Most of us have experienced heartburn at one time or another—that burning sensation that rises up through your chest. The pain from the “burn” can be so mild it’s hardly noticeable or be so sharp and intense that you might think you’re having a heart attack. Heartburn often happens at night, when it can awaken you out of the deepest sleep.
Conventional medicine treats heartburn as a problem of too much stomach acid. You probably won’t be surprised to hear that functional medicine disagrees completely, and treats heartburn as a condition of too little stomach acid.
The burning pain of heartburn is a symptom of acid reflux and occurs when stomach acid leaks back up through the lower esophageal sphincter (LES), the muscle that separates the lower end of the esophagus from the upper end of the stomach. Acid reflux is also known as gastroesophageal reflux (GER), or when it’s a chronic problem that happens more than twice a week, gastroesophageal reflux disease (GERD). According to the American College of Gastroenterology, over 60 million Americans experience heartburn at least once a month and at least 15 million as often as daily. (1)
Conventional medicine seeks to alleviate heartburn symptoms by reducing stomach acid, largely via the use of medication. In fact, proton pump inhibitors (PPIs), which inhibit gastric acid production, are some of the most commonly prescribed drugs in the world with sales in the billions.
While meds can provide temporary relief of symptoms, they are not a cure. In fact, 30 to 40 percent of heartburn sufferers are not helped by meds at all and up to 60 percent still have some symptoms even while taking them. (2) Unfortunately, reducing stomach acid is also known to cause additional health problems. When we don’t have enough stomach acid—whether from natural processes such as aging or as the result of acid-reducing medications—we are prone to: (3)
According to the functional theory of heartburn, low stomach acid leads to bacterial overgrowth and improperly digested carbohydrates, which creates increased intraabdominal pressure (IAP) from gas and bloating. Increased IAP forces the lower esophageal sphincter to open when it should be closed, allowing stomach acid to spill into the esophagus. The functional medicine approach seeks not only to relieve heartburn symptoms but to address these underlying causes of this painful condition. (4)
What can you do to conquer heartburn? The following are 15 ways to address heartburn with diet and natural remedies.
This is probably the easiest change you can make in regards to controlling heartburn. Since water dilutes stomach, acid which further inhibits your digestion, drink your H2O and other liquids at least 30 minutes before or after your meal.
Low carbohydrate diets have been shown to resolve heartburn. (5,6) Moderately low carbohydrate diets are also effective. In one recent 16-week long study, investigators sought to discover whether heartburn was associated with carbohydrate intake. They found that by week 10, a moderately low carb diet resolved heartburn symptoms in all subjects who remained symptom-free without the use of acid-reducing medications during the remaining six weeks of the study. (7)
The indigestible carbohydrates in fiber and FODMAPs contribute to gas production during digestion. An example of a FODMAP is fructose, which is found in high concentrations in some vegetables and fruits. Too much of one or more FODMAPs in the diet can lead to increased intraabdominal pressure and result in acid reflux. (8) Since intolerance to FODMAPs is very individual, it’s worth figuring out those which affect you.
Both intolerances to certain foods and true food allergies can cause GERD. (11,12,13) Folks who go Paleo often find that their GERD resolves because they’ve eliminated commonly problematic food groups such as dairy and grains. If your symptoms persist after following a regular Paleo diet, you can try the AIP, short for autoimmune Paleo, which eliminates additional foods that may be causing heartburn such as eggs, nuts, seeds, and nightshades.
Consider working with a practitioner to determine if a regimen of digestive support is appropriate for you. Taken before meals, digestive enzymes such as ox bile, bromelain, pancreatin, and papain support the breakdown of fats, carbohydrates, and proteins in the stomach.
HCL, short for hydrochloric acid, supplements can help by increasing levels of hydrochloric acid in the stomach. HCL supplements should not be taken if you are on certain drugs including corticosteroids such as prednisone, as well as aspirin and NSAIDs such as ibuprofen, due to the risk of damage to the stomach lining. If you’re not sure which digestive supplements are right for you, seek out a knowledgeable healthcare practitioner.
