The Pain of Heartburn (GERD)
GERD is short for gastroesophageal reflux disease commonly called heartburn, acid indigestion or reflux disease.
Between the bottom of your throat (the esophagus) and your stomach you have a valve that separates the two called the lower esophageal sphincter (LES).
Normally the LES opens to let food go into the stomach and closes to prevent the contents of your stomach flow back.
In GERD what happens is that the LES valve is weak, or relaxes at the wrong times, allowing your stomach contents (partially digested food mixed with stomach acid and bile) to flow back into the bottom of your throat. This is what is called reflux disease.
You experience this as heartburn - a burning pain that begins behind your breastbone and moves up to your neck and throat.
Sometimes you might feel as if food is coming back up, leaving a bitter, acid taste. It can last around 2 hours after eating and is worse if you lie down or bend over. It can be exceedingly painful and interfere with your life making you feel miserable.
Other symptoms can include chest pain or pressure, abdominal pain and sometimes, a cough.
What causes GERD?
GERD is nearly always caused by poor diet and lifestyle. You can make it better by addressing the cause even if the change to a healthier diet and lifestyle seem hard initially, it is best for you in the long run.
Left untreated, the backwash of stomach contents into your esophagus can damage its lining. There is potentially a link between this damage and esophagal cancer. But aside from that, heartburn is painful and needs to be sorted out!
Taking drugs only alleviates the symptoms temporarily and does not solve the underlying cause. In fact, taking drugs often makes it worse because when you stop taking them your body experiences 'rebound' - a period when the original symptoms come back, seeming worse than before, as your body tries to readjust again. So many people experience rebound and go back on the drugs, for years, but these drugs weren't meant to be taken for a long time and this can lead to diarrhoea, poor calcium metabolism - in some cases leading to broken bones - and a build up of magnesium in the body which is harmful for your kidneys.
Diet is the best reflux treatment
"Let food be your medicine and let medicine be your food"
Hippocrates 460-370 BC
Step 1: When you eat
Eat smaller amounts and more often. Try five smaller meals during the day rather than 3 large ones. Watch your portion size with everything. For example, coffee can trigger heartburn and a 'tall' is equivalent to 3 cups! So order small sizes on everything when you're out. Also don't eat last thing at night. Allow at least 3 hours between eating and sleeping. A rule like not eating after 6 pm often makes a big difference.
Step 2: How you eat
As well as eating smaller amounts, eat more slowly. Take smaller amounts and chew your food well. Also don't wash it down with water or a flavoured drink.
Step 3: What you eat
Initially when you read the lists of food triggers and do's and dont's in a diet for reflux, it feels as if you can no longer have anything that you like! The secret to not having to give up all food and drink is keeping a food diary. Write down everything you eat for a few weeks and score your heartburn symptoms from 1 to 5 (where 1 is a bad as they can be and 5 is as good as they can be). Soon you will start to see patterns and the cause and effect of different foods. You'll soon identify the culprits that are setting you off.
Here are some pointers for the most common heartburn trigger foods:
Citrus fruits such as oranges, grapefruits and orange juice are all acidic and often caused heartburn especially if taken on an empty stomach first thing in the morning.
Tomatoes sadly are also highly acidic and will trigger heartburn if you are sensitive to it. Some people also find onions and garlic problematic.
Pepper, chillies and spicy foods such as Mexican, Indian or Schezuan Chinese can trigger heartburn.
Foods that are high in fat take longer for the body to process. This involves the body needing more acid around in your stomach longer to try and digest them. You may need to avoid steak, cheese, cream, nuts, avocado and other high fat foods especially late and night. If you love cheese, try moving it to morning snack time instead of having it after a meal. Fried foods also come into this category and they are fried in fat and oils.
Alcohol (beer, wine and cocktails), fizzy and caffeinated drinks don't help either as they weaken the LES valve.
