Managing Heartburn Through Lifestyle
What is heartburn?
Heartburn is a common issue affecting the upper part of the gut. The medical term for this is Gastro-oesophageal Reflux Disease (GORD). Dyspepsia describes the feeling of pain or discomfort in the upper abdomen, heartburn, acid reflux with nausea and/or vomiting (1).
Who is at risk of GORD?
GORD affects between 10-30% of the adult population in developed countries (2).
There are a number of risk factors for GORD including: stress, smoking, alcohol, trigger food groups such as coffee and chocolate, obesity, certain medications and pregnancy.
By understanding the risk factors we can adapt our lifestyles to reduce our symptoms of GORD. If GORD goes on a for long time untreated it can progress to Barrett’s Oesophagus (a pre-cancerous condition of the gullet) (3).
How can I address GORD using lifestyle medicine?
Diet
Diet is thought to be central in the causation of GORD, the evidence however varies on what food groups are typically responsible. This is likely due to our gut’s highly individual make up and different guts responses to different foods. That being said however there are several known culprits that exacerbate GORD including caffeine, fatty and spicy foods, fermentable carbohydrates, fizzy drinks and alcohol.
The Low FODMAP mentioned in my previous blog post on irritable bowel syndrome (IBS) is thought to reduce heartburn symptoms by 68% in just 8 weeks.
Ginger is also helpful for speeding up the emptying of the stomach and this in turn can reduce your symptoms of GORD. There isn’t however an agreed amount of ginger to take as a treatment dose so it will be somewhat trial and error depending on your individual makeup.
High fibre diets may decrease symptoms of GORD and there have been trials looking at taking sachets of water-soluble fibre which have helped reduce symptoms but more evidence is needed (4).
Stress
Stress can play a big role in heartburn. Emotional stress increases the amount of acid produced in the stomach. For times of heightened stress learning relaxation techniques can be helpful. Counselling with cognitive behavioural therapy (CBT) can be helpful is your stress levels are chronically high; this can be accessed through your GP or privately (5).
Smoking
Smoking is a major factor in GORD. Smoking weakens the ring of muscle that keeps acid from flowing from the stomach back up into the gullet. Reducing or quitting smoking completely will be useful in reducing symptoms and reducing risk of long term complications. Support for not smoking can be found through your GP, local pharmacy and smoking cessation clinics in your local hospital (6).
Alcohol
Alcohol causes a number of problems for our gut health with heartburn being one of them. Long term excessive alcohol use is associated with Barrett’s Oesophagus.
If you are unsure whether you are drinking excessively then please use the alcohol unit calculator linked below or speak to your GP. There are many options to support you in reducing or stopping your alcohol misuse (7).
When lifestyle isn’t enough
Sometimes in spite of these lifestyle changes you will still have symptoms which require medication. The main medication that manages GORD is called a proton pump inhibitor (PPI); this is usually prescribed as omeprazole, esomeprazole and lansoprazole (8). These are taken for a 4 week trial period. If symptoms are persistent with this or you develop symptoms such as vomiting or weight loss you’ll be referred to the hospital for a camera test to confirm the cause of your symptoms.
Resources:
https://cks.nice.org.uk/topics/dyspepsia-proven-gord/background-information/prevalence/
https://www.chelwest.nhs.uk/your-visit/patient-leaflets/surgery-services/barrett2019s-oesophagus
https://www.health.harvard.edu/diseases-and-conditions/could-stress-be-making-my-acid-reflux-worse
https://alcoholchange.org.uk/alcohol-facts/interactive-tools/unit-calculator
https://www.cuh.nhs.uk/patient-information/proton-pump-inhibitors-ppis/
