As a nutritional therapist I have recently noticed a growing number of new clients taking a particular type of heartburn medication called 'proton pump inhibitors' or PPIs.
In my experience, PPIs are a concern because they can sometimes do more harm than good.
PPIs, such as omeprazole and lansoprazole, work by suppressing the formation of stomach acid.
Contrary to popular belief, heartburn is rarely caused by excess stomach acid. In fact, stomach acid is pretty useful.
Stomach acid is required for the proper digestion of proteins and carbohydrates, for absorption of nutrients and for protection against harmful bacteria.
Without stomach acid, our digestion and immune system is compromised. For this reason PPI use has been linked with deficiencies of nutrients such as B12 and magnesium. as well as increased risk of bone fracture and bacterial overgrowth in the digestive system (1-4).
So what really cases heartburn?
Most often, the problem is caused by a problem with the Lower Esphageal Sphincter (LES) - a valve between the stomach and oesophagus which prevents stomach acid from escaping upwards.
Even if our levels of stomach acid are low, we can experience heartburn if this valve is not functioning as it should. The proper functioning of this valve can be affected as we age. It can also be affected by the types of foods we eat, and our eating patterns and behaviours.
A Natural Approach to Heartburn
Those experiencing heartburn can benefit by addressing their diet. Including protein with each meal is helpful, because protein encourages the LES to close properly. On the other hand, fat has the opposite effect, and so fatty foods and meals are best avoided.
Fizzy drinks, alcohol, chocolate and smoking also 'loosen' the LES, and so are best avoided.
Other foods can irritate the lining of the oesophagus, especially when acid reflux has already made this tissue sensitive. These foods include orange juice, tomatoes and spicy foods. Until heartburn is resolved, it can be helpful to avoid these particular foods.
Helpful foods include sources of soothing pectin such as almonds, apples, apricots plums, carrots and strawberries. A teaspoon of Manuka honey, taken twenty minutes before a meal, may also help to reduce symptoms by coating the oesophageal lining.
Simple lifestyle changes can also be beneficial. Wearing loose-fitting clothing, eating slowly and chewing thoroughly are all helpful measures. Eating small meals and remaining upright for at least three hours after eating can also eliminate symptoms of heartburn.
Nutritional supplements are often used in heartburn in order to protect and repair the delicate tissue of the digestive tract and to combat bacterial overgrowth. Supplements which coat and protect the digestive tract are known as 'demulcent' nutrients, and these include slippery elm and marshmallow root. Herbal preparations such as this have been found to improve symptoms of heartburn (5).
In clinic I have also had success using deglycyrrhizinated licorice (DGL) supplements as a powder or chewable tablet before meals. DGL seems to support the mucosal barrier, promoting healing of inflamed tissues.
Glutamine, an amino acid used as fuel for the cells lining the digestive tract (6), may be also beneficial.
Finally, a probiotic preparation can provide useful support, especially for those taking PPIs. Treatment with probiotics is believed to help the small bowel problems such as inflammation and bacterial overgrowth seen in those taking PPIs (7).
For those looking for a more natural approach, one of my favourite formulations is Holford Digest Pro, which provides glutamine, digestive enzymes and probiotics.
Biocare's Slippery Elm Intensive is another promising formulation combining marshmallow, DGL and slippery elm alongside other nutrients designed to support the health of the digestive tract.
Alongside the right dietary and lifestyle choices, supportive supplements such as these may represent a sensible approach to addressing heartburn for those wishing to avoid long-term PPI use.
References 1. Jameson RL et al (2013) Proton Pump Inhibitor and Histamine 2 Receptor Antagonist Use and Vitamin B12 Deficiency. JAMA 310(22):2435-2442 2. MHRA (2012) Proton Pump Inhibitors in Long-Term Use: Reports of Hypomagnesia. Drug Safety Update 5:9. http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON149774 3. Yu EW et al (2011) Proton Pump Inhibitors and Risk of Fractures: A Meta-Analysis of 11 International Studies. http://dx.doi.org/10.1016/j.amjmed.2011.01.007 4. Lombardo L et al (2009) Increased Incidence of Small Intestinal Bacterial Overgrowth During Proton Pump Inhibitor Therapy. http://dx.doi.org/10.1016/j.cgh.2009.12.022 5. Melzer J, Rosch W, Reichling J, et al. Meta-analysis: phytotherapy of functional dyspepsia with the herbal drug preparation STW 5 (Iberogast). Aliment Pharmacol Ther 2004;20:1279-87. 6. Reeds PJ, Burrin DG. Glutamine and the bowel. J Nutr 2001;131:2505S-8S. 7. Wallace JL et al (2011) Proton Pump Inhibitors Exacerbate NSAID-Induced Small Intestinal Injury by Inducing Dysbiosis. Gastroenterology. July 2011.