MANY of our readers will agree that many diseases that we have looked at in this column have one thing in common; and that is in terms of causation or risk factors involved, lifestyle does take a centre stage. For instance, we have looked at non-communicable diseases like diabetes, hypertension, heart disease, stroke, cancer and even HIV and, they all have lifestyle in one way or another contributing to their development or acquisition as the case may be.
Just last week and the other week, we dedicated time and space to discussing another medical condition which is also largely driven by lifestyle; we dealt with hypercholesterolemia (having excessive cholesterol levels in blood circulation, in the body) and its attendant complications; with heart attack and stroke being among the common ones.
Now, the word lifestyle is quite broad and so some of the factors considered under it as risk factors for disease include: a sedentary lifestyle, smoking, alcohol consumption and nature of food one consumes, and so on and so forth. And in regards to food, reference is especially made to the type of food one often eats, quantities consumed per meal, and indeed not forgetting such things as additives or the processing involved to either improve taste or flavor and or indeed preserve a particular food type that will sooner or later be consumed.
With this background on lifestyle and food in particularly set out, we can now turn to our topic of discussion today, which is heartburn; heartburn is a very common condition that more often than not results from consumption of certain types of food, as this article reveals. It is important to note that heartburn in itself is not a disease as such, but rather it is a symptom that represents something going on and wrongly so, involving the stomach and the food pipe (the food pipe in medical jargon is called the oepophagus).
Now in order to appreciate how heartburn occurs, let us understand one thing first and foremost: when one is eating food and once it is chewed and swallowed, the food is pushed by muscular motion and waves down the food pipe and then through a muscle ring into the stomach. Normally this muscle ring works like a valve and serves the primary purpose of making swallowing a one way affair; therefore, it (the valve or lower esophageal sphincter, or LES according to doctors) prevents food from returning to the oepophagus by pinching the tube closed. So every time food is swallowed, the LES relaxes so food can enter the stomach. However, reality is that when the stomach is full, sometimes tiny amounts of food can sneak back (up) into the esophagus whilst one is swallowing. That’s normal. It does happen in ‘normal individuals’ as we noted earlier and many of us have at one time or another experienced some form of heartburn, when contents of the stomach can squeeze up through the sphincter and back into the esophagus and one experiences a ‘reflux’ and therefore feel a burning sensation behind the breastbone.
Yes, almost all of us have had or do get to have a little reflux from time to time but many times we just don’t know that it is happening; or when we get to know, it might just be an occasional minor nuisance that we might just ignore because in many cases it will go away on its own, anyways. On the other hand however, there are some people who are (more) prone to getting relatively or even more serious episodes of heartburn. In the latter case, a substantial amount of stomach acid and digestive juices enter into the esophagus, causing a condition doctors refer to as GERD or GORD (we return to this in a little while). The stomach itself, however, has a tough lining that resists acid, but the food pipe does not and so when this acidic material hits the food pipe, its sensitive tissues are injured by acid and therefore one gets to experience or suffer from heartburn.
Heartburn, therefore is a feeling of discomfort or burning or even pain felt rising up from the upper abdomen or lower chest into the neck; sometimes it is referred to as indigestion. As noted, it is due to stomach acid rising up into the food pipe (oepophagus), where it ends up causing pain and inflammation. Occasionally, this acidic stomach content in form of food and or liquid can come higher up into the throat and mouth – this is called regurgitation.
If or when heartburn occurs regularly, say a few days a week or even every day and also in many cases accompanied by burping and or bloating, doctors will refer to it as gastroesophageal reflux (GERD or GORD; mentioned earlier); in which case it can be quite distressing and this will in many cases call for more attention and appropriate treatment and care. And GERD in some people can sometimes cause chest pain that is severe enough to even mimic a heart attack or belly pain that mimics an ulcer.
We have noted that sometimes the acid can make it all the way to the throat and mouth, and if or when this happens, other problems can arise; in some cases these other problems can occur in the absence of heartburn and this might lead to misdiagnosis or a delay in making appropriate diagnosis on the part of the doctor (s). And here are some of these stealthy signs of GERD which you might want to look out for – a sour or bitter taste in the mouth, regurgitation of food or fluid, hoarseness (otherwise known as laryngitis) especially in the morning, sore throat or the need to clear the throat, a persistent cough without apparent cause, dental erosion (damage to teeth), feeling that “there is a lump in the throat”, and sometimes wheezing. Indeed in some cases (particularly in kids) some people have ended up being treated for asthma (when the underlying problem is GERD) and given all sorts of unnecessary medication. It is important that both our doctors and patients take note of this potentially confusing presentation.
Poor function or weakness of this sphincter or valve at the junction of the food pipe and the stomach is responsible for most cases of heartburn. And a variety of chemicals can make this valve or sphincters (or LES) relax when it shouldn’t, while others can irritate the esophagus, making the problem worse; yet again other conditions can put too much pressure on the LES. This inevitably affects the integrity and efficiency of this supposedly or ideally one-way valve mechanism.
