Do They Work?
Heartburn is a common problem that affects many Canadians at one time or another. It is that familiar burning sensation behind the breastbone resulting from acidic stomach contents rising into the esophagus (acid reflux). Occasional heartburn might result after a large holiday meal, or a night out drinking alcohol and eating greasy food, or perhaps from not having eaten recently enough. However, when heartburn becomes frequent and chronic, it is likely a symptom of gastroesophageal reflux disease (GERD).
It might be difficult to figure out what to do when heartburn strikes. With such a variety of over-the-counter (OTC) treatments, miscellaneous herbal or other natural remedies, and prescription medications available, choosing the right treatment can be an adventure.
GERD vs Heartburn
The first step in finding the right treatment involves understanding the differences between heartburn and GERD. GERD is a chronic condition defined by an improperly functioning sphincter between the esophagus and stomach (lower esophageal sphincter), which causes stomach contents to regularly push up into the esophagus. Heartburn is the most common symptom of GERD, but other symptoms include persistent sore throat, hoarseness, chronic coughing, frequent throat clearing, difficult or painful swallowing, asthma, unexplained chest pain, bad breath, erosion of enamel on teeth, a feeling of a lump in the throat, and an uncomfortable feeling of fullness after meals. Untreated and persistent GERD can also lead to more harmful diseases such as esophagitis, Barrett’s esophagus, and esophageal cancer.
If you experience these symptoms of GERD, please consult your physician, because the treatment for this disease is more complex than the treatment for occasional heartburn and will likely involve prescription medicines. If you only experience heartburn infrequently, usually after specific triggers, and you don’t experience the other symptoms of GERD, it is likely that you are just experiencing bouts of heartburn. However, please consult your physician if you have any questions or concerns.
These are for treating GERD, not occasional heartburn, and include two types of medications that supress acid production. Histamine-2 receptor antagonists (H2RAs) work by blocking the effect of histamine, which stimulates certain cells in the stomach to produce acid, and include cimetidine (Tagamet®), ranitidine (Zantac®), famotidine (Pepcid®), and nizatidine (Axid®). Proton pump inhibitors (PPIs) work by blocking an enzyme necessary for acid secretion and include omeprazole (Losec®) lansoprazole (Prevacid®), pantoprazole sodium (Pantoloc®), esomeprazole (Nexium®), rabeprazole (Pariet®), pantoprazole magnesium (Tecta®), and dual delayed release dexlansoprazole (Dexilant®).
Most of those who have experienced heartburn are familiar with OTC medicines. They offer quick relief for occasional heartburn, and are available at any drug store or grocery chain. These can also be helpful for those who have GERD, for those times when they notice that their ongoing treatment is temporarily not enough. Medications such as Maalox®, Tums®, and Pepto-Bismol® neutralize acid, and another product, Gaviscon®, neutralizes stomach acid and forms a barrier to block acid rising into the esophagus.1,2 Some small dose H2RAs are also available OTC. Generally, you shouldn’t use these products for longer than two weeks and, if you feel like you need to, then it can be a sign that you might have GERD or that your prescription GERD medication isn’t working well enough.
Most of the medications used to treat heartburn, both prescription and OTC, have gone through rigorous testing and studies to establish safe and effective use, but what about natural remedies? You’ve likely seen long lists of natural heartburn cures, or maybe had friends or family members who swear by baking soda or apple cider vinegar to relieve their heartburn, but what does the evidence say about these methods?
Sodium bicarbonate (baking soda): baking soda is alkaline, and is generally safe to consume, which makes it a good candidate for neutralizing acidity. It makes sense that people reach for this common household item to treat heartburn. While some evidence does show that it is safe for occasional use, overdoing it can lead to a medical state known as alkalosis which can cause cardiovascular disturbances and is potentially dangerous.3 Baking soda is also very high in sodium, and can prevent the absorption of certain medicines. Use in moderation.
