The People's Perspective on Medicine

Heartburn

You can manage occasional heartburn with home remedies or OTC medications. More frequent symptoms deserve medical attention.

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.

Modern-Day Mix-Ups:

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.

Learn More:

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:

Show 1078: How to Have Good Digestion Without Heartburn Drugs

Show 1144: New Ways to Heal Your Digestive Tract

Show 1024: Could Popular Heartburn Drugs Destroy Your Kidneys?

Updated 1/7/2019

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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Try eliminating all mint from your diet, especially mint flavored toothpaste. I discovered this when I realized I experienced GERD pain right after brushing my teeth, which I did right after eating. Toothpastes seem to be trying to outdo each other with more and more powerful mint flavor. A possible connection to the GERD “epidemic”? Mint apparently relaxes the esophageal sphincter.

I was sure that I was having a heart attack the pain in the left pectorial was intense. A visit to the emergency room resultd in a diagnoses of
GERD. I have changed my diet and the Gerd is on its way out of my life.
THANKS

please supply recipe for this remedy

I have an unscientific, empirical study of one subject–me. And it was an accident. I went to my doctor and complained of some sleeping problems and, after some tests, he suggested melatonin to help me sleep more deeply and stay asleep longer during the night. I started taking it and it did exactly that. What I ALSO realized was that I didn’t have heartburn anymore. Not the intention for taking the melatonin at all–hadn’t even heard of that possibility at that point–but that was the unexpected side effect.
Prior to that I had seen myself starting to go down the path my dad had, frequently taking a Rolaid or Mylanta or some such at bedtime, even getting up during the night on occasion to do so. Bothered by “typical” (I thought) heartburn. I just chalked it up–like father, like son (then in my late 40s). After a while of concentrating on my sleep situation it dawned on me that I hadn’t taken any antacids lately–at all. And I had not changed my diet or lifestyle in any way. It’s been well over a year now (closer to one and a half) and that is still the case. Never take a Rolaid or anything and never even think about doing so.
I’ve been taking just the standard dosage my doctor recommended of 3mg melatonin every night when I go to bed. Very interesting and definitely did not see that coming. As side effects go, I’ll take it! Keep in mind I was NOT being treated for GERD or any such disorder, so my prior digestive situation may have just been “normal” annoying acid reflux, indigestion, heartburn… whatever you want to call it. But, yeah, I’ve experienced the “melatonin effect” and I’m really curious about it.

This is my newly discovered tip to ameliorate heartburn. Suffered off and on for forty years and increasingly so lately, especially when going to bed, and even with a head-end raised bed. Doctor prescribed Prilosec and it works, but I decided to discontinue after hearing of the possible side effects. Then I decreased my evening meal portions and took an antacid as Tums before bedtime. That helped.
By chance, I had half Cream cheese covered bagel before bed time. No heartburn! Did again next night. Same results. Concluding that the bagel wasn’t the angel, I stared on a regimen of cream cheese thirty minutes before bedtime each night. Heartburn is gone, unless I overeat at the evening meal. I eat one once, i.e., one eighth of a an eight once packet of Philadelphia or equivalent cream cheese.

I was put on a PPI—Prevacid & have read a lot of Bad Press about using PPIs for long periods of time. SOMEONE mentioned something about taking Apple Cider vinegar each morning instead of taking those drugs……but I can’t remember EXACTLY how much vinegar & if you mix it with something.
I tried going OFF Prevacid for two days & had terrible vomiting….so am back on the drug but would really like to know about the “vinegar cure”
RES

For years I suffered heart burn, test showed a hiatal hernia and GERD, Dr put me on Prilosec for 5 years, Then I started reading about calcium loss if on these type of Drugs too long a. I tried to get off Prilosec but HB would return. I went to a holistic Dr who had me stop eating white refined bread products, like store cookies, english muffins, etc, put me on Ezekiel Bread.
I’ve been off these drugs 4 years now. Only get occasional HB if overeat tomatoes or a English muffin, then I take a TUM. I still go to a western Dr, but more and more my Holistic Chiropractor Dr comes thru for me. I’m now off my Asthma meds. and my Family Dr can’t believe how healthy my lungs are now. I also have RA, Lupus, and was born with Marfan Syndrome, With food supplements, adjustments and swimming I’m not on any meds. Other then Blood pressure because of the Marfan’s since I already had my Aorta replaced. I wish we would embrace both medical cultures to get off the spiral drug phase. Been there.

I have had a chronic cough for many years, recently realizing it is due to GERD even though I do not have heartburn. An internist put me on a trial of Prilosec a few months ago and within days it got much worse. I have too little hydrochloric acid, not too much.
A new doctor is now having me take Hydrochloric Acid/Pepsin supplements. The cough is finally getting better and I can now sleep through the night without waking up coughing all night long. From what I have read lately, a patient is never tested to determine if they have too little or too much acid in their stomach and is always treated with the assumption that heartburn is due to too much.
There is a clinic in Seattle that does test for HCL levels and after testing 1,000’s of patients with heartburn, not even one has had too much acid. By suppressing the little acid one has left in the stomach, which can be due to age or other unknown reasons, the ability to absorb nutrients from food is greatly compromised which can cause all sorts of problems. Their viewpoint is that for many patients with heartburn there is too little acid causing the symptom, not too much, as counter-intuitive as it sounds.

Mine gets really bad at night – I put raisers under the front legs of my bed so I wasn’t sleeping flat but with my head higher than my feet. Just a tip :)

Regarding heartburn and acid reflux – I have finally found that 2 or 3 tablespoons of Aloe Vera Gel works immediately to stop the pain. More is ok if needed but a small amount works for me and I have had severe heartburn for years and got no relief from over-the-counter remedies.

I found that you can just purchase persimmon tea leaves in loose or bagged quantities. Just making the tea without the extras is just as effective! Now I can take the tea with me wherever I go and I enjoy the taste.

I just had my tonsils and adenoids removed and I am having a challenge getting the “glarp” in my throat to go away and to get my voice back. I sound like Minnie Mouse most of the time. My doctor suggested zegerid to treat acid reflux but I don’t have any heartburn or other symptoms. I didn’t like the list of side effects listed on the drug and I don’t want to have to stay on this medication into the future.
I got the advice to make persimmon tea. Where can I find the recipe for the proper amounts of each ingredient to make it?
PEOPLE’S PHARMACY RESPONSE: HERE’S THE RECIPE:
https://www.peoplespharmacy.com/2009/08/02/persimmon-tea-eases-acid-reflux/
WE DON’T THINK YOU NEED NEARLY THAT MUCH SUGAR.

Has anyone heard or read anything about recent studies or literature linking Melatonin with heartburn relief? What I read states that Melatonin is produced in the Pineal gland as well as the stomach and, for reasons I don’t understand, supplementing with Melatonin has helped some people who suffer from GERD symptoms.
I would love to hear if anyone has tried this or knows any more scientific data to back this assertion up.
I read one study quoted that sounded promising.

I will try some of these remedies, but my reflux is LPR not GERD. Any insight would be helpful.

I have tried all the prescription drugs for GERD with no success. Are there any natural remedies for GERD? Need help–Very frustrated. Thank you.

A caller on the October 18, 2009 radio program gave a recipe for a tea made with fresh persimmon, cinnamon sticks, sugar and fresh ginger. Her husband and sister, both of whom suffered with severe acid reflux at night, had immediate relief by daily taking a shot glass of the tea once in the AM and again around 8 PM.

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