Episode 36: Cooling the Heartburn Flames

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Welcome to Supplementing Health, a podcast presented by Advanced Orthomolecular Research. We are all about applying evidence-based and effective dietary lifestyle and natural health product strategies for your optimal health. In each episode, we will feature very engaging clinicians and experts from the world of functional and naturopathic medicine to help achieve our mission to empower people to lead their best lives naturally.

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[1:42] Cassy Price: Welcome to another episode of Supplementing Health. Today Dr. Lara Spector, ND, is joining us to discuss the details of heartburn. Dr. Spector helps her patients achieve wellness by addressing the root cause of their imbalances by using evidence-based therapies and natural forms of medicine. Thanks for being here today, Lara.

[2:01] Dr. Lara Spector: It’s my pleasure. It’s great to be here. 

[2:06] Cassy Price: So heartburn is one of the most common digestive disorders affecting North Americans. I’ve seen numbers that estimate nearly one in every four Canadians experience heartburn on a regular basis. Do you think this has become more prevalent in recent years?

[2:20] Dr. Lara Spector: Yes. It definitely has been documented to be more prevalent, as well, due to obesity and people being overweight, more being on the rise as well. It tends to increase heartburn prevalence. That one definitely is the biggest factor that we’ve seen trend across most countries.

[2:46] Cassy Price: So what exactly is heartburn?

[2:49] Dr. Lara Spector: Heartburn is actually a symptom, which basically means burning where we all associate where the heart is. It’s actually not a condition. It is a symptom.

[3:05] Cassy Price: Okay. So, I’ve also heard heartburn referred to as acid reflux or GERD, which is gastroesophageal reflux disease. Are these conditions actually all the same thing?

[3:25] Dr. Lara Spector: Pretty much. Basically, acid reflux occurs when stomach acid backs up into our esophagus. Typically, we just have stomach acid in our stomach or meant to, at least. So heartburn is essentially a symptom of that acid reflux happening. What gastroesophageal reflux disease, or GERD, I like to call it, is the more severe form of acid reflux. So, typically, when you have acid reflux more than two to three times a week, it would be classified as GERD. So heartburn is essentially a symptom of both acid reflux and GERD. It tends to be more severe with GERD.

[4:13] Cassy Price: What causes GERD or acid reflux?

[4:18] Dr. Lara Spector: A lot of people assume that acid reflux or GERD is caused by too much stomach acid production. But, really, it is basically stomach acid coming up from the stomach into the esophagus. Typically, there’s this sphincter – well, all of us have this sphincter called that lower esophageal sphincter that connects the esophagus to the stomach. The majority of the time, it is closed except for when there’s food being ingested, and that allows for the sphincter to be relaxed and for food to go from the esophagus down into the stomach.

[5:00] What can happen is that sphincter can become more relaxed, which allows for stomach acid to travel upward from the stomach into the esophagus. That’s what the acid reflux is pertaining to – reflux of the acid from the stomach into the esophagus.

[5:22] Cassy Price: Are there ways to strengthen the sphincter then if it’s becoming relaxed, in theory, shouldn’t be?

[5:31] Dr. Lara Spector: Exactly. The key is to get to the root cause of why it’s not functioning optimally. Again, most people think it’s too much acid that is causing that sphincter to not work, or it’s just spilling over. But, actually, what it comes back to is a little bit deeper than that, not actually having enough stomach acid in the first place.

[5:58] When you don’t have enough stomach acid, it allows bacteria to overgrow in the stomach, and what that can cause is the fermentation of carbohydrates by bacteria, and that puts extra pressure on that sphincter, which causes it to malfunction. So, it’s more complex, but ultimately it comes back to low stomach acid in the first place that causes that sphincter to malfunction.

[6:28] Cassy Price: Then regular use of antacids probably has a fairly large impact on regular heartburn, and I’m guessing does not help to heal the root cause?

[6:41] Dr. Lara Spector: Exactly, yeah. If anything, it actually lowers that stomach acid even more, which is why people tend to rely on these medications long-term. What they do work on is symptomatic relief of acid being present in the esophagus, which is causing the heartburn, but you have to get more to the root cause, which is the low stomach acid being produced in the first place.

[7:09] In order to get someone feeling better right off the bat, definitely antacids would do that, but you do want to work deeper on that root cause and try to avoid antacids and use alternatives because they do have other effects, as well, not just overall lowering stomach acid long-term. They also have increased risks and side effects long-term.

[7:32] Cassy Price: If someone is suffering from heartburn, but they don’t want to be taking those antacids to perpetuate the issue, what are some of the things they can do to start reducing that inflammation and start on the healing track?

