Heartburn is something most people associate with overeating, like that classic feeling after Christmas dinner.
And yes, large meals are a major culprit — but sometimes the problem can be due to less obvious triggers, like wearing tight clothing (a belt that’s too tight, high-waisted jeans, or even a bra), constipation, or bloating.
How are these related to your heart, you might ask. In fact, heartburn has nothing to do with the heart, it’s all about your esophagus (or esophagus).
Heartburn is a common symptom of acid reflux. This occurs when stomach acid and other stomach contents travel the wrong way and are regurgitated up into your esophagus via a trap door (the esophageal sphincter, a ring-shaped ring of muscle that acts as a gateway between your esophagus and the acid-filled stomach).
Heartburn is something most people associate with overeating, like that classic feeling after Christmas dinner
Unlike your stomach, your esophagus isn’t built for harsh acid, and this causes an uncomfortable burning sensation just behind your breastbone — that’s heartburn.
Overfilling your stomach in one sitting creates an unequal pressure between the stomach and esophagus, essentially raising the trapdoor.
Tight clothing can lead to such a pressure imbalance, as can constipation.
But if you experience heartburn and/or reflux at least twice a week and it’s not related to overeating, tight clothing, or constipation, then you may have gastroesophageal reflux disease (GERD).
This common condition affects more than ten percent of adults. The causes vary – some people are genetically more prone to reflux, for example they may have a weaker esophageal sphincter; others may have a physical cause, such as B. a hiatal hernia (where part of your stomach pushes up through the diaphragm).
Did you know?
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But not all chronic heartburn is due to acid reflux — it’s thought that in up to four out of ten people, the symptoms are caused by a sensitive gut as a result of miscommunication between the gut and the brain.
The first-line medical treatment for acid reflux is proton pump inhibitors (PPIs), which suppress the production of stomach acid.
However, various studies have estimated that these drugs (even at higher doses) do not provide adequate relief in 10 to 40 percent of patients with suspected GERD.
And when you test such “unresponsive” patients, the acidity (i.e. pH) tests usually come back to normal, even though they have very real symptoms.
This type of heartburn, where there’s no clinical explanation or abnormal test result, is what’s called a “functional” esophageal disorder — structurally everything is normal, but it’s like a showcase where everything seems to be in the right place but the fridge is not turned on (irritable bowel syndrome is another form of the disorder).
If you’ve been prescribed PPIs and they aren’t helping, don’t assume you need a stronger prescription – you could have functional heartburn, which means you’re taking the medication unnecessarily, and like all medications, PPIs have potential side effects. impact over time.
For example, long-term use has been linked to a higher risk of vitamin B12 deficiency (stomach acid is needed to release B12 from food). This, in turn, can lead to problems such as fatigue and even neurological damage in severe cases, especially in the elderly.
PPIs also affect your gut microbiota, that colony of microbes that are so important to our well-being. In fact, PPIs have been shown to increase the risk of gut infections (our stomach acids normally kill pathogens and create a healthy environment for the right balance of microbes to grow and protect against invasion).
But there are several important diet and lifestyle strategies that can help you manage heartburn and reflux.
Admittedly, the evidence behind most of these strategies is limited in terms of high quality studies – by that I mean studies where treatments were administered in a controlled setting, e.g. B. a clinic to be tested.
However, observational studies (where people are observed in their normal environment) and expert consensus support trying these strategies before moving to medication.
Here are my suggestions for the things you can do now to make a difference:
- Avoid large meals. Break up food into smaller portions and eat five or six meals throughout the day.
- Leave at least three hours between your last meal of the day and bedtime. This ensures that most of your food has passed through your stomach and thus reduces pressure on your esophageal sphincter.
- Identify your triggers. Keep a food and symptom diary for seven days, looking for patterns between foods, lifestyle factors (such as stressful days), and your symptoms.
Commonly reported diet triggers include high-fat meals (e.g., fried foods and pastries—switch to grilled and whole-grain options); carbonated drinks and citrus fruits or juices (switching to herbal teas like ginger); spicy foods (swap them for cayenne pepper or other aromatic herbs like smoky paprika or turmeric); Tomatoes; chocolate, caffeine (choose decaffeinated drinks); and alcohol.
Several of these commonly reported triggers have been shown to affect pressure on the esophageal sphincter.
- Avoid tight clothing – including belts! Remember to equalize pressure in the sphincter.
- If you get reflux while lying in bed or sleeping, try lying on your left side. Because the esophagus connects to the right side of the stomach, lying on the left side prevents acid from being pushed back up.
- Elevate one end of your bed 10cm to 20cm so that your head and chest are at a level just above your waist – this in turn helps reduce the pressure that can open the esophageal sphincter. And the following longer-term strategies can also help:
- Keep your weight under control – higher body weight is associated with a higher risk of acid reflux. It’s that esophageal sphincter again – the extra weight puts more pressure on it. For example, a 2014 US study of overweight people (with an average BMI of 35) found that losing weight improved their symptoms, and in 65 percent their symptoms disappeared completely.
- For the same reason, constipation and bloating can also make reflux worse – see my column last week on how to address the former (I’ll be writing about bloating soon).
- Stop smoking. Yes, I know, easier said than done, but a 2016 study from Osaka City University in Japan showed that people who quit smoking for a year had a nearly 50 percent improvement in their GORD symptoms.
If you need medication, of course you need it – it’s a matter of weighing the pros and cons.
For those tempted to just accept the symptoms, it’s important to realize that chronic reflux is not only debilitating in terms of symptoms, it can also increase your risk of diseases like esophageal cancer. Whichever path you choose, it’s important to stay on top of things.
Note: If you have any of the red flags listed below, discuss them with your GP immediately:
- any lump or tenderness in your throat or abdomen;
- A family history of esophageal or gastric cancer.
Try this: avocado popsicles
High-fiber ice cream lollies to help you (and your gut bacteria) thrive during this heat wave.
- 2 ripe avocados
- 240ml coconut milk
- 2 tbsp honey
- 2 kiwis, cut into pieces
- 60 g frozen raspberries
- 1 tbsp chia seeds
- Juice of half a lime
- 2 tbsp water to loosen the mixture if necessary
Put everything except the raspberries in a blender and puree until smooth. If the mixture looks too thick, add the extra water. Stir the raspberries into the mixed mixture, pour into molds, add lollipops and freeze until set (which will take about four hours).
I struggle with my gut health – it starts with chills, headaches, intestinal cramps and then hunger and fatigue. This takes a few days at a time and is happening more regularly than ever. It’s really getting me down.
John Watkins, Swansea.
Although many of these symptoms are ‘non-specific’ – meaning many different things could trigger them – the cluster you describe is particularly common in ‘dumping syndrome’.
This is when food moves from your stomach into your small intestine too quickly. As a result, your gut produces more hormones than normal and your gut can swell with extra fluid, triggering a cascade of symptoms like yours.
This is most common after gastric surgery, but I’ve also seen it in people with recent diabetes or pancreatic problems. I would recommend discussing your symptoms with your GP. In terms of nutritional management, try the following:
Eat smaller meals more often – instead of eating three large meals, split the same amount into five meals.
Limit foods high in added sugars like breakfast cereals (try oatmeal) and fizzy drinks (try soda water sweetened with mashed fresh fruit).
Eat more slowly. The goal is to chew each bite at least 20 times.
Contact dr. Megan Rossi
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The answers should be viewed in a general context; Always consult your GP if you have any health concerns.