Is your heartburn or indigestion a symptom of IBS?
Acid reflux or heartburn, also referred to as gastro-oesophageal reflux disease (GORD or GERD), is not the same as irritable bowel disease (IBS), however, both conditions can often co-exist. And if you experience IBS, then it's more likely you will also experience reflux or indigestion (or dyspepsia).
Indigestion and reflux are symptoms arising from the ‘upper’ digestive tract and may be a sign of reduced digestive enzyme output or low gastric or stomach acid, otherwise known as hypochlorhydria.
Heartburn or acid reflux presents as an intense burning sensation in your chest that spreads to your throat, caused by stomach contents flowing back up into the oesophagus.
GORD affects hundreds of millions of people worldwide (1) and occurs when the muscles at the bottom of the oesophagus stop working correctly, which results in acid reflux. Over time this can lead to erosion of the mucous membranes that line the oesophagus.
While excessive flatulence, gas, and bloating can be present with irritable bowel syndrome, these symptoms may also be caused by indigestion, or poorly digested food.
Smoking, obesity, and a genetic predisposition increase the risk of developing GORD, with allopathic treatment usually involving the use of proton pump inhibitors (PPI’s), which are associated with adverse effects after long-term use.
There are other reasons why we might experience GORD, and these can be due to poor eating habits and lifestyle factors, such as eating in a hurry, overeating, or eating while distracted or on the run.
We need to be in a relaxed state when eating to get the most out of our food, helping us to digest and absorb our nutrients optimally. Eating while we are stressed or in sympathetic nervous system state (e.g., “fight or flight” mode) is not helpful, as our digestive system ‘shuts down’ resulting in low hydrochloric or gastric acid and pancreatic enzyme output.
Excessive coffee, sugar, or alcohol, as well as increased stress are contributory factors for low stomach acid or poor digestive function. Certain medications, ageing, a bacterial imbalance in the gut (dysbiosis), or parasites may also be a cause of gas, bloating, abdominal pain, and discomfort.
It’s important to be aware that long-term acid reflux may, in rare cases, cause damage to the oesophageal cells which may develop into a condition known as Barrett’s oesophagus. This condition needs to be caught early as it has the potential to progress to more serious issues such as oesophageal or stomach cancer (2).
Any ongoing issues after diet and lifestyle changes should always be investigated. While the research can be contradictory, Helicobacter pylori infection should be ruled out.
Common food triggers include:
· Onions and garlic
· Spicy foods
But remember, we’re all different and triggers will vary for different people. It’s important to know that removing these foods is NOT the long-term solution. It may help with your symptoms in the short-term, however, long-term dietary restrictions are associated with lower gut microbial diversity, so are therefore not recommended for a healthy microbiome.
Working with a suitably qualified health professional is always recommended to get to the root cause of your issues.
Management and dietary support
Proton Pump Inhibitors (PPI’s) such as Omeprazole or Lansoprazole, and other antacids which reduce the amount of acid produced in the stomach, are often prescribed. In 2019 alone, 60 million doses of PPI’s were prescribed.
Stomach acid plays a vital role in the digestive process. It is required for activating pepsin for protein digestion and intrinsic factor for vitamin B12 absorption.
The high acidity is necessary for destroying various bacterial pathogens. Therefore, long-term suppression is likely to lead to nutrient insufficiencies, and potentially an overgrowth of harmful bacteria.
Functional medicine and nutritional therapy approaches differ greatly from the conventional approach, as we are always looking to find the root cause of health problems rather than masking symptoms. This approach may ultimately help with long-term resolution.
Nutritional support and specific supplements, with guidance to
re-establish healthy digestion are usually required before reducing these medications, which should always be done under medical supervision.
While weight loss and the cessation of smoking would be first line recommendations, there are many other dietary and lifestyle modifications that may reduce the likelihood of ongoing issues.
Avoid drinking large amounts of water or other liquids during mealtimes, as this may dilute the stomach acid. It is recommended to sip on smaller quantities, and drink most of your liquids in between meals.
Avoid processed foods, fried foods, and high sugar and refined carbohydrates.
Excessive alcohol and caffeine consumption are also associated with the onset of acid reflux or gastritis.
Smoking, being overweight, and pregnancy are other risk factors that weaken the pressure of the oesophageal sphincter, which may contribute to GORD.
Lifestyle support to reduce acid reflux
- Eat the last of meal of the day earlier than usual, or at least 2 to 3 hours before bed, to avoid reflux during the night.
- Raise the head of your bed to reduce the gravitational effect and avoid strenuous exercise after eating may help.
- Manage your stress (6 Ways to Improve our Response to Stress).
Ideally, PPI use should be at the lowest dose possible for the shortest amount of time, unless there is a co-existing condition that requires longer-term use.
Prolonged PPI use has the potential to contribute to small intestinal bacterial overgrowth (SIBO), magnesium insufficiency, increased risk of bone fractures, dementia, kidney disease, heart disease and many other conditions.
It is always important to work alongside your GP or gastroenterologist if you plan on discontinuing acid suppressing medications, as the rebound heartburn symptoms can be quite debilitating.
Have you downloaded my FREE eBook “10 Ways to Assist the Digestive Process”?
There are lots of helpful tips to ensure you are getting the most out of your food.
Poorly digested food may result in nutrient deficiencies, which should always be checked by a suitably qualified health professional.
Microbiome stool testing helps us to get to the root cause of your health issues, by assessing not only the health of your gut microbes, but also how well your digestive system is functioning.
Please get in touch if you’d like to discuss your health issues, or if you think microbiome testing may be beneficial for you.
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1. Decai Zhang et al (2022). Global, regional and national burden of gastroesophageal reflux disease, 1990–2019: update from the GBD 2019 study, Annals of Medicine, 54:1, 1372-1384, DOI: 10.1080/07853890.2022.2074535
2. Lv J, Guo L, et al. Alteration of the esophageal microbiota in Barrett's esophagus and esophageal adenocarcinoma. World J Gastroenterol. 2019 May 14;25(18):2149-2161. doi: 10.3748/wjg.v25.i18.2149. PMID: 31143067; PMCID: PMC6526156.
3. Eom, C-S. et al. (2011). Use of acid-suppressive drugs and risk of pneumonia: a systematic review and meta-anlaysis. Canadian Medical Association Journal; 183(3) pp.310-319. doi: 10.1503/cmaj.092129
4. Cai, D., Feng, W. and Jiang, Q. (2015). Acid-suppressive medications and risk of fracture: an updated meta-analysis. International Journal of Clinical Experimental Medicine; 8(6); pp. 8893-8904. PMID: 26309543
5. Novotny M et al (2019). PPI Long Term Use: Risk of Neurological Adverse Events? Front. Neurol. 9:1142. Doi: 10.3389/fneur.2018.01142