Some of the chief culprits involved in compromising the function of this valve system are actually lifestyle and or food related, but there are still others not really related to any of these two main factors: so the common culprits include – fried and fatty foods, chocolate, coffee and tea, carbonated beverages, peppermint and spearmint, tomato-based foods as well as citrus fruits. For some people, it is due to medications such as some of those used for prostate cancer treatment, some meds used for heart disease and hypertension, some anti-depressants, and also some anti-inflammatories (such as those used in arthritis, pain and fever).
Still for others, heartburn is or will be triggered or worsened by smoking, obesity, and indeed many expectant (pregnant) moms do get heartburn from time to time. Yes others will get heartburn because of overindulgence i.e. when they overeat – (on a lighter note; if late veteran journalist/broadcaster Matteo Phiri [m.h.s.r.i.p.] were still with us and read this article, he was going to go like “Kudya vakudya sitilesa, manje kadyedwe”).
Indeed there is also a small proportion of people who will suffer from heartburn when they have a medical condition called hiatus hernia (this is when part of the stomach bulges through the diaphragm muscle into the chest).
Indeed the list of triggers of heartburn given here is not necessarily exhaustive nor is the idea to suggest that anyone consuming these foods will automatically experience the discomfort of heartburn. Many people who consume many of these foods we have listed here are free from the nuisance that come with heartburn. The idea in this article is to point out that for those who are prone to heartburn, they might need to look out on these foods as they are the ones that have in many cases been found wanting in as far as acid reflux and heartburn are concerned. Indeed many other foods and factors which are not on our list here may be behind this condition, certainly.
Acid reflux does affect individuals in different ways. For many it may merely be a very occasional upset that might go away even without treatment. For others, however, symptoms may be severe and quite frequent. They might also experience throat or lung symptoms. A few may go on to develop complications, with the commonest being esophagitis (inflammation or irritation and swelling of the food pipe/esophagus). This complication may give the sufferer a steady burning pain that can make swallowing and eating difficult. The inflammation or irritation and swelling can cause ulcers of the tube’s lining and may also be associated with bleeding. Now, when one has repeated cycles of esophagitis and healing, they are likely to end up with scarring and narrowing of the tube (a condition doctors refer to as a ‘stricture’ – and a stricture has its other complications and may need surgery to be corrected). For those with severe damage to the tube, a small proportion might suffer a pre-malignant condition (Barrett’s esophagus). A few folks with this condition go on to develop cancer of the esophagus.
The good news however is that most people with stomach acid reflux (GERD) don’t need any test at all. If the symptoms are typical and mild, one may even be able to treat themselves (mainly lifestyle and dietary modifications and maybe a short course of an antacid). Similarly, if doctors suspect one has ordinary acid reflux, they with work with them to figure out what the possible trigger (s) might be from the potential list we have looked at (above); if the trigger is identified, then it is addressed accordingly, as discussed below. Doctors may also recommend a trial of therapy, as the next step and if one responds promptly then they probably won’t be asked to have any tests. However, in an event that tests are needed, the common ones include a barium swallow (x-ray), a scope (endoscopy/oesophagoscopy), or monitoring of acid levels in the food pipe (24-hour PH monitoring). Sometimes a bacterium or germ called H. pylori may be the cause and so doctors sometime do a test to check for this germ, and appropriate treatment is administered.
Lifestyle change and dietary modification, in many instances are key modalities in addressing the problem of heartburn. Acid reflux and heartburn are in many ways problems of modern life. As we have learned, smoking, poor eating habits, obesity, alcohol abuse and stress all fuel the fire of heartburn. A little heartburn from time to time, however, is no big deal – but persistent GERD can lead to serious complications. Fortunately, however, this modern problem can be solved with old-fashioned lifestyle changes, modern drug therapy, and probably with (new) surgical options, if necessary. However, for many who get occasional heartburn, diet and lifestyle changes go a long way in easing or avoiding the symptoms of stomach acid reflux or heartburn.
Indeed the key to lessening the likelihood of reflux and to avoid irritation of sensitive and inflamed esophageal tissues is dietary changes and lifestyle modification in general. It is therefore important to decrease total fat (high fat meals and fried foods) intake; avoid large meals; decrease total carbohydrate intake, cut down on weigh if obese; avoid chocolate as much as possible; avoid or cut down on coffee, depending on individual tolerance; avoid or cut down on other known irritants such as alcohol, mint, carbonated beverages, citrus juices and tomato products. However, if you are able to tolerate them you can consume these products in just adequate amounts.
For those with acid reflux and heartburn, it is advised that they need to quit smoking (if they are smokers); avoid clothing that is tight in the abdominal area; and avoid eating within 3 hours before bedtime. They may have to lose weight if they are overweight or obese. And when sleeping, they may have to elevate the head of their bed. These are but just some of the key measures one needs to apply if they get regular heartburn. I have deliberately avoided to mention long term use of drugs such as those doctors refer to as proton pump inhibitors (PPIs), examples being omeprazole and its cousins like pantoprazole, esomeprazole, rabeprazole etc, partly because not all doctors agree they are “good enough and or are helpful for long term use”; but you can however, get more clarification on the use of these drugs from your regular doctor. As for yours truly, he does prescribe these meds as and when necessary and for specific duration of time, anyways (of course not through this platform).
I rest my case…
And hey, I certainly wish you a healthy and successful 2016.