Diabetics are especially prone to acid reflux, aka heartburn … that burning sensation you get in your throat, after a meal, as stomach acid is regurgitated up into your mouth. But what really causes acid reflux and what is the best way to treat it?
Heartburn usually kicks in when you lie down to sleep, especially after a heavy meal.
You wake up in the middle of the night with a fire in your throat and a sour taste in your mouth. A blob of something vile with a burning sensation pops up from your stomach and you have to spit it out.
After you get rid of it, your throat feels sore and you sound hoarse when you talk. Sometimes you start to cough or your chest sounds wheezy.
What you have experienced is heartburn … which has nothing to do with your heart.
It happens when stomach acids, which you use to digest your food, flow back into your oesophagus (the long tube between your mouth and your stomach). These acids irritate and burn the lining of your oesophagus and throat.
Everyone experiences some heartburn now and then. But it can become chronic, ie recur constantly. If you experience heartburn a few times a week, it is likely you have gastroesophageal reflux disease, otherwise known in short as GORD (or GERD if you are American).
The chronic condition should be treated with seriousness for several vital reasons.
What chronic acid reflux (GORD) does to your body
The constant back-flow of stomach acid into your oesophagus can lead to:
[1] Dental problems … stomach acids in the mouth can wreak havoc on tooth enamel, requiring more trips to the dentist than usual.
[2] Voice and throat problems … stomach acid in the throat can cause hoarseness and laryngitis, and even changes in the voice. However these problems tend to resolve easily when GORD is treated.
[3] Asthma … studies have found that up to 80% of patients with asthma also have chronic acid reflux. Whether asthma causes GORD or chronic heartburn causes asthma is not known, but some medical scientists are of the opinion that acid that backs up from the stomach can get into the airways and damage them.
[4] Other respiratory problems … GORD has been statistically linked to other respiratory conditions including … chronic bronchitis, chronic cough, chronic sinusitis, emphysema, pulmonary fibrosis (scaring of the lung), and recurrent pneumonia.
[5] Narrowing of the oesophagus … chronic acid reflux can, over time, produce scarring (strictures) that narrow the opening of the oesophagus. This can make swallowing difficult. It can also cause oesophageal spasms that can mimic a heart attack (a frightening experience).
The weird thing is that people who develop strictures find a bit of relief from their heartburn … as the narrowing stops the stomach acids from refluxing into the oesophagus.
[5] Oesophagitis …. the sensitive lining of the oesophagus can be injured by refluxing acid and this can cause a painful inflammation called oesophagitis. Eventually the acid causes bleeding which, if it is heavy enough, it can pass into the digestive tract and show up as dark tarry stools.
Oesophagitis can also cause painful ulcers on the lining of the oesophagus.
[6] Barrett’s oesophagus and cancer … in a small number of people, long-term acid reflux can lead to a condition (Barrett’s oesophagus) in which abnormal cells take the place of cells damaged by the acid. These cells have the potential to turn cancerous.
Persons with Barrett’s oesophagus have an increased risk of cancer of the oesophagus. This risk is increased if you smoke, are obese or are a white male over the age of 50.
A few decades ago, most cancers of the oesophagus were caused by cigarette smoking and alcohol. But over the last 15 years oesophageal and other cancers of the upper digestive tract caused by GORD have been developing into an epidemic. This is likely caused by changes in diets in the modern world.
Whatever the cause, it is obvious that putting a stop to the backflow is vital. There are many ways in which this can be done successfully once you understand what is going on.
What causes heartburn?
Your oesophagus joins your pharynx (at the back of your throat) to your stomach. A ring of muscle called the lower oesophageal sphincter (LES) controls the junction between the oesophagus and the stomach. The LES acts like a valve, opening and closing the entry to the stomach.
When you swallow the LES opens to allow the food or drink coming down the oesophagus to enter the stomach. The LES then closes to prevent the food and your digestive juices flowing back up the oesophagus. Each time you swallow, the LES relaxes and allows the food into your stomach.
Certain medical conditions can weaken the LES and prevent it from closing properly after you swallow. These include:
- Hiatal hernia (an abnormality where a part of the stomach slides up into the chest cavity)
- Obesity
- Some asthma medicines
- Pregnancy
- Smoking
- Diabetes
- Delayed stomach emptying (a consequence of nerve damage, often due to diabetes)
Acid reflux statistics
In both Europe and America, chronic heartburn is becoming extremely widespread, affecting about one-third of the populations on both continents.
