Dealing with Chronic acidity

Overview

Chronic acidity or heartburn has become a very common phenomenon among the population these days.  Acidity or heartburn involves burning sensation in the upper abdomen or lower chest area just behind the breast bone.

Gastric acid, gastric juice, or stomach acid, is a digestive fluid formed in the stomach and is composed of hydrochloric acid (HCl), potassium chloride (KCl), and sodium chloride (NaCl).

Stomach acid (hydrochloric acid) is basically required for three reasons -

• digestion of food
• to kill the disease causing pathogens
• Maintain the optimal pH for the digestive enzymes

While the acid is restricted to the stomach, for some people stomach acid and food flow back into the esophagus or food pipe causing discomfort and burning in the throat and chest area.

Signs and Symptoms of acidity

Chronic acidity is actually a symptom of an underlying disease.  Acidity can manifest in the following ways -

• Stomach pain
• Headache which may be due to acid reflux or bloating
• Sore throat and hoarseness
• Bitter or acidic taste in the mouth
• Burning sensation in the chest after eating
• Worsening of heartburn while lying down or bending over.

When to see a doctor?

It is better to check with your medical practitioner if you have the following symptoms -

• Persistent heartburn
• Recurrence of the heartburn even after taking over the counter medications
• Nausea or vomiting
• Weight loss due to inability to eat/loss of appetite

What causes acidity/heartburn

There are a number of causes leading to acidity. It is better to find out the root cause and treat the issue accordingly -

Diet

Food is one of the most important causative factors in heartburn. Triggers are different for different people. The most common triggers include -

• Fried food
• Spicy food
• Citrus foods, tomatoes and its products like ketchup
• Commercial foods like cakes/puffs etc
• Carbonated beverages
• Chocolates
• Salads, garlic, raw onion
• Caffeine and alcohol

Eliminating the above food from the diet and then adding them one at a time, can help to identify the specific foods that lead to acidity and heartburn.

Other factors include -

• Large quantity in one meal
• Eating late night dinners
• Having heavy or large meals
• Sleeping immediately after eating

Medications

Several medications also can trigger heartburn or aggravate acidity. Before taking any medications it is better to check with the doctor to find out if the medicine can cause acidity. Following medications have been known to exacerbate the problem -

• Regular use of aspirin
• Certain drugs used to treat asthma
• Painkillers called non-steroidal anti-inflammatory drugs (NSAIDs) can irritate the esophagus.
• Sedatives
• Certain supplements like iron and potassium
• Chemotherapy drugs

Risk factors for chronic acidity

Other common risk factors leading to acidity are -

• Obesity - weight loss can help reverse acidity and heartburn.
• Physical activity - exercise can either help or hurt the acid reflux. A healthy diet and exercise can help to lose weight and help to manage the symptoms. However intense exercise can worsen the already existing problem. These movements include hanging upside down and bending for extended periods. Always check with an expert before starting off on an exercise regimen.
• GERD - Gastroesophageal reflux or GERD, is the presence of stomach contents in the esophagus or food pipe. A weakened valve between the esophagus and stomach allows gastric contents to irritate the esophagus. GERD affects many people, and usually presents itself as heartburn.
• Hiatus Hernia - Hiatal hernia is diagnosed when the stomach moves up into the chest through an opening in the diaphragm. (The diaphragm is the boundary that separates the abdominal contents from the chest cavity) GERD can be one of the symptoms of hiatus hernia .
• Infection - H. pylori is a common type of bacteria that grows in the digestive tract and has a tendency to attack the stomach lining. These bacteria can survive the harsh acidic environment of the stomach. These bacterial infections can lead to symptoms of chronic acidity and diseases like peptic ulcer and inflammatory condition in the stomach called gastritis.
• Stress - Stress on its own may not be the cause of acidity. However, people who have chronic acidity can feel their symptoms worsening when under high stress levels⁴. Stress can also deplete the production of substances called prostaglandins, which normally protect the stomach from the effects of acid. This could increase the perception of discomfort in some individuals.
• Pregnancy - Hormonal changes and the growing fetus puts pressure on the diaphragm leading to heartburn which generally goes away after delivery.
• Other lifestyle factors include - smoking, skipping meals, erratic meal timings, sleeping immediately after meals.

Diagnosis

Diagnosis² is usually based on the symptoms and following diagnostic tools are employed if the symptoms do not become better with medication and lifestyle changes.

• endoscopy: camera imaging
• biopsy: taking a tissue sample for laboratory analysis
• barium X-ray: imaging the esophagus, stomach, and upper duodenum after swallowing a chalky liquid that helps provide contrast on images
• esophageal manometry: pressure measurement of the esophagus
• impedance monitoring: measuring rate of fluid movement along the esophagus
• pH monitoring: acidity testing

Treatment

Treatment is based on the causative factor of the acidity -

Medicines for acidity

Antacids

Many people with heartburn or acidity find it easier to take over the counter medicines than to address the root cause of heartburn.