Acids: this is an odd remedy, and typically involves consuming either apple cider vinegar or lemon juice to quell heartburn. The logic behind it is that not all heartburn is caused by an increase in acid, which would make the treatments that neutralize acid pointless. According to proponents of this method, heartburn can be a result of an improperly functioning stomach that allows contents to backflow into the esophagus because it isn’t acidic enough. Therefore, consuming acids helps to restore the normal acidity level in your stomach and aids digestion. However, there isn’t much evidence that this is actually effective, and in some cases, adding extra acid to your stomach might make symptoms worse. Physicians generally do not recommend this method. This theory might stem from the fact that some individuals experience heartburn or GERD as a result of delayed gastric emptying. But there isn’t any good evidence that vinegar will speed up gastric emptying, so you are better off using a medication made for that purpose. Don’t use for heartburn.
Milk: using milk to ease heartburn seems like a good idea intuitively. Milk is alkaline, and it can feel soothing to drink. And while it is true that initially milk can ease your discomfort, the fat and protein it contains can lead to worse heartburn once digestion begins. Lower fat milk might be easier to tolerate during bouts of heartburn. Try a calcium-based OTC treatment (such as Tums® or Maalox®), which have the benefits of the calcium in milk without the drawbacks. Don’t use for heartburn.
Chewing gum: chewing any type of gum could be a simple way to ease mild heartburn. Our saliva is slightly alkaline due to the presence of various enzymes. Chewing gum stimulates the production of saliva, which can help reduce reflux when you swallow. In addition, the very act of swallowing might help to push stomach contents back into the stomach. This method is generally harmless, as long as you avoid consuming large quantities of artificially sweetened gum, which can cause diarrhea in some individuals.4 Chewing gum might also increase your ingestion of air, increasing flatulence. Use in moderation.
Gingerroot: ginger has many benefits when it comes to stomach aches and nausea, and it might also help reduce acid reflux. While many peoples have been using ginger as a treatment for all varieties of stomach ailments for a very long time, it isn’t quite clear how it helps ease heartburn. One study found that it might actually reduce acid production in the stomach, but there isn’t enough research.5 Use in moderation.
Iberogast®: containing nine herbal extracts, Iberogast® is a prokinetic medication proven to help ease heartburn, along with several other digestive ailments and disorders, including GERD, irritable bowel syndrome, functional dyspepsia, nausea, constipation, bloating, cramping, and diarrhea. The herbs included are iberis amara, angelica, chamomile, caraway, St. Mary’s thistle, balm, peppermint, celandine, and liquorice. Generally, peppermint can actually worsen heartburn, but the combination of herbs in this product is still often effective in those with heartburn. Use in moderation.
Treatments for GERD and Heartburn
|Treatment||Use for Heartburn or GERD?||How it Works||Notes|
|proton pump inhibitors (PPIs)||GERD||prevent acid production in the stomach||by prescription only|
|histamine-2 receptor antagonists (H2RAs)||GERD||prevent acid production in the stomach||by prescription and OTC in smaller doses|
|calcium carbonate (Maalox®, Tums®)||temporary relief of heartburn||neutralizes acid||do not use for longer than two weeks|
|bismuth subsalicylate (Pepto-Bismol®)||temporary relief of heartburn||neutralizes acid||do not use for longer than two weeks|
|alginates (Gaviscon®)||temporary relief of heartburn||creates a barrier between stomach contents and esophagus||likely safe in pregnancy (no systemic effect)|
|sodium bicarbonate (baking soda)||occasional relief of heartburn or when other products are unavailable||neutralizes acid||potentially dangerous if used frequently|
|acids (apple cider vinegar or lemon juice)||not recommended||adds more acids to the stomach||likely not effective, might worsen heartburn|
|milk||not recommended||temporarily eases discomfort, might lead to worse symptoms||low fat milk might work better than high fat|
|chewing gum||mild heartburn||neutralizes acid, swallowing pushes contents back into stomach||avoid large quantities of artificially sweetened gum|
|gingerroot||mild heartburn||unknown||research is still early, not necessarily effective but generally safe|
|Iberogast®||heartburn or GERD||positive interaction with the mucous membranes of the stomach and intestines||speak with your physician before using regularly|
In addition to these treatments, there are some lifestyle and dietary changes you can make to lessen heartburn or GERD symptoms. Avoiding dietary triggers, eating several small meals instead of fewer large ones, losing weight, quitting smoking, and avoiding lying down for a few hours after eating can all help reduce acid reflux. Elevating the head of your mattress six to eight inches when you sleep can help prevent night time heartburn. As always, speak with your physician before making any long-term changes to your medicine regimen.