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What is heartburn?

Heartburn is characterised by a burning sensation behind the sternum. It is caused by the reflux of the acidic gastric contents (acid reflux) up into the oesophagus (the tube that links the mouth to the stomach). The acidic gastric contents irritate the sensitive lining of the oesophagus causing pain (heartburn) and inflammation (reflux oesophagitis). If this keeps happening, it’s called gastro-oesophageal reflux disease (GORD).

Other common names for acid reflux include acid indigestion, acid regurgitation and heartburn. In the US, GORD is known as GERD, or gastro-esophageal disease.

How common is heartburn?

Occasional heartburn is very common affecting approximately 8% of the population every day and 35% of the population every month. GORD is estimated to affect 20% of the US population.

Symptoms of Acid Reflux

The main symptoms of acid reflux include:

• heartburn – a burning sensation in the middle of your chest
• an unpleasant sour taste in your mouth, caused by stomach acid
• recurrent cough or hiccups
• hoarse voice
• bad breath
• bloating and nausea.

The symptoms are usually worse after eating, when lying down and when bending over.

If you experience acid reflux symptoms more than twice a week, you most likely have GORD, which includes heartburn, bloating and gut discomfort.

Causes of heartburn and acid reflux

Acid reflux is very common and can be caused, or aggravated, by

• certain foods and drink, such as coffee, alcohol, chocolates, tomatoes and fatty or spicy foods
• over-eating and eating late at night
• obesity
• smoking
• pregnancy
• stress and anxiety
• medicines such as anti-inflammatory painkillers (like ibuprofen)
• a hiatus hernia (when part of your stomach moves up into your chest)

As we get older, our stomach produces less acid and digestive enzymes. In addition, we have fewer beneficial bacteria in our intestines as a result of excessive antibiotic use. As a result of this, the stomach works harder to break down the food thus forcing the gastric juices into the oesophagus. The sphincter that closes the top of the stomach usually weakens with age thus making reflux into the oesophagus easier.

Natural Treatments for Acid Reflux

Acid reflux usually responds well to home treatment. We will separate the treatments in to practical advice and home remedies.

Practical advice

1. Food

Avoid eating large meals. Instead, eat small meals frequently. This reduces the amount of food in the stomach which reduces gastric distension and so helps to prevent reflux. Gastric emptying is delayed when there is a large amount of food in the stomach and this can aggravate symptoms. High-fat meals delay gastric emptying and so should be avoided. The evening meal should be eaten 3-4 hours before going to bed. Avoid food or drinks which trigger your symptoms

2. Obesity

Studies show that weight loss reduces the symptoms of heartburn. Therefore, if you are overweight try losing weight.

3. Posture

Avoid bending, stooping and even slumping in a chair as these can cause symptoms. It is better to squat rather than bend over. Symptoms are usually worse when lying down and so raising the head of the bed can help prevent reflux. Using extra pillows is often recommended but this is not as effective as raising the head of the bed. This is because extra pillows only raise the upper part of the body which causes bending at the waist. This leads to increased pressure on the stomach which can cause reflux. You should raise one end of your bed 10 to 20cm by putting something under your bed or mattress. Your head and chest should be above the level of your waist so that stomach acid does not travel up towards your throat

4. Clothing

Do not wear clothes that are tight around your waist as they increase the pressure on the stomach.

5. Other aggravating factors

Smoking, alcohol, caffeine and chocolate should be avoided as they reduce the strength of contraction of the gastro-oesophageal sphincter. This increases the risk of acid reflux. Stress is also linked to acid reflux, therefore find ways to relieve stress and to relax.

Home Remedies

Natural remedies that may help with occasional bouts of heartburn, indigestion and other minor reflux symptoms include:¹

1. Aloe Vera juice

The juice of the aloe plant naturally helps reduce inflammation, which may ease the symptoms of acid reflux. Drink about half a cup of aloe juice before meals. To avoid the laxative effect of aloe juice, choose a brand in which the laxative component has been removed.

Aloe vera is available as juices, gels and capsules, or you can juice your own aloe vera plants. Just cut open a leaf and scoop out the inside pulp.

2. Apple cider vinegar

Acid reflux usually occurs as a result of having too little acid in your stomach. You can easily increase the acid content of your stomach by consuming between ½ a teaspoon and 1 tablespoon of raw unfiltered apple cider vinegar in a large glass of water just before a meal.

Start with a small amount of apple cider vinegar and slowly increase if required. Some people find the taste unpleasant is its flavour is quite strong, even in water.

Apple cider vinegar can also be mixed into tea in place of lemon.

3. Apples and Apple Sauce

Apples usually help to relieve the symptoms of acid reflux. You can consume fresh apples, apple sauce or apple cider when the acid reflux symptoms begin. Alternatively, you can add more apples to your diet as a preventative measure.

4. Lemon

Adding lemon to your food or drinking homemade lemonade with your meal increases the acidity of your stomach thus helping prevent acid reflux.

5. Ginger root

Ginger has a gastroprotective effect as it suppresses H. pylori. Add 2-3 slices of fresh ginger root to 2 cups of hot water and let it steep for several minutes. Drink it approximately 20 minutes before eating a meal.

6. Glutamine

Glutamine is an amino acid which has been shown to heal gastrointestinal damage caused by H. pylori. It is available as a supplement or is found in several foods such as beef, chicken, dairy products, eggs, fish and certain fruits and vegetables.

7. Baking soda

Baking soda (or sodium bicarbonate) can be used in an emergency when you are in severe pain, but it should not be used regularly. ½ to 1 teaspoon of baking soda in an 8 ounce glass of water is sufficient to help neutralize your stomach acid and ease the heartburn.

8. Mustard

Mustard is a popular remedy for acid reflux. This may be due to its vinegar content which provides acidity. In addition, the mustard seeds contain anti-inflammatory compounds and phytonutrients which may be beneficial for preventing and relieving heartburn.

A spoonful is usually taken after a meal to get rid of acid reflux, with yellow mustard being preferred over other mustard types.

9. Papaya (papain supplement) or Pineapple (bromelain supplement)

Papaya and pineapple contain enzymes which help the body breakdown heavy meals. Papaya, fresh or dried, contains papain. This is an enzyme useful for breaking down both protein and carbohydrates.

Bromelain is a proteolytic enzyme found in pineapple which helps digest proteins. Bromelain also promotes anti-inflammatory activity and helps you maintain regular bowel movements.

10. Slippery elm

Slippery elm coats and soothes the lining of your gastrointestinal tract (mouth, throat, stomach and intestines). It protects against ulcers and excess acidity as it increases mucus secretion. It also contains antioxidants which may help heal inflammatory bowel conditions.

11. Vitamin D

Vitamin D is very important for gut health. When your vitamin D levels are in the optimum range your body produces over 200 antimicrobial peptides that help eradicate gut infections.

12. Probiotics

Consuming foods rich in probiotics, or probiotic supplements, are very beneficial for a correctly functioning gastrointestinal system. Probiotics are the beneficial bacteria found in the gastrointestinal system which are necessary for the digestion of food and for proper gastrointestinal balance. Relief is not rapid but takes time.

Acid reflux is a very common condition which can be easily prevented or treated naturally. This mainly involves certain lifestyle changes which are very effective. If these are not sufficient then simple natural remedies can be used to relieve the symptoms.