Oh so many people have heart burn. It is also known as GERD, which stands for gastroesopohageal reflux disease. That is simply a more clinical name for chronic acid from the stomach that backs up into the esophagus. It technically does not have any relation to the function of your heart, but for some people the pain is situated in the center of your chest and can easily be confused with chest pain associated with cardiac complications. Other symptoms of heart burn can include a dry cough, problems swallowing or feeling that there is something stuck in your throat, hoarseness, sore throat and juicy burps that contain regurgitated food in liquid form that is very sour.
At some point everyone experiences acid reflux, but most people do not truly understand its cause. Acid reflux actually occurs when the band at the bottom of your esophagus (known as the lower esophageal sphincter or LES) cannot stay closed. When the LES is open highly acidic content from the stomach can move back up into the esophagus where it does not belong. So how do we manage acid reflux without using medications that have unwanted side effects and lead to other digestive disturbances?
Grateful Guts top 10 tips for lifestyle changes to manage acid reflux:
- Work with a registered dietitian nutritionist, like yours truly, to complete a short elimination program to determine which foods may be considered triggers. Often we become de-sensitized to signs of dis-ease because these symptoms have become so common. Know that a common symptom does not mean it is normal function. The best example of this was a client who went through an elimination and re-introduction program with me in order to identify the cause of gas, bloating and abdominal pain. Interestingly though the first thing she noticed was that her persistent dry cough disappeared when she eliminated gluten. It returned when she tried to reintroduce gluten-containing foods. She had not even considered her persistent dry cough as a sign of dis-ease because she was so used to having it. Not until it was gone did she notice how it affected her quality of life.
- Eat real food! Shocking that I would say such a thing. Most real food, consumed in a form that is as close to its natural source as possible, is going to be lower in acidity and therefore will not be trigger foods. These real foods include whole muscle meat products from grass-fed, free-range, sustainably raised animals, as well as fruits and vegetables and wonderfully gelatinous bone broth. I also recommend avoiding all dairy products (milk, yogurt and cheeses), along with gluten containing foods (barley, wheat, rye, soy sauce, processed lunch meats, most convenience foods and products containing modified food starch and maltodextrins). This is where #1 is important. People like me can really help with this part.
- Get exercise that strengthens your muscles. Try yoga, Pilates and functional movement training. Cardio exercise like walking, swimming or riding your bike are helpful in maintaining good heart health, but these forms of exercise are not as effective for maintaining muscle tone (think diaphragm) as strength training.
- Eat slowly. Put down your eating utensil between bites and do not pick it up again you have swallowed the first one. It takes approximately 20 minutes for your body to recognize that you are full. If you are still eating when you start to feel full, then you have over eaten. You will continue to feel full for at least another 20-30 minutes. Remember that overeating creates excess pressure in the stomach, which can prevent the LES from closing thereby causing the acid to back up into the esophagus…ouch! If you slow down the speed at which you eat, then your brain can keep up with your body and you will be able to recognize when the physical sensation of hunger is gone. That is when you should stop eating.
- CHEW your food. Do not just chomp and swallow. Help your stomach work more efficiently by actually chewing. Chewing breaks down your food into tiny particles. The acid in your stomach continues breaking down those tiny particles into their most basic forms. If the particles are still too big when they hit your stomach, then the chemical breakdown from the acid can create gas, in your stomach, increases the pressure in your stomach and can prevent your LES from closing. Gas in your stomach escapes as a burp. Have you ever noticed that the faster you eat the more you burp?
- Eat more frequently throughout the day, but consume smaller quantities in one sitting. This is important so that you do not overeat. I feel like a broken record now. Eating smaller portions will prevent you from overeating. And once again overeating creates excessive pressure in your stomach and prevents the LES from closing…sigh.
- Avoid ALL sodas and any carbonated beverages. Carbonation is a gas. Gas inside your stomach can create pressure…you get my point. Also sodas and chemically created beverages made in a lab or factory contain a lot of sugar and A LOT of acid. Don’t put extra acid in if you do not want to feel it come back up.
- Stop drinking alcohol and stop smoking. These damage your health, including your GI tract. Enough said.
- Consume your last meal at least three (3) hours before lying down. Myth, eating too close to bedtime makes you gain weight. Fact, eating too close to bed can cause acid reflux.
- Sleep with the head of your bed at a 30 degree angle. OK not every person needs to actually measure the incline of the head of their bed, but know that sleeping at an incline can help keep the stomach acid from moving up into the esophagus.
To understand why these are my top 10 tips, let’s do a quick anatomy/physiology review. The gastrointestinal tract (GI tract) is technically a one-way street. It starts when you put solid and liquid items in your mouth. Mechanical digestion occurs through the act of chewing and your tongue in needed to move the food back to your throat so that it can be swallowed. Once swallowed it moves down a tube called the esophagus, hence the E in GERD. At the bottom of the esophagus is the stomach. The LES is the band where the esophagus and stomach join. In this same general vicinity is a sheet of muscle that runs horizontally across our upper abdomen known as the diaphragm. This muscle is important for breathing and it helps maintain closure of the LES, thereby preventing stomach acid from sloshing upward into the esophagus. Now let’s understand part of the physiology of the GI tracts. The environment inside the stomach is very acidic. It contains hydrochloric acid (HCL), which is important for chemically digesting nutrients, especially protein. HCL can also activate other digestive enzymes in the small intestines needed for absorbing nutrient. There are cells inside the stomach that create a protective lining in the stomach that prevents acid from causing damage. There are no such cells in the esophagus, which is why we often feel a burning sensation when stomach contents back up.
So, the burning question is what prevents the LES from closing all the way? Unfortunately there could be many explanations for this. For example obesity, pregnancy and overeating can cause excess pressure in the stomach that prevents the LES from closing. Occasionally older adults can develop a hiatal hernia, that occurs when the top of the stomach protrudes into your chest. When this happens the LES is above the diaphragm and therefore no longer has the musculature support that helps keep it closed. Lifestyle factors such as smoking, alcohol and caffeine consumption can cause damage throughout the GI tract, including weakening the LES and causing heartburn. There are also some medications that can weaken the LES. Anecdotally I have had clients with food intolerances experience heartburn after eating an offending food, and I attribute this experience to inflammation occurring within the GI tract that temporarily prevents LES closure.
Regardless of the cause, the pain associated GERD is exacerbated by highly acidic foods like alcohol, caffeine, soda (regular and diet…don’t even get me started…there will be an entire blog post dedicated to the syrupy, bubbly poison), tomato and citrus based products and even chocolate. Other triggers can be foods that create acid when they are digested, such as dairy products and simple sugars, especially those that are refined and added to processed foods. And of course there are those pesky food intolerances which can be both a cause the LES dysfunction and can be a trigger that can create excess acid.
Treating heartburn is often multi-factorial, and being the crunchy-not quite hippie-let’s try a natural approach-kind of girl, I prefer to start with lifestyle changes rather than medication…and here is why. More often than not, too much acid is not the actual problem; rather the problem is that the acid from the stomach is simply in the wrong spot. We want acid so that we can actually digest our food, especially protein. We also need acid to activate other digestive enzymes in the small intestines to aid in nutrient absorption, especially calcium, magnesium and vitamin B12. Problems associated with not digesting or absorbing nutrients properly cause many of the side effects listed in the fine print of these medications, which interestingly enough are also symptoms of irritable bowel syndrome (IBS) – bloating, gas, abdominal pain and diarrhea.
There are a number of natural remedies such as DGL (licorice) and slippery elm, along with other supplements that complimentary healthcare practitioners recommend for symptom management. While I truly believe these can be very helpful when used appropriately, it is important to work with a qualified practitioner to ensure the appropriate use of such remedies.
I could probably write an entire dissertation on this topic, but I think we have covered enough for now. If you have questions, then please leave them in the comments. And once again cheers from my cup of gelatinous bone broth to yours.