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Heartburn

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Heartburn

In 2013, the federal government spent more money on the brand drug Nexium, than any other drug prescribed to Medicare patients,  $2.5 billion for 1.5 million patients.

Many patients are diagnosed with heartburn or acid reflux. But heartburn is actually a symptom, not a diagnosis. It describes the sensation of burning or pain in the upper chest or throat and can also result in hoarseness, throat clearing, the feeling that something is stuck in the throat (globus sensation), chronic cough, nausea and stomach upset. Patients are often treated with very strong medications and told to stop eating acidic foods, even after a normal endoscopy from a GI doctor. But rarely is the symptom “cured.” Perhaps this is because we are thinking about it backwards.

The esophagus and stomach lining are designed to handle gastric acid and enzymes. It is normal for secretions from the stomach to travel up into the throat as well. We need stomach acid to digest food, especially proteins. However, under certain circumstances, the lining of the esophagus and throat becomes irritated and raw, so the normal acidic and enzymatic secretions begin to cause pain and symptoms of heartburn.

Now let’s consider what can irritate the lining of the esophagus and throat. The answer is obvious: food. What you eat, drink, or otherwise ingest can create irritation. But it isn’t as simple as avoiding acidic foods. Food can cause allergic-type reactions. Meat from animals raised with antibiotics and hormones can cause pH imbalance and kill off good  bacteria in the gut. GMO’s can alter the way your gut functions as well. High fructose corn syrup can create free radicals and make certain “bad” bacteria and yeast grow like crazy. Alcohols like beer and wine are active yeast cultures. Dairy contains proteins that over one third of the American population cannot digest. The list goes on and on.

Once you have esophageal and gut irritation, eating or drinking acidic foods and even normal acid refluxing into the throat can cause symptoms. But “acid” is not the root problem. The pain is our body’s way of telling us to change what we are eating. To really cure “heartburn” you have to heal your gut lining and stop the irritation. A simple rule to follow is to only eat food.Food then has to be redefined, primarily, as a source of nutrition, not only as an oral emotional regulator. Food can be fun, but everything you put in your mouth affects your body. It is better to have a clearer awareness that you are what you eat.

Factors that worsen heartburn symptoms:

Other than food, certain factors can worsen symptoms:

  • Over-the-counter medications such as: aspirin, buprofen, naproxen
  • Smoking
  • Pregnancy
  • Obesity
  • Primary diseases of the esophagus such as: scleroderma and sarcoidosis

Heartburn Treatments

Treating heartburn means first examining your diet and removing inflammatory foods. Since everyone is different, this is not a one size fits all answer and may take sometime time to figure out. Cleanses and supplements, such as probiotics and digestive enzymes, can help reline the gut with healthy bacteria. Supplements can create a gut environment that promotes healthy bacteria and decreases inflammation.

In severe cases or when symptoms are prolonged, temporary use of medications can be helpful. Tums (calcium carbonate) neutralizes acid. Medications like ranitidine block some acid production. Proton pump inhibitors (PPI’s), such as Prilosec or Prevacid, are very strong and completely shut down acid production. They also come with an increased risk of heart attack and pull calcium out of your bones which can lead to osteoporosis with prolonged use (years). Every effort should be made to come off these medications as soon as functionally possible.

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Linda D. Dahl, MD