Heartburn – Everything you need to know
Heartburn is an extremely common condition, which affects up to 25% of UK adults. (1)
It is usually caused by stomach acid travelling up towards the throat, causing ‘acid reflux’. Acid reflux is when some contents of the stomach, including gastric acid, is regurgitated into the oesophagus. Reflux mostly happens without us even being aware that it’s happening. If it continues to happen, it may be diagnosed as gastro-oesophageal reflux disease (GORD).
WHAT IS HEARTBURN?
Heartburn is a burning type of sensation which occurs in the chest, usually leaving a bitter taste in your throat or mouth. The symptoms can become worse after eating a large meal or when you lie down.
Heartburn symptoms can include:
A burning sensation in the throat or chest
A sour taste in your mouth
Being woken up in the night by a cough or gastric discomfort
A stuffy nose
CAUSES OF HEARTBURN
Heartburn is usually triggered when food contents from the stomach go back up into the esophagus, the tube that carries food and liquid from the mouth into the stomach.
The esophagus is connected to your stomach, at a juncture called the cardigan or lower esophageal sphincter. When the cardiac sphincter is working smoothly it should close once food leaves the esophagus to enter the stomach.
In some individuals, the cardiac sphincter does not function well and becomes weakened, resulting in contents from the stomach leaking back into the esophagus.
Stomach acid can irritate the esophagus, therefore causing symptoms of heartburn. This condition is actually reflux!
Heartburn is common during pregnancy, with the progesterone hormone causing the lower esophageal sphincter to relax, allowing the stomach contents to travel into the esophagus, causing irritation.
Other health conditions or lifestyle habits can make heartburn worse, these can include:
Being a smoker
Consuming stimulants such as caffeine, alcohol and chocolate
Eating foods that are spicy
Lying down straight away after eating
Taking certain medications such as aspirin or ibuprofen
Having an underlying infection such as with H pylori
High stress levels
GUT HEALTH AND HEARTBURN
There are a number of extended causes of reflux that are associated with gut health, these can include:
–SIBO: Heartburn could be an indication that an individual has SIBO. A study demonstrated that SIBO could be contributing to symptoms of heartburn. Intestinal dysbiosis relates to an imbalance in the gut microbiota, which is also linked with the over-the-counter medications that are used to treat heartburn such as proton pump inhibitors (PPI’s). This medication may increase your risk of SIBO. (2)
–Low stomach acid: When there is not enough stomach acid, the stomach has to work harder to break down protein and other foods. It undergoes this by a churning-and-squeezing muscular action- as it has to try harder to physically digest food when the chemical breakdown process initiated by stomach acid isn’t working as well. This often results in pushing existing stomach acid up into the esophagus, which can result in heartburn.
–H Pylori Infection: The bacterium H pylori is an organism that infects the gastric mucosa, which can result in chronic gastritis. H pylori has been associated with the development of acid reflux and the increased risk of developing GERD. (3)
–Dietary triggers: The specific triggers for heartburn will differ from person to person with fatty foods, large portions and late-night meals being the top 3 triggers that affect most people with heartburn.
Food and drinks that commonly set off heartburn include:
-Alcohol, especially red wine
-Garlic, raw onion, black pepper and other spicy foods
-Citrus fruits and products such as lemons, oranges and orange juice
-Coffee and caffeinated drinks
– Dairy products
–Magnesium Deficiency: This can prevent the valve at the bottom of the stomach from relaxing and releasing food out. Magnesium is also an ingredient found in many treatments for acid reflux, so ensuring your magnesium is topped up is a good place to start.
–Stress: If an individual is experiencing an ongoing state of stress, the body may divert energy away from the digestive system to help the body deal with the stressor. Stress can cause the valve at the top of the stomach to relax and cause changes in our stomach acid production, potentially triggering reflux.
–Overeating: Late night eating and lying down after eating can sometimes spark a heartburn attack. Try to finish eating at least 3 hours before you go to bed so your body has time to undergo the proper digestion period it requires. You may also find that exercising after a meal may be a trigger, so avoid too much movement if this is the case.
HOW LONG CAN IT LAST?
Depending on the cause of the heartburn, the uncomfortable feeling and symptoms can last for two hours or even longer.
Mild heartburn from eating a certain type of food usually lasts until the food has been digested, with heartburn symptoms usually returning several hours after eating if you lie down.
If heartburn is an ongoing problem for you, and you find yourself having it 3 times a week or more, it is best to get this checked by your doctor in case of an underlying condition.
HEARTBURN V INDIGESTION
Many people find themselves not knowing if they are suffering from heartburn or indigestion. However, you may be able to tell the difference based on the location of the symptoms.
Indigestion mainly affects the abdominal area, with heartburn symptoms primarily affecting the chest and esophageal areas.
It is possible to experience both heartburn and indigestion at the same time, see below for which symptoms are related to each:
Burning feeling in the chest
Burning in the upper abdomen
Feeling full early during a meal
Sour taste in mouth
MEDICAL TREATMENT FOR HEARTBURN
Many over-the-counter medications are given to help relieve heartburn symptoms. These usually include:
Antacids- these help to neutralize stomach acid, and provide quick relief. However, they can’t heal a damaged esophagus.
H-2-receptor antagonists- These can help reduce stomach acid and ay help heal the esophageal lining
Proton pump inhibitors- These include lansoprazole and omeprazole which help to reduce the amount of stomach acid
However, these medications may trigger an imbalance in your healthy gut bacteria, which can cause further problems down the line. It is always best to get to the root cause of the underlying problem, rather than masking it with easy to take medication which may do more damage than good if taken long-term.
NATURAL TREATMENT FOR HEARTBURN
There are a number of natural methods you can consider when it comes to heartburn relief:
Eat sparingly and slowly- when the stomach is extremely full, this can cause more reflux in the esophagus. Avoid eating till you’re uncomfortable as this can make heartburn symptoms worse.
Avoid eating when stressed- try mindful eating
Avoid/ monitor certain foods- go back to the “Dietary triggers” list earlier and keep a food diary of how you feel after consuming these foods
Stay upright after eating-fFinish eating at least 3 hours before lying down and going to bed, as this can be a big trigger for heartburn
Take it slow- Don’t exercise straight after eating, a gentle walk is fine but a more intensive workout can send acid into the esophagus.
Sleep on an incline- Your head should be 6-8 inches higher than your feet when it comes to your sleeping position. Try using a foam wedge to support your upper body,
Check your medications- some medications can irritate the esophagus, check with your doctor if you think your medication is resulting in reflux symptoms.
Get to the root cause of your heartburn… For more info read below.
Working with a nutritional therapist will always help to get to the root cause of what is causing your heartburn or reflux. In addition to identifying your reflux triggers, they will also investigate what is going on in the gut to cause these symptoms.
A nutritionist will look into your digestive health by looking into your case history, concentrating on your diet, lifestyle, past and current symptoms, in addition to functional testing to assess the bacterial balance in your microbiome if needed.
Together you will create a plan to help both ease symptoms and get to the root cause of your symptoms, so you can reach sustainable, long-term gut happiness.
Remember to always talk to a nutrition professional or GP in order to get to the cause of your symptoms, before starting any medical protocol.
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