[7:47] Dr. Lara Spector: There are a couple of options. One of the most studied ones is DGL, Deglycyrrhizinated Licorice – it’s a mouthful. It’s been studied to be affected in treating gastric and duodenal ulcers, and one study has shown it works as well as Zantac with none of the undesirables, like the acid suppression side effects. So it helps to promote mucus secretion and is anti-inflammatory.

The other option is zinc carnosine. It works well also as an inflammatory and helps to protect the mucosal lining of the esophagus. There’s also mastic gum, as well, which has been used since traditional Greek times, over 2,500 years ago, to treat peptic ulcers and gastritis. It also has anti-bacterial effects against H pylori. All of these are wonderful. Of course, work with your practitioner to see if any of these are okay for you and get the go-ahead. Those are some good alternatives to antacids for sure.

[8:56] Cassy Price: That’s good to now. When should someone experiencing regular heartburn seek help from a medical professional?

[9:05] Dr. Lara Spector: I think anyone who is experiencing heartburn should seek help, but if we’re talking about more serious help, if you’re experiencing severe chest pain or pressure, especially when there are other things going on potentially like pain in your arm, like the left arm, especially, or pain in your jaw or any difficulty breathing, shortness of breath; you, obviously, want to rule out a heart attack. That’s number one. So a lot of people can get freaked out when the heartburn happens.

[9:35] And if you’re experiencing any of those symptoms or a more severe form of heartburn, definitely right away go to the ER to rule that out. But if you know for sure that it’s heartburn or acid reflux, then typically, if it’s happening more than twice a week, you do want to seek help from your doctor or a naturopathic doctor. 

[9:55] Cassy Price: Cool. What can happen if it’s left untreated?

[10:01] Dr. Lara Spector: Left untreated because of the reflux of stomach acid in the esophagus, which really, the esophagus isn’t meant to have acid in it because the lining of the esophagus is not like the stomach. It doesn’t have a protective lining but protects it from the acid. So, over time, if you’re not addressing the acid reflux, the stomach acid can damage the tissue lining of the esophagus, and that can cause inflammation, pain, and ulcers. Eventually, down the line, it can actually lead to permanent damage of the esophagus and potentially even esophageal cancer.

[10:40] Cassy Price: Oh, wow. That can be very serious then. 

[10:43] Dr. Lara Spector: Exactly. It’s always good if you’re feeling a symptom to get it looked at. That’s for sure.

[10:48] Cassy Price: Yeah. Absolutely. Earlier, you mentioned that excess weight and obesity have been playing into the increased epidemic of heartburn that people are experiencing. Can you explain what role weight plays in heartburn?

[11:04] Dr. Lara Spector: Yeah, of course. Because when there’s more weight, it can cause more abdominal pressure because we tend to put on that weight in the abdominal area. It can actually put pressure on that specific sphincter below our esophageal sphincter and cause it to malfunction. That can cause the stomach acid to travel into the esophagus, causing that symptom of heartburn.

[11:33] Cassy Price: Right. Does age or gender play a role in whether you’re likely to experience heartburn?

[11:40] Dr. Lara Spector: Yes. As we age, we do get a weakening of muscles, in general, but because the lower esophageal sphincter is also a muscle, it can also weaken with age. So, it actually tends to relax more and not just around the time that we’re eating to allow food in it to relax, even when we’re not eating as well. So it can allow for that stomach acid to escape into the esophagus.

[12:09] The other factor is that as we age, we decrease our stomach acid production. They did a study in the elderly, and they found that 80% of women over 80 years old were not making more than 5% of the stomach acid that they would have in their 20s. So, there’s a huge reduction in stomach acid. Again, if we go back to that root cause of why the heartburn is there, it would make sense why it increases with age.

[12:43] The other factor – I think you said gender. Correct?

[12:45] Cassy Price: Yeah.

[12:46] Dr. Lara Spector: Typically, women experience heartburn more than men. More men experience the erosion of heartburn, the more serious effects of heartburn, and I think that comes back to men maybe not going to see their doctor as often as women do. But women tend to experience more heartburn on a regular basis.

[13:13] It’s interesting because in women, typically over 50, which has to go into the whole age phenomenon, but there is a role of estrogen and how it’s an anti-inflammatory hormone specifically for the esophagus. When women run lower on their estrogen, they tend to experience more heartburn, which typically happens after menopause, which is around 50.

[13:36] Cassy Price: That’s very interesting. Hormones play so many different roles in the body. It’s amazing as you learn all the different things that the same hormone can do all over the body.

[13:45] Dr. Lara Spector: Oh, for sure. We definitely underestimate our hormones. That’s for sure.

