Archive for May, 2011

Heartburn at Night – Causes and Remedies of Nighttime Acid Reflux

One of the most common times people experience heartburn is at nighttime, and for good reason. There are several contributors to nighttime acid reflux, some of which are quite surprising.

Fortunately for you, in this article, you will find what causes heartburn at night, what you can do to avoid it, and some heartburn remedies you can use if you are already experiencing it.

Causes of Heartburn At Night

In addition to normal heartburn causes, such as eating irritating foods and overeating in general, there are a few specific causes of heartburn at night which may increase your symptoms:

Body Position: Body position is the number one to most cases of heartburn at night. The reason is simple: when you are lying flat, fluid no longer has to go against gravity to leave the stomach and enter the esophagus (heartburn is caused by the stomach’s contents moving into the esophagus).

There are a few simple remedies for this. If you experience heartburn at night several times per week or more, you should elevate the head of your bed by placing wooden blocks (or another sturdy object) to raise the head of your bed by about 6 inches.

This will put your bed on a slight incline, so that gravity can work in your favor even while sleeping. This slight incline is just as effective as sitting up, and after a few days, sleeping on a slight incline will feel natural.

If you experience heartburn at night only occasionally or if you travel a lot, consider buying a bed wedge pillow. This pillow is for your entire torso and puts your body on an incline.

Toothpaste: One of the most unusual culprits of nighttime heartburn is toothpaste. There are certain chemicals in commercial toothpastes which are known to trigger acid reflux. Additionally, mint flavors are also well known to trigger heartburn.

If you get heartburn at night, try switching to a “natural” toothpaste and using a non-mint flavor. The difference can be quite staggering!

Night-time Eating Habits: Another reason why people frequently get heartburn at night is due to their eating habits.

People are more likely to eat a lot of food late at night, as well as eat sweets or more spicy food, at least in the United States. In many countries, dinner is the most elaborate meal of the day, and dessert often follows suit.

You definitely want to avoid overeating at night. You already have body position working against you, the last thing you want to do is guarantee heartburn at night by overeating. The best thing you can do to stop heartburn at night aside from raising your bed is to not eat for 2 hours before sleeping.

Avoiding food 2-3 hours before laying down for the night can do wonders for acid reflux at night. Better yet, avoiding food late at night can help you lose weight and sleep better, too!

Heartburn At Night Conclusion

By raising your bed, changing your toothpaste, and avoiding eating too much at night, you can significantly reduce nighttime heartburn.

If you are still experiencing heartburn, try chewing a piece of non-mint gum for 10 minutes after eating your final meal of the day, and then once again briefly before getting into bed. Also, if you have heartburn twice per week or more, you will want to talk to your doctor as this can lead to some serious health problems over time if left untreated.

Fennel Seed as a Heartburn Remedy – Does It Work?

As part of our ever-growing database on heartburn remedies, in this article we will be reviewing the research on fennel and its possible effects on acid reflux.

If you are unfamiliar with it, seeds of this herb are a popular supplement and have been increasingly recommended as a popular home heartburn remedy.

Below, you will find out exactly what fennel seed is, how it works, and if it is an effective heartburn remedy.

Fennel Seed – What Is It?

Fennel is a flowering herb that has been introduced to many parts of the world and is a common supplement. In most supplements, an extract of oil is taken from its seeds.

This oil has been the subject of some studies, particularly examining its effects on the digestive tract.

Fennel Seed As a Heartburn Remedy – What the Research Says

Unfortunately, I have been unable to find any direct research on the usage of fennel or fennel oils for the reduction of heartburn. There are a lot of claims out there boasting about the heartburn-fighting effects of fennel but there is no research to support this conclusion.

However, this does not necessarily rule out fennel as a heartburn remedy. While we do not have any direct evidence, we can examine the indirect evidence.

Fennel Seed’s Effects on Digestion

While no research links heartburn relief to fennel seed supplementation, there are a few studies out there on the effects of fennel seed on the digestive tract. In particular, fennel has commonly been used to treat infant colic and adult constipation.

Before you think that these two problems have nothing to do with acid reflux, GERD, and heartburn, you should know that irregularities in digestive tract motility (movement of food along the digestive tract) are strongly associated with acid reflux.

In other words, slow or impaired motility not only leads to constipation but may also lead to acid reflux (1). Anything that improves constipation may improve reflux as well.

Infant Colic

If you are unfamiliar with infant colic, it simply refers to frequent, lengthy bouts of unexplained crying in infants. While the exact cause of colic is unknown, many physicians believe it is related to poor digestion or digestive pains.

Fennel seed is commonly recommended as a natural treatment for this condition. One study examined the efficacy of fennel seed oil for this purpose; researchers reported that 65% of treated infants has complete elimination of colic, which is an incredible success rate (2).

While this result does not tell us exactly what fennel seed does, the study does tell us that if colic is indeed the result of a digestive tract irregularity, then fennel seed oil is beneficial.

Also, it is likely that there are multiple causes of colic. Naturally, pinpointing the exact cause of crying is difficult in babies cannot tell us what is wrong and that most babies usually outgrow colic within a few months. It is possible that the some of the remaining 35% of babies who did not improve had colic for some other reason than digestive problems.

Adult Constipation

I was able to find two studies on adult constipation and fennel oil. Both of these effects studied the effects of herbal concoctions (both containing fennel) on adult constipation. While one study was performed in adults and one on the elderly, both reported significant improvements in constipation on groups that supplemented with the studied herbs (3, 4).

The only downside to these studies is that multiple herbs were used that included fennel seeds. As a result, any positive effect on constipation may have been due to other herbs. As a result, these studies are a wash.

