Heartburn Treatment: Hunting Triggers
Do you suffer from painful heartburn? Then you surely want to know how you can successfully treat your symptoms.
I will tell you how to get relief from your pain.
You will see that there is no magic trick to it. Instead, successful treatment of heartburn (= GERD) is based on fixing its root causes. So, let’s have a look at them:
The Root Causes of Heartburn (GERD)
When we drink or eat anything, food passes from our mouth, through our esophagus into our stomach.
Sometimes, stomach contents flow back into the esophagus. That event is called reflux.
Having some reflux here and there is not a big deal. The esophagus can weather that. Only if the reflux becomes too strong and happens too often, do we get an inflamed and sensitive esophagus that causes heartburn. Once reflux starts making us sick, physicians talk about gastroesophageal reflux disease – GERD for short.
Enough about terms. How do we fix that stuff?
Well, we must treat the reasons why we get too much reflux in the first place.
By fixing reflux, we cure heartburn permanently.
So, let’s look at the reasons for getting excessive reflux:
The Leaky Valve
The body has several valves that separate organs from one other. The medical term for these valves is “sphincter”.
The valve that is important when it comes to heartburn sits between the stomach and the esophagus. It is called the lower esophageal sphincter (LES).
Reflux is the result of a failing lower esophageal sphincter. Stomach content leaks through the valve into the esophagus where acids and stomach enzymes cause inflammation.
The inflammation will make the mucous membrane extremely sensitive. That is why healthy people can tolerate some reflux, while for people with GERD, even small amounts of reflux cause heartburn.
3 Promoting Factors for Reflux
There are many triggers for reflux. But they all come down to a basic principle: there is more pressure in your stomach than your lower esophageal sphincter can hold back.
Once the pressure in the stomach forces your valve to open, reflux spills into the esophagus. Each time, the acid and stomach enzymes irritate the esophagus, causing more inflammation and heartburn.
Let’s talk a bit more about how this can happen.
1) The Valve Becomes Too Weak
You can imagine the lower esophageal sphincter like a muscle that constantly presses the esophagus together. The strength of the pressure is measured by the so-called sphincter tone. Some people have a weaker sphincter tone than others, which makes them more susceptible to GERD and heartburn.
But the strength of that valve is not only God-given. We can influence our lower esophageal sphincter to some extent.
Constant overeating for decades leads to wear and tear on the valve. It loses its strength. Reflux becomes more frequent and more violent. This is one reason why GERD occurs more frequently with increasing age.
But even in the short term, the valve can loosen if we eat the wrong things. Chocolate, for example, contains substances (e.g., theobromine) that causes the valve to relax. Caffeine has the same debilitating effect on the valve. That's why chocolate & coffee are major heartburn triggers for many people.
2) The Pressure in the Stomach Is Too High
An increase of pressure in the stomach can cause heartburn as well. If the pressure becomes too much, the valve has no chance of holding reflux back.
Overeating is the most frequent cause. The more you stuff into your stomach, the higher the pressure becomes. Makes sense, right? That is why frequent overeating leads to GERD.
Obesity is another factor, as the oversized belly puts additional pressure on the stomach.
There are other factors, but talking about all of them would go beyond the scope of this article.
3) Deteriorated Self-Cleaning Mechanisms of the Esophagus
Since a certain amount of reflux is normal, our body has adapted to it over the course of evolution.
Our body has several mechanisms to shove reflux back into the stomach and neutralize the remaining acidity. For example, the esophagus contracts in a wave-like manner, which causes reflux to return to the stomach. The medical term for this is esophageal motility.
However, chronic reflux damages the self-cleaning functions over time. A vicious cycle arises, as the lack of cleaning results in even more damage.
But don't worry, with the right measures you can give your body a rest from reflux and break the vicious cycle. The self-cleaning mechanisms will recover by treating the reflux.
Finding the Right Treatment for Heartburn
Many doctors are quick to write a prescription at the first sign of heartburn. The go to medications are so-called proton-pump inhibitors (PPIs) which massively reduce acid production.
Sadly, prescribing PPIs is all most physicians do, despite the fact that pills do not fix the disease. They just cover up symptoms until they come back with a vengeance.
It is not that most physicians don’t want to cure your heartburn permanently. They just do not have the time.
Our medical system works under extreme constraints of time and resources. There are too many sick people for too few medical professionals. There is not enough time for detailed consultations that involve a detective-style search for root causes. A medication like an acid blocker is, on the other hand, a quickly prescribed treatment. It takes a second of the physician’s time and they can rush to the next patient.
Leading experts I’ve interviewed agree that acid-reducing drugs should, at most, be only a short-term fix. They are great at quickly relieving the pain.
In the long run, however, acid medication damages the digestive system, which leads to even worsened reflux symptoms.
Damage at the cellular level continues despite acid blockers, as the medicine only takes out the acidic component of the reflux. But reflux also contains damaging stomach enzymes. That is why some patients are suddenly confronted with a cancer diagnosis after they have taken PPIs for years or decades, without feeling any pain.
In addition, PPIs make a patient dependent upon them. Once you try to quit them, your body will react with an overproduction of acidity that makes the symptoms even worse than before. This so-called “rebound effect” can last weeks to months. It is why many patients have a rough time trying to get off PPIs.
Diet is Crucial to Healing GERD
Changing what, when and how we eat is a much more effective solution to heartburn than medication. It not only addresses acidity, but the root cause: reflux.
Many foods lead to a relaxation of the lower esophagus valve. Avoiding those foods reduces reflux.
Of course, there are also many things you can do to reduce the pressure in the stomach. Most people are unaware that not only how much you eat matters, but also when and with which frequency.
The topic of nutrition is extremely complex, too complex for one blog article.
I already wrote a book in German on heartburn treatment. I plan to do a translation into English in the future. But this will still take a while, months at the minimum.
But don’t worry. You can find a lot of information on the treatment of another type of reflux here on Refluxgate. I am talking about airway reflux, also known as silent reflux or LPR. Like it sounds, it is reflux that reaches the airways. It results in symptoms like hoarseness and chronic cough.
Treatment of airway reflux and GERD is very similar. In fact, it is much easier to treat heartburn than airway symptoms. If you follow my advice on airway reflux, it will help you even if you have heartburn.
If you want all the help you can get with your heartburn now, instead of waiting for my book, I recommend you check out my online course on airway reflux (LPR).