Bitters are herbs that literally taste bitter. They have been used across cultures throughout time to activate the digestive system. (14) Interestingly, just the very taste of something bitter is enough to stimulate digestive juices.
Bitters can include any whole foods such as very dark chocolate, bitter greens such as arugula, and even coffee, or specially prepared tinctures of bitter herbs. Just a few drops of bitters on your tongue will do! Common bitters that you might find in tinctures include:
Acids can be a very effective aid to digestion so that less gas is produced after eating. Raw apple cider vinegar comes with the added bonus of beneficial probiotics. Taking one or two tablespoons of either vinegar or lemon juice 10 to 20 minutes before a meal may help symptoms. Diluting these acids with some water will make them easier to tolerate.
Raw sauerkraut and other fermented veggies, as well as kombucha tea, are the best food sources of probiotics, the good gut bacteria that live in our bodies. Kombucha also provides plenty of beneficial yeast.
Since those with heartburn usually have gut dysbiosis, repopulating the gut with healthy organisms is important. Good gut microbes need replenishing on a regular basis to crowd out pathogenic organisms that contribute to poor digestion and absorption, gas, bloating, a leaky gut, and heartburn.
Research shows that treating pathogenic yeast infections in the GI tract helps to resolve inflammatory processes such as gastric ulcers that are associated with heartburn. (15). Although treatment with antifungal medicine may be required, following a Paleo lifestyle can go a long way to controlling candida overgrowth.
Anti-inflammatory collagen and gelatin are found in collagenous meats, bones, bone broth, and supplements. Decrease intestinal inflammation and support mucosal and epithelial cell health with plenty of collagen and gelatin each day.
The anti-inflammatory effects of omega-3 fatty acids are indisputable and they may very well impact the prevention or treatment of GI conditions related to intestinal inflammation. (18) The standard western diet provides too many omega-6 fats compared to omega-3s with a ratio of 10:1 to 25:1. This is a huge departure from our Paleolithic past where our ancestors ate a dietary ratio of 1:1 or even 1:4.
Just by avoiding processed food, industrial oils (like canola and vegetable) and an excess amount of nuts, you can decrease your omega-6 intake. By eating more grass-fed beef, pastured eggs, and fatty fish such as salmon, tuna, mackerel, and sardines, you can bring your dietary ratio of omega-3 fatty acids into a desirable range.
Giving thanks and expressing gratitude on a regular basis has been shown to have an array of health benefits, including improved digestive function. (19) Taking steps to overcome stress, prioritizing exercise, and getting enough quality sleep are all things that can favorably impact GI function. (20)
Acupuncture has been used to treat GI symptoms in China for thousands of years. Acupuncture may work because it has been shown to stimulate GI motility and decrease pain in patients with heartburn. (21,22) Look for a certified acupuncturist if you are going to give this ancient treatment a try.
In addition to improving your diet and lifestyle and healing your gut, the following general tips may help:
If you have persistent heartburn that hasn’t responded to diet or any other natural remedies, get tested for H. pylori bacteria. This nasty bacteria lives in the thick mucus lining of the stomach and actually reduces stomach acidity in order to thrive. Treatment for H. pylori can resolve heartburn symptoms.
Finally, if you’ve been suffering from heartburn, make sure your vitamin and minerals status is optimal. Stomach acid is required for the absorption of certain nutrients and low stomach acid can result in deficiencies of folate, B12, calcium, magnesium, potassium, zinc, and iron. (23) Consider working with a practitioner to find the best method of replacing these essential nutrients if you have a deficiency.
When I began my Paleo journey, I was taking a prescription PPI for excruciating heartburn. I was on a maximum dose and still having symptoms daily. Just a few weeks after going Paleo, my heartburn was gone and I felt so good, I stopped taking my medication. The low-carb, anti-inflammatory foods of Paleo allowed my digestion to normalize and my GI tract to heal. The Paleo diet remains a huge gift to my health.
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