Effect of Fennel Seed Oil on Smooth Muscle

Perhaps the most interesting study of the lot was one that examined the effects of different herb oils on the contraction of the smooth muscle of the ileum (part of the small intestine) and trachea.

This particular discovery found that the consumption of fennel seed oil, unlike most of the oils studied) led to increased phasic contractions of the ileal muscle (5).

To simplify the results, the researchers report that fennel oil appears to make the small intestine contract more frequently, which would propel food along the intestinal tract at a faster rate.

Since better digestive motility is associated with lower instances of acid reflux and constipation, this could not only explain why fennel seed is effective at relieving constipation and colic but also why it has anecdotally been reported to relieve heartburn.

However, this study was conducted in gerbils, not humans. We cannot know for sure what the exact effect of fennel in humans is until more research is performed, but given its positive effects on constipation and colic, it may indeed improve gastric motility and reduce colic.

Fennel Seed as a Heartburn Remedy – The Bottom Line

After looking through the research, I think that this supplement may indeed benefit those with GERD and acid reflux, particularly if other digestive problems such as constipation are present.

Unlike many other supplement and medications, researchers in all 3 studies mentioned in this article reported no side effects as a result of fennel supplementation among participants (3, 4, 5). While it is within the realm of possibility that there may be undiscovered side effects or a rare allergic reaction, current research reports that it is generally recognized as safe.

The bottom line with fennel seed as a heartburn remedy is that the research looks promising, but the evidence is only indirect.

However, given that fennel seed supplements are not exactly an incredibly profitable industry, it is unlikely that any amount of research will be performed on fennel seed and acid reflux anytime soon.

Be sure to mention fennel seed supplementation to your doctor before you try it out, particularly if you take any other prescription medication (particularly birth control or other hormonal medications), have a history of seizures, or have plant allergies.

The only way to know for sure if this will work for you is to try it out. If you shop online, you can get a few month’s supply for under 10$, so it is not a huge investment by any means.

References

1. Kamiya T, Adachi H, Joh T. Relationship between gastric motility and the pathophysiology of GERD. Nippon Rinsho. 2007 May;65(5):836-9.

2. Alexandrovich I, Rakovitskaya O, Kolmo E, Sidorova T, Shushunov S. The effect of fennel (Foeniculum Vulgare) seed oil emulsion in infantile colic: a randomized, placebo-controlled study. Altern Ther Health Med. 2003 Jul-Aug;9(4):58-61.

3. Picon, P.D., et al. Randomized clinical trial of a phytotherapic compound containing Pimpinella anisum, Foeniculum vulgare, Sambucus nigra, and Cassia augustifolia for chronic constipation. BMC Complement Altern Med. 2010 Apr 30;10:17.

4. Bub S, Brinckmann J, Cicconetti G, Valentine B. Efficacy of an herbal dietary supplement (Smooth Move) in the management of constipation in nursing home residents: A randomized, double-blind, placebo-controlled study. J Am Med Dir Assoc. 2006 Nov;7(9):556-61.

5. Reiter M, & Brandt W. Relaxant effects on tracheal and ileal smooth muscles of the guinea pig. Arzneimittelforschung. 1985;35(1A):408-14.

Antacids Side Effects – The Truth About Antacids and Heartburn

In our ongoing series into the effectiveness and possible dangerous side effects of heartburn remedies, today we will turn our attention to one of the oldest acid reflux remedies of all: antacids.

Antacids – What Are They and How Do They Work?

At least in the United States, by far the most popular antacid is a compound known as calcium carbonate. This is the main ingredient in the majority of over-the-counter (such as TUMS).

Calcium carbonate works by directly reacting with stomach acid. Every molecule of calcium carbonate reacts with 2 molecules of hydrochloric acid (stomach acid) and forms a calcium salt (similar to table salt), water, and carbon dioxide:

CaCO₃ + 2 HCL → CaCl₂ + CO₂ + H₂O

As a result, from a chemical perspective, antacids like calcium carbonate relieve heartburn by neutralizing stomach acid and they do this very well. “Extra strength” varieties simply offer extra calcium carbonate to neutralize more stomach acid.

Another common antacid is baking soda, also known as sodium bicarbonate, operates via similar reactions. Baking soda for heartburn relief has become less popular over the years after some serious side effects began to emerge.

The Truth About Antacids and Heartburn

On paper, the idea that antacids can reduce heartburn and make us feel better looks great. However, this does not always work out so well in practice. There is a simple question that many people do not stop to ask:

What other effects does consuming calcium carbonate have on my body? What antacids side effects exist?

There are two areas we need to look at: the side effects of neutralizing stomach acid and the side effects of consuming the excess calcium molecules left behind by the reaction of calcium carbonate and stomach acid.

Problems with Neutralizing Stomach Acid

One thing we cannot forget when working with digestive issues like heartburn is that the stomach is acidic for a reason: it helps us digest our food. An acidic pH serves two primary functions:

An acidic pH denatures proteins, forcing them to unfold so that digestive enzymes can break them up into smaller pieces.

An acidic pH activates pepsin, a crucial digestive enzyme which then starts breaking up denatured proteins. Pepsin stops working when pH rises, as it does temporarily with the use of an antacid.

When we digest foods, our body just does not mush up food into a liquid but rather breaks it down into very microscopic pieces. Our body prefers to absorb single amino acids rather than whole proteins; amino acids are so small that we cannot possibly hope to see them with our eyes or even under a standard light microscope!

