Humans have suffered from heartburn for all of history. Hippocrates warned in 400 BC that eating cheese after a full meal could cause indigestion, especially if accompanied by wine. Centuries ago, doctors called it dyspepsia, from Greek words meaning difficult to digest. These days, drug companies stress an even scarier name: gastroesophageal reflux disease (GERD). If you have frequent heartburn, that could be a symptom of GERD.
What Is Heartburn?
Whatever you call it, heartburn is unpleasant. It can ruin the memory of a great dining experience. And trying to sleep with a burning sensation in the middle of your chest can be difficult at best and impossible at worst. Reflux can also lead to more serious conditions. The longer irritating stomach contents stay in contact with the delicate tissue of the esophagus, the more damage they do. Repeated exposure to this noxious nastiness can cause scarring, stricture, and abnormal cell growth, a condition known as Barrett’s esophagus. Most worrisome of all is the risk of esophageal cancer. People with Barrett’s esophagus do have an increased risk for this serious cancer, but the danger is not always quite as high as the gastroenterologist may imply. (Listen here for more details.)
Let’s be perfectly clear. Anyone who experiences prolonged bouts of heartburn must be seen by a competent gastroenterologist for a thorough workup. This is not a do-it-yourself project!
Why Do We Have Stomach Acid?
The underlying cause of GERD is more mysterious than you would think. Commercials for antacids or powerful prescription reflux drugs often blame heartburn on excess stomach acid, as if Mother Nature made a giant mistake. But we’re supposed to have acid in our stomachs. Starting some 350 million years ago, virtually all animal species evolved sophisticated systems for creating strong stomach acid. Halibut make hydrochloric acid in their stomachs. So do dogs, cats, cows, birds, frogs, snakes, and salamanders. Just because drug companies have figured out ways to shut down acid production with medications such as omeprazole (Prilosec), lansoprazole (Prevacid), and esomeprazole (Nexium) does not mean this is the only way to combat heartburn.
Stomach acid is essential for digesting food and facilitating the absorption of certain nutrients. The acid environment in the stomach also creates a barrier against infection. We swallow germs every day from our food and other sources. But it is hard for bacteria to survive in the stomach if there is a hostile acidic environment. Trying to prevent the creation of stomach acid is like fighting back the tide. We’re not at all certain that long-term acid suppression is always such a good idea.
How to Handle Your Heartburn:
Persistent symptoms of pain, burning, or pressure behind the breastbone should be investigated by a doctor to rule out a serious condition. For an occasional attack of indigestion, however, there are lots of things you need to consider. Before pulling out the heavy artillery of acid-suppressing drugs, there are many options to contemplate. Here is a quick snapshot:
- Avoid foods or drugs that might make the lower esophageal sphincter lazy and let gastric juice creep back into the esophagus. There are few good studies, but some possible culprits include chocolate, carbonated beverages, smoking, diazepam, and progesterone.
- Cut back on carbs. Although the data are preliminary, there is some suggestion that the typical high-carbohydrate American diet may be contributing to reflux.
- Saliva is the body’s natural buffering agent and fire extinguisher for heartburn. Chewing gum or sucking on hard candy can help relieve symptoms.
- Chamomile or ginger tea also can wash acid out of the esophagus and back into the stomach where it belongs. These traditional remedies also may help calm an upset stomach.
- Other herbal products that can be helpful include fennel seed (in capsules or tea) or flaxseed tea.
- Home remedies such as sipping diluted apple cider vinegar or even swallowing yellow mustard may help. Each person is different, though, so trial and error will be the only way to find out if a home remedy will work for you.
- Baking soda remains a time-honored solution for occasional heartburn. Dissolve 1/2 teaspoon of powder in 4 ounces of water. For those on sodium-restricted diets because of congestive heart failure or high blood pressure, this is not an option.
- If you need an antacid, calcium carbonate remains one of the cheapest and most effective in the pharmacy. Tums Ultra contains 1,000 milligrams of calcium carbonate and is a cost-effective option.
- In our opinion, a sensible first choice for an OTC acid-suppressing drug is Pepcid Complete. It combines the immediate action of antacids (calcium carbonate and magnesium hydroxide) with the longer-acting H2 antagonist famotidine. Short-term use should be safe.
