Drop That Pill: Heartburn
Let’s talk about why the purple pill doesn’t treat heartburn.
Heartburn is a painful sensation in the stomach or behind the sternum, often after meals.
When a patient comes to me with symptoms, I can usually draw from two big buckets: a bucket of treatments that relieve symptoms, and one of treatments that resolve underlying problems. I like both buckets—I always want to tackle the root cause, but this can take time; symptom relief is necessary for someone who is in the long game of holistic healing.
In that sense, over-the-counter heartburn remedies fit in the “symptom relief” bucket. Unfortunately, they also belong in a third bucket—things that make the underlying problems worse.
Typical heartburn remedies include chewable calcium tablets, proton pump inhibitors, and histamine blockers. All three of these pills aggressively tackle the superficial culprit of heartburn: stomach acid. Eliminate stomach acid, and there’s nothing left to cause pain. Problem solved! –Right?
This VERY UGLY drawing will help with the landmarks mentioned at right.
Let’s step back and consider why we have stomach acid in the first place. It’s definitely not by accident: the stomach has a specialized protective lining, and cells throughout the organ are entrusted with the task of maintaining a pH as low as hydrochloric acid. The low pH has two main functions.
First, it continues the process of digesting food. In fact, when you anticipate delicious food and find yourself salivating, your stomach is simultaneously secreting acid to prepare for the incoming meal. Without adequate stomach acid, your digestion is seriously hampered.
Second, the low pH kills microbes that you swallow, both harmful and beneficial. While microbes are important for healthy digestion, their role happens much farther down the line in the large intestine. Partially digested food passes from the stomach into the small intestine, where there should be relatively few microbes. Without adequate stomach acid, you run the risk of accumulating unwelcome microbes in stomach and small intestine (and possibly a higher risk of gastroenteritis).
Another important effect of stomach acid—it signals the lower esophageal sphincter to stay closed.
Our bodies are really smart. Generally speaking, things are there for a reason. Stomach acid has really important jobs. In the context of heartburn, LOW stomach acid is an important cause of symptoms, even though most folks assume the opposite. Suppressing stomach acid may help relieve burning pain, but it sets people up for a cycle of worsening heartburn and digestive issues. Without enough acid, food sits in the stomach longer than it’s supposed to, giving rise to an uncomfortable sensation of fullness. With low acid, the lower esophageal sphincter tends to stay loose rather than tightening up after you swallow. When the sphincter is relaxed, the slowly digesting food sitting in the stomach can pass up into the esophagus, causing pain and discomfort.
Conventional heartburn remedies do work; they are all effective at reducing stomach acid and relieving burning pain. However, they don’t address the root of the problem and just end up perpetuating it. There won’t be lasting relief or healing on this route.
So what are the alternatives? Here’s where we start:
—> Soothe irritated tissues
Instead of suppressing stomach acid, I recommend plants that help coat the esophageal tissue to protect it from any stomach contents that splash up through the lower esophageal sphincter.
—> Deal with stress
You’ve heard of “fight or flight”, have you heard of “rest and digest”? We have partitions of our nervous system that are in charge of the many processes that aren’t under our conscious control. One system helps us respond to threat, the other helps us perform necessary maintenance. The maintenance system (which governs digestion) doesn’t perform as well in conditions of prolonged stress.
—> Figure out problem foods
For many of us, there are foods that just won’t ever sit well. Identifying these (unfortunately they’re often staple ingredients) can be hugely beneficial for digestive symptoms.
—> Support healthy digestion
Digestion is a dance, different organs coordinating with each other to get the most out of each bite of food. When the dance is off-kilter, people get digestive symptoms like heartburn. Using a combination of healthy meal habits, herbs, and other supplements, I help folks get their food well digested so they’re nourished and feel good. Usually as we restore healthy function, symptoms fade away.