Please excuse our error – the correct author for this entry is now displayed below (Jenna Katzman ANP). Jennifer Weinberg MD is one of our other collaborators and we are excited to show you her work soon! – The Practice Vitality Team.
Heartburn is an incredibly common problem, and often can be really distressing to people. Heartburn can show up in many ways; from the classic pain in the stomach or chest, to coughing, sour taste in the mouth, feeling of a lump in the throat, and even shortness of breath. The most common cause of heartburn is gastroesophageal reflux disease (GERD).
When someone goes to his/her primary care provider with a symptom of heartburn, they are usually prescribed a type of medication called a proton-pump inhibitor (examples: Nexium, Prevacid). Ideally, the doctor would also discuss lifestyle changes recommendations to help with the heartburn. Two months after these measures are put into place, hopefully the symptoms have resolved. Then the challenge comes with taking people off of the medication.
GERD can be managed with lifestyle changes, medications, and/or supplements. While medications are helpful at minimizing symptoms, they also have side effects, including decreased nutrient absorption in the gut when used long term or increase risk of certain stomach infections.
- Foods & beverages to avoid. Many foods and drinks are associated with relaxation of the LES. Beverages to avoid include alcohol, coffee (both caffeinated and decaf), cow’s milk, orange juice, caffeinated tea and tomato juice. Foods to avoid include: chocolate, fatty foods, spicy foods and tomato sauce. Sometimes people tolerate certain foods better than others, so I often encourage my patients to keep a symptom diary to track how they reach to different foods. Smoking is a bad idea when it comes to reflux. Increased abdominal pressure, such as from obesity, pregnancy, or even tight clothes can lead to GERD as well. If you are overweight, losing weight can improve symptoms and can sometimes eliminate them completely.
- Avoid laying down within 2-3 hours of eating
- Raise the head of the bed 4-6 inches using blocks under the bedposts (it’s not recommended to use extra pillows, because this may compress abdomen and worsen symptoms).
- Supplements: Probiotics- probiotic pills often found at the health-food store and probiotic foods in the diet can be helpful, including: fermented vegetables (sauerkraut, pickles), fermented dairy (yogurt, kefir), fermented soy (miso, tempeh), kombucha. Pu-erh tea is another option. Apple cider vinegar- although there haven’t been many studies, 2 or 3 teaspoons (10-15 ml) alone or in an 8 ounce glass of water may be helpful. Licorice (DGL)– Dose: 2-4 280mg tablets before meals. Other supplements that may be helpful: chamomile, marshmallow, ginger, slippery elm, aloe-vera (click for aloe-vera recipe).
Without treatment, remember that reflux can lead to the beginnings of esophageal cancer. If symptoms persist, people need to see a Gastroenterologist once a year and possibly undergo further testing. Going off the medication can be tricky too because after stopping the meds, sometimes you get rebound heart-burn. Coming down very slowly can be helpful, and asking your doctors help in this regard can be useful. Medications can be a good temporary solution. Medicine comes with its own risk, but if you don’t get better with lifestyle change or other integrative methods, it may have to be the option.
-Written by Jenna Katzman, ANP-BC (edited by the Practice Vitality team)
- Rakel, D. Integrative Medicine, 2nd edition. Chapter 42. Elsevier, 2007.
- Williams, D. http://www.drdavidwilliams.com/acid-reflux-natural-treatments/#axzz344fxyfu6.
Jenna Katzman is an Adult and Holistic Nurse Practitioner. She works as an NP at One Medical Group in Manhattan. Her background includes Bachelors degrees from Rutgers University and the University of Medicine and Dentistry of New Jersey. She has a Masters Degree from NYU College of Nursing and previously worked as a neuroscience nurse at NYU Langone Medical Center. Her interests include integrative healthcare, aromatherapy, nutrition, Kundalini yoga, Reiki, and diabetes management.