- If you feel you must take a powerful acid-suppressing PPI, we would opt for Prilosec OTC. If you have great insurance coverage, you might save money if your doctor prescribes generic omeprazole instead. We think a little vitamin insurance is appropriate whenever acid-suppressing drugs are taken for any length of time (vitamin B12, vitamin C, and vitamin E).
- Try sauerkraut juice.
Sauerkraut Juice as a Heartburn Remedy:
Q. One “old wives’ tale” remedy for heartburn is sauerkraut juice. I think homemade works the best. Are there other natural remedies for heartburn?
A. Homemade sauerkraut juice contains probiotic organisms. Studies suggest that such good bacteria may help ease symptoms of digestive distress (Gut Microbes, Nov-Dec, 2010).
There are quite a few other natural remedies for heartburn, ranging from persimmon tea to ginger, mustard, vinegar or hot peppers. Deglycyrrhizinated licorice (DGL) can often be helpful.
For more information on treating heartburn naturally along with the pros and cons of drugs used for reflux, we are sending you our Guide to Digestive Disorders.
Try Changing to a Low-Carb Diet:
One approach that is not usually suggested can work surprisingly well: Change the diet to reduce the amount of carbohydrates you eat, especially simple carbs like bread, pasta, pizza or rice. Of course, cakes, candy and cookies also contain simple carbs, mostly sugar, and can aggravate digestive difficulties. While weight loss can reduce the need for drugs to control heartburn symptoms (Diseases of the Esophagus, Feb-March 2016), the relief from heartburn kicks in early, even before significant weight loss has occurred (Digestive Diseases and Sciences, Aug. 2006). Recent research suggests that protein from vegetable sources is less likely to trigger symptoms (Gastroenterology Research and Practice, April 19, 2018), so it might be appropriate to consider a vegetarian or mostly plant-based diet.
Is Your Lifestyle to Blame?
When’s the last time you sat down to a leisurely dinner with the family? Nowadays, that seems like a fantasy from Norman Rockwell.
Americans eat on the run. With pressure to work late, lots of after-school activities for the kids, committee meetings and exercise, there’s rarely enough time to sit down together even if there were time to cook.
We gobble down burgers or pizza from fast food joints or “grab and go” with supermarket sushi. It’s hardly any wonder that indigestion is a national affliction.
The Old Days of Heartburn Help:
For many, treating heartburn has become a way of life. It used to be simple and cheap. Half a teaspoon of baking soda in a glass of water offered fast relief from stomach upset.
Those who wanted a store-bought remedy could choose Alka-Seltzer, Tums, Rolaids, Maalox or Mylanta. These familiar antacids were medicine chest staples. They often relieved heartburn within minutes.
Nowadays Americans spend billions on a vast array of sophisticated stomach medicine. There are so many options, both prescription and over the counter, that making a cost-effective choice is a challenge.
Twenty years ago, prescription acid suppressors like Tagamet (cimetidine), Zantac (ranitidine) and Pepcid (famotidine) revolutionized the treatment of ulcers. When they lost their patents, these drugs went over the counter to compete head-to-head with old-fashioned antacids. Patients had to decide whether to purchase Zantac 75 instead of Tums or Maalox.
Simultaneously, doctors turned to more powerful prescriptions such as Prilosec (omeprazole) and Prevacid (lansoprazole). These proton pump inhibitors (PPIs) are very effective at suppressing acid, but at a steep price. In its prescription heyday Prilosec ran over $4 per pill, and grossed about $4 billion annually.
When Prilosec lost its patent, the company decided to cash in on its brand name recognition. Prilosec OTC became highly successful as a nonprescription aid to indigestion.
No sooner did Prilosec go over the counter than other PPIs took over its place in the Rx marketplace. Soon Prevacid and then Nexium became prescription favorites for combating reflux, raking in billions for their manufacturers. As each lost its prescription patent, the company took it OTC. Nexium 24HR is just the most recent prescription-to-OTC switch.
