUT, as we age, we produce less stomach acid. And as we age are more prone to Heartburn. Could it be that too little stomach acid is responsible?

Unfortunately, the exact mechanism of what causes the Lower Esophageal Sphincter to weaken and lead to reflux has not been determined with certainty. The prevailing theory and treatment model is that if you have reflux, you are given a medication to reduce your acid production. Without a doubt this provides symptomatic relief.  But is it the right answer?

What’s missing is a test to determine an individual’s cause of reflux- a test to determine your stomach acid function.

The Heidelburg capsule test offers a solution. This test can be used to measure the pH of your stomach acid. Unfortunately, it is not a test that is widely available. It doesn’t hurt to ask your physician about it.

In this test, the patient’s pH is measure before and after a challenge drink of baking soda. Based on how long it takes for the stomach to re-acidify, a diagnosis can be made. If it takes longer than 20 minutes to re-acidify you may have a condition known as Hypochlohydria (too little stomach acid). (4)

Since the Heidelburg capsule test is not widely available, there is an easy test you could try at home. Dilute 1 Tablespoon of Apple Cider Vinegar with water and drink it. If it doesn’t provide relief, you may need to supplement your stomach acid.(5)

[*Disclaimer time: do not take these supplements without speaking with a qualified health practitioner. If you have gastritis, ulcers or a diagnosed overproduction of acid, you do not want to take this supplement] (6)

Treatment for hypochlohydria involves Hcl Supplements –typically Betaine Hydrochloride. If you take the supplements and don’t need them- you will feel a burning sensation, which you can neutralize with milk or baking soda.

If you are deficient in stomach acid, the HCl supplements will provide you with relief. Typically start with 1 tablet with meals.

This is not designed to be a long-term supplement—use for 90 days at the longest.

In Part II, we are going to talk about GERD/Heartburn from the view of Chinese Medicine. How we treat it with acupuncture and herbs-naturally with no side effects.

 

This article is for informational purposes only. This article is not intended to diagnose, treat, cure or prevent any condition. Do not stop any medications without consulting with your physician.

Sources:
1. http://www.diet.com/g/gastroesophageal-reflux-disease
2. Ibid.
3. Bernstein, Lenny "Common Heartburn Medications Linked to Greater Risk of Heart Attack" Washington Post. June 10,2015
4. Functional Medicine University. Gastrointestinal Disorders Module
5. Ibid.
6. Designs for Health –Betaine HCl product disclaimer

Mark Whalen is a Licensed Acupuncturist and Board Certified Herbalist and the founder of Five Points Acupuncture & Wellness in Reading, MA.

Mark Whalen – who has written posts on Acupuncture Reading MA - Five Points Acupuncture & Wellness.


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