90% of Heartburn is Self Inflicted!

I often see patients in the office who are suffering from something that, although is distressing to them and causing them true discomfort, is completely self-inflicted.  These conditions remind me of the story an old doctor told me one time about a patient who came into his office complaining of a headache. 

As the old doctor interviewed the patient, he noticed that the patient kept banging himself in the head with a hammer...  In the coming months I'm going to be touching on several of these topics.  For now, Let's start with Heartburn, AKA: reflux, GERD or esophagitis.  Heartburn is not always self-inflicted, but easily over 90% of all the cases I see are...

Your stomach was made to hold acid 24/7.  There is nothing wrong or abnormal with there being acid in your stomach.  It is actually a good thing; without it, you would not be able to digest much of your food.  Commercials on TV sometimes lead you to believe that acid is the problem, but the problem is when the acid lingers too long somewhere it should not be. 

Your esophagus is made to only endure an occasional splash of acid without much trouble, but cannot handle being in contact with stomach acid for hours at a time. 

The average person probably had some acid splash back up into their esophagus just a few minutes ago, but since their esophagus is not already irritated, they felt no discomfort, and didn't even know it happened.

There is a small pucker-muscle between your stomach and your esophagus that normally prevents much more than the occasional splash of acid back up into the esophagus.  As long as this muscle works properly, Heartburn is a rare thing to have.

So, with this understanding of heartburn, we can make some deductions:

• stomach acid is a liquid, so it follows the law of gravity
• anything that keeps open the way between stomach and esophagus increases Heartburn
• anything that irritates the stomach or esophagus lining can increase Heartburn
• anything that increases stomach pressure can increase Heartburn

Further Reading

Now with this understanding, it is pretty easy to create a list of things that will increase your risk of Heartburn, and increase how severe it is if you have it.  By knowing what can cause Heartburn, you can do thinks to prevent it, or make it better without medicine.  A good rule of thumb to remember is that although you might suffer from Heartburn symptoms during waking hours, most of the damage is actually done while you sleep. 

When you lie in bed, any leak in the pucker muscle between your stomach and esophagus allows the acidic stomach liquid to seep up into the esophagus.  Since the esophagus is made to handle an occasional acid attack without much pain, you don't notice this initially.  By the time that the esophagus' acid defenses are broken down, you are sound asleep. 

Therefore, you can lie in bed for hours with stomach acid eating at the lining of your esophagus before you have any pain.  The next day, however, the least splash of acid causes pain in the already irritated esophagus; ugh, Heartburn!

So our first way to prevent or improve Heartburn is to place a brick under each head-post of your bead.  Not enough lift for you to notice, but just enough to keep the acidic liquid down in the stomach where it belongs.  I have had patients who have taken thousands of dollars worth of Nexium or Prevacid or Protonix be able to stop the medicine within two weeks of putting the bricks where they belong.  For those of you with water-beds, no, this won't work.  Also, propping up on pillows will not work as well as the bricks because the act of propping up can actually increase pressure within the stomach.



Possible Cause

 The next things we can discuss increase the pressure inside the stomach, thus pushing stomach acid up into the esophagus.  These are being overweight, and being pregnant, or propping up on too many pillows.  These things increase the pressure and decrease the room in the stomach and can push acid back up into the esophagus.  So yes, I have had many patients excitedly tell me that since they have lost that weight (or had that baby) the Heartburn is gone!  Eating a big meal right before bedtime can also lead to this same thing.

Another culprit that can lead to Heartburn is anything that relaxes the pucker-muscle between the stomach and the esophagus.  The most common substances that cause this are Nicotine, Caffeine and Alcohol.  This does not mean you have to stop drinking coffee, or the occasional mixed drink; it does, however, mean you need to QUIT SMOKING! (or dipping, or chewing) 

These substances have a time limited effect on this pucker-muscle so stopping them before dinner time will usually keep them from causing much problem, unless your esophagus is already irritated and inflamed by one of the other causes.  A Hiatus (Hiatal) Hernia can also cause this pucker-muscle to fail.  This is a more complicated mechanical process, but it is safe to say that if you have a hiatus hernia, you should avoid any of the other causes of Heartburn. 



Makes it Easier



You must remember that the tissue lining your esophagus is like the skin on your hand; it will take 2-3 weeks for it to completely heal after you stop doing whatever it was that damaged it.  So if your stop doing all the wrong stuff and start doing all the right stuff, it's going to take from 2-3 weeks before you really feel the benefits of your changes.  Be patient, not having Heartburn it is worth the wait.  Years of continued reflux can lead to scarring of the esophagus or even cancer.

Anti-inflammatory medicines, such as Steroids and NSAIDS block a chemical pathway in the body and can lead to stomach irritation, which can lead to Heartburn.  If you must take these types of medicines, do so with your first meal of the day so the food protects the stomach lining, and you will probably be upright for the next few hours after taking it. 

More and more often, I am finding that patients with Heartburn have a mild form of lactose intolerance or gluten intolerance, and when they stop dairy and/or wheat products their Heartburn goes away.  I must confess that when I switched to Almond Milk (really good stuff!) my years-long mild Heartburn disappeared...



Makes Great Pizza!



By following these few guidelines, and their underlying logic, you should not have to take medicines to treat your Heartburn more than occasionally.  These medicines seem relatively safe when taken for brief periods of time (usually no longer than six weeks), but may lead to a whole 'nother set of problems if taken for long periods of time.  Remember, the acid in your stomach is good and is supposed to be there...



  A worst-case patient scenario would be an overweight smoker who turns in after a late-night dinner of rib-eye, baked potato and all the fixin's, washed down with a couple of Whiskey Sours, finished off by a Marlboro Light, and two ibuprofen to prevent a headache in the morning.  Heartburn!  Don't be this guy...
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