Without stomach acid and pepsin, we cannot digest proteins properly. For this reason, people who use antacids often report constipation, indigestion, and related digestive problems.

However, these are relatively mild and may not happen in everyone.

Side Effects of Antacids – Problems with Excess Calcium Consumption

While digestive side effects are more likely, the chronic use of calcium carbonate can lead to two much more serious health problems.

The first problem is that of kidney stones; frequent usage of calcium carbonate can indeed to kidney stone formation (1). This is particularly true if you have a family history of kidney stones. Kidney stones are extremely painful but generally are not life-threatening.

The real danger with calcium carbonate is that it can lead to hypercalcemia (i.e. high blood levels of calcium), which may cascade into kidney damage and ultimately metabolic alkalosis (blood pH higher than normal values), which is a life-threatening condition (2).

Are Antacids Dangerous?

The more serious side effects of antacids are extremely rare and are more typical of antacid abuse. We do not recommend using antacids on a daily basis (or several times per day) as this may lead to undesirable side effects. Like many over the counter medications, they are fine occasionally but excessive usage may be dangerous.

It is recommended that you speak to your doctor about your acid reflux if you experience heartburn two times a week or more rather than trying to rely on antacid usage.

References

1. Allie S., & Rodgers A. Effects of calcium carbonate, magnesium oxide and sodium citrate bicarbonate health supplements on the urinary risk factors for kidney stone formation. Clin Chem Lab Med. 2003 Jan;41(1):39-45.

2. Jeong JH, & Bae EH. Hypercalcemia associated with acute kidney injury and metabolic alkalosis. Electrolyte Blood Press. 2010 Dec;8(2):92-4.

Baking Soda For Heartburn – Sodium Bicarbonate as a Reflux Remedy?

Baking soda is one of the most popular home heartburn remedies, but is it effective? More importantly, is it safe? We address both of these concerns in this below. You will definitely want to read the side effects section before you think about using this popular acid reflux remedy.

Baking Soda and Heartburn – Path of Action

Baking soda, also known as sodium bicarbonate or NAHCO₃, is an effective counter-agent to stomach acid, chemically known as HCl. The chemical interaction is as follows:

HCl + NaHCO₃ → NaCl + H₂CO₃ → Na+ + Cl- + H₂CO₃

Most of the H₂CO₃ then dissociates into H₂O + CO₂

In simple terms:

Stomach acid and baking soda react to form table salt and carbonic acid, carbonic acid mostly dissolves in water to form water and carbon dioxide. The remaining carbonic acid is very weak compared to HCl (stomach acid).

In short, stomach acid is indeed neutralized by baking soda. This means that it can reduce heartburn symptoms, since stomach acid leaving the stomach is what causes acid reflux in the first place.

Side Effects of Baking Soda

While baking soda can indeed stop heartburn, the major problem with this remedy is that an in-depth look at the research shows that it may have some serious side effects, especially when used regularly.

Baking soda, also known as sodium bicarbonate, has not only a strong influence over the acidity of the stomach but the pH of the entire body. When ingested, sodium bicarbonate essentially exerts an alkaline effect on the entire body.

This can be a good and a bad thing. This alkaline effect is seem to have strong positive influences on those who may be at risk for some types of renal (kidney) failure. Many recent protocols have been established using sodium bicarbonate to treat certain types of to slow both chronic and acute kidney disease (1, 2).

How does this work? Sodium bicarbonate is thought to help bring potassium into the kidney for excretion and kidney failure can lead to high blood levels of potassium. Carefully regulated sodium bicarbonate intake (i.e. by doctors reading bloodwork) may be used to help control blood potassium levels.

However, this is a specialized treatment for a specific portion of the population. For the rest of us, chronic sodium carbonate usage may lead to hypertension (high blood pressure) and edema (excess fluid retention) (3). It may also significantly increase the risk of kidney stones (4).

In short, baking soda may interfere with a healthy individual’s ability to maintain appropriate electrolyte balance in the blood, which can culminate in impaired regulation of blood pressure and the retaining of body fluids. This could then lead to many undesirable side effects, such as heart problems.

What about Calcium Carbonate

Due to these realizations, calcium carbonate has become the main ingredient in most over the counter antacids. It seems to have less overall side effect risk than the use of sodium bicarbonate.

However, calcium carbonate also may be dangerous when used regularly. Regular usage of calcium carbonate can contribute to kidney stone formation (4). Also, persistent use of calcium carbonate may lead to hypercalcemia (or high blood levels of calcium) which in turn can cause kidney injury and metabolic alkalosis, a potentially life threatening-condition (5).

Baking Soda as a Heartburn Remedy

While baking soda does indeed relieve heartburn, if you are using baking soda regularly for this purpose you may be playing with the proverbial fire.

It is not very likely however that the occasional and careful use (i.e. doctor-recommended dosages) of either sodium bicarbonate or calcium bicarbonate will lead to problems in otherwise healthy individuals. For example, if you use a baking soda toothpaste, the small amount you may accidentally ingest it not likely to lead to kidney failure.

However, if you are taking antacids or baking soda on a daily basis, this may eventually lead to serious health problems.

For this reason, we recommend an alternative remedy like chewing gum; chewing a stick of non-mint gum can help produce saliva, improve digestion, and stop heartburn without all the life-threatening side effects.

If you experience heartburn twice a week or more, talk to your doctor about possible treatment options. Consider lifestyle changes as well, such as weight loss and dietary restrictions.

References

1. Motohiro, M., et al. A New Protocol Using Sodium Bicarbonate for the Prevention of Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography. Am J Cardiol. 2011 Mar 18. [Epub ahead of print].

2. Lim S. Approach to hyperkalemia. Acta Med Indones. 2007 Apr-Jun;39(2):99-103.

3. Hypertension corrected by discontinuing chronic sodium bicarbonate ingestion. Subsequent transient hypoaldosteronism. Am J Med. 1975 Feb;58(2):272-9.

4. Allie S., & Rodgers A. Effects of calcium carbonate, magnesium oxide and sodium citrate bicarbonate health supplements on the urinary risk factors for kidney stone formation. Clin Chem Lab Med. 2003 Jan;41(1):39-45.

5. Jeong JH, & Bae EH. Hypercalcemia associated with acute kidney injury and metabolic alkalosis. Electrolyte Blood Press. 2010 Dec;8(2):92-4.

Milk and Heartburn – Is Milk A Good Acid Reflux Remedy?

In this article, we will be investigating the idea that milk can help relieve acid reflux. Milk is popularly recommended as one of the best heartburn remedies, but is this the truth or just an old wives’ tale?

The Chemistry of Milk and Heartburn

First, we need to look at any path of action that milk may be able to use in order to reduce heartburn. The first step is to look at exactly what is in milk itself.

Milk is actually a weak acid, with a standard pH of 6.7 (anything between 0-7 on the pH scale is considered an acid). However, since it is a weak acid, it acts as a buffer solution. A buffer solution is a solution that resists changes to its pH.

To clarify for those not versed in chemistry; hydrogen ions (H+) are what makes a solution acidic; the more H+, the more acidic a solution is. Buffer solutions (i.e. milk) are able to absorb H+ ions without any change in their pH, by storing them in a different chemical form.

As a result, when you mix milk and stomach acid, the resulting solution is less acidic than stomach acid. This occurs because milk absorbs some of the H+ ions that make stomach acid acidic.

In this way, milk acts much like antacids. Calcium carbonate, a popular antacid, acts as a buffer as well, absorbing H+ ions to resist changes in pH.

The Problem With Milk as a Heartburn Remedy

One major problem with milk is that some people are allergic to milk. There is some evidence, for example, that lactose intolerance (also known as lactose malabsorption) can lead to heartburn when drinking milk (1). While milk protein allergies are not as common as lactose intolerance, it is well-documented that milk may lead to reflux in this particular group (2).

Just because milk can act as a buffer solution does not mean we necessarily recommend it. Milk acts much in the same way as calcium carbonate does (calcium carbonate is the primary ingredient of nearly all over the counter antacids). While “natural”, milk is not necessarily superior to calcium carbonate given milk’s ingredients (lactose and casein are particularly troublesome for some people).

The real issue here is that we know antacids are not always effective at relieving heartburn, and milk acts just like an antacid. Antacids often leave people with a “sour stomach” feeling or only work temporarily.

Taking too many antacids (or drinking too much of any buffer solution such as milk) might temporarily change the pH of the stomach, causing pepsin to become deactivated (pepsin is an extremely important digestive enzyme that only works under acidic conditions). Anything which interrupts digestion may only make heartburn worse.

Milk as a Heartburn Remedy – The Bottom Line

The end result is that some people might get temporary relief from heartburn after drinking a glass of milk, but this is likely to be short-lived and no more effective than taking a simple antacid.

Overall, we feel that this drinking milk to stop heartburn is much less effective than other natural remedies such as chewing gum; the saliva produced by chewing gum can help blunt symptoms as well as improve digestion, whereas milk only blunts symptoms.

References

1. Minenna MF, Palieri A, Panella C, Ierardi E. Gastro-oesophageal reflux disease and lactose malabsorption: Casual comorbidity or neglected association? Dig Liver Dis. 2006 Jun; 38(6):437-8.

2. Caffarelli, C., et al. Cow’s milk protein allergy in children: a practical guide. Ital J Pediatr. 2010 Jan 15; 36:5.

Heartburn Tips – Top 7 Natural Tips for Beating Acid Reflux

In this article, we will be revealing our top 7 tips for both getting relieving heartburn naturally and preventing reflux from occurring in the future.

Heartburn Tip #1 – Lose Weight

By far the simplest way you can stop heartburn is by losing some weight. Recent studies have linked the amount of abdominal fat to acid reflux (1). The more stomach fat you have, the more likely you are to experience heartburn.

Abdominal fat is also associated with many other diseases like heart disease, arteriosclerosis, cancer, and diabetes, so by losing abdominal fat you will not only stop your heartburn but also live a longer, healthier life.

Heartburn Tip #2 – Chew Non-Mint Gum

If you have read our heartburn remedies homepage, you know chewing gum is one of our favorite heartburn remedies. To take this remedy one step further, make note of the times of day you normally experience heartburn. Start chewing a piece of gum about 15 minutes before that time comes and you may often avoid heartburn altogether.

Mint can actually stimulate the production of stomach acid and lead to reflux, so stick to non-mint varieties. Mild, sugar-free fruit flavors seem to work best.

Heartburn Tip #3 – Keep a Food Log

We all know that “trigger foods” are often one of the top reasons people get heartburn. While we have put together a list of acid reflux foods to avoid, it can be very helpful to make a journal of what you eat and whether you get heartburn or not. This way you can identify your own individual trigger foods and avoid them in the future.

Heartburn Tip #4 – Elevate Your Bed

Elevating the head of your bed and putting your bed on a slight incline is a great way to reduce heartburn. As mentioned in our article on wedge pillows, we think elevating your bed is superior to using a special pillow.

However, reflux pillows are great to take with you when you travel.

Heartburn Tip #5 – Ditch the Alcohol

Alcohol, especially when consumed regularly, absolutely destroys the digestive tract. A glass or two of wine a week may not cause any problems, but even a glass or two daily may lead to heartburn.

Don’t believe us? If you have any friends that are regular drinkers, ask them what they do about heartburn. Even “social drinkers” end up getting GERD.

Heartburn Tip #6 – Switch from Coffee to Green Tea

Like it or not, many people who drink coffee end up getting reflux. In order to get your caffeine fix, try drinking green tea instead. Very few people report reflux after drinking green tea. Green tea also has the added benefit of containing many antioxidants and cancer-fighting properties.

Heartburn Tip #7 – No More Tobacco

While smoking and chewing tobacco are not gaining any traction in the United States, they are becoming more popular than ever in many countries, especially in China.

Nicotine causes inflammation, stimulates the production of stomach acid, and may cause the Lower Esophageal Sphincter (the LES) to relax. A poorly functioning LES is the primary cause of reflux, and inflammation and extra stomach acid only make the situation worse.

Heartburn Tips Conclusion

By applying these 7 tips, you can naturally and effectively relieve your heartburn symptoms and prevent reflux from occurring in the first place. Try them out – you will not be disappointed!

References

1. Nam, SY., et al. Abdominal visceral adipose tissue volume is associated with increased risk of erosive esophagitis in men and women. Gastroenterology. 2010 Dec;139(6):1902-1911.

Acid Reflux Pillows – Can A Bed Wedge Pillow Stop Heartburn?

Bed wedge pillows are one of the most popular heartburn remedies, but do they really work? In this article, you will find the truth about bed wedge pillows, whether they work, and what the possible side effects can be.

Acid Reflux Pillows – How They Work

The idea behind bed wedge pillows is quite simple. Acid reflux occurs when liquid flows backwards from the stomach and into the esophagus. When we are standing upright, the esophagus is above the stomach, and as such gravity helps keep the stomach’s contents in the stomach.

When we lay down, that changes; the stomach are at about the same elevation, and as such it is much easier for fluid to flow out of the stomach and into the esophagus, leading to reflux. This is why many people suffer reflux exclusively at night.

A wedge pillow is literally a wedged-shape pillow that is designed to put your torso on an incline in order to allow gravity to help keep stomach fluid in the stomach. By putting the torso on an incline, reflux’s ability to travel up the esophagus is very limited, much like a ball is not very likely to roll uphill; even if it is kicked, it will roll back down the hill fairly quickly.

Bed Wedge Pillows – Are They Comfortable and Effective?

The comfort and effectiveness of your wedge pillow depends of course on which brand you buy. The most comfortable pillows are made with memory foam, though your mileage may vary. Different people have different opinions on what is comfortable, of course.

A fair warning: men with broad shoulders or well-developed backs may find sleeping on your side with a bed wedge pillow to be quite uncomfortable. Broad shoulders alone make it uncomfortable to sleep on your side, and the pillow does exemplify that. It is more comfortable to use one to sleep on your back.

Are they effective? Simply put, yes, they are effective. Any true wedge-shaped pillow will be effective at reducing reflux in most individuals. Make sure the pillow is wedge-shaped and actually puts your torso on an incline; if a pillow claims to be made for heartburn but only elevates your neck, it is not going to work!

Potential Negative Effects of Acid Reflux Pillows

As someone has a background in kinesiology (the study of human movement), one thing that worries me about these wedge-shaped pillows is the possible long-term side effects on the spine, hip flexors, and posture.

Here is the problem: wedge pillows are not a hard (they are pillows after all), so when you lay on them your spine remains slightly curved. The spine flexes laterally if you lay on your side, flexes slightly forward if you lay on your back, and extends if you lay on your stomach.

Spending long periods of time in flexion is one of the main risk factors for developing a herniated disc, and spending long periods of time in extension may lead to facet joint pain (1).

Even if the spine was evenly propped up and supported, the hips would remain flexed throughout the night. We sit all day (hips flexed) and rarely go into full hip extension; taking this away at night could lead to improper function of the hip musculature, which could degenerate into dysfunction and pain down the road.

The bottom line is that for many people, sleep is the only time they spend an extended period of time in a neutral position with good posture. A bed wedge pillow may this away over time.

Of course, no studies have ever been conducted linking bed wedge pillows with acid reflux, but really, who would conduct such a study? Since this sort of degeneration and pain would build up over the course of years, it would take an extremely long study to truly investigate, and the funds for which no unbiased third-party would put up.

Bed Wedge Pillows for Acid Reflux – The Simple Solution

Fortunately, there is a simple (and free) work-around: put your bed on an incline. You can take textbooks, stacks of magazines, or preferably a few wooden blocks, and place them under the two bedposts at the head of your bed. This would put the actual bed itself on an incline. Just make sure the bed is raised evenly on both sides.

An incline of 4″-6″ is plenty and can go a long way to reducing heartburn. This incline is also so slight that you and your partner will not be able to tell the difference. Many people will actually find this incline more comfortable than a completely flat bed and eliminates the need for a thick pillow (thick pillows that prop up the neck can lead to neck pain).

Acid Reflux Pillows – When To Use One

With all that said, bed wedge pillows do have a function. Most people who suffer from serious reflux can actually make use of these pillows, so they are convenient to have in a few particular instances:

Travel. You are not going to take your boards with you and elevate the hotel bed; a bed wedge pillow can be great to take on the road with you

Lounging around the house. A bed wedge pillow can be great to lay on the couch with as you watch TV to prevent heartburn.

If your partner objects to raising the bed or your bed cannot be raised. Perhaps your bed-frame is not able to be raised. If you cannot raise your bed, a reflux pillow may be better than no incline at all.

Bed Wedge Pillows and Acid Reflux Conclusion

For reasons outlined in this article, I do not recommend using an acid reflux pillow on a daily basis simply because these wedge pillows may lead to back pain and tight hips over time. Why trade one problem (reflux) for another (back pain) when you can reduce reflux without side effects just by raising your bed?

While wedge pillows are inferior to putting your bed on an incline, bed wedge pillows are great for occasional use, travel and for use around the house.

References

1. McGill, Stuart. Low back disorders: evidence-based prevention and rehabilitation. 2007. Human Kinetics, Champaign, Illinois.

Do Foods High in Fat Cause Heartburn?

Our understanding of human nutrition has advanced rapidly over the past few decades, and at Heartburn Remedies we take pride in separating fact from fiction. In this article, we will be reviewing the research and investigating the common assertion that fatty foods cause heartburn.

Foods High in Fat and Acid Reflux – What the Research Says

After reviewing the research, it turns out that the common assertion that high fat foods cause acid reflux is technically true. However, there are quite a few caveats to this. For many people, foods high in fat may not cause heartburn, so be sure to keep reading before making any dietary changes.

High Fat Foods and Heartburn – Path of Action

A very recent study actually found that by injecting fat into the duodenum (initial portion of the small intestine), the pressure exerted by the Lower Esophageal Sphincter (LES) decreased significantly (1).

In layperson’s terms, the LES is the band of muscle that normally keeps food in the stomach. Adding fat to the duodenum (fat will begin to enter the duodenum from the stomach shortly after eating) caused the LES to relax, at least a bit. This makes it much easier for reflux to occur and gives us a good physiological reason why eating fatty foods might lead to heartburn.

However, it does not paint the whole picture. Another study found that adding fat to the duodenum made the pyloric valve contract tighter (2). This means that food will exit the stomach slower, increasing the likelihood that reflux may occur.

In short, eating foods high in fat increases the likelihood of experiencing heartburn by not only causing the LES to relax but also by holding food in the stomach longer.

This also helps explain the study which reported that while high fat diets did not increase the intensity of reflux, but rather the frequency of reflux (3).

Nutrient Density – Regulator of Heartburn Intensity?

An interesting thing I managed to dig up was a study which reported that the intensity of heartburn was directly related to the nutritional density of a meal (3).

In other words, the more calories per gram the meal had, the more intense the reflux participants experienced. An example of a calorically dense meal known for causing serious heartburn is a batch of barbeque wings. Wings are a very fatty, calorically dense meat, and barbeque sauce is very thick and fatty as well.

The antithesis of this would be something like a meal consisting of a piece of salmon and a few cups of steamed vegetables (with no fat added). The salmon in and of itself is a fatty meat, and a meal like this would have many of its calories come from fat. However, the vegetables make the caloric density of the meal very low.

As a result, while both meals are fatty, the salmon and vegetable meal is a lot less calorically dense than the barbeque wings, and as a result the salmon meal is less likely to cause intense reflux.

However, in pregnant women, who experience heartburn frequently, the amount of fats ingested (particularly polyunsaturated fats) was directly correlated with acid reflux (4).

It is thought that the growing fetus puts pressure on the stomach; combine this with the LES relaxing due to fat intake and it is not surprising that pregnancy plus a fatty meal leads to acid reflux.

What Constitutes High Fat Diets?

The key question here is.. what exactly is high fat anyway? That is a pretty vague term after all.

Well, one study mentioned in this article found that people who ate 25% of their calories from fat had acid reflux much less frequently than those who had 50% of their calories from fat (3).

While the Western diet is higher in fat than ever, 50% of your total calories coming from fat is quite extreme. The truth is that fat, like most things in life, may be eaten in moderation without serious negative consequences.

Sure, if your diet primarily consists of fast food burgers, fries, wings, and pizza, you will have acid reflux more than the person who eats a low-fat diet. It is not all that surprising that an unhealthy diet has negative health consequences.

However, if you eat a balanced diet with some healthy fats in conjunction with plenty of vegetables, fruits, and lean meats, odds are this will not have any significant impacts on your acid reflux.

What About Body Fat?

Another key thing to mention is that body fat has significant impacts on acid reflux. A very recent study reported direct correlations between the amounts of abdominal adipose (fat) tissue and the risk of erosive esophagitis experienced in both men and women (5).

To clarify, erosive esophagitis signifies an inflamed and possibly ulcerated esophagus, which sometimes occurs when gastroesophageal reflux disease (GERD) goes untreated. Men and women with more abdominal fat were more likely to experience erosive esophagitis.

What is more interesting is that waist circumference and BMI alone were not as strong as signals as abdominal fat (5). The amount of fatty tissue was the strongest factor for predicting acid reflux. It is thought that abdominal fatty tissue puts pressure on the stomach (and hence the LES), increasing the risk for reflux.

High Fat Foods and Heartburn Conclusion

At the end of the day, for most people, dietary fat is part of a normal, healthy diet and will not lead to heartburn unless you eat too much (i.e. more than 25-30% of your daily calories). Very calorically dense meals also can increase the intensity of heartburn.

One exception to this rule of moderation may be pregnant women, especially during the third trimester. However, restricting too much fat from the diet may be unhealthy for your baby. If you are having serious problems with heartburn during pregnancy, consider working with your doctor or a nutritionist to find a diet plan that minimizes your heartburn and provides your growing baby with the nutrients it needs.

Just remember that if you know you are going to eat a high-fat meal, follow it up with these heartburn remedies and you may be able to prevent heartburn from occurring in the first place!

References

1. Lacy BE, Carter J, Weiss JE, Crowell MD. The effects of intraduodenal nutrient infusion on serum CCK, LES pressure, and gastroesophageal reflux. Neurogastroenterol Motil. 2011 Mar 21 (Epub).

2. Aste H, & Molinari F. Gastric reflux measurements during duodenal infusion with saline, acid and fat. Digestion. 1976;14(2):184-7.

3. Fox M, Barr C, Nolan S, Lomer M, Anggiansah A, Wong T. The effects of dietary fat and calorie density on esophageal acid exposure and reflux symptoms. Clin Gastroenterol Hepatol. 2007 Apr;5(4):439-44.

4. Dall’Alba V, Fornari F, Krahe C, Callegari-Jacques SM, Silva de Barros SG. Heartburn and regurgitation in pregnancy: the effect of fat ingestion. Dig Dis Sci. 2010 Jun;55(6):1610-4.

5. Nam, SY., et al. Abdominal visceral adipose tissue volume is associated with increased risk of erosive esophagitis in men and women. Gastroenterology. 2010 Dec;139(6):1902-1911

Probiotics and Acid Reflux: Do Probiotics Help GERD?

As part of our ongoing series in the investigation of heartburn remedies, in this article we will be answering the question.. can probiotics reduce or relieve heartburn? Do probiotics and acid reflux have any relationship? Read on to find out!

Probiotics and Heartburn – What the Research Says

Unfortunately, very little research exists on the relationship between GERD and probiotics. There are only two studies which directly examined the effect of probiotics on acid reflux.

One study, performed on infants, found that infants with “functional” acid reflux (i.e. no significant health consequences from reflux) improved after being given Lactobacillus reuteri (1). This probiotic reduced instances of reflux and helped speed up digestion times (slow emptying of the stomach can contribute to reflux).

However, the other significant study on this topic, this time performed on adults, found that large doses of probiotics actually lead to more instances of acid reflux (2). In this case probiotics led to even more reflux!

So how do we make sense of one positive study and one negative study?

Probiotics – What Are They and How Do They Work?

The problem with making any definitive conclusions about probiotics is the incredible complexity of the subject matter. Most people, even those selling probiotics, have no idea how they work!

People have good bacteria living in their digestive tract (called the gut for short) which help us digest food and even battle off harmful invaders.

The vast majority of these “good” bacteria live their entire life-cycle in the digestive tract, feeding off of certain compounds we cannot digest, such as certain types of fiber and sugars. These bacteria then often release compounds which we can then absorb and make use of, such as Vitamin K.

As a result, most people promote probiotics under the “if some are good, more is better” philosophy. However, such a thought process is extremely flawed. More is not always better, as demonstrated by the study which showed large doses of probiotics led to increased occurrences of acid reflux (2).

The Gut Ecosystem – Can Probiotics Reduce Heartburn?

The fact is that the human gut acts like a miniature ecosystem. Billions of bacteria colonize the digestive tract in humans, cut off from the world with the exception of what enters the mouth and goes into the stomach. As a result, you can think of each human’s digestive tract as its own individual ecosystem.

Why is this important? Simply because the bacteria that live in one person’s gut may be completely different from the bacteria that exist in another person’s gut.

In fact, researchers have recently discovered 3 prominent “gut enterotypes”, which are essentially 3 very different gut ecosystems composed of different bacteria in different amounts (3). The prefix “entero” refers to the “gut” or “intestines”; enterotype is to the gut what blood-type is to the blood.

As a result, when you give these two different people a certain supplement containing bacteria (i.e. a probiotic), they may respond in very different ways. One gut enterotype may respond favorably to a certain probiotic supplement, whereas another gut enterotype may respond negatively to such a supplement.

To sum it all up and simplify the concepts: different people have different digestive tracts which can respond to probiotics in different ways.

Probiotics for GERD – Interpreting the Results

The truth is that the research does not provide much insight at all into the effects of probiotics on reflux, but this may be very much related to the existence of varying gut ecosystems from person to person.

We will not get any true insight into whether or not probiotics can be used as heartburn remedies until more research can be done, particularly research evaluating the effects of probiotics on specific gut enterotypes.

In the meantime, there is only one way to find out: try it out. If your heartburn gets better, great; if it does not improve, stop taking the probiotic. Even if it is beneficial, you should cycle the probiotic, as chronic use seemed to be related to the development of reflux (2).

Rather than taking a probiotic every day, take one for a few weeks, and then take a few month’s break to see how you fare. The introduction of probiotics into the digestive system may lead to changes over time. Taking a break will allow any possible changes to the gut’s ecosystem to come into fruition.

Also, note that “probiotics” is a very general term. A lot of different types of bacteria colonize the gut. The Lactobacillus reuteri bacterium used in the infant study, while readily available from supplement stores, is not the most popular probiotic; the most popular probiotic is Lactobacillus acidophilus, which is a similar but different species of bacterium. As a result, you may have to try different probiotics to get the results you are looking for.

Probiotics as a Heartburn Remedy – The Bottom Line

For now, the issue is too complicated to give a definitive yes or no on whether probiotics are good for acid reflux.

The answer is likely to be very different for different people. Some may benefit significantly from probiotics where some may not benefit, or even get worse. The only way to know whether they work or not for you is to give them a try.