Antacids do work for a short duration of time but it is completely useless in certain gastrointestinal diseases like

• Esophagitis - inflammation of the food pipe causing pain and difficulty swallowing, chest pain.
• Hiatus hernia - part of the stomach enters or pushes into the diaphragm.
• Other complications of reflux disease.

It is always better to get yourself checked if heartburn or acidity stays for a long period of time.

The main allopathic treatment options for acid reflux are:

PPIs and H2 blockers decrease acid production and reduce the potential for damage caused by acid reflux.

Alginate drugs containing alginic acid works by creating a mechanical barrier against the stomach acid, forming a foamy gel that sits at the top of the gastric contents itself. Any reflux is then relatively harmless as it consists of alginic acid and not damaging stomach acid.

Diet and Lifestyle to manage acidity

Changing the diet works for many people to manage acidity or heartburn. Include the following foods which are low in acid levels and will not aggravate the existing condition -

Foods that reduce acidity -

• Non-citrus fruits - banana is a great option for a problem of acidity. Naturally occurring potassium in bananas help to reduce neutralize the acid content in the stomach. Other recommended fruits include sweet melon, papaya, water melon.
• Vegetables - high moisture vegetables like ash gourd, cucumber should be included. Others low acid vegetables include cauliflower, broccoli, green beans and leafy vegetables.
• Lean meat like chicken, turkey and seafood. Better to go for stir fried, broiled, baked or poached than deep fried versions.
• Oatmeal is a good option to manage acidity. It is a good source of soluble fibre and help to prevent acid reflux.
• Fluids - consumption of water from earthen pot than RO purified water since RO water is more acidic in nature. Preference of buttermilk over curd can help to manage acidity.

Home remedies to reduce acidity -

There are a number of herbs and spices present in our kitchen that can provide relief from the acidity and heartburn. In case the symptoms are mild then a few of these home remedies can be tried before popping a pill.

• Ginger - anti-inflammatory and antibacterial in nature. Ginger both in fresh and dry form helps to improve appetite and digestion. Ginger tea helps to stimulate digestion and improve the digestive fire.

Ginger mixed with jaggery is helpful in case of indigestion and constipation. Chewing on fresh ginger mixed with salt just in the beginning of a meal helps in stimulating digestion.

• Fenugreek - has anti heartburn properties. In a pilot study of subjects with frequent heartburn, 2 week intake of fenugreek fiber product, taken 30 min before two meals/day, diminished heartburn severity^3,5.
• Fennel - chewing fennel seeds post a meal is known for its digestive properties and also help to neutralize stomach acids. Fennel tea twice a day helps to improve digestion and prevent bloating.
• Cumin seeds - prevents indigestion and bloating. Drinking cumin water (adding a tsp of cumin seeds in water, soaking overnight and drinking in the morning on an empty stomach) helps to deal with acidity.

Ayurvedic treatment for acidity

The main principle behind ayurvedic treatment is to treat the acidity and improve the appetite and digestion. The following treatment options are employed - 

1. Panchakarma - detox treatment which balances all the doshas by getting rid of accumulated toxins in the body.
2. Vamana/Virechana - treatment mainly advised once a year preferably in the month of February for vamana, october/april for virechana as a process of detoxification.
3. Herbal formulations - madiphal rasayan, avipattikar, sootshekhar, kamdudha on the advice of an ayurvedic practitioner.
4. Herbs such as yashtimadhu and shatavari water to overcome acidity.
5. Intake of 1 teaspoon pure cow ghee on an empty stomach.
6. Warm castor oil - 5 ml at night either mixed with milk or water.
7. Sheetali pranayama - helps to calm the body and mind, a simple technique to manage stress.
8. Ayurveda also advocates taking alkaline food and avoiding any junk/commercially available food.

Lifestyle practices to prevent acidity

• Smaller meals: spaced throughout the day rather than three large meals helps to prevent indigestion and acidity.
• Light Dinner: Avoid eating large meals at dinner. 
• Gap between meals and sleep: Sleeping immediately after eating should be strictly avoided. There should be at least 2-3 hours gap between eating and sleeping.
• Exercise: Include mild to moderate exercises like walking daily. Avoid strenuous exercises that involve bending or pressing the abdomen.
• Sleeping Posture: Sleep in an inclined position. Ideally, the head should be 6 to 8 inches higher than your feet.
• Relax: Include relaxation techniques like pranayama to manage stress.
• Lose Weight: If you are obese, losing weight helps to manage the acidity better.
• Review your medications with your doctor in case it could be one of the triggers for the acidity problem.

Acidity left untreated makes a conducive environment for other diseases to occur and increase.

References:

1. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/210441
2. https://www.medicalnewstoday.com/articles/146619.php
3. https://onlinelibrary.wiley.com/doi/pdf/10.1002/ptr.3229
4. https://www.ncbi.nlm.nih.gov/pubmed/15184707
5. https://www.nutraingredients-usa.com/Article/2011/02/02/Fenugreek-extract-may-ease-heart-burn-Frutarom-study