Heartburn: Beyond Antacids
Updated: Oct 29, 2020
Commonality and Presentation
Heartburn is experienced by 10-20 percent of people annually in Westernized cultures. Interestingly it is only 5 percent in Asian cultures. Heartburn can present with chest pain, burning, early fullness, stomach pain, need to clear throat or cough. Those that experience heartburn self-treat with the many over the counter (OTC) medications are used on a daily basis to suppress heartburn.
Normal Physiology of Digestion
Digestion begins with the aroma of cooking foods. Then chewing and tasting food produces saliva to breakdown carbohydrates. Once a person swallows the food travels into the stomach where acid begins to break down proteins and more complex carbohydrates. After that the food bolus, or chyme, enters the small intestines and is mixed with bile and pancreatic juices to emulsify fats and absorb various nutrients. Lastly the chyme migrates through to the large intestines, or colon, to absorb mostly water and a few final nutrients before excretion as feces.
OTC Medications and Long-Term Side Effects
There are three classes of medications that are commonly referred to as antacids: H2 blockers like Zantac and Pepcid, calcium carbonate tabs like Tums and Maalox and proton-pump inhibitors (PPIs) like Prevacid, Prilosec and Nexium. H2 blockers inhibit the massanger that stimulates the production of stomach acid. Calcium carbonate tablets soak up stomach acid to neutralize it and may contain aluminum. PPIs block acid production. All three of these medication classes are meant to be taken short-term (less than two weeks) or for occasional heart burn. Long-term side effects may include nutrient deficiencies, poor digestion and worsening of symptoms or miss diagnosing a more serious condition.
Treat the Cause
There are many causes to heartburn including, but not limited to, one’s relationship to food, pace of eating, hiatal hernias, poor digestion, over use of medications, nervous system dysregulation and contrary to popular belief - hypochloridria or low stomach acid. Naturopathic doctors help to identify the root cause of heartburn and rule out more severe diagnoses if necessary.
Dent, J. (2005). Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut, 54(5), 710–717. doi: 10.1136/gut.2004.051821
Yarnell, E. (2011). Gastroesophageal Reflux Disease (GERD) and Reflux Esophagitis. In Natural Approach to Gastroenterology (Vol. 2, pp. 1335–1375). East Wenatchee, WA: Healing Mountain Press.