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Reverse Heartburn By Changing Your Diet

Reverse Heartburn By Changing Your Diet
February 19, 2011 Patrick Nemechek, D.O.

Heartburn is a very common problem that affects approximately 20% of the general public.

It’s commonly associated with symptoms such as bloating after meals, belching, a burning sensation of the stomach or in the center of the chest, a bitter taste in the mouth and regurgitation of stomach acid.

Most people assume heartburn (otherwise known as GERD or gastroesophageal reflux disease) is a condition of excessive acid production.  This is understandable since we use antacids such as Tums, Zantac or Prilosec to decrease acid production and our symptoms seem to improve.  But in reality, heartburn is a neurological problem.

Watch Dr. N’s CoffeeTalk on Heartburn

Patients with heartburn have excessive stomach acid accumulation, not excessive acid production. Acid accumulates because it is not being emptied fast enough by the stomach.   Just as a sink will overfill if the drain doesn’t empty correctly, so will your stomach.

The poor emptying of the stomach is also accompanied by an ineffective valve between the esophagus and the stomach that allows stomach acid to splash back up into the esophagus and results in the burning sensation in the chest, the regurgitation of acid and belching.

Your Intestinal Tract is A One-Way Conveyor Belt 

The intestinal tract is in essence a one-way conveyor belt pushing your intestinal contents forwards.  Food should pass through the mouth into the esophagus, from the esophagus into the stomach, then through the small and large intestines and finally passed out through the rectum and anus.

If the intestinal conveyor belt slows down at all, we get symptoms such as food sticking in our throat or esophagus, bloating and acid build-up in the stomach, abdominal cramps (such as in Irritable Bowel Syndrome) or constipation.

The slow forward motility of your conveyor belt-like intestinal tract is because your autonomic nervous system is not working correctly.

Take ANS Quiz 00001

The Autonomic Nervous System

Briefly, the autonomic nervous system is a portion of your nervous system (brain, spinal cord and nerves) that controls the function of all the organs (heart, blood pressure system, bladder, skin, fat, stomach, intestine, etc.) of your body.

It helps the bladder to empty, helps maintain proper blood flow to the brain, regulates the sweating of our skin, coordinates erection and ejaculation, dilates and constricts your pupils as well as coordinates the muscles and valves that push the contents of our gastrointestinal tract forward.

The autonomic nervous system has three main divisions, sympathetic, parasympathetic and enteric. The sympathetic system is activated in response to stress, exercise, exposure to heat or cold, low blood glucose, and other environmental challenges. This system is critical for maintaining the correct brain blood pressure throughout the day whether we sit, stand or lay down.

For example when standing, a sympathetic autonomic reflex constricts the blood vessels in our legs and abdomen to keep blood from rushing away from our head. The sympathetic system also increases the frequency and strength of heartbeats during exercise and controls sweating and blood flow to the skin to maintain healthy body temperature.

The parasympathetic system is important for digesting and absorbing nutrients, slowing the heart during sleep and emptying the bladder and bowel. In many organs, the effects of the parasympathetic system oppose those of the sympathetic; for example, the sympathetic dilates the pupil in darkness and the parasympathetic constricts the pupil when exposed to bright light.

The enteric system is a network of fibers within the intestinal tract that automatically regulate intestine movement and function without any direct control from the brain.  This is unlike the sympathetic and parasympathetic components because these 2 components engage in constant feedback between the various organ of the body and the brain.  The enteric system works somewhat on its own without direct control from the brain.

When the autonomic nervous system fails to work properly, a wide variety of symptoms can occur.   Patient can feel lightheaded when standing, have frequent urination or urgency, feel tired or fatigued, sweat too much or too little, develop dry eyes or dry mouth, experience constipation as well as bloating after meals and even heartburn.

Dyspepsia, Heart Burn and the Autonomic Nervous System

As we briefly discussed in the first section, heartburn (also known as reflux or GERD, gastroesophageal reflux disease) refers to the symptoms caused by stomach acid splashing backwards up into the esophagus (our swallowing tube).  The esophagus is not designed to withstand the powerful acids within the stomach.  It’s when these acids squirt back into the esophagus that we experience the pain, belching, chest tightness and the bitter taste in our mouth that we associate with heartburn.

The backwards splash of the acid is the result of 3 events happening simultaneously. The first step is inadequate emptying of the stomach.  If the stomach isn’t actively emptying itself into the small intestine, stomach acid will accumulate.  When this happens without steps 2 and 3, it’s often referred to as dyspepsia or indigestion.  The decrease in stomach muscle contractions that causes the acid retention is often due to poor function of the autonomic system.