[13:50] Cassy Price: Right. You had mentioned that the low stomach acid can lead to bacterial growth in the stomach. Is that bacteria, such as H pylori, and that’s why ulcers occur? Or are there other bacteria that are growing?

[14:07] Dr. Lara Spector: Yes. H pylori is definitely the most common one. I was also referring to, sorry, bacteria overgrowth that can occur in the small intestine, which is just right below the stomach, as well, which can also cause increased pressure on the stomach and the lower esophageal sphincter.

[14:26] But, yes. H pylori tends to overgrow when there’s not enough acid in the stomach, so H pylori doesn’t like an acidic environment. It tends to grow in a more alkaline environment or a high PH environment. So when stomach acid levels are low, it can increase the PH in the stomach allowing for the H pylori to overgrow. And, yes. H pylori left untreated can result in ulcers in the stomach. It’s definitely important to address H pylori if that’s happening, but also address the low stomach acid, as well, so that you prevent it from continuing to happen.

[15:14] Cassy Price: So what kind of things can you do to address low stomach acid or increase the production of stomach acid?

[15:21] Dr. Lara Spector: If you are experiencing heartburn, you actually don’t want to work on stomach acid right away because a lot of the things that increase stomach acid can right away worsen heartburn in the moment. First, you actually want to work on calming inflammation in the esophageal lining caused by stomach acid being there in the first place.

[15:42] After you’ve done that, and people are starting to notice potentially that their heartburn has come down a little bit, then you can start to work on the root cause, which is the low stomach acid. Things that I find that work really well for increasing stomach acid are bitter herbs. You can purchase from the health food store a combination of bitter herbs. They can be herbs like wormwood, ginseng, and berberine. They often come in a combination. 

[16:14] Often, we’re not eating in the right state of the nervous system. What that means is, we want to be in the parasympathetic dominant form of our nervous system when we’re eating because that’s when all of our stomach acid is being produced as well as other digestive enzymes. 

[16:33] What I often suggest is taking three deep breaths before a meal to get your nervous system into that parasympathetic state. Also, avoiding consuming liquids with meals, so it doesn’t dilute the stomach acid. Apple cider vinegar before meals, as well, can be really helpful. You can actually take hydrochloric acid – hydrochloric acid and stomach acid are the same thing. You can take that as a supplement, but again, you don’t want to do it until after you’ve calmed some of the heartburn. 

[17:07] Cassy Price: Speaking about the nervous system, do anxiety and heartburn often go hand-in-hand then, or is there a link that exists there?

[17:18] Dr. Lara Spector: Yes, definitely. I’ve seen it across the board, especially with patients. Stress and anxiety are major triggers for heartburn. It actually comes back, again, to that low stomach acid. When your nervous system is in more of a sympathetic state, where that’s the fight or flight state with more adrenaline producing, always sort of flying at the seat of our pants, that’s when all of our blood flow is going to our hands and feet, essentially to keep running from that bear.

[17:54] So if we’re constantly in that state, we’re not concentrating blood flow in our abdomen where we can produce that stomach acid and those digestive enzymes to help digest our meal. So, over time, if we remain in that anxious or stressed-out state, we can end up with really low stomach acid, which can definitely contribute to heartburn.

[18:18] Cassy Price: Some people use alcohol or even sugar to help cope with stress. Can these exacerbate the issues, or are there other foods that make heartburn worse or trigger it?

[18:34] Dr. Lara Spector: Definitely, unfortunately. Yes, specifically, alcohol can directly damage the lining of the esophagus and the stomach. So definitely, again, worsening that heartburn. Then there are other foods. You mentioned sugar, gluten, dairy, spicy foods, citrus foods, tomatoes, coffee, peppermint, and chocolate are the ones that tend to worsen heartburn the most.

[19:08] So, I typically try and get my patients on a more bland diet. I know it doesn’t sound as fun, but trying to stick to whole foods and trying to cut back on stimulants like coffee and alcohol, which tend to have a negative effect on our nervous system anyway – so trying to work on the diet to really calm things down. Not forever, but just in the beginning as we’re working on trying to get to the root cause.

[19:37] Cassy Price: Peppermint really actually surprises me because it can often be used for indigestion. You can get peppermint supplements, or there are lots of suggestions to use peppermint to calm down the system, so I’m surprised that it actually can trigger heartburn.

[19:53] Dr. Lara Spector: Yeah. Specifically, it can actually relax the sphincter more in-between the esophagus and the stomach. It’s great for IBS; it’s great if you have lower-digestive issues, but if you have heartburn, it would definitely not be one of my first herbs to go to.

[20:13] Cassy Price: That’s very good to know. For women, some of them experience increased heartburn during pregnancy. Is this, again, due to increased pressure in that area, or are there other reasons for that?

[20:28] Dr. Lara Spector: Exactly. It’s because of the increased abdominal pressure that’s pushing everything up and essentially relaxing that sphincter more and allowing for that stomach acid to travel up into the esophagus.

[20:45] Cassy Price: Are all the herbs and suggestions you made safe for pregnant women because I know I know a lot of natural supplements actually aren’t suggested when pregnant or conceiving, so would they still be able to treat their heartburn in the same way?

[21:01] Dr. Lara Spector: No. In women, specifically, I would not be using herbs like bitter herbs or stomach acid, like the one I suggested, the stomach acid you can get in a capsule form. I’d be using things like probiotics to help balance that bacterial overgrowth that typically is happening. 

[21:25] I would also recommend magnesium because magnesium can help with motility more as well. Then, specifically, calcium with magnesium especially can be very soothing for the esophagus. Taking a calcium/magnesium liquid, especially at night when women tend to experience heartburn more from pregnancy. It can be really calming at that time and before bed.

[21:55] Then, also, working on all of the lifestyle pieces. So, with the diet, for example, trying not to eat too much at once. Eating smaller meals will help with the heartburn because it’s less food that the body has to process at once, so the digestive tract has to process that once. And then, also, try not to lie down, of course, right after a meal is really important, waiting at least an hour or two before going to bed. Those are the big things that I would suggest for pregnancy.

[22:29] Cassy Price: That’s great. Why is it that some people experience heartburn more at night than other times of the day?

[22:36] Dr. Lara Spector: Typically, at night, that’s when the sphincter tends to relax more. At the beginning of the day, that’s when our muscles are most toned and more active. By the end of the day, that’s when they tend to relax more. Then, also, it tends to be, at the end of the day, that’s when our stomach acid production is the lowest. So it has to do with the muscles and the lower stomach acid levels.

[23:05] Cassy Price: Were there certain nutrients or supplements besides the one specifically treating the heartburn that someone should be incorporating in their daily routine to help prevent heartburn down the line?

[23:20] Dr. Lara Spector: For sure. I think probiotics are a huge one because they’ll help balance bacteria in the gut to prevent an overgrowth of certain other bacteria that can worsen heartburn if you have low stomach acid. I think being aware of stress levels and taking any supplements to help support that. Because, like we mentioned before, stomach acid production can go down with stress.

[23:20] I also think Apple Cider Vinegar and lemon in hot water are all excellent in helping to increase stomach acid naturally. The other thing I would suggest too is, if you already know that there’s a bit of a weakened digestive tract and you’re wanting to prevent heartburn down the line, bitter herbs can be really helpful, too, to take before dinner. The reason I’m saying dinner is because that’s at night when we have the lowest amount of stomach acid being produced. We want to actually increase that output at nighttime.

[24:33] Cassy Price: Yeah. That totally makes sense. One last question and it ties back to what we were talking about with sugar and alcohol and all of that. Why is it that fast food tends to trigger heartburn for a lot of people?

[24:47] Dr. Lara Spector: Typically, with fast food, you’re combining a lot of different food groups in one. The biggest one with fast foods are those oils, those refined oils, and you’re blending that with a protein like chicken or beef. It’s the combination of those foods that tend to have a negative effect on our digestion. It’s very hard to digest at once. So it just puts a lot of pressure on the digestive tract and can cause that sphincter to relax even more react even more allow that acid to back up into the esophagus.

[25:30] Cassy Price: Okay. Well, this has been fantastic. I can think of several people I want to share this episode with already. So thank you for taking the time to share all of your insights with me.

[25:43] Dr. Lara Spector: Absolutely.

[25:43] Cassy Price: If listeners want to work with you or get ahold with you to get additional information and any of that sort of stuff, how would they go about doing that?

[25:50] Dr. Lara Spector: They can access my website at www.LaraSpectorND.com. I do work in two clinics, and I do online consults as well. So they can contact me through that website if they have any questions or if they’d like to book an appointment.

[26:10] Cassy Price: Wonderful. Thank you so much for joining me today. This has been a riveting conversation, lots of great information, so I really appreciate it. And thank you to the listeners who have tuned in today for another episode of Supplementing Health.

[26:23] Dr. Lara Spector: Awesome. Thank you so much. 

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Thank you for listening to Supplementing Health. For more information about our guests, past shows, and future topics, please visit AOR.ca/podcasts or AOR.us/podcasts. Do you have a topic you want us to cover? We invite you to engage with us on social media to request a future topic or email us at marketing@aor.ca. We hope you tune in again next week to learn more about supplementing your health.

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