Heartburn: what remedies are available?

Heartburn: symptoms

Heartburn, or pyrosis, is a a painful sensation in the epigastric region (the pit of the stomach) which can extend behind the sternum and up into the throat. It usually occurs after a meal and is more pronounced when leaning forward, lying down or engaging in exercise.

Heartburn is very often associated with acid reflux which is the main symptom of gastro-esophageal reflux disease (GERD), the chronic condition in which stomach contents travel back up the esophagus (1).

Heartburn: causes

While the occasional episode of heartburn, following a heavy meal for example, is not a cause for concern, it is a problem when it becomes a daily occurrence.

Weakness of the lower esophageal sphincter

The stomach is equipped with anti-reflux mechanisms designed to prevent regurgitation towards the esophagus. The lower esophageal sphincter (LES), a kind of valve located at the junction of the esophagus and cardia (entrance to the stomach), is the main such mechanism. When it fails to close completely, gastric juices leak out which attack and damage the esophageal walls (2).

This over-relaxation of the LES is precipitated by factors that weaken the tone of the sphincter or cause the stomach to become distended: excessively large meals, insufficient chewing, drinking too many fizzy drinks (3-4)…

Heartburn and pregnancy

Pregnancy exerts upward pressure in the abdomen which often causes LES dysfunction (5). For the same reason, being overweight, wearing clothes that are too tight around the waist, or excessive fermentation in the gut all exacerbate acid reflux (6-7).

Hiatal hernia

A hiatal hernia occurs when the upper part of the stomach bulges outside of the abdomen into the chest cavity. In what are referred to as ‘sliding hernias’, the LES can become lax due to the jerky movements of the diaphragm during respiration.

Heartburn and stress

Whether physical or psychological, stress promotes heartburn because it delays gastric emptying, increases stomach distension and acidity, and maintains a state of chronic inflammation (9).

Taking certain medications

It is now scientifically established that long-term use of aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) weakens and erodes the gastric mucosa (10).

Heartburn: what to eat and what to avoid

In terms of diet, it’s advisable to reduce your consumption of alcohol as well as foods that irritate the gastric mucosa such as spices, tomatoes, garlic, onions, citrus fruit, salt, sugar and vinegar. Fats, especially saturated fats, inhibit emptying of the stomach and should therefore be restricted, as should coffee, tea and chocolate which reduce LES tone (11). The best advice is to listen to your body and see what it can tolerate.

There are foods that are neutral or protective against gastric discomfort. A good intake of lean protein (poultry, fish…) may strengthen LES tone (12). Reasonable quantities of green vegetables and starches are usually well-tolerated.

It’s best to eat fresh fruit in between meals to restrict fermentation. The fruits most recommended for acid reflux include bananas, apples, pears and papaya (13).

Heartburn: allopathic medicine

If you suffer from heartburn and acid reflux, seek advice from your doctor who will be able to suggest a suitable treatment. Over-the-counter antacids rapidly neutralise excess acidity, but as they do not address the root cause, they only offer temporary relief and require repeated doses.

Proton pump inhibitors (PPIs) are the most commonly-prescribed medication for acid reflux. By reducing the secretion of hydrochloric acid (the acid component of gastric juices), they reduce the intensity of heartburn and encourage the healing of lesions.

Taken long-term, however, they have adverse side-effects: increased risk of cardiovascular problems, malabsorption of various nutrients (calcium, magnesium, iron and vitamin B12), dependence (14)...

Note that in cases of severe acid reflux, surgery may be considered to reseal the valve at the base of the esophagus.

What can you do to relieve heartburn naturally?

Good daily anti-reflux habits

• reduce, or better still, give up smoking as it inhibits salivation, irritates the gastric mucosa and reduces lower sphincter pressure (15);
• chew your food thoroughly to facilitate its digestion;
• consider dividing up your meals to avoid that ‘over-full’ feeling;
• remain upright for 1-2 hours after a meal, and wait at least 3 hours before exercising;
• wear loose clothing that does not constrict the waist;
• raise the head of your bed by 10-15 cm to reduce heartburn at night;
• try to lose a few kilos if you’re overweight or obese;
• control your stress levels with relaxation techniques (meditation, yoga, cardiac coherence breathing…).

Use green clay to relieve heartburn

Make a green clay poultice (mixing the clay with water) and apply a 3cm thick layer to your stomach. Cover with a damp cloth and leave for between 20 minutes and 3 hours.

Heartburn and honey

With its anti-free radical properties, honey is thought to help prevent damage to digestive tract cells. What’s more, its sticky texture may line the stomach wall and protect it from excess acidity (16). Among the most sought-after varieties are dandelion, acacia, lemon balm and manuka.

Heartburn every day: supplements to the rescue

Once a diagnosis has been made, it can help to take certain supplements alongside conventional treatments.

Liquorice (Glycyrrhiza glabra) supports gastrointestinal health by stimulating mucus production by the stomach (17). At high doses, however, its high glycyrrhizin content carries the risk of side-effects (headaches, heart problems, raised blood pressure) (18). To benefit safely from its properties, choose a deglycyrrhizinated form (such as DGL, guaranteed glycyrrhizin-free and made from liquorice root, the part of the plant most widely-studied for its effects on the stomach).

Native to the Mediterranean region, the mastic tree (Pistacia lentiscus L.) produces a resin called Chios mastic. By coating the stomach wall, it is thought to reduce the adherence of pathogens involved in gastro-esophageal reflux (the mastic extract Mastic Gum is standardised to 10% masticonic acids for enhanced effects) (19).

It’s also worth mentioning the possibility of infection by the bacteriaHelicobacter pylori (20). One in four people in the West are believed to harbour this bacteria in their gastric mucosa. Though sometimes asymptomatic, it can also manifest in digestive pain or the development of an ulcer. Recent research has identified a particular strain of lactobacillus as able to bind to H. pylori (it can be found in the formulation H. Pylori Fight, which contains the patented strain Pylopass™ obtained from L. reuteri) (21).