The second event is the distension or stretching of the stomach that occurs as a result of a buildup of stomach acids and the addition of food when we eat.  This is why heartburn usually occurs after we eat; food stimulates an increase in stomach acid production.

And the third event is the relaxation and opening of the LES (lower esophageal sphincter) valve between the esophagus and the stomach.  When the LES valve opens, stomach acid is able squirt backwards from the overfilled stomach into the esophagus.

Steps to Develop Heartburn

Step 1 – Inadequate Stomach Emptying

Step 2 – Stomach Distention or Stretching

Step 3 – LES Relaxation and Opening

Without the abnormal opening of the LES valve, heartburn would not occur.  The same abnormal process that results in heartburn occurs in several different types of animals including humans.

The Myths of Heartburn

There are a lot of things that are spoken of as the cause for heartburn but a poorly functioning autonomic nervous system is the cause of heart burn in the vast majority of patients.

As we outlined above, it’s the stretching of the stomach that triggers the reflux.  It’s not because you ate something spicy.  Spicy food may taste worse than bland food when it refluxes into your esophagus and the back of your throat but there is no compelling evidence spicy food or anything else for that matter triggers heartburn alone.

It’s not from a hiatal hernia…

it’s not from drinking too much coffee….

and it’s not from eating spicy food.

Heartburn is primarily the result of a poorly functioning autonomic nervous system.

Carbohydrates and Autonomic Dysfunction

There is accumulating evidence that the excessive amount of carbohydrates (sugars and starches) in our diet is impairing the ability of our autonomic nervous system to function correctly.  The exact mechanisms are unknown but excess dietary carbohydrates result in excessive sympathetic and diminished parasympathetic autonomic responses.

As we continually consume excessive carbohydrates, a diminished response of both the sympathetic and sympathetic components occurs leading to a generalized state of autonomic dysfunction.   Autonomic dysfunction is often experienced by us as common physical ailments such as heartburn, constipation, bloating, abdominal cramps, fatigue, lightheadedness, erectile dysfunction or frequent urination.

Carbs-> ANS dysfunction -> heartburn, lightheadedness, fatigue, frequent urination

There is additional evidence that impairment of autonomic function triggers a rise in serum fatty acids from our fat tissue resulting in insulin resistance (IR).

Carbs-> ANS dysfunction -> Fat tissue releases fatty acids->IR

Remember, if insulin resistance remains unchecked it often results in medical conditions such as diabetes (DM), high blood pressure (HTN), heart attacks (CAD) and strokes.

Carbs->ANS dysfunction -> IR -> DM/HTN/CAD

Amazingly, it’s looking as if diabetes and high blood pressure are simply the consequence of impaired neurological functioning.  And if this continues, the diffuse, unregulated inflammatory state and metabolic disruption that stems from insulin resistance leads to the development of heart attacks, ischemic strokes (CVA) and various forms of cancer (CA).

Carbs->ANS dysfunction -> IR -> DM/HTN/CAD -> CAD, CVA, CA

 It seems the sequence of events surrounding carbohydrate toxicity unfolds as follows:

  1. Consume excessive amounts of carbohydrates for many months to years.
  2. Carbohydrates cause your autonomic nervous system to operate erratically.
  3. Insulin resistance develops with continued excessive carbohydrate consumption.
  4. Diseases such as diabetes, high blood pressure, gout, heart attacks or strokes follow after progressive worsening of insulin resistance.

Aside from the fact that heartburn is very uncomfortable, heartburn is a signal that your body is on the path towards the development of other diseases of carbohydrate toxicity, namely high blood pressure, diabetes and ultimately to ischemic stroke, heart attacks or cardiac arrest.

Autonomic Testing Guides Treatment for Improved Autonomic Function

The autonomic nervous system (ANS) can be tested and evaluated through a process known as spectral analysis.  This simple, quick (15 minute) and painless test can provide the ritical understanding that helps your physician for their treatment plan.

The ANS can become imbalanced in many different ways.  Some ANS dysfunction requires a short course of medication (3-6 months) alone or in concert with nutritional strategies to reduce systemic inflammation and oxidative stress in order for the brain to regain maximal function.  The safest way to reverse heartburn is with a map of your autonomic nervous systems to guide treatment.

Dr. Nemechek often performs autonomic testing prior to initiating treatment for heartburn and other autonomic symptoms (lightheadedness, headaches, fatigue, constipation, frequent or urgent urination).  To learn more about this technique visit his practice website at www.DrBuckeye.com.

Lower Your Carbohydrate Intake to Reverse Heartburn

It strikes some patients as overly simplistic to say that if you reduce your carbohydrate intake, your heartburn will be greatly reduced within a few weeks and you probably won’t need any more antacids within 1 month.

Fortunately for you, it is this simple.  This recent study of low carbohydrate eating tells us this approach works.

I have my patients reduce their carbohydrate intake (all sugars and starches) to less than 100 grams per day to reverse their heart burn.  Not only does their heart burn get better but so do their diabetes, high blood pressure, gout, sleep apnea, bladder irritability, lightheadedness and erectile dysfunction.

Give it a try for a month and I know you’ll feel better than you have in a long time and you won’t be needing to take that expensive Prilosec, Protonix or Nexium any longer.

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Laura Roth
Laura Roth

Hi from Missouri – I am a healthy looking 37 yr old triplet mom! I’m starting the NP in hopes to help with my chronic heartburn, coat hanger pain and nighttime numbness in my fingers. In addition, to protect myself from heart disease and stroke risk as I have high cholesterol (268) and my mother had a quadruple bypass and then stroke from A-fib after, at age 58. Right at a month ago, I started the EVOO, Cali Olive Ranch 2 tbsp/day ( 1 tbsp in the am and 1tbsp in the pm) and 3000mg NOW DHA. I haven’t yet… Read more »

Anonymous
Anonymous

Dr. Nemechek, I am interested in evaluating my son. He is now 21, but has had digestive issues since birth. He was treated with PPI’s for years, until they stopped working. Last year, he started to throw up after eating and had the stretta procedure, which did not work. Shortly after, his symptoms became worse. He could not eat anything but plain protein and was diagnosed at Mayo with gastroparesis and an autonomic nervous dysfunction with no options except a port in his stomach. A month after Mayo, he ended up hospitalized for pancreatitis. He had his gallbladder removed, but… Read more »

Esther
Esther

I found your website because I’ve been having some nasty heartburn lately, especially after a trip to Cuba where I had bad stomach pains everyday. The food at the resort was very sketchy. I’m taking some probiotics and my stomach pain is gone, but the heartburn keeps me awake at night (note: I usually don’t eat after 8pm). I’m going to try taking inulin and olive oil next. I’ve had nasty heart burn since I was a teenager, as well as constipation, bloating, very very tired after eating almost feeling intoxicated. I was obese a few years ago but lost… Read more »

Michelle
Michelle

Dr. Nemechek, I have had some GERD for years and was put on a PPI, which I was told to stay on for life. I stayed on it for several years until I fractured my femur skiing. I was told by my surgeon that it was healing on the slow side. I did some research and decided to stop the PPIs thinking that contributed to the slow healing. Then a few years later I decided to try a Ketogenic diet. I felt completely awful on this diet. I was into it for about 3months trying to make it work and… Read more »

Ginger howell
Ginger howell

Hi Dr. Nemcheck, I love your simple unique approach to health. My 19 year daughter was recently diagnosed with ruminaton syndrome at uab in birmingham. She has been sick 5 years with doctors not knowing what was wrong with her. She involuntarily vomits after every meal and drink within 5 minutes and up to 5 hours after compsumption. Finally we have an answer, she actually figured it out herself after seeing a girl with it on the doctors show.. She also suffers from anxiety and depression and over Concerned with body flaws. I have been tesding about sll the info… Read more »

Sandy Wilson
Sandy Wilson

Dr Nemechek,
Do you have a post on how to correct a slow moving digestive tract? My food sits in my stomach way too long, causing all sorts of problems. Any tips? Thank You!
Sandy

Anonymous
Anonymous

Dr. N, I went on the SCD diet a long time ago and I did not get any better. I was on it for over 3 months, and I lost 15 pounds (I was 130 pounds, 5’6. Not much to lose). Symptoms back then were strictly my stomach burning (gastritis, verified by scope) and heartburn. Now, fast forward 3 years and I just had a recent exacerbation of my symptoms. It went from gastritis and heartburn to severe nausea and lightheadedness (feeling like I will pass out) and transient joint and muscle pains that are correlated with this new lightheaded… Read more »

Suzy
Suzy

Hi. My friend Annie just saw you and had wonderful things to say. I have GERD (caused by a PPI I think) and do find eating low carb helps, however I am severely underweight. How can I gain weight eating low carb? I eat lots of fat (ghee, olive oil) and protein already. Thanks very much Dr N.

Dr. Patrick Nemechek and Jean Nemechek
Dr. Patrick Nemechek and Jean Nemechek

Suzy,

I don’t think that eating low carb is necessarily the right thing to do for everyone especially if underweight.

