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With the recent recall of one of the most popular Heartburn medications, Zantac – Ranitidine – made by GlaxoSmithKline as a “precautionary measure”, this week we’re going to take a look at Heartburn. What it is, the most common triggers, one often overlooked – and counter intuitive – underlying cause and things you can do at home to help yourself. 
But, first, a quick reminder about your internal plumbing – as a client so beautifully put it – and, we hasten to add, without too many gory details (!). 
After being chewed, food is swallowed and passes down a tube – the Oesophagus – into the Stomach through a valve known as the Oesophageal Sphincter. This opens to allow food to pass through, before closing tightly to prevent any backflow of the Stomach’s contents into the Oesophagus and up into the Mouth. 
As food enters the Stomach, cells in its lining release Hydrochloric Acid (HCL), together with various other digestive enzymes. HCL is needed for two slightly different, but associated, reasons. First, it inhibits bacterial growth, so preventing the food from fermenting before it can be properly digested. Second, and much more important as far as Heartburn is concerned, HCL also provides the acidic conditions needed by digestive enzymes to work efficiently. 
To speed up digestion, muscles in the Stomach wall alternatively relax and contract, churning its contents to ensure they’re well mixed. At this stage, the mixture of HCL, food and digestive enzymes is known as “chyme.” 
As more HCL is released into the Stomach, the chyme gradually becomes more acidic – or, if you want to be more technical, has a lower ph – until it becomes low enough to trigger the Pyloric Sphincter at the bottom of the Stomach to open. The chyme then passes into the Duodenum for the next stage of digestion. And, you’ll be pleased to know, we’re going to leave the biology lesson there for today. 
What is Heartburn? 
Well, quite simply, it occurs when chyme passes backwards through the Oesophageal Sphincter, up into the Oesophagus and Mouth. 
With it being very acidic, it’s not surprising that the best known symptom of Heartburn is one of burning, both in the Oesophagus / Mouth and also in the middle of the Chest. This is accompanied by an unpleasant sour / metallic taste. There may also be an irritated cough or hiccups, hoarse voice and nauseous feeling. 
Heartburn is also a symptom of Gastroesophageal Reflux Disease (GERD), a more persistent acid reflux that happens more than twice a week. 
What makes it worse? 
Not surprisingly, laying down or bending forward makes things worse, as both put pressure on the Oesophageal Sphincter. Eating a large or rich meal can also have a similar effect. 
What are the most common triggers? 
Certain foods and drinks are well known for causing Heartburn. These include fried, fatty and spicy foods, tomatoes, coffee, alcohol and chocolate. 
While it was thought that this was due to their acidic – or rich – nature, it’s now become apparent that this is not the case. Instead they all affect the Oesophageal Sphincter, causing it to relax, so allowing the acidic chyme to pass up the Oesophagus and into the mouth. 
The exception to this are fatty foods, which simply need much longer to digest. As a result, the Stomach becomes fuller, causing pressure on the Oesophageal Sphincter. 
Smoking is another potential trigger as, longer term, it causes both Sphincters to weaken with similar results. 
Stress and anxiety have also been linked to Heartburn. This is due to the release of adrenaline, which shuts down non essential body functions including digestion, as energy is diverted for the fight / flight response. 
A number of medications have Heartburn listed as a possible side effect. The best known are anti inflammatories, such as Aspirin and Ibuprofen. Other medications include calcium-channel blockers, beta-blockers – used to lower blood pressure – and anticholinergics used to treat Parkinson's Disease. 
Heartburn can also occur during pregnancy, particularly in the later stages, where there simply isn’t enough room for the Stomach to expand. Pressure builds up and the Oesophageal Sphincter is forced open with all too predictable results. 
For similar reasons, it’s also linked to obesity, particularly where excess weight is carried on the Abdomen. 
Finally, Heartburn often occurs in those with a Hiatus Hernia
Now for one easily overlooked – and counter intuitive – underlying cause 
As we’ve already mentioned, HCL plays a key role in the early stages of digestion. With the burning sensations accompanying Heartburn, it’s all too easy to assume that the underlying cause is too much HCL. However, often this isn’t the case. And if this sounds completely wrong, bear with us, it’ll all make sense in a minute! 
If you stop and think about it, what would happen if enough HCL wasn’t produced? 
Well, as the Pyloric Sphincter at the bottom of the Stomach won’t open until the chyme becomes acid enough, it would have to remain in the Stomach for much longer. The Stomach would become much fuller and pressure increase on the Oesophageal Sphincter, forcing it open. Chyme would then flow backwards up the Oesophagus and into Mouth, causing Heartburn. 
The good news is there’s a really simple naturopathic trick to finding out if this applies to you. Next time you have Heartburn, simply take 2 or 3 tablespoons of apple cider vinegar in a small glass of lukewarm water. Don’t gulp it, sip it slowly. If this improves – or completely clears – the Heartburn, then it confirms that low Stomach acid production is part – or all – of the problem. 
What can you do at home to help? 
To start with, eat little and often. Make sure each mouthful of food is thoroughly chewed. 
Base meals around fibre, ie, around vegetables. Replace fats with lean protein. 
Many herbs have digestive qualities and can easily be added to meals. These include mint, dill, caraway, horse-radish, bay, fennel, tarragon, marjoram, cumin, cinnamon, ginger, and cardamom. 
Naturally fermented foods are acidic and contain “good bacteria” to help support digestion. These include sauerkraut and traditionally made pickles. 
Chewing gum stimulates the release of HCL, so reducing symptoms. 
Alternatives to apple cider vinegar include a pinch of baking soda in a glass of lukewarm water or a slice of fresh ginger, left to steep in newly boiled water. They can be sipped before or after meals to help reduce the likelihood of Heartburn. Drinking fennel or chamomile tea after a meal may also help. 
Aloe juice and Slippery Elm are traditional Naturopathic solutions to help soothe the burning pain associated with Heartburn. 
If you’re overweight – particularly those with an “apple” shape, carrying excess weight on the abdomen – losing weight will help, for obvious reasons. 
As will giving up smoking for lots of different reasons. Need we say any more?!? 
Finally, if stress or anxiety are playing a part, taking steps to reduce them – and so adrenaline levels -will help. As with giving up smoking and losing weight, this will have many other health benefits too. 
Finally, why has Zantac been recalled? 
Zantac, made by GlaxoSmithKline, has recently been recalled because it contains a chemical called N-nitrosodimethylamine (NDMA). This has been classified as a “probable human carcinogen” by the International Agency for Research on Cancer (IARC). NDMA has been linked to abnormal cell growths and liver abnormalities in rats, even at low doses. 
If you are currently taking it, don’t panic – or just stop taking it – but check with your Doctor or Pharmacist. 
As always, the choice is yours. 
Tagged as: Health, New perspectives
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