Chocolate and mints are definitely triggers. High amounts of peppermint oil in after dinner sweets definitely aggravate heartburn even though sipping peppermint tea after a meal traditionally helps a lot of people with indigestion. However, if you have had a confirmed GERD diagnosis, avoid peppermint - take chamomile tea instead.
Foods that help GERD symptoms
Food that tend to be safe tend to be plainer but if you cook with herbs and ginger (not hot spices), that doesn't have to mean less interesting.
- Chicken breast, skinless
- Egg whites and egg substitute
- Fish, no added fat
- If red meat, minced beef extra-lean
Try broiled, baked or roasted chicken (without the fatty skin).
Fish and seafood are excellent - again, like chicken, baked, grilled or sautéed but never fried! Oily fish, such as salmon, herring and sardines two omega-3 fats; EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) which help relieve inflammation linked to tummy troubles.
- Baked potato
- Green beans and Peas
Accompany these with baked potato, sweet potato and vegetables or a salad. Most root and green vegetables, including cauliflower, broccoli, asparagus and green beans.
Fennel is a great vegetable for acid reflux diets as it has a positive beneficial effect on stomach function. Try it thinly sliced in a salad with spinach or rocket, or baked with chicken. Celery and parsley are both tasty additions to any meal as well.
Salads are good but don't add tomato, onions, nuts or cheese.
FATS / OILS
- Salad dressing, low-fat
- Apple cider vinegar
Salads are excellent but use a dressing made with a light oil and Apple Cider Vinegar - it is not acidic in the same way that other vinegars are. Try a bean salad for a change.
- Bread, multi-grain or brown
- Cereal, bran or oatmeal
- Corn bread, sourdough bread
- Pretzels or rice cakes for snacks
- Rice, brown, red or wild
- Bulgur wheat or couscous
Oatmeal is excellent in porridge to start the day, in cereal bar snacks and, lightly toasted, as a base with raspberries and honey for a dessert.
All complex carbohydrate are good carbohydrates! So also include couscous (semolina wheat), bulgur wheat and rice (wild, red or brown rice).
Other snack ideas could include wholegrain toast with cottage cheese.
- Cheese, feta or goat
- Cream cheese, fat-free
- Sour cream, fat-free
- Soy cheese, low-fat
- Cottage cheese
- Skimmed, low fat milk
- Apple, fresh, dried and juice
Bananas and melons (including honeydew, cantaloupe and watermelon) are good for all but 1% to 2% of acid reflux sufferers.
- Mineral water
- Organic Chamomile Tea
Try and control your heartburn through diet and herbs.
Herbs that help
The herbs of choice for GERD are Chamomile flowers, Calendula flowers and Marshmallow root. These can be taken together as a tea or used in tincture form.
2 parts Marshmallow root Althaea officinalis
1 part German Chamomile Matricaria recutita
1 part Calendula Calendula officinalis
Take up 5ml in a little water up to three times a day. In addition, make up Organic Chamomile Teaand sip slowly throughout the day. You can also make an infusion of Marshmallow root if you want a change.
Add small amounts of fresh ginger to your cooking. It helps with many gastrointestinal symptoms and is anti-inflammatory.
If you are overweight, try and lose some weight. Excess body fat pressing on your stomach exacerbates the symptoms of GERD.
Raise the head of your bed by putting a 6 inch block of wood under the legs at the pillow end. This helps gravity to keep your stomach contents down. Don't just add another pillow as that doesn't help.
It may sound obvious, but don't wear tight clothes even if skinny jeans are all the rage. And loosen your belt an extra notch.
Give up smoking as it weakens the LES valve.
Aloe vera gel is considered an excellent soothing food supplement.
There is a lot of debate as to whether taking digestive enzymes can help but we find that patients report good experiences with them. The body produces around 22 digestive enzymes. Each has a specific actions.