The key is to figure out why you have GERD and to reverse the factors that are either suppressing your hunger or preventing full absorption of nutrients or both.

Dr. N

Hannah
Hannah

Hi! I’ve been diagnosed with GERD about 2 years ago and was told to take Nexium. Sometimes i would still suffer from heartburn. I started probiotics about a year ago with my Nexium and had no trouble at all. I’ve recently been told by my doctor probiotics might not be the greatest thing to use, and heartburn medicine might not be either. I’ve stopped taking both. Since then I’ve had terrible heartburn and just recently started a low carb diet, which has helped some so far, but was wondering your take on anything else I could be doing to rid… Read more »

Dr. Patrick Nemechek and Jean Nemechek
Dr. Patrick Nemechek and Jean Nemechek

If probiotics help heartburn, the heartburn is at least in part a result of underlying SISBO. Try supplementing with inulin fiber and cutting back on the carbs. You can find advice about this on other posts.

Dr. N

Mel
Mel

Hi,

When restricting your carbs to 100 g/day, what do you suggest for fat and protein intakes on a daily basis? It would be great to resolve this with diet adjustments.

Thanks!

Dr. Patrick Nemechek and Jean Nemechek
Dr. Patrick Nemechek and Jean Nemechek

Just focus on carbs less than 100 grams per day and the fats and protein will take care of themselves. Just make sure you’re getting high grade protein (grass fed beef, wild fish, etc).

Dr. N

Shana
Shana

Hi Dr. N, Thank you for sharing your insight on this. One questions, once SIBO is reversed and functioning properly, is it ok to start adding a few more carbs to your diet? I am currently have a very high carb diet (between 350 – 450g per day) and now starting a diet under 100g per day. I’ve had chronic acid reflux for the past year triggered by stress, and always trying to avoid high acid foods, didn’t really work. Now that I think of it, every time a I have a large bowl of cereal it gets worse. My… Read more »

Dr. Patrick Nemechek and Jean Nemechek
Dr. Patrick Nemechek and Jean Nemechek

Shana, Many people have abnormal metabolism due to hypothalamus damage, and this leads to impairment of the endocannabinoid system. Much of this damage is due to excessive consumption of linoleic acid found in vegetable and soy oils. One of the effects of this is an inability to properly metabolize glucose (sugar) correctly – as this progresses we call it insulin resistance and it is a fundamental aspect of diabetes, PCOS, fatty liver disease, cardiomyopathy and Alzheimer’s Disease. Because of this, I generally recommend my patients maintain themselves on a carbohydrate restricted diet of less than 100 grams per day permanently.… Read more »

Joe
Joe

Hello Dr. N,

I was recently diagnosed with LPR and was prescribed Omeprazole and told to avoid highly acidic foods like citrus, tomatoes, vinegar, etc. Do you recommend staying away from these highly acidic foods while transitioning to a low-carb diet?

Also, do you ever recommend drinking Apple Cider Vinegar? I’ve read a lot about the benefits of this.

Thank you!

Dr. Patrick Nemechek and Jean Nemechek
Dr. Patrick Nemechek and Jean Nemechek

You problem is that you can’t empty your stomach of the foods you eat and the acid you make.

You need to focus on reversing SIBO and restoring autonomic function.

Armando
Armando

hi!… amazing information. I have been suffering from GERD and really bad acid reflux for the last 2 years. It comes and goes, I spent the last 8 months without any problem, I though I had finally overcome the problem, but now something has triggered it and it’s back again. I was diagnosed with a hiatal hernia, although I know that this physiological condition it is not the root problem, it just aggravates the symptoms of the real issue. I have been reading a lot about what it might be the main cause of my problems and after reading this… Read more »

Dr. Patrick Nemechek and Jean Nemechek
Dr. Patrick Nemechek and Jean Nemechek

It might help, you just need to give it a try.

Seth
Seth

Ok. I was quite concerned abouthow to store/replenish muscle glycogen for exercise and also because I don’t want my weight loss to be ‘water weight’ ( I’m told that glycogen holds water. )

I was planning on getting my 100g carbs from orange juice because it doesn’t give me reflux BUT apparently fructose does not get converted to glycogen… are they any ‘safe’ carbs, that provide glucose, that you have come across?

Hopefully that all made sense!

Dr. Patrick Nemechek and Jean Nemechek
Dr. Patrick Nemechek and Jean Nemechek

Sorry, beyond my scope of expertise.