There is a strong link between chronic heartburn and being overweight. Research shows that people who are overweight are 50% more likely to have GORD compared to persons who are at a healthy weight. Persons who are obese are 200% more likely to have the disease.
Diabetics are also likely to suffer from GORD. A study published in 2008 in the World Journal of Gastroenterology found that about 40% of people with diabetes suffer from chronic heartburn.
The researchers also found it to be more common in people with diabetes who also had neuropathy or nerve damage due to diabetes. In addition, the study showed that people with both diabetes and neuropathy were more likely to have the disease, regardless of their weight, compared to people without neuropathy.
Medical treatments for heartburn
Conventional doctors have several approaches to treating chronic heartburn.
Antacids such as Tums®, Maalox® and Rennies® are very popular. These products come in the form of tablets that you chew or dissolve in your mouth. They work by using simple mineral salts such as calcium carbonate and magnesium carbonate to neutralize stomach acid.
You do get temporary relief from your symptoms… but they treat the symptom, not the cause. Using them, however, is unlikely to damage your health.
Some doctors prescribe H2 blockers (more properly called histamine H2-receptor antagonists) such as like Zantac®, Tagamet® and Gertac®. These medications block the action of histamine, which normally stimulates the secretion of stomach acid. Personally, I have found that Gertac®, which contains ranitidine, to be gently effective in reducing GORD.
Proton-pump inhibitors (PPIs), such as Nexium, Prilosec and Prevacid, also block the production of stomach acid. These drugs target the last stage in the production of stomach acid and the blockage is irreversible. These drugs are significantly more effective than H2 blockers and reduce the secretion of gastric acid by up to 99%.
With more than 100 million prescriptions written for these three medicines every year, Big Pharma pockets a cool US$14 billion a year on just these drugs alone.
Many professional organizations recommend that people take the lowest effective PPI dose to achieve the desired therapeutic result when used to treat gastroesophageal reflux disease long-term. In the USA, the Food & Drug Administration (FDA) has advised that no more than three 14-day treatment courses should be used in one year.
For good reason … here is why blocking the production of stomach acid is not a smart thing to do:
Why you should NOT use proton-pump inhibitors (PPIs)
The parietal cells in your stomach secrete the stomach acid used in the digestion process. The secretion of the acid is governed by proton pumps which provide energy for the process.
Proton-pump inhibitors prevent the proton pumps from working and so reduce the amount of acid produced by the parietal cells. This prevents acid reflux (no acid, no reflux!).
The problem is that proton pumps are present in just about every cell in your body, not just the parietal cells in the stomach. These proton pump systems are necessary for the production of the energy used in a wide variety of your body’s processes. Though this energy can be produced in several ways, without proton pumps them these processes could not work at their best.
While proton-pump inhibitors are designed to interact specifically with the proton-pumps in the parietal cells in your stomach, research suggests that it is likely that their effects are not limited to the specific acid producing cells of the stomach.
There are many other good reasons why you should not use proton-pump inhibitors:
(1) Stomach acid is a critical part of your immune system
PPIs reduce the acidity of your stomach. This is dangerous as certain harmful bacteria thrive in low-acid environments. Examples include H Pylori, which is a major cause of stomach and duodenal ulcers, gastritis and can even cause gastric cancer (according to a report in Drug Safety in 2003).
Several recent studies have shown that PPIs alter the micro-organisms in the gut by reducing its overall diversity. As a result, dangerous pathogens, such as Enterococcus, Streptococcus, Staphylococcus, and E. coli, tend to be more prevalent in the guts of PPI users.
As stomach pH becomes less acidic, many ingested microorganisms that get in through the mouth but which would normally be destroyed are able to make their way into the gut. Those who use acid blockers increase their chances of acquiring Clostridium difficile, Campylobacter, Salmonella, Shigella, Listeria, and pneumonia compared to persons using other medications.
(2) PPIs impair the absorption of nutrients
Stomach acid is essential for the digestion and absorption of food, both macro- and micro-nutrients. Studies show that persons who use PPIs have an increased risk of vitamin and mineral deficiencies, including vitamin B12, vitamin C, calcium, iron, and magnesium.
