Heartburn: Why you’ve got heartburn

Hello. Hello. Welcome. You’re listening to Dr. Martha Reid at Doctors Choice Integrative Medicine in downtown Vancouver, a space where I bring passion, inspiration and nourishment to the conversation of your health.

I had a conversation yesterday with one of my young patients, (and in this case, young… I mean young). Young, like mid twenties. And this patient came in complaining of heartburn and reflux. She’s not the first person in this age category that I have met that has dealt with this. And I started to think like, oh, my goodness gracious! How many people your age are struggling with heartburn and reflux? It can be so debilitating.

And so what she came to me with was, “OK, this is happening. I’ve got pain in my chest. And every time I eat, I feel really, really full. And then I get this sensation of food coming up into my mouth and I don’t know what’s going on. So, I’ve started taking over-the-counter antacids and that didn’t work. So I’m now on a prescription proton pump inhibitor, but I don’t want to be on this long term and I don’t know what to do about it.”

I said, OK, well, do you know why you have heartburn?

And she’s like, “Well, because I have too much acid so I’m taking an acid blocker.”

I said, Well, interestingly enough, in your age category, the vast majority of people with heartburn it’s actually too little stomach acid, not too much. She kind of gave me this quizzical look of like, What do you mean, too little stomach acid? I said, Well, what it has to do with is your esophagus (which is the tube connecting your mouth), the back of your throat, down to your stomach. And that tube at the bottom of it has a little sphincter (which is one of my favourite words in the entire world… sphincter). So, it has this little sphincter.

The one at the bottom is called the lower esophageal sphincter, and it’s controlled by the amount of stomach acid in the stomach. Think of it as if your stomach were a room and the room has a light switch on the wall. And if the room has enough stomach acid in it, high enough to flip the light switch, the light switch turns on. And the lower esophageal sphincter, (which is the light fixture on the ceiling), closes If you don’t have enough stomach acid, which in the vast majority of cases of young people with heartburn, this is the case: the amount of acid in the room is not high enough to flick the switch.

So, that lower esophageal sphincter remains open, or partially open. And this has to do what we call “the tone” of the lower softened sphincter. So, the problem is not, in fact, too much acid… the problem is too little. And so the treatment of taking acid blockers will certainly block the symptom that you’re experiencing, (is what I said to my patient), but it won’t treat why you’re experiencing it.

She said to me very logically, “well, why would I have too little stomach acid? Is there something wrong with my stomach?”

And I said, well, potentially. So why don’t we do a physical exam and check that out? So we did that. Turned out that her stomach seemed just fine in that regard.

So I asked her a logical question: Have you had any stomach surgery where you might not have portions of your stomach to have those cells make stomach acid?

She said, “No, never had a stomach surgery”.

I said, Okay. So then there’s another process shutting down those cells for making stomach acid. And the most likely and common cause of that is stress.

So stress, regardless of the source of it, (whether it’s a sabre tooth tiger or boring tribe, starvation, boot camp, too much caffeine, sugar, negative thoughts, negative emotion) doesn’t matter! From the body’s perspective, stress is stress, and the nervous system goes into sympathetic dominant mode. It is not your body’s priority when you’re fighting a sabre tooth tiger to make stomach acid.

So, the cells of the stomach called the “chief cells” don’t make that stomach acid to the degree that you need to hit the light switch and close that lower esophageal sphincter… so it stays wide open. So, here you are sitting at work drinking coffee, too busy and too stressed to take lunch and you eat it while you’re working. You’re not in a restful state, making stomach acid enough to close that lower esophageal sphincter. Instead, it’s staying wide open. So, you’re drinking the coffee, you’re eating, you’re rushing to lunch, and now you’re dealing with heartburn.

So the problem is really at the stress level, we need to shift the stress to then get the digestive system functioning again.

But, if we’ve had chronic prolonged stress, (which many of us do), we may have fired the workers in the stomach that make the stomach acid, because quite frankly, we don’t need them when we’re fighting a sabre tooth tiger. So you know what? That’s just a cost that the company can’t handle. Get rid of the workers making stomach acid. And so we fire them and the cells become lazy.

