HEARTBURN

EVER WONDER HOW ANYONE COULD drink water standing on his head? You'd think the liquid would come right back out. But the human body, being the engineering marvel that it is, is able to keep the water moving in the right direction.

Wrapped around the gastrointestinal tract is a remarkable kind of smooth muscle that's designed to push solids and liquids in one direction, from the mouth to the anus. In addition, each section of the digestive tract is separated from the others by a thick ring of muscular tissue called a sphincter. The sphincters serve to keep food from moving backwards.

Although the gastrointestinal tract is really just one long tube, its individual sections have very different functions and very different inner linings. The stomach is lined with a thick layer of mucus designed to withstand exposure to potent acid. However, the oesophagus, which links the mouth to the stomach, has a lining that's relatively thin and very sensitive to acid.

If the sphincter that separates the oesophagus from the stomach relaxes too much, acid can splash back from the stomach into the oesophagus. The symptoms resulting from this phenomenon can be quite painful: an intense burning or pressure that begins underneath the lower breastbone and radiates up to the throat or out into the chest.

Heartburn pain typically occurs within an hour or two after eating. (In contrast, the pain of stomach and duodenal ulcers tends to increase on an empty stomach and is often relieved by eating.) In advanced cases, heartburn is associated with a condition called hiatus hernia and gastro-oesophageal reflux disease (CORD).

Normally, the muscles of the diaphragm help keep the oesophagus tucked inside the chest cavity and the stomach inside the abdomen. These muscles act in concert with the lower oesophageal sphincter. When the muscles of the diaphragm become lax and when there is sufficient pressure in the abdomen - such as after a large meal - all or part of the stomach can slide up into the chest. People with hiatus hernia or CORD can have reflux of partially digested food along with stomach acid and other fluids.The pain is often intense.

What makes the lower oesophageal sphincter open inappropriately? One cause is mechanical: eating too much in one sitting, which can stretch out the sphincter. Thus, eating a large meal and lying down afterwards is a definite no-no because it makes food more likely to flow in the wrong direction. This is especially true for obese people, who already have constant external pressure on the stomach. Another cause is chemical: certain foods and chemicals can make the muscles of the sphincter relax. The best examples are cigarette smoke, alcohol, high­fat foods, mints, chocolate, onions and caffeine.

In addition to making lifestyle changes, using herbs can prove quite effective for heartburn. Along with avoiding troublesome foods and chemicals (listed above), stay away from fennel, lemon balm, peppermint, and spearmint - members of a group of herbs called carminatives, which relax the lower oesophageal sphincter.

KEEPING STOMACH ACID WHERE IT BELONGS
In the case of heartburn and its cause, gastro-oesophageal reflux, prevention is crucial. Studies show that the leakage of stomach acid into the lungs while a person sleeps is at fault in some cases of asthma. But that's not the worst news. Medical studies have shown that recurrent reflux over a period of months or years can lead to inflammation of the oesophageal wall. It appears that people with such inflammation may be at risk of developing oesophageal cancer, which is extremely life-threatening and difficult to treat. It's all the more reason to take heartburn seriously.
Do:
· Stick to smaller, more frequent meals.
· Cut back on saturated fats - especially deep-fried foods - and alcohol, coffee, tea, white sugar and unrefined carbohydrates.
· Try elevating the head of your bed 15 to 23 centimetres. This slant may prevent acid reflux during sleep.
Don't:
· Eat a large meal just before bedtime.
· Lie down for a nap after eating.
· Eat spicy foods, onions and acidic juices such as citrus or tomato.
· Take non-steroidal anti-inflammatory drugs (aspirin, ibuprofen or naproxen) unless you absolutely must, because these drugs can further irritate the oesophageal lining.

DRLIG TREATMENT

Antacids
Calcium tablets (Rennie, Turns, others), magnesium and aluminium hydroxide (Maalox, Gaviscon 250, Gelusil, others). Function: neutralise excess stomach acid for a short period of time. Side effects: possible rebound acid, meaning the stomach produces more acid when the treatment is discontinued.

Histamine-2 Receptor Antagonists
Cimetidine (Dyspamet, Tagamet), ranitidine (Zantac), nizatidine (Axid), famotidine (Pepcid). Function: block the receptor for histamine in the stomach to reduce the secretion of acid. Side effects with long-term use: headache, muscle aches, rashes, mental disorientation.

Proton Pump Inhibitors
Lansoprazole (Zoton), omeprazole (Losec), esomeprazole (Nexium). Function: affect cells in the stomach wall to reduce production of acid dramatically. Side effects: because these drugs are usually prescribed for a few months' duration, long-term effects are unknown.

Promotility Agents
Metoclopramide (Maxolon). Function: improves tone of the lower oesophageal sphincter and enhances downward contraction of smooth muscles in the oesophagus and stomach. Metoclopramide side effects: depression and anxiety.

HERBAL REMEDIES

Liquorice (Glycyrrhiza glabra)
Studies have shown that liquorice accelerates the healing of intestinal ulcers. It is anti-inflammatory and very soothing to mucous membranes. To use liquorice for heartburn or reflux, choose a special kind called DGL (deglycyrrhizinated) liquorice. It is just as effective as regular liquorice without affecting the body's sodium-potassium balance. Typical dosage: for mild heartburn, drink 1 cup of tea after meals as needed (steep 1 to 2 teaspoons of dried, chopped root in 1/4 litre of hot water for 10 to 15 minutes); for moderate-to-severe symptoