Introduction to Acid Reflux
[00:00] Hello and welcome to Zoe's Shorts, the bite-sized podcast where we discuss one topic around science and nutrition. I'm Jonathan Wolff and today I'm joined by my friend Dr. Will Bulsowich. Today's subject is acid reflux or heartburn as it is often known.
Understanding the Esophagus and Acid Reflux
[00:20] The condition goes by many names. As a reflux, you call it GERD. It can also have many symptoms with the classic being a burning sensation, neurosophagus, which we often refer to as heartburn. This is so widespread that it affects nearly two in every 10 people globally. And well before we go any further, I've sort of heard it
[00:40] the esophagus, but what exactly is it? The esophagus is a dear organ from my perspective. It's a tube that connects the throat down to the stomach and it serves a simple purpose, which is transfer. It transfers the things that you swallow from your throat down to your stomach and it's supposed to be a one-way street. Things are not
[01:00] supposed to go backwards into the esophagus, Jonathan. Got it. And so the acid reflex is when this is travelling in the opposite direction from the way that nature intended. That is correct. It's intended to be a one-way street and so this is like a car driving the wrong way down the road. And so given that, why is it so common and are there ways to prevent it?
Symptoms of Acid Reflux and Heartburn
[01:20] Absolutely. There is some strong evidence that there are ways we can prevent acid reflux and there are some myths that we need to deal with when it comes to treatment. Fantastic. So let's get into it. Now I'm sure that some of the audience has had experience with heartburn or indigestion in the past. I think, especially when you think about events where maybe you drink a little bit too much alcohol.
[01:40] alcohol or you're overindulged in terms of what you're eating, you can experience these symptoms that I think we often call heartburn. Obviously not something I would ever do well, but for other people, I know the festive period is just around the corner and there could be people going to maybe office Christmas parties or celebrations with
[02:00] family who might be particularly interested in this topic. So let's start with the basics. I did some research and although it's called heartburn, it's not actually your heart that's burning, but it's this sort of burning sensation in the chest caused by acid from your stomach. How does this happen Will? Heartburn can occur when
[02:20] acid from your stomach travels in the wrong direction back up into the esophagus. You have to understand, Jonathan, the lining of your esophagus is very different from the lining of your stomach. It simply isn't designed to handle acid. So what happens is the acid causes injury in this area and it can be either microscopic or in some cases even manifest as a full-blown ulcer. So
Causes and Misconceptions About Acid Reflux
[02:40] heartburn is what you feel when the acid is irritating the nerves. And so for you, heartburn and acid reflux aren't exactly the same thing as a doctor who's specializing in this area? Yeah, so I get a little bit picky because I'm a gastroenterologist and these terms are meaningful in different ways for people in my field. But heartburn is the
[03:00] classic symptom of acid reflux. But it's by no means the only thing people need to be cautious of. Other symptoms could include regurgitation, where you don't necessarily have nausea, but things come back up. This could also be associated with what we call acid brash, which basically means that you get a sour taste in the back of your throat that's actually coming from the regurgitation.
[03:20] And you can even have trouble with swelling and the feeling that your food is not going down easily. And so what causes the acid to travel in the wrong direction here? It's a common misconception that harp burn is caused by an excess of stomach acid. That's not the root of the problem. I'm actually shocked to hear that. I think I have seen so
[03:40] so many ads on the television of sort of unhappy middle aged men, you know, rubbing their stomach with pictures of too much acid on the inside. So if that's not what's going on, what is happening? So really it involves two main parts if I were to just sort of break this down. First, it involves compromise or weakness.
[04:00] of the valve that separates your esophagus from your stomach. So at the bottom of your esophagus, there is a valve that we call the borosophageal sphincter. And its purpose is really to keep things in the stomach and stop them from going backwards. But if this barrier is disrupted, such as if a person
[04:20] person has a hidohernia, then we become vulnerable to the reflux taking place. Additionally, the esophagus and stomach are supposed to have coordinated movements that sort of keep things moving along in the direction that they're supposed to go. And we call this motility, Jonathan. And so if you mess up these coordinated movements,
Medications for Acid Reflux and Their Effects
[04:40] disturbs the forward flow. So between an impaired barrier and messed up motility, you ultimately get inappropriate backwards flow from the stomach up into the esophagus and then here we go, these symptoms start to take place. So I have this vision of my littlest one sort of splashing
[05:00] in the bath and the water going everywhere. And what you're sort of saying is it's designed to be this nice flowing sort of start of the lake going into the river, but in fact, it's going everywhere. I'm not managing to keep this closed and it's getting into, in my case, the bathroom floor and in your case into the esophagus.
[05:20] And then I guess that's where for the audience who's familiar with many of these symptoms, they're like, okay, so what do I do? And I think they go to the doctor and they take these medications sort of used to treat heartburn. Can you tell me a little bit more about them? Sure. So the most commonly used medicines are called Proton.
[05:40] pump inhibitors and they have drug names like omeprazole, ansoprosole, or pantoprazole. So these medicines, they work by blocking the stomach acid from being secreted, which makes people feel better because what refluxes into their esophagus is now less acidic. So just to be totally clear, it's not an excess of acid
Long-Term Use of Acid Reflux Medications
[06:00] that is the actual problem. But if you reduce the acid, people do actually feel much better. And so these medicines end up being highly effective. And so I think a lot of our audience will be thinking, I've got a little heartburn or indigestion. What's the big deal? I just have to pop a tablet either if I'm having it all the time, one of
[06:20] drugs you're describing or maybe if it's occasionally just an antacid, a tenth of the world's population is believed to have used some form of medication to treat these gastric issues we saw with some research. So why are we discussing this if we already have like these great medical solutions? So they're effectively
[06:40] this is why they have become some of the most widely prescribed medicines globally and they're incredibly popular over the counter as well. In the US alone, over 10 million doses of these medicines are used every day. I mean, that's a staggering number. 10 million. That is a enormous number. Yeah. So for occasional symptoms, to take these medicines
[07:00] medicines, it's really not that big of a deal. The issue is that people with symptoms several times per week can become very dependent on these medications to suppress their symptoms. And there are a lot of people who end up on these medicines for years or in many cases, even decades. And so why is that a problem? Well, I mean, there's lots of medications that people use for decades for their
[07:20] blood pressure or whatever. And why are you concerned? And I'm guessing this is linked to your explanation that the medication actually reduces people's stomach acid for the long term? Jonathan, we evolved to have stomach acid for a reason. And so reduction of stomach acid can alter the balance of
Risks of Reducing Stomach Acid
[07:40] It can increase our risk for infections. There have been a number of infections that have been associated with taking these medicines chronically. One specifically that people may have heard of is called Clostridioides difficile, or more commonly referred to as C. diff. Additionally, chronic use of these medicines has been associated with
[08:00] associated with a higher risk of pneumonia and small intestine bacterial overgrowth, otherwise known as SIBO. And I'm guessing that in addition to this, if we are reducing our stomach acids, then it's somehow going to alter the way that our bodies are going to process the food that we eat? Yeah, the stomach acid is in fact a part of our digestive process. And so
[08:20] it can change how we digest our food and this could affect access to our nutrients. So those who regularly consume heartburn medications could potentially become deficient in vitamin B12, calcium, iron, just to name a few. So if we don't want people to be depending on this medication for the rest of their lives, what other alternatives are there to treat the underlying
Dietary and Lifestyle Adjustments for Acid Reflux
[08:40] acid reflux. Well, the answer isn't as quick and as easy as popping a pill. And this is part of the reason why these alternative choices don't get the attention that they deserve in your doctor's office. But what's exciting, Jonathan, is that we can change what we eat and how we eat. And that could potentially improve acid
[09:00] reflux. And generally those choices come with additional benefits beyond just improving your heartburn. And so what are the things that our listeners need to be conscious of? And is this the part where you take away all of their favorite foods? Sorry to the listeners at home, I'm just the messenger.
[09:20] But unfortunately, the reality is that lifestyle choices in foods that we often find to be fun can actually provoke acid reflux. So just to name a few spicy or acidic foods like citrus and cooked tomatoes can irritate the esophagus and aggravate the symptoms. You'll want to be conscious of fat intake from fried tomatoes.
[09:40] foods, meat, full fat, dairy. And the reason why is that the fat slows down the stomach emptying, which can worsen reflux. And some sweet treats like chocolate or peppermint, they actually relax the lorosophageal sphincters. So these things also could potentially make things worse. I've always been told that you need to put some distance between when you last eat and when you go to bed. Like I remember
Timing of Meals and Sleep Considerations
[10:00] my mum always saying this. And in fact we did a podcast episode recently on intermittent fasting and apparently a lot of people see their heartburn complaints reduce. They're assuming this is because they're no longer eating just before they go to bed. You know I know that when I've just eaten just before I go to sleep you know I can quite often still feel my stomach churning.
[10:20] And although I generally don't have any issues with heartburn, those, you know, on those occasions it happens, it's normally this in particular. How does that tie into acid reflux? Ideally, we want to go to bed with an empty stomach. So when you lie down flat, gravity stops helping you because you're laying flat. And so anything that's
[10:40] in your stomach could actually start to reverse up into your esophagus, into your chest while you're lying there. So ideally we should have dinner three or even better four hours before bedtime because that's how long it takes for most of the food to exit our stomach. Four hours? Okay, I don't think I can sign up for that, Willis. Sorry, Jonathan.
[11:00] Is that and that is presumably it's not to say this impossible. I mean we all know we can Go upside down and the food doesn't suddenly come out, right? So we've got a valve that normally keeps this closed But you're sort of saying that if you're lying flat, it's putting more pressure on this and so if you're prone to these issues This is going to be worse or you're saying absolutely. This is sort of a problem for
[11:20] anybody who's listening to this? Well, the beautiful thing is that ultimately if you are having a problem with acid reflux, you're going to manifest symptoms. And so one of the things that I've said to many of my patients through the years is let the symptoms guide you. If your symptoms are getting worse, then you know that there's a problem.
Key Takeaways and Final Thoughts
[11:40] So I think a lot of our listeners will now be thinking twice before grabbing an antacid. It's clearly a very complicated issue. There's a lot of treatment options. What do you think are the key takeaways that our audience should learn from this topic? Okay, so one of the
[12:00] things I just want to be clear on. The point isn't that we should never use medicine to treat acid reflux. The point is that we have diet and lifestyle options that can improve our reflux and we should take advantage of them as much as possible. Not only to minimize our dependence on long-term medicine use, but also to address the root of the problem and improve our health more globally.
[12:20] I mean, there's benefits that we get that go beyond just improving reflux. This isn't an instant fix, but it's the best long-term strategy for these chronic conditions. So given time, you may find that your reflux symptoms improve, that the dose of medicine you require can be reduced, or in some cases it's even stopped. And if that's the case, I'm dancing.
[12:40] Some of the things that we can do include taking time to enjoy our food and eating in a relaxed manner. Avoid bending or lying down after eating. Give yourself time. We just mentioned, you know, three to four hours before going to bed. And again, we want to move towards a more high-five-year-old person.
[13:00] diet and this absolutely can be a delicious diet that you are just thrilled to sit down, it makes you salivate. So just because we're giving up things like reducing our red and processed meats or fried foods, high fat dairy, or keeping our alcohol and caffeine to a minimum.
[13:20] You deserve to enjoy your food and one of the ways that we can express that is through a Mediterranean diet pattern. That's sort of a general construct that we could follow. Brilliant. Well, thank you so much. If you'd like to try Zoe's personalized nutrition program to improve your health based on the science of your own body, you can get 10% off by going to joinzoe.com.
[13:40] I'm Jonathan Wolf and I'm Will Borsaw. Join us next week for another Zoe podcast.