Persons who use acid blockers can also end up with achlorhydria (a lack of stomach acid). This, combined with atrophic gastritis (stomach inflammation), allows bacteria, which compete with the host (you!) for the consumption of micro-nutrients such as vitamin B12, to flourish.
Studies have found an association between the use of PPIs and the total number of bone fractures in the elderly. The association was significant enough for the FDA in the USA to issue a warning in 2010. A more recent study has shown a similar association between PPI use and bone fractures in young adults.
(3) PPIs damage the cardiovascular system
A study published in May 2016 found a link between proton-pump inhibitors and the premature aging of blood vessels, with the cells losing their ability to split into new cells.
Other recent studies indicate that PPI users have a significantly greater risk of heart attack compared to person using other antacid medications.
PPIs reduce the production of nitric oxide, a nutrient that increases lung power, helps your heart pump blood and oxygen to your cells, and even helps with erectile function by allowing blood vessels to expand and relax when you are on the job.
PPIs also affect lysosomes. Those are acid-producing cells in your body that clear up unwanted debris. Without enough acid to remove the waste, the cells protecting your blood vessels age rapidly. That can lead to a stroke, heart attack or kidney failure.
(4) PPIs harm the kidneys
Patients using PPIs were compared to patients using H2 blockers, another common antacid drug in a study published in 2016.
The study indicated that, over five years, the PPI users were 28% more likely to develop chronic kidney disease and 96% more likely to develop end-stage renal disease.
(5) PPIs harm cognitive function
A study published in 2015 that assessed cognitive function in users of PPIs compared to controls found statistically significant impairment in visual memory, attention, executive function, and the working and planning function among the PPI users.
Another study in 2016 found that regular PPI users had a 44% increased risk of dementia compared to non-users.
Why this is so is not known. However, communication between brain cells requires the action of proton pumps. It may be that the proton pumps in the brain are affected by PPIs that target stomach acid.
(6) Rebound reflux
When your body senses a reduced production of stomach acid, it produces gastrin, a hormone that stimulates the secretion of gastric (stomach) acid by the parietal cells.
As a result, the individual parietal cells expand in size. Larger parietal cells have more proton pumps and can produce larger amounts of stomach acid. An overproduction of stomach acid caused by PPIs is called rebound hyper-secretion.
Rebound hyper-secretion illustrates why getting off PPI therapy is so difficult once you start using them … long-term use fundamentally changes the physiology of stomach cells.
The basic problem with PPIs is that they treat the symptoms of a condition (the production of acid that flows back up the oesophagus) rather than the underlying cause (a weakness in the lower oesophageal sphincter (LES)).
There are two main approaches you can take to dealing with chronic heartburn that focus on the underlying causes:
- Heartburn avoidance techniques
- Natural remedies for heartburn
How to avoid heartburn
Here are some simple ways you can prevent heartburn:
- Eat smaller meals … this makes digestion easier and reduces the pressure in your stomach that causes reflux.
- Eat slowly … digestion starts in the mouth and chewing your food thoroughly reduces the likelihood of reflux.
- Avoid tight clothes … tight clothes can put pressure on your stomach, pushing food back up into your oesophagus.
- Don’t smoke … smoking irritates the membranes of the throat and oesophagus. Nicotine also weakens the oesophageal valve, allowing stomach acid to come up to your throat.
- Avoid certain foods … chocolate, tomatoes, fatty or fried foods, fatty meats (choose lean cuts), synthetic dressings (use olive oil), spicy sauces (choose mild or avoid), alcohol, cola and other sodas as well as caffeine are all contributors to LES malfunction.
- Avoid certain spices … hot spices as used in curries and other hot Eastern foods, as well as cinnamon, can irritate your stomach and oesophagus causing pressure that forces acid back up through the LES.
- Avoid peppermint tea … as it tends to relax the LES and allow acid to flow back up the oesophagus.
- Raise the back of your bed … use short planks of wood between the legs of the bed and the floor to raise the pillow-end 4 to 6 inches higher than the foot-end; by sleeping with your head lightly higher than your feet you will be using gravity to reduces the chances of stomach acid flowing back up to your throat … this really does work in my experience.
Persons who take these simple steps to prevent acid reflux experience fewer and milder bouts of acid reflux.