Seth
Seth

I live in the UK. I’m 26 and I check all the boxes for ANS dysfunction. I’ve been ill since I was 21 and changed my diet (junk food vegan) coinciding with a lot of psychological stress. I’ve been trying for 5 years to get my health back but nothing I’ve tried works. Is there anyway I can get help in the UK?

Dr. Patrick Nemechek and Jean Nemechek
Dr. Patrick Nemechek and Jean Nemechek

Unfortunately I don’t know of a clinician in the UK who understands the restorative pathway for autonomic recovery. I do international Skype consults and can give you a lot of instruction on what to do. I have a number of patients around the world who are doing much better without traveling to the US for a consult. For more info, go to http://www.drbuckeye.com/about-dr-n/75-phone-consultation.

Good luck – Dr. N

Seth
Seth

Would ZERO carbs be optimal?

Dr. Patrick Nemechek and Jean Nemechek
Dr. Patrick Nemechek and Jean Nemechek

No. Maximal effect for most people seems to be around 100 grams and it is easier to do in the long run.

Dave
Dave

Very interesting article! I would love to book an appointemnet with you

Jc
Jc

Hello doc. Could you be a little more specific about the plan. Another words I can eat as much potatoes milk fruit and dark chocolate as long as I keep under 100 grams of carbs?

Dr. Patrick Nemechek and Jean Nemechek
Dr. Patrick Nemechek and Jean Nemechek

Yes, I’ve found for most people a non-specific reduction in carbs less than 100 grams is very beneficial.

Janet Coffin
Janet Coffin

I started following “Eat Fat, Get Thin” and noticed that on the few occasions when I lapsed and ate simple carbs, I would have acid reflux and unpleasant burping. I don’t have a history of heartburn or reflux, so this is totally new. So I’m back to lean meat, and lots of veggies. Pasta isn’t worth the discomfort.

Tony
Tony

Very interesting article. I decided to go on a very low carb diet to lose some weight. It’s been a month now and I realised the other day I haven’t had indigestion for a month. I thought it was just a coincidence but today I googled low carb and indigestion and found this article.
Now I’m starting to think it’s not a coincidence. 20 years of indigestion has now completely gone.

Dr. Patrick Nemechek and Jean Nemechek
Dr. Patrick Nemechek and Jean Nemechek

Excellent job Tony!!!

Caroline Almroth
Caroline Almroth

Hi, Very interesting article! I would love to book an appointemnet with you but I live in Europe (Sweden) so it is a little too far to travel. Do you by any chance collaborate with any specialists in Europe? I suffer from LPR and duodenal ulcers (H.pylori negative)which will not be cured despite PPI’s. I have only had LPR and ulcers for 5 months. Before that I was as healthy as anyone. Never been sick before. I am not overwight, I exercise, don’t drink or smoke. I didn’t even have heaqrtburn during my pregnancy! I really don’t understand why this… Read more »

tracy
tracy

hi, i have been on a low carb diet for a year now and feel much healthier, but i started judo classes 5 weeks ago and have had awful heartburn in my gullet and upper chest for almost the whole time. i also have a bad metallic taste in my mouth. i was running appx 12 miles a week before starting judo and did not have heartburn at all. i dont eat any starch or sugar so really am stuck as to what to do.
( i am a 40yr old female)

Dr. Patrick Nemechek and Jean Nemechek
Dr. Patrick Nemechek and Jean Nemechek

Tracy, is the Judo stressful? Stress (both physical or psychological) can alter the balance of gut bacteria. Maybe try taking a little Inulin once daily. Inulin is a very effective prebiotic fiber that will help balance intestinal bacteria. Much more effective than probiotics.

Mark Hemphill
Mark Hemphill

Hi. Very interesting article.

Re: reducing carbohydrate levels. I exercise frequently ( 3 four mile runs per week and various other bit) and normal convention says we must fuel our bodies for exercise so need more carbs than normal. What considerations do we need to make for folks who exericise please?

Thanks

M

Dr. Patrick Nemechek and Jean Nemechek
Dr. Patrick Nemechek and Jean Nemechek

Mark, When eating a high carbohydrate diet, the body adjusts to needing sugar (glucose and glycogen) as the primary fuel source. After 4-6 weeks of low carbohydrate eating, the body shifts over to prefer burning fat as the primary fuel source. The body can burn both fat and glucose very quickly for any athletic pursuit but the body of a normal weight individual carries 10,000-15,000 available calories of fat and only 1,500-2,000 calories of sugar. Which sounds like the most favorable energy source for competition? Once you reduce your carbs and get past the first few weeks, you don’t need… Read more »

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