- Proteases break down protein
- Amylases break down carbohydrates
- Lipases break down fats
- Cellulases from plants break down fibre (cellulose)
Some people lack enough enzymes because of poor diets that lack nutrient and are high in refined foods, environmental toxins, over use of antibiotics and general poor health. Symptoms of indigestion, bloating, gas and heartburn are thought to be the outcome.
Patients have found taking additional plant-based digestive enzymes such as bromelain (from pineapples), papain (from papayas), and enzymes grown on the fungus aspergillus, to be helpful in managing the symptoms of GERD.
They are also often used by older people who have lower amounts of stomach acid and take longer to digest food, which can then pass into the intestines without being fully broken down, causing indigestion.
Are drugs the answer?
Your doctor can prescribe drugs which inhibit the amount of acid your stomach produces but these are not meant to be a long-term solution. When you stop taking them you often have a 'rebound' period when the symptoms come back and seem even worse than before - this is your body trying to adjust again. Reflux treatment is best approached naturally first, as this can lead to permanent change.
Drugs can also have unpleasant side effects. Many of our patients on omeprazole complain of low libido. Here is an example of the known side effects for rabeprazole (Aciphex):
Side effects of Rabeprazole
Headaches - up to 9.9 percent of people
Diarrhea - up to 4.5 percent
Nausea - up to 4.5 percent
Vomiting - up to 3.6 percent
Abdominal pain (stomach pain) - up to 3.6 percent
Pain (the type of pain was not specified) - up to 3 percent
Sore throat - up to 3 percent
Flatulence - up to 3 percent
Infection - up to 2 percent
Constipation - up to 2 percent.
The above side effects were discovered during the clinical trials before this drug was approved and so stated on the Patient Information Leaflet. Probable and possible side effects reported after a drug has been approved are called the post marketing experience. For Aciphex these include:
Osteopenia (as calcium absorption is impaired)
Broken bones (some studies suggest this or other similar medications may increase the risk of bone fractures)
Low blood magnesium (hypomagnesemia)
Yellow skin (jaundice)
Increased TSH (found using a blood test), indicating possible hypothyroidism
Low white blood cells
Low blood platelets
Serious skin rashes
Allergic reactions, including life-threatening reactions
If you ever experience a side effect from any medication please report this to The Yellow Card Reporting Scheme
HERBS THAT HELP
Marshmallow root is demulcent. This means that it soothes and coats and protects the lining of the esophagus and stomach. In herbal medicine we use it in treatments for acid reflux, GERD and stomach ulcers.
Chamomile is anti-inflammatory, carminative and soothes digestion, especially where there is also an element of stress.
Calendula is astringent and also anti-inflammatory. It is a very healing herb and helps cells to regenerate quickly.
Ginger is anti-inflammatory and has been used as a treatment for gastrointestinal conditions for centuries.
Aloe vera gel juice is extremely soothing for reflux.
Foods to avoid include:
Fatty foods like milk, cream and cheese will trigger heartburn especially taken late in the evening. Switch to low-fat milk and have cheese as a morning snack and not after a big meal.
Many nuts also have a high fat content and are hard to digest.
Alcohol, like acidic wines, beer, as well as fizzy or caffeinated drinks, orange juice should be avoided to keep GERD at bay.
Foods to choose instead
Oats are helpful. They are a slow burning carbohydrate providing a lot of energy from a small amount. Make with low fat milk, add grated apple and sprinkle with cinnamon for the perfect breakfast.
Choose apples, pears and non-acidic fruits instead of oranges and citrus fruits.
Cook chicken without the fatty skin for a tasty, easily digested meat instead of red meat.
Fish is also an excellent source of protein and will not cause heartburn. Eat with lightly steamed vegetables.
Salads and green vegetables are a really important part of a healthy pain-free diet.
Fennel really is food as medicine. Whether used as the herb and the vegetable.
Celery helps to liven up dishes and salads too.
If you need help balancing your diet, or self help methods are not helping, you can see a medical herbalist for a consultation.