Heartburn is a symptom that many individuals can identify with experiencing at least once in their lives — the burning and aching in the chest and substernal region often associated with meal consumption. Perhaps it was triggered by the acidic tomato sauce or spicy salsa and a margarita of a recent Italian or Mexican food feast, or just by the increased volume of food in one setting. For some, however, this is a chronic state of digestive imbalance, and for these individuals, physicians often prescribe treatments such as antacids, histamine receptor antagonists or proton pump inhibitors. These medications are used as chronic heartburn is very painful and possible long-term sequelae include malignant (cancerous) changes.
The problem with proton pump inhibitors. Proton pump inhibitors, also known as PPIs, are not medications that are meant for long-term treatments. Our stomach requires an acidic state for the digestive process. Stomach acid and other secretions are the stimuli that trigger appropriate secretion of other digestive proteins and signaling molecules, and are necessary for the absorption of vitamins and nutrients in the small intestine. When we suppress stomach acid with a medication such as a PPI, this inevitably leads to other problems with digestion. Some of these problems may not be recognized right away, but studies have shown that long-term use of a PPI may lead to increased risk of fractures associated with decreased calcium and magnesium absorption, as well as other problems due to decreased absorption of vitamin B12 and iron.
Naturopathic assessment. Naturopathically, many things may be assessed in the development of chronic heartburn symptoms. The state our body is in when we eat meals can contribute to many different digestive symptoms. Many individuals eat meals in a high-stress “on the run” fashion, however, all aspects of digestion need our body’s parasympathetic function, which we know as the “rest and digest” state. The consumption of “C.R.A.P.” contributes to the development of heartburn, with many things including coffee, cigarettes, chocolate, cayenne, refined carbohydrates, alcohol, aspirin, acidic foods and pop (soda): this acronym serves to remind us of these controllable factors which many individuals take in every day. However, there are further things which are considered by naturopathic physicians in the assessment of heartburn, such as the possibility of food sensitivities, hiatal hernia, small intestinal bacterial overgrowth and chronic stress. Each of these is treatable with naturopathic interventions.
Naturopathic support for heartburn relief. Aside from the elimination of the contributing consumption items previously mentioned, there are many different steps of intervention. Botanical treatments for stress reduction and gastric mucosal protection, supplemental enzymes for digestive support, and physical medicine treatments for hiatal hernia are often the starting basics for treatment. For individuals who have been on PPIs or other heartburn medications for longer periods of time, these interventions are initiated prior to the gradual discontinuation of pharmaceutical medications to prevent the exacerbation of symptoms. If heartburn is resistant to these treatments, further assessment and treatment of food sensitivities or small intestinal bacterial overgrowth is the next step in treatment, as these are often contributing factors as well. With the appropriate assessment and treatment of the contributing factors which manifest as heartburn symptoms, the holistic interventions often manifest in improved digestion and sleep, reduction of chronic stress and pain, and a greater overall state of health.