Heartburn and Indigestion

What Is It?

One out of every ten Americans suffers from heartburn and nearly all of us have, at one time or another, experienced the discomfort of indigestion. These problems are so widespread that over-the-counter medications for the relief of stomach and intestinal upset have become the biggest selling medications in America.

Indigestion and heartburn are really two separate issues. Indigestion usually causes stomach and intestinal pain, which is often accompanied by gas and bloating. Miriam Webster’s Dictionary defines indigestion as “the inability to digest or the difficulty in digesting something.” So, indigestion is basically a symptom of a person’s inability to digest properly.

Heartburn, on the other hand, is a whole different story. Sometimes called acid indigestion, sour stomach, or acid reflux, the symptoms of heartburn are usually a burning, painfully sensation in the chest. Heartburn is caused by a back flowing of stomach acid into the lower part of the esophagus (the tube that goes from the mouth to the stomach). The tender lining of the esophagus is not designed to withstand the acid juices of the stomach. The pain we feel is the inflammation of this very tender tissue. The sensation of pain can be so intense that people will rush to the hospital, thinking they are having a heart attack.

An elastic muscle at the bottom of the esophagus is supposed to keep contents of the stomach down and out of the esophagus. This muscle is supposed to open to allow food into the stomach and then close tight to prevent a back flow of stomach acid back into the esophagus. Sometimes this muscle is genetically weak in people with heartburn. But certain foods and poor eating habits also can aggravate and weaken it.

Risk Factors

Over-the-counter medications for heartburn and indigestion are some of the best-selling drugs on the market. These products do relieve the symptoms temporarily. However, they do nothing to address the underlying cause of the symptoms and in the long run can actually aggravate those symptoms. For example, gas and bloating are symptoms of digestive inefficiency and poor diet, which need to be addressed if a person is going to see permanent improvement. Covering up the symptoms and leaving the underlying problem can lead to further damage.

When the oil light flashes on you dash board it is a warning that you need to add oil to the engine. Pain and discomfort associated with heartburn and indigestion are equivalent to the oil light. They are warning you of an internal problem that needs your attention. Taking an antacid or other medication that suppresses the symptoms is like bashing out the oil light with a hammer. Sure, you’ve eliminated the pesky symptom but the underlying cause has not been addressed. If you were a car this would lead to burning out your engine. In a human, inefficient digestion can lead to fatigue, allergies of all kinds and a weakened immune system that can leave you vulnerable to all kinds of problems. Unresolved heartburn can lead to permanent damage of the esophagus.

In my opinion, it is never a good idea to take an antacid for heartburn. When someone has the sensation of heartburn it doesn’t always mean they have an excess of stomach acid. The fact is, the symptoms of over and under stomach acidity can be virtually identical.

Hydrochloric acid (HcL) production in the stomach begins to decline at about the age of 40. Many older people with heartburn are not producing too much HcL, but too little. When a stomach is chronically low in HcL, the mucousal lining thins, making the walls of the stomach more vulnerable to the normal amounts of acid produced during digestion. In this case, stimulating acid production is the answer, not suppressing it.

Even for people who have an excess amount of stomach acid, taking antacids may not be a good idea. Many naturopaths argue that when you suppress HcL with antacids, the stomach is encouraged to produce more in a sort of rebound effect.

So instead of reducing acid, antacids can actually increase acid production in these people.

Dietary Considerations

Acid reflux almost always requires a change in eating habits (the way a person eats) as well as a change in what they eat. Let’s talk about the kinds of foods that can aggravate heartburn. Certain foods can act as muscle relaxants for people who are predisposed to acid reflux, further weakening the muscle at the bottom of the esophagus.

• Chocolate contains 4 substances that can loosen this muscle and allow acid to wash back
  - Caffeine (so coffee and black tea are a bad idea)
  - Theobromines
  - Theophylline
  - Fat

• Fatty foods, fried foods, and dairy products trigger the release of a hormone in the stomach that act as a muscle relaxant.
  - Fatty foods also stay in the stomach longer, so there’s more of a chance for pressure to build and cause reflux.

• Peppermint, spearmint, alcohol and onions also seem to relax that muscle. Onions are especially potent and long-lasting in promoting reflux.

Once the esophagus is damaged by repeated episodes of acid reflux, other foods can aggravate the esophagus on their way down. Citrus juices and tomatoes (especially cooked) are very acidic and aggravate the already irritated esophagus. Spicy foods are usually too much for the tender tissue.