Alternatively, you could play it safe and avoid them at all, as this heartburn remedy is definitely not proven. If you have had negative side effects from a probiotic, see a doctor and mention what you were taking and how it effected you, as in some cases antibiotics may be used to reverse the negative consequences of probiotic use.

In the distant future, odds are we will be able to submit our gut bacteria for testing and be able to take probiotics suited for our individual guts’ ecosystems. Until then we will have to wait for better technology or go by trial and error.

References

1. Indrio, F., et al. Lactobacillus reuteri accelerates gastric emptying and improves regurgitation in infants. Eur J Clin Invest. 2011 Apr;41(4):417-22.

2. Marteau P., & Seksik, P. Tolerance of probiotics and prebiotics. J Clin Gastroenterol. 2004 Jul;38(6 Suppl):S67-9.

3. Arumugam, M., et al. Enterotypes of the human gut microbiome. Nature. 2011 Apr 20. [Epub ahead of print].

Alkaline Water Benefits: A Viable Heartburn Remedy?

Recently, ionized alkaline water has been promoted as a heartburn remedy. I have reviewed the research and physiology behind this new-age cure and put together this report.

Below you will find out how ionized alkaline water works and whether alkaline water benefits those suffering from acid reflux and its effects on other conditions.

Ionized Alkaline Water – What Is It?

Alkaline water is simply water that has been buffered with a base (a base is an alkaline substance), such as bicarbonate. Most ionized alkaline waters are advertised to have a pH between 9.5 and 10.

If you did not know, pH is a measurement of the acidity or alkalinity of a solution. The pH scale goes from 0-14; a pH of 7 is neutral while anything below 7 is acidic and anything above 7 is alkaline.

The pH of bodily fluids varies greatly from location to location. For example, the pH of stomach acid is typically 1.5-2 (indicating a powerful acid), whereas the pH of the blood is 7.35-7.45 (indicating a mild base).

What pH really measures is the amount of H+ (hydrogen ions) and the amount of OH- (hydroxide ions) a solution contains. Alkaline water has been “ionized” through the creation of “OH-” ions.

When H+ and OH- meet, they combine to form H2O, also known as water. This process is known as neutralization. If H+ and OH- are present in equal quantities, many of them will combine to form water (typically some will remain ionized) and the pH of the solution will become neutral.

Alkaline Water – Path of Action on Acid Reflux

Recently alkaline water has been billed as one of the best heartburn remedies because in theory, the alkaline water will neutralize stomach acid and thereby will stop heartburn.

The idea however of liberally drinking alkaline solutions as if that would be good for the stomach demonstrates a poor grasp of physiology. Alkaline water may indeed neutralize stomach acid, but at what cost? What you really have to stop and consider is.. why is the stomach acidic in the first place and what will happen if we neutralize that acid?

To keep things brief, using alkaline solutions regularly on the stomach is not good for digestion. One of the key digestive enzymes in the stomach, pepsin, needs a very acidic environment to operate in. If of the stomach even approaches neutral, pepsin will completely cease to function.

Pepsin is necessary for protein digestion. We are not able to adequately digest our food without it. Pepsin is stored as pepsinogen in specialized cells in the stomach, and only when exposed to a low pH does pepsinogen convert into pepsin and become active.

This is simply a protective mechanism; pepsin loves to break down proteins into amino acid chains; if pepsin were to be always “on”, it could digest the cells that store it! Keeping its functionality tied to acid is a very clever way for the body to be able to digest protein without digesting itself.

However, when we drink alkaline water, even if we do successfully neutralize stomach acid, we are only interrupting the stomach’s natural environment and the function of pepsin.

Does Ionized Alkaline Water Work to Stop Acid Reflux?

Does alkaline water stop acid reflux? Yes and no. It operates much in the same way as an antacid. Antacids can be effective but often lead to indigestion and stomach aches if taken over time.

If you have ever taken an antacid before, you know that they often work well for occasional heartburn, but if you take them over time they lead to indigestion, a sour stomach, and overall become less effective.

After all, your body adapts to stress. If you continuously eat and drink basic substances, your body will simply produce more stomach acid to counteract this.

Other Ionized Alkaline Water Benefits

Proponents of alkaline water (typically people selling water ionizers!) also claim that drinking this water will reduce cancer rates and improve acid-base balance in the body.

I have found that there is some evidence that suggests that alkaline water may reduce the breakdown of bone tissue. Calcium carbonate, a base, is a major component of bone tissue, and our body can and will break down bone tissue if the blood gets too acidic. Alkaline water provides some pH and may prevent this from happening.

In healthy individuals, the absorption and replacing of bone is a completely normal and healthy process. With that said, alkaline water may be beneficial for those with low bone density or osteoporosis, as drinking it may protect bone tissue from breaking down.

For better or worse, there is no evidence that the benefits of alkaline water include reduced cancer risk, nor do I find that very likely to happen in the future.

If you have read our celery article, you know that many fruits and vegetables have alkaline byproducts when digested. I suspect any link between alkaline diets and reduced cancer risk is simply due to the health benefits of fruits and vegetables rather than the merits of the pH of our food. This helps explain why alkaline diets are associated with better health whereas alkaline water is not.

Ionized Alkaline Water Benefits – The Bottom Line

The bottom line is that even if alkaline water does reduce reflux, it is a “band-aid” fix. Your body will adapt and your digestive tract will suffer if you over-rely on alkaline water (or any antacid) to relieve heartburn in the long term. We do not recommend drinking this as a heartburn remedy.

However, alkaline water may be beneficial for those with low bone density or osteoporosis. At the time of this writing, there is no evidence to suggest that alkaline water can reduce cancer rates or provides any other health benefits.