Natural remedies for heartburn
There are several natural remedies for heartburn that actually work:
- D-limonene
- Magnesium
- Ginger
- Baking soda
Some of these ‘cure’ acid reflux for a time at least if not permanently. Others provide temporary but effective relief.
D-limonene
D-limonene is an extract from orange peel which is safe to use as a food additive or supplement.
Research at WRC Laboratories in the USA indicates that a daily intake of one 1,000mg capsule of d-limonene every second day for 20 days reduces or eliminates acid reflux in most people for at least six months. This is supported by anecdotal evidence among researchers and further research that has yet to be published.
D-limonene is a cell rejuvenator yet scientists don’t know why it is so effective. Researchers have speculated, however, that as d-limonene is lighter than water, it floats to the surface of the gastric juices in your stomach.
The minor burping you experience with d-limonene causes it to be carried directly into the oesophagus. By coating the oesophagus, d-limonene may protect it against the caustic contents that are regurgitated during acid reflux. This would help heal and strengthen the lower oesophageal sphincter (LES) and heal erosion in the oesophagus.
It is also thought that d-limonene may promote quicker movement of food and gastric juices out of the stomach so that these oesophageal irritants promote less reflux.
Scientists also suggest that d-limonene may provide a barrier in the oesophagus and stomach against bacterial infection, such as helicobacter pylori, which are ingested in food or water. H pylori attack the lining of the stomach eventually causing ulcers and even stomach cancers.
The generally accepted opinion (or shrewd marketing) suggests that the best d-limonene, which is available in health food stores, is the Jarrow Formulas D-Limonene.
I recently took a 1000mg capsule of the Jarrow Formulas D-Limonene (sourced online through Amazon) each day for 30 days. There were no side-effects and it appears to have cured my acid reflux.
Magnesium
Magnesium is a calming and relaxing mineral. It is an ingredient in several antacids.
This mineral helps your LES to relax so that it can close properly, thus preventing the backflow of stomach acid that causes heartburn.
Magnesium chloride is absorbed better than other compounds of magnesium and is thus more likely to be effective in relieving your heartburn.
Take 450 to 500mg once or twice a day to see if it helps. Each dose should contain about 150mg of magnesium and about 350mg of chloride.
Ginger
Ginger is prized for its health-giving qualities in Asia, Africa, the Middle East and the Caribbean. Most of the health benefits of ginger are in the woody root of the plant, the rhizome.
Ginger is absolutely loaded with antioxidants. It has antibacterial, antiviral, antioxidant and anti-parasitic properties. It can relieve the discomfort of heartburn without side-effects.
Fresh ginger is best, though you can use dried ginger. When buying ginger root, make sure it feels firm and fresh. Fresh ginger, provided it is unpeeled, can be stored in a refrigerator for up to three weeks or in a freezer for up to six months.
You can peel ginger with a paring knife and add it to cooked dishes, mix it into a stir-fry or drop it into homemade chicken soup. But taking it as a supplement is not recommended as the ginger in capsules is not easily absorbed or used by your body.
In Uganda, doctors and herbalists use ginger tea to treat heartburn. The root’s anti-inflammatory properties speed up the digestive process, preventing the build-up of gas, and helping to regulate bile and gastric juices.
Adding a simple ginger tea to your daily diet will tighten your LES and help prevent the back-flow of acid from your stomach according to a report by the Thai Medical Association in 2010.
Here’s an easy recipe:
- Remove the skin from a piece of fresh ginger root and chop it into small pieces or slices
- Fill a small pot with two cups of water and boil
- Add the ginger and cover.
- Let it simmer for about 10 minutes
- Strain the tea
You can drink it hot or cold. You could try adding a pinch of cinnamon to boost the flavour.
I make a batch twice a week, store it in the refrigerator and drink a chilled glass first thing in the morning. It seems to help immensely.
Bicarbonate of soda
Sodium bicarbonate, aka baking soda, offers a very quick remedy when you are having an attack of acid reflux.
Just mix a flat teaspoon of baking soda into a glass of water, stir and wait a minute for it to dissolve and then drink it down. Relief will be fairly immediate.
Baking soda works because it contains bicarbonate which neutralises the acid in your stomach.
This is not a permanent solution for chronic heartburn. But it works a dream for a quick fix and there are no side effects.