Treating the pain of heartburn

WellBeing’s resident holistic practitioner Dr Karen Bridgman details one patient’s struggle with heartburn and how she treated the condition naturally.

A middle-aged moderately overweight woman visited the clinic with a persistent cough that had been gradually worsening over the last few months. She had been to the GP and initially given antibiotics thinking it was a lung problem, but they had made her symptoms worse. She felt her lungs were good (and a chest X-ray had been clear), but she had noticed that some foods made the cough worse. She also at times had a burning feeling in the middle of her chest that was worse when she was lying down and particularly severe after a big meal at night. Her doctor had then suggested she take Nexium, a proton pump inhibitor (PPI), to reduce her stomach acid. She found this helped a bit but was not keen on taking these medications indefinitely so was looking for other suggestions.

She was concerned as she sometimes experienced a “lump” in her throat and her voice seemed to be increasingly hoarse, all common symptoms of acid reflux. She was also experiencing a range of digestive symptoms including belching after most meals, and in the evenings she felt her stomach was so bloated that she thought she looked pregnant.

The problem

While almost everyone has symptoms of reflux or heartburn occasionally (usually after eating too much), if it happens more than twice a week it is called GORD — gastro-oesophageal reflux disease — and needs to be corrected.

GORD is a long-term condition in which the stomach contents rise up into the oesophagus, usually due to an incompetent oesophageal sphincter (a ring of muscle at the bottom of the oesophagus that is designed to prevent this). This sphincter can become weakened, allowing the stomach acid to rise into the oesophagus triggering an inflammatory response, as the oesophagus does not have the thick protective mucous layer of the stomach walls.

While this condition is common, it needs to be corrected as it can lead to more serious complications.

There are various things that contribute to the development of this condition. Diet is obviously a major contributor, and some foods are more implicated in problems than others, and in this case her diet needed an overhaul. She had a stressful job, and stress is also a major factor that alters the functioning of the digestive system. She was a “good” eater and preferred rich foods (generally high-fat) and was fond of sweets including desserts and cakes. She also ate her main meal late at night with her husband.

The oesophageal sphincter is more likely to become weakened for other reasons, such as being overweight and eating a diet high in fatty foods because the stomach takes longer to digest these. There are also lifestyle habits where people consume substances that relax the sphincter such as tobacco, alcohol, coffee and chocolate. The consumption of anti-inflammatory medications such as the NSAIDs (aspirin, ibuprofen etc) are known to damage the stomach lining, and in this case she had arthritis so she regularly took ibuprofen to relieve the pain.

While the PPIs such as Nexium reduce the inflammation, which is important, in the long term they can also exacerbate the problem. The oesophageal sphincter functions correctly when the stomach is also healthy. Taking medications to decrease stomach acid long-term, while reducing the symptoms, can exacerbate the condition as the integrity of the oesophageal sphincter is determined to some extent by the level of stomach acidity. They can also reduce the absorption of critical nutrients such as vitamin B12 and magnesium.

Instead GORD needs to be corrected with diet and lifestyle changes to improve the health of the digestive system, repair the membrane and strengthen the oesophageal sphincter — not just reduce the symptoms.

Treatment

Dietary measures that I recommended included eating smaller more frequent meals during the day instead of three large ones, and not eating for at least three hours before going to bed; I also suggested a smaller night-time meal. I recommended avoiding alcohol, fatty foods, coffee and chocolate (and sweet foods generally), as well as avoiding wheat and dairy-based foods. All these can contribute to reflux and heartburn.

I recommended herbs to improve the integrity of the mucous membrane of the digestive tract; these also have an anti-inflammatory effect. To soothe and repair the lining of her oesophagus, I added slippery elm powder and aloe vera gel to her breakfast, and also recommended she take them at night. The night-time dose was important, as this was when she had her major symptoms. I also suggested meadowsweet tea, as it has anti-inflammatory properties and helps heal stomach lining, including damage from the NSAIDs.

I prescribed deglycyrrhisinated liquorice root as a chewable tablet when she had symptoms. Liquorice root is an important membrane repair herb, being anti-inflammatory and improving stress management through the adrenal function. It is important to get the deglycyrrhisinated form as this does not disrupt potassium levels, as does the liquorice root tea if used long-term.

I also recommended protein-digesting enzymes containing betaine hydrochloride. These are important, as a major issue with reflux is the reduced ability to digest the proteins needed for nutrient availability and repair. She found these provided almost immediate relief when taken after a meal. They also made a significant improvement in her bloating and overall digestive symptoms.

After several weeks of these changes, she was noticing significant improvement and was happy to continue. She was also becoming aware of which foods were a particular problem for her — certainly fatty foods and wheat were implicated so was continuing to avoid these. A major bonus included losing a few kilograms in weight and feeling healthier and more energetic.