So, you might need to prime them, so to speak; priming the pump. You can do that with hydrochloric acid. My preferred way, however, is to use a broad spectrum digestive enzyme because I suspect that if we’re not making enough stomach acid… (stress doesn’t just shut down the stomach, by the way, it shuts down the upper digestive system to a certain degree. Well, that then involves the pancreas. And the liver, gallbladder, all who make enzymes to help you break down your food. So it’s not just stomach acid. That’s important)… So, I use a broad spectrum digestive enzyme that supports the production of stomach acid as well as these other digestive organs enzymes, so that we can really get the patient feeling better, faster.

And in the vast majority of cases, people feel better so quickly. It doesn’t take long. However, there is one little caveat to that.

Just taking enzymes without treating the stress, which is really the root of and won’t solve the problem long term. It’ll just become another crutch. Not that different than taking an acid blocker, in that respect. So ultimately, while I’m working with someone to get their enzyme levels up to snuff and their acid levels up to snuff to support digestive processes, we ensure that we’re treating the stress response. And that can be challenging for a lot of us.

For many of us, the stress pathway, the predominant one in all of us, is called the hypothalamic pituitary adrenal axis. The HPV. And that’s laid down in its “blueprint”, so to speak, when we’re really pretty young. So: how we respond to stressful triggers. We’re running on an old program, many of us. So it can be challenging to actually shift our patterning.

The good news: it’s possible. Totally doable. And there are a lot of ways to do that. You can practice things like mindfulness, for sure. And if that seems oddly stressful (for myself, for a long time, mindfulness was the whole word. Meditation kind of tripped me out and got me stressed, so I didn’t call it that). I had to call it my “thinking time” and then “mindfulness”.

So anyway, for those of you who can just jump right on mindfulness and meditation, if you can practice that straight away, that is such a wonderful way to switch your nervous system into its digestive state called parasympathetic nervous system mode! But if mindfulness isn’t your gig right now, try curating some joy in your life.

What do you love to do? And it doesn’t matter what that is. Whatever it is that lights you up will shift you from stress mode to rest mode. So, play in that arena for a little bit.

Another area that you can use to help decrease stress is movement. Move your body. Release the tension. Right. And again, whatever lights you up, if you’re a runner, run if you like to cycle, cycle, do yoga, go for a swim. Go for a walk. Just stretch and move your body. And that will do wonders for stress reduction. And then one of my favourites is making individualised plant medicines for people.

Our Earth has such incredible medicine in the plant foods. And so we have a whole system of medicine and naturopathic medicine called botanical medicine. And I can truly individualise a tincture of herbs suited specifically to a patient’s needs. That is one of the coolest things I get to do in my work. And I love it. And that can make such a huge difference to stress levels. And then, by treating that stress and then potentially taking some digestive enzymes, next thing you know, that room of your stomach is filling with stomach acid, flipping that switch, closing that lower esophageal sphincter and voila! Goodbye heartburn! Chow, chow, reflux!

And why I think treating it this way at the root holistically is so important is that, yes, a proton pump inhibitor will work, and in some cases I will use them because they are a really useful tool short term. The problem is that a proton pump inhibitor long term depletes certain nutrients in the body. So, for example, B12 which is a vitamin necessary for every energetic cycle in the body… it also depletes certain minerals like calcium, which is pretty important for bones just for one area alone. But the other thing is that our stomach acid isn’t just about breaking down our protein in our food. The stomach acid is about killing the bugs that are negative for our health on our food. So if you don’t kill the bugs that have come in on your food, and you don’t digest that food properly, that undigested, potentially bug ridden food is entering the sacred chamber of your small intestine where it now has access to getting into the body. And once things get into the body, into the bloodstream, it’s a lot harder to get them out. So I recommend not letting them in in the first place. Kill them with your stomach acid.

So, treat the stress, support acid production and I think (in relatively short order), unless there are underlying other health conditions going on, (which by all means speak to a registered health care practitioner, to your medical doctor or a naturopathic doctor here in B.C. and get those other conditions sorted), but in the absence of that, treating your stress, supporting upper digestive function and you can say “chow chow” to some of those things like heartburn and reflux.

Thank you so much for spending this time with me and joining this conversation. If any of the things that you’ve heard today have landed with you, moved you, resonated with you, and you’d like to pipe in, I would sure love to hear from you. Some of the best conversations happen right in the medicine house with me and the easiest way to do that.

Pop over to the website www.doctorschoiceintegrative.com. Book a discovery conversation with me. It’s called a discovery call, and it’s a complimentary 15 minute slot where we can explore health together. I’d love to do that with you. Hope to see you there.