Q: When is “just a little heartburn” not just a little heartburn?

A: When it’s a lot of heartburn—happening twice a week or more, with the symptoms growing worse. Maybe it’s waking you up at night. And, especially, when those symptoms are accompanied by chest pain, chronic cough, or asthma.

These are all symptoms of what’s usually called heartburn or acid reflux, which I’ll call gastroesophageal reflux disease (GERD). And those symptoms say it’s time to see your doctor. This can get serious, leading to ulceration, scarring, or narrowing of the esophagus. And even esophageal cancer.

When you see your doctor, keep in mind that GERD is not a difficult fix.

But the fix your doctor might offer is all wrong.

Warning: Big Pharma ahead

If your doctor wants to prescribe an acid blocker or neutralizer, politely say “No, thank you.”

Why? These are among the most prescribed drugs on the market. And thereby, are perpetual money-spinners for their makers and marketers, Big Pharma.

The active ingredients in these meds are:

• Proton-pump inhibitors (PPIs), which neutralize stomach acids, and
• H2 blockers, which block the acids from being produced

And the reasons to avoid them are compelling:

• You might not even have GERD. Many patients come to me with GERD symptoms, which, after thorough testing, turn out to be caused by food allergies. That’s a completely different situation. Make sure your doctor tests you for food allergies before taking any action.
• GERD causes some people to permit an overdose of gastric juices—our body’s carefully blended mix of acids, bile, and pancreatic secretions—to rise from the stomach back into the esophagus.
• Our stomach acids aren’t even the problem. In fact, when PPIs and H2 blockers interfere with their proper functioning, all kinds of gastric and other health hells can break loose. Not the least of them being – when you hamper acid production, you prevent the breakdown of food into nutrients while obliterating the good bacteria that fight off bad bacteria in your gut.

And finally, in the end, besides causing internal havoc, PPIs and H2 blockers do nothing but temporarily relieve the pain and burning sensations.

No, wait—they do something else.

PPIs increase the risk of heart attack

PPIs have already been linked to an increased risk of heart attack among users with a history of heart attack.

But recent research also found increased risks among PPI users with perfectly healthy hearts—no history of cardiovascular disease.

In other words, PPIs increase the risk of heart attack—for everyone.

What causes GERD?

What causes heartburn/reflux/GERD is a dysfunctional lower esophageal sphincter valve (LES), the flap that separates the esophagus from the stomach. A normal LES lets food and liquid pass down into the stomach, and lets only gas (and vomit) rise up.

A troubled LES lets your stomach’s acidic contents leak back up into the esophagus. That’s when you feel the burn. And as I wrote earlier, that can cause trouble.

The lifestyle and dietary causes of GERD are the usual suspects that lead to the usual bad health outcomes:

• Immoderate alcohol
• Smoking
• Stress
• Caffeine overload
• Hernia
• Over-or under-eating, even of good food
• Lack of exercise

Big Pharma not needed here

Do you see anything other than lifestyle choices at work here?

No. No drugs needed here.

Let’s focus on diet, our go-to preventer-fixer-upper in all instances of health distress. You should avoid irritants like:

• High fat foods
• Caffeine
• Chocolate (sorry)
• Onions, garlic
• Peppermint
• Carbonated beverages
• Alcohol
• Citrus and tomato products

And you should build every meal around:

• Fresh, organic, local fruits and vegetables, except citrus
• Lean protein, like eggs, lean meat that you grill, poach, broil, or bake—never fry
• Complex carbohydrates—(non-instant) oatmeal, 100% whole grain bread, brown rice, and couscous
• Potatoes and other root vegetables for their good carbs and digestible fiber (but never prepared with onion or garlic)
• Good monounsaturated fats, from fish and plants, from olive, sesame, canola, and sunflower oils, and from avocados, peanuts, and peanut butter, and many nuts and seeds
• Good polyunsaturated fats—oils such as safflower, soybean, corn, flaxseed, and walnut, and soybeans/tofu; and fatty fish such as salmon, mackerel, and trout

Lifestyle changes for Heartburn Relief

Some simple additional lifestyle changes can help tremendously:

• For safe temporary relief, try a drink made with aloe vera
• Chew gum. It increases saliva production and reduces the amount of acid in the esophagus (but avoid spearmint or peppermint, which can relax the LES)
• Sit up straight while eating. It gives gravity a chance to help food travel downward
• Don’t lie down for at least two hours after eating—same reason
• Don’t eat and run—to bed. Hitting the sack less than 3–4 hours after eating a full meal bed can lead to increased distress

You might see improvements in as little as several days, but give the changes at least a couple of weeks, with your doctor’s signoff, before looking for alternatives.

References

• New York Presbyterian Hospital. “Gastroesophageal Reflux Disease (GERD).”
• International Foundation for Functional Gastrointestinal Disorders. “Diet Changes for GERD.“
• Connealy, L. “New Proton Pump Inhibitor Danger.”
• Gastroesophageal Reflux and Motility Disorders Laboratory. “Treating Gastroesophageal Reflux Disease (GERD.)“

Weill Cornell Medical College Women’s Nutrition Connection. “Got GERD? Dietary Changes Can Ease the Burn.

Last Updated: July 30, 2021
Originally Published: August 31, 2016