Heartburn is a very common symptom. The NIH estimates that 60 million Americans experience a burning sensation in the chest or an acid taste in their mouths at least once a month. Heartburn can be an occasional symptom associated with heavy meals or alcohol consumption, or it could be associated with GERD.
Gastroesophageal Reflux Disease, or GERD, is diagnosed as heartburn that occurs at least twice a week of sufficient severity to affect quality of life. It occurs when stomach fluids and acids rise into the esophagus and even the throat and sinuses causing irritation and inflammation. GERD is frequently associated with abnormalities of the lower esophageal sphincter (LES) which results in relaxation of the sphincter thus allowing fluids to escape the stomach.
Risk factors for GERD
- Obesity or being overweight
- Low stomach acid
- Cigarette smoking
- Hiatal hernia
- Eating large meals too close to bedtime
The Standard American Diet (SAD) is strongly associated with GERD—diets high in fatty foods and animal products and low in plant-based foods, and increased alcohol consumption. As traditional cultures move to more western diets, incidences of heartburn and GERD increase accordingly. Specific foods such as coffee, chocolate, citrus fruits, carbonated beverages and alcohol among others are common heartburn triggers.
Standard medical treatments for heartburn and GERD
- Over the counter (OTC) antacids for occasional heartburn
- OTC or prescription H2 Blockers
- Proton Pump Inhibitors (PPIs)
- Motility regulators such as Reglan
GERD medications are big business for pharmaceutical companies. In 2012, 157 million prescriptions were written in the US for PPIs; $9.5 billion was spent for OTC and prescription GERD meds, with $6 billion spent on Nexium, a PPI. These medications were originally recommended for short-term use in GERD sufferers (no more than 14 days), but it has become increasingly common for people to be on these meds for months and even years.
Problems associated with long term use of PPI's
PPIs act on stomach parietal cells to block the production of hydrochloric acid (HCl) which unbinds vitamin B12 from protein, and it blocks the production of intrinsic factor which is necessary for B12 absorption. It has been shown that without HCl, vitamin B12 absorption is reduced by 98%. B12 is critically important for our nervous symptoms, and deficiencies are linked with dementia, cognitive and mood changes, paresthesia, muscle weakness and fatigue, among others.
Long-term PPI use has been shown to cause deficiencies in a number of vitamins and minerals including vitamin B12, magnesium, and calcium. By reducing stomach acid, PPIs over time weaken the LES which actually worsen one of the basic causes of GERD.
People on long term PPIs have increased risks of hip, wrist and spine fractures, have a 50% greater risk of getting pneumonia, an increased risk of heart attacks in those who have had a first heart attack, and have been linked with a 25% increased chance of early death from all causes. Animal studies have linked use of PPIs with the development of brain amyloid plaques which are linked with Alzheimer’s disease, and studies of elderly people on PPIs vs those who are not show a greatly increased risk of being diagnosed with dementia for long-term PPI users. PPIs have also been linked with kidney damage, contributing to both acute and chronic kidney disease, which affect over 13% of the US population.
As you can see, PPIs, especially with long term use, increase our risks for a host of medical and health issues. Fortunately, we know that relatively simple diet changes, smoking cessation, maintaining a healthy weight, and eating a whole foods, plant-based diet along with appropriate support from supplementation work well to prevent and reverse GERD effectively without the use of harmful medications.
How can Naturopathic Approaches Help?
In my integrative naturopathic medical practice, I see people with GERD on almost a daily basis. Treatment principles include addressing causal factors, providing individual and holistic patient care, correcting lifestyle factors including attention to diet, use of specific enzyme- based formulas to improve stomach and digestion as well as soothing and supporting irritated tissues, herbal and nutritional supplements, and appropriate weaning from prescription medications. Elimination of PPIs can be associated with rebound heartburn that makes withdrawal challenging, and strategies must be used to improve effectiveness in discontinuing these medications.
In addition to enzyme-based formulas, I use substances that support mucus membrane health and reduce inflammation caused by GERD.
While most naturopathic therapies for heartburn and GERD involve soothing tissues or addressing imbalances in gastric acidity, there are only a few therapies that have been shown to address the basic cause of GERD—inadequate closing of the lower esophageal sphincter. Acupuncture is one of these effective therapies. A 2005 study, for example, showed that specific acupuncture can reduce LES relaxations by 40%. I always use acupuncture in addressing GERD and withdrawal from PPI therapy.
In conclusion, there are many useful strategies for addressing heartburn and GERD that allow people to discontinue their medications, which over the long term can cause harm, while improving their health and accelerating the healing process.
Dr. Carl Hangee-Bauer is SFNM’s founder and Clinic Director. He has a general naturopathic medical practice and specializes in immune support for allergies, autoimmunity and cancer support, functional gastroenterology and pain management. He has over 30 years of clinical experience using individualized care and treatment plans to provide effective naturopathic based care.