The standard American diet virtually guarantees eventual indigestion for people with weak digestive systems. Fast foods, refined foods, fatty foods, foods high in sugar and white flour all snuff out our digestive fire over the years. Many people notice that they are able to get away with eating garbage in their teens and twenties, but find that their bodies become much less forgiving once they reach their thirties and beyond. Typically, this is the time that a lot of people find their way to our clinic. When symptoms of heartburn or indigestion arise, the wise thing is to recognize that these foods just don’t work and change the nature of our diets instead of taking a pill that suppresses the messages our bodies are giving us and eating our way into deeper trouble.

Many people with digestive discomfort are eating foods that are very low in fiber and water. As a result, many people with indigestion are also often constipated. Increasing high water content alkalizing foods, fruits and vegetables, can help spark sluggish elimination. Miso soup can be helpful to clear acid toxins out of the intestines. Eating enzyme-rich food such as raw figs, raw dates, grapes, mangos, papaya, raw nuts and seeds also help to replenish dwindling enzyme reserves.

Lifestyle Modifications

The most powerful thing that helps my clients with their digestive problems is educating them on their body clock, especially the circadian rhythm of the digestive system. There are times of the day when it’s good to challenge the body with food and times when it is not. Let’s talk for a moment about eating in a way that honors the body’s natural rhythms.

In the morning the body has a lot of digestive energy, but if we use that energy to digest a big breakfast, there won’t be enough for later in the day. In truth, the body is most interested in cleansing itself during the morning hours. The foods we eat in the morning should therefore be easy to digest and promote cleansing and elimination. Fruits, fresh vegetable juices and protein shakes work well.

Digestive fire is still strong at lunch. This is the time to have the main meal of the day. For people with poor digestion, it’s best to separate proteins from starches and have either with plenty of vegetables at lunch.

By 7 or 8 o’clock at night, digestive energy is waning and our body is getting ready to do repair work during the nighttime hours. Eating a big dinner within three hours of bedtime is a big mistake, especially for people with indigestion or heartburn. Our digestive fire has gone out for the day and food will sit in the stomach, be poorly digested and build pressure that can aggravate heartburn. If you experience nighttime heartburn lie in bed on your left side instead of your right side or back. The esophagus enters the stomach from the right. When we lie on our right side or back we make it easier for acid to flow backwards into the esophagus.

Following these general suggestions should help.

• Eat smaller meals. Don’t stuff yourself. Chew thoroughly.
• Drink little or no liquids with meals (they dilute digestive juices).
• Eat only when relaxed. If you are upset or stressed, play music, close your eyes and breathe for a moment. Take a short walk.
• Don’t eat late at night.
• Eat slowly. Eating too fast, something very common among the general public, can easily aggravate heartburn.

Suggested Supplementation

There are several herbs that can be made into tea to help relieve indigestion.

• Catnip and fennel teas are good for easing children’s digestive discomfort.
• Peppermint tea will soothe the stomach (if a person doesn’t have acid reflux).
• Chamomile tea, especially if the upset is due to eating while stressed.
• A digestive enzyme product that includes these enzymes should help.
  - Amylase and glucoamylase to digest carbohydrates
  - Lipase to digest fats
  - Protease, bromolain and papain and HcL to handle proteins
  - Lactase to handle milk sugar
  - Alpha galactosidase to digest the gas-producing complex sugars in legumes, beans and cruciferous vegetables
• Carminative herbs can help to reduce gas and bloat
  - Orange peel, which also helps to soothe the stomach
  - Cardamom seed, which also increases trypsin activity
  - Cloves, fennel seed, asafoetida seed (used is aryurvedic formulas to reduce gas)

One quick way to relieve painful gas is to put a pinch of cinnamon, nutmeg, ginger and cloves in four to six ounces of water and drink it down.

• Ginger is a great tonic herb for the stomach. It is carminative so it reduces gas. And because ginger is a bitter herb, it also stimulates our own digestive juices.
• Swedish bitters will also help stimulate digestion.
• L-Glutamine – 1,500 mg daily will help acid damaged tissues heal.
• DGL tablets will sooth raw esophageal tissue.
• Chewable papaya or bromelain tablets will aid digestion.

Some of our clients find that if they take liquid acidophilus before meals, it keeps them from bloating. This could be the result of the acidophilus keeping unfriendly bacteria from having access to the food, which produces gas.

The nutritional suggestions in this material are not offered to treat, mitigate or cure disease, and should not be used as a substitute for sound medical advice. This information is designed to be used in conjunction with the services of a trained, licensed healthcare practitioner.