Revisiting Heartburn, Reflux, & GERD.
Revisiting Heartburn, Reflux, & GERD.
Recently, I have received many questions regarding heartburn. Let's dive in.
Over the last couple of months, the growth of this publication has been unlike any other time since I started writing online. With this has come many new readers who are unaware of the articles I have published over the last few years.
Recently, I have received many questions about one of the most common complaints a doctor will receive in his clinic - heartburn aka reflux aka GERD.
Bird’s Eye View
First of all, there is no single cause of heartburn. Therefore, there will be no single treatment that will solve this problem. Key word is solve the problem. That does not mean there are not things you can do to reduce symptoms, but these are merely band-aids.
To get a complete overview of all of the different structural, functional and physiologic processes that can contribute to heartburn, I would highly recommend reading this root cause article.
One you have a sense of what may be causing your heartburn, you can embark on trying to find a cure.
Once you read the above, you will find that heartburn can be caused by anything from diet to a herniated disc.
Recent Research Findings
As I embarked on understanding heartburn beyond what I had been taught in medical school, I stumbled upon some interesting research.
Although deficiencies in a few vitamins are discussed in the standard medical literature, there isn’t really a clinical exploration in the relationship between nutritional intake and heartburn.
One of the first pieces of research I found was published by Brazilian pharmacist Ricardo de Souza Pereira. In this paper, Pereira had participants with known heartburn and placed them into 2 treatment groups. One continued their standard medical therapy, Omeprazole (a proton pump inhibitor). The other group was put on a stack of vitamins:
Melatonin 6mg
Tryptophan 200mg
Vitamin B12 50 micrograms
Methionine 100mg
Vitamin B6 25mg
Betaine hydrochloride 100mg (Yes, hydrochloric acid)
Folate 10mg
In the group receiving the vitamin stack, 100% of the participants reported markedly improved symptoms within 7 days.
In the group receiving the standard medication, 65% reported improvement within 9 days. The remaining 35% had persistent symptoms even after 40 days.
Interestingly, he then switched the group that was still symptomatic on Omeprazole, and placed them on the vitamin stack. 100% of them reported symptom resolution.
Interesting Follow-Up Study
Now, you might be thinking that’s a lot of different vitamins - do you really need to be taking all of them?
Pereira performed another study to understand which of the supplements was doing the most work. So, he placed a patient on the full stack. Then, he removed one supplement at a time to see if the patient’s heartburn symptoms returned.
He found that the only time the symptoms came back was when he reduced the dose of melatonin from 6mg to 3mg. No other supplement withdrawal caused symptoms to recur.
Does this mean everyone with heartburn should take Melatonin?
Not exactly. I’ll tell you why in a moment.
Heartburn Complications
There are many complications that can occur from longstanding heartburn/reflux. Complications ranging from simple gastritis or esophagitis (inflammation of the stomach or esophagus, respectively) to ulcers. Ulcers are particularly concerning because they can eventually perforate the gastrointestinal track, which can be fatal.
The next two questions you may consider is:
Do natural approaches like lifestyle changes and vitamins prevent progression to these complications?
By extension, does the standard medical therapy (like Omeprazole) also prevent progression?
More importantly, can these natural approaches reverse (or cure) the complications?
To answer the first question: Yes. There’s little need to elaborate here, because if you are taking a natural and root-cause approach to addressing the heartburn, you will also prevent the complications.
You can read more about it here.
What’s interesting is that the literature in favor of standard medical therapy to prevent progression is weak. The reason should be quite obvious - if you are not addressing the underlying problem, you cannot prevent its progression. Only soothe some symptoms for a limited period of time.
The second question is even more impressive, especially since the answer is also Yes.
You see, Pereira performed yet another study in which a young man had been “treated” for heartburn by gastroenterologists for years, without relief.
He was put on a similar vitamin stack, this time with a lower does of melatonin.
Not only did his pain resolves within hours of starting the vitamin stack, but within a month he regained much of the weight he lost from an inability to eat.
What’s even more interesting is 9 months later, his grade 4 ulcer had regressed to a grade 1 erosion.
Melatonin, To Supplement or Not?
Now we get to the crux of the these studies: should people be supplementing melatonin?
In my opinion, only in dire circumstances after other options have been exhausted. Even then, only for a short period of time.
Melatonin is a compound made by the body under certain circumstances. For instance, in medical school we are taught that it is produced at night. Which is true-ish.
Specifically, melatonin is made at night in the absence of blue or green light. Unfortunately, most of our environments are filled with artificial blue light. The power light on your electronic devices, the light bulbs, your smartwatch, the phone display, and more.
In the past, people made melatonin at night. These days, many people are deficient in melatonin usually due to a combination of inappropriate dietary intake of precursor proteins and artificial lighting. Unfortunately, melatonin “deficiency” isn’t something that is recognized in the medical literature. There is no reliable or accessible test for “melatonin levels.” This is a modern problem, that needs a modern solution.
Melatonin is also made throughout our body by our mitochondria. Mitochondria make melatonin in the presence of near-infrared light - such as the light obtained during sunrise and sunset.
Thus, it is insufficient to claim that simply by the presence of blue light at night do we get in the way of making melatonin. We also need to promote the production of melatonin by regularly exposing our skin and eyes to sunrise and sunset (regularly means daily).
Why might we want to promote endogenous production of melatonin instead of taking the supplement?
For starters, any supplement you take will discourage your body from making it - because it will already have enough. Do this long enough, and you turn off the mechanisms by which your body is used to making the thing you are replacing.
Secondly, chronic melatonin supplementation has several concerning side-effects. Some people believe it may even promote cancers.
Many people still ask if they should supplement with melatonin, and what I tell my loved ones is that if you have tried all other methods of promoting endogenous melatonin production…and it still doesn’t resolve your symptoms, then you can experiment with low-dose melatonin to see if it improves your heartburn.
At least this way, you can find out if its your habits that are inadequate or the melatonin itself. Once that has been determined, other optimization pathways can be explored to minimize the need for chronic melatonin supplementation.
If after reading the articles above, there are still some uncertainties or questions, let me know in the comments below. I’m always looking for new perspectives, challenges, and solutions.
It’s evident that something as complex as heartburn will not have a silver-bullet that works for everyone. But, little by little I’m putting together a protocol that anyone can implement and keep the strategies that works for them.
Great article. I learned a lot.
After reading your brief tutorial of the anatomy and physiology involved in digestion—as pertains to the diaphragm in particular—it reminded me of something so beneficial that every human being can, and should, do it every day . . . sing. Improves diaphragmatic tone & function, breathing, core stability and, certainly one of the most important things, nervous system and mood improvement. I have a Bachelor of Music (Vocal Performance) degree, and after reading that post, I felt quite chastened because it reminded me that as I’ve gotten older, even I don’t do enough. Doesn’t matter whether one can carry a tune or not. Be it Bob Dylan or Beethoven, sing! Good for the body and the soul.