We forget how amazing human physiology is.
Our bodies give us signs and symptoms that something isn’t working how it should be. Often, we don’t listen and ignore these signs. When things get too loud to ignore, we may visit our doctor or drop into the pharmacy to get some pills to quash these unwanted symptoms.
As a nutritionist, I see many clients that suffer from indigestion and heartburn.
In fact, between 15 to 20% of adults experience heartburn at least once a week. Around one adult in three will have heartburn every few days and one adult in ten will have it every day. That’s pretty high numbers! For some, it may be an inconvenience, for others it can affect their quality of life.
I have a confession, before I started on my quest to sort out my health, I used to reach for the tums pretty regularly because of indigestion. It was pretty convenient to take an antacid. I wasn’t tuned into the message that my body was trying to tell me. Eventually things got worse and I realized I needed to make some changes.
If you are suffering from indigestion or acid reflux, the questions you should be asking are “What is the root cause and how do I correct it”.
The focus of this article is acid reflux. Heartburn is a symptom of acid reflux. If you suffer from this regularly you may be told that you have gastroesophageal reflux disease (GERD), which is chronic acid reflux.
When you have reflux, it means that your stomach acid travels up your food pipe (oesophagus) from your stomach. The oesophagus isn’t geared to deal with acidity like the stomach is, and that’s why many people experience a burning sensation when the acid travels up into the oesophagus.
When heartburn occurs, it is a sign that the ‘valve’ called the lower oesophageal sphincter (LES) at the top of the stomach isn’t functioning properly. The role of this muscular ‘valve’ is to stop food travelling back up into the oesophagus.
How does the valve become weak?
When we overeat or are overweight, the stomach swells and puts pressure on the LES. Overtime the LES loses its shape and strength, allowing acid to flow up, damaging the LES further.
Smoking exposes the oesophagus to lots of nasty toxins and chemicals, which can damage the membranes in the LES, causing it to weaken.
Alcohol is another trigger for reflux since it reduces the LES’s ability to close. Alcohol also relaxes the muscles of the LES, allowing the acid to flow upwards into the oesophagus, further damaging the LES.
Medications such as blood pressure medication, sleeping pills, sedatives, antibiotics, antidepressants and proton pump inhibitors (PPIs) can all cause damage to the LES.
Ironically, PPIs are commonly used to treat acid reflux. It’s interesting that the very medication that is given to help with this condition by decreasing acidity in the stomach (where it is needed) can weaken the LES and actually worsen acid reflux. More on this later!
Foods are also known triggers for GERD. High fat foods tend to relax the LES, allowing acid to enter your oesophagus and cause the burning sensation. Other foods that are problematic for some are spicy foods, citrus, tomato-based foods, processed foods and caffeine.
Other factors that can play a role are eating before bed. Eating when you are already full. Having intolerances or sensitivities to some foods.
One of the overlooked causes of reflux is chronic stress. And boy, have some of us been stressed since the advent of Covid-19. Financial worry, loneliness, fear of the unknown, fear of dying, fear of getting sick, fear of losing family. It has been a tough time for the world.
Stress affects the nerves in our stomach, which results in poor digestion and food gets pushed back up into the oesophagus instead of into the small intestine. Magnesium levels drop when we get stress and magnesium is needed to relax the ‘valve’ going from the stomach into the small intestine. A magnesium deficiency will cause food to travel back up the oesophagus.
Is reflux caused by too much acid or too little acid?
According to Dr Wright of the Tahoma Clinic in Washington State, “When stomach acid is measured in people suffering from heartburn and GERD it is almost always low, not high”. He found very few people with excessive stomach acid and says that it is only found in a few rare conditions.
The problem with GERD is that there is not too much acid, but it’s in the oesophagus rather that in the stomach. Antacids and PPIs block the secretion of acid, thus eliminating symptoms, but they do not address the root cause of regurgitation into the oesophagus. In other words, PPIs only treat the symptoms but not the cause.
They are helpful in the short term but can be problematic long term. PPIs should generally on be used for two to twelve weeks.
What are the long terms risks of taking PPIs?
In the stomach, gastric enzymes breakdown proteins, which release vitamin B12. PPIs reduces the amount of acid in the stomach, which decreases protein digestion and B12 release. PPIs increase a hormone called gastrin, which can cause osteoporosis.
PPIs are also associated with other vitamin and mineral deficiencies such as vitamin C, calcium, iron, folic acid, magnesium and zinc. Low acid levels may also promote bacterial overgrowth in the stomach and small intestine.
Since PPIs lower acid levels, the body will also respond to the suppression by trying to make more acid. This can lead to worsening of symptoms. This is known as rebound acid hypersecretion.
If you don’t get to the root cause of what’s causing your heartburn in the first place, once you stop taking the antacids, your symptoms will return. Symptoms are usually worse than before you started.
Heartburn is definitely a sign that something isn’t working as it should. Look at what the possible triggers are. Don’t overlook stress, we often do. If you need help, find a nutritionist that can support you in finding out the root cause so that you can improve your quality of life and overall health.