Good food and wine are integral components of Tom Meyer’s life. Yet for most of Meyer’s adult life, food and drink have been a source of chronic pain. “As far back as I can remember, I’ve been plagued with heartburn, and at times almost anything, including water, will set it off,” says the 55-year-old wine distributor and gourmet chef. The pain got so bad about five years ago that Meyer finally went to see his doctor, who prescribed Prevacid, an acid-reflux medication. Since then, Meyer has taken several different prescription and over-the-counter drugs to ward off the pain. Although he has not experienced adverse side effects from taking these medications, Meyer would like to be able to manage his acid reflux naturally. “As a chef and wine lover, I would be particularly happy if I could do this without drastically changing my lifestyle or eating habits,” he says.
Q. Tom Meyer: I have never been able to pinpoint what exactly is triggering my heartburn. What are the most common causes?
A. Mona Morstein, ND: Several different things could be causing your heartburn symptoms. Doctors once believed that heartburn and acid reflux were caused by the overproduction of stomach acid. For a certain percentage of people, this is the case. But in many situations, it is not. In fact, for some people—especially as they get older—their bodies are actually producing too little stomach acid, and this can cause heartburn as well.
Q. How so?
A. At the junction of the esophagus to the stomach is the esophageal sphincter. Eating food causes the production of stomach acid, which, in turn, triggers the sphincter to close. If we don’t make enough stomach acid, however, the sphincter may not get that trigger and will stay open, and this will lead to heartburn. In addition, certain foods such as chocolate, coffee, tomato sauce, and citrus fruits can trigger heartburn by relaxing the lower esophageal sphincter.
People also often experience heartburn pain when they have an anatomical defect such as a weak or dysfunctional esophageal sphincter or a hiatal hernia, a common condition that occurs when the stomach partially bulges into the chest cavity because of a weakness in the diaphragm. For these people, surgery is often required to fix the problem. Being overweight also can contribute to acid reflux, because the extra abdominal fat causes upward pressure on the stomach, forcing acid back up into the esophagus. Heartburn is common during pregnancy because of the pressure exerted on the stomach by the developing fetus.
What most people don’t know, however, is that food allergies can trigger some of the worst heartburn symptoms. I’ve seen numerous situations where a person doesn’t seem to have any other allergy symptoms, but when they eat a particular food it feels like a blowtorch is going off in their stomach. The foods that most often cause this are dairy and wheat.
Q. How would I find out if I have a food allergy?
A. The first step is to keep a diet diary in which you write down everything you eat for a week. You also want to write down the heartburn symptoms you experience and when, so you can potentially clock them to the food you ate. I recently treated a patient who had severe heartburn for ten years. She kept a diet diary, and we learned that every time she ate wheat she had heartburn. We took her off wheat and, bingo, for the first time in a decade she has no heartburn.
I would also suggest you have your doctor or a naturopath draw your blood and send it to a lab for what we call an IgG food-sensitivity test. The IgG blood test, in conjunction with the diet diary, will help determine if specific foods are aggravating your stomach.
Q. You mentioned foods that could trigger heartburn, but are there foods or herbs and supplements that can help ease the pain?
A. Absolutely. The stomach naturally has a thin mucous lining that protects it from acid. If you don’t have a good mucous lining, your body can make even small amounts of acid and you will feel the burn. So when working with this problem in naturopathic medicine, we build up a really healthy mucous lining in the stomach. My favorite way to do this is to drink a gruel made from slippery elm (Ulmus rubra) powder. In my experience, there is nothing more soothing or better at building up the mucous lining of the stomach. To make the gruel, mix 1 teaspoon slippery elm powder with 1/4 cup cold water to make a thick paste. Then add about 1 cup hot water and stir. Let it cool a bit, and drink it down. Slippery elm doesn’t taste bad, but if you let it cool too much it will develop a very mucouslike texture. You can drink this once or twice a day. If you can’t stomach the gruel, you can take slippery elm capsules.
Like slippery elm, marshmallow (Althaea officinalis) is an herbal demulcent, meaning it’s an oily, sticky herb that helps soothe irritated tissue and rebuild the stomach’s mucous lining. Licorice (Glycyrrhiza glabra) is an anti-inflammatory herb that helps ease inflammation of the stomach and esophagus so healing can occur. Licorice can also be very soothing. I don’t like to use licorice long term, however, because it could raise blood pressure. If a patient already has high blood pressure or is overweight, I will use deglycyrrhizinated licorice (DGL), which has had the part of the licorice herb that raises blood pressure removed. In addition to these supplements, you want to eat foods that are good at settling the stomach, including aloe juice or foods rich in anti-inflammatory oils, such as fish and walnuts.
Q. Are there other steps I can take that might help?
A. You might want to try acupuncture and homeopathy. I’ve seen both help with heartburn. Also, for many people, stress or a dysfunctional emotional state can affect the stomach. So learning how to remain calm by working with yoga, meditation, or prayer can help ease heartburn and indigestion. With some of my patients, I will look at their spine to make sure there are no vertebrae out of alignment, which can cause nerve irritation to the stomach and other organs.
Q. I’ve been taking acid-reflux medications for about five years, and I’m currently taking the maximum daily dose of Prilosec OTC. Are there risks associated with taking these drugs long term?
A. These drugs are not dangerous, but they are also never curative. Prevacid, Prilosec OTC, and other types of proton-pump inhibitors work by shutting down the production of hydrochloric acid in the stomach. Although this can stop the symptoms of heartburn, it is important to understand that severely reducing stomach acid can also lead to several problems, including impaired protein digestion. In addition, stomach acid helps to kill any bacteria we may eat in our food and is vital to the absorption of vitamin B12. Still, prolonged exposure of the esophagus to stomach acid can lead to serious medical conditions, so something must be done to take care of the acid. If a natural approach isn’t available or is not something you want to do, then you’d better take one of these medications.
Q. Do you think it is possible that I could eventually go off the medication, or at least reduce the dosage I need to take?
A. Yes. Stomachs can heal. But first you must remove any obstacles to the cure, which in your case could be a food allergy or other constant irritation. It may be that you need to reduce your consumption of wine, coffee, and other irritants until your stomach is healthy again. Once it is healed, you can begin adding these back into your diet.
Of course, the reality is that you may have to live permanently with a restriction or two because a certain food simply will not work in your body. A naturopath could help you find the cause of your problem, but in the end you’ll need to make your own decision. Do you want to continue eating the food that is irritating your stomach and stay on your medications, or do you want to get off the food, heal your body, and live a life without the pills but with that food restriction? The choice is up to you.