Heartburn Relief When You Need It:
What is rarely mentioned in the advertising is that proton pump inhibitors take longer than old-fashioned baking soda or calcium carbonate (Tums) to go to work. In response to the question, “How quickly does Nexium 24HR work?” the company responds:
“Nexium 24HR may take 1-4 days for full effect, which is 24 hours of complete relief from frequent heartburn.
“Use as directed for 14 days to treat frequent heartburn. Do not take for more than 14 days or more often than every 4 months unless directed by a doctor. Not for immediate relief.”
Did you catch that? “Not for immediate relief.” In other words, if you overdid it at the ballpark or at Thanksgiving dinner, Nexium 24HR is not your drug of choice. Nor is any PPI. They take a couple of days to go to work to suppress acid. If you want immediate relief from overindulgence, an old fashioned antacid will go to work in minutes, not days. By the way, a two-week supply of Nexium 24HR will cost about $12 to $15 compared to pennies for baking soda.
What About Side Effects?
Occasional use of proton pump inhibitors like Prilosec, Prevacid or Nexium will probably not cause an adverse reaction. But people tend to ignore the warning to only take such acid suppressors for two weeks. What people don’t realize is that stomach acid exists for many reasons. One is to kill unwanted germs. Without an acid barrier, bacteria that would normally die can survive and land in the lungs because of reflux. This can increase the likelihood of developing pneumonia. There is also a risk of developing a hard-to-treat intestinal bug called C. difficile, which can cause terrible diarrhea.
Another issue is nutritional deficiency. Long-term use of acid suppressing drugs can lead to a deficiency in vitamin B12. To be absorbed adequately, this nutrient needs an acid environment. Calcium, magnesium and iron may also be harder to absorb with a PPI on board. There are serious health consequences to such nutritional deficiencies.
Other side effects of a drug like Nexium 24HR include, paradoxically, digestive upset, nausea, stomach pain and diarrhea. Headaches, skin reactions, fractures and blood disorders are also possible problems. In addition, doctors have recently identified a link to kidney failure.
PPIs and Kidney Problems:
Canadian researchers have found that older people taking acid suppressing drugs such as esomeprazole, lansoprazole and omeprazole are at higher risk for kidney failure (CMAJ Open, April 16, 2015).
The scientists used medication and hospitalization records of nearly 600,000 senior citizens in Ontario between 2002 and 2011. Approximately half of these people were taking proton pump inhibitors like Nexium or Prilosec, while the other half were not.
Although hospitalization for kidney injury was uncommon, occurring in less than 1 percent of those in the study, it was still more than twice as likely among people on the heartburn medicines.
Other Worrisome Side Effects:
This is not the only potentially serious side effect these drugs have been linked to. Other complications include osteoporosis and bone fracture as well as pneumonia and C diff intestinal infections. We have written about them here.
Weaning Off Proton Pump Inhibitors
Finally, and rarely mentioned, is the problem of stopping a PPI suddenly. When someone has been on an acid-suppressing drug for several months it can be challenging to get off such a drug. That’s because of something called rebound hyperacidity. The cells that make acid go into overdrive and start churning out extra acid. That can produce really bad heartburn for several weeks until things eventually calm down. To learn more about getting off PPIs, here is a link.
Howard told his story:
“I used to have bad heartburn everyday. I had to take PPI’s everyday. But I switched to tumeric, do stress management, and avoid canned/process food. Now, I don’t have heart burn any more. Occasionally my heartburn returns when I eat too much spicy food.”
By now, you are probably as confused as can be about what to do for heartburn. You will find lots of non-drug approaches in our book, Quick & Handy Home Remedies from The People’s Pharmacy. You will learn that a handful of almonds can be surprisingly effective (on page 104). As shown in the video at the top of this post, broccoli can also be beneficial. You may also be surprised to learn that bananas can be helpful, as can chewing gum. There are also hints about fennel, “digestive tea” and ginger. You will also get more details about “Persimmon Punch,” as shown in the video.
What about eating more sensibly? If we could avoid the temptations of fast food and faster snacks, some of the heartburn that troubles us might not need treatment at all. In Quick & Handy Home Remedies you will learn how a low-carb diet can tame heartburn. There is even scientific research to support this approach. In addition to the video above, you may want to listen to a few of our radio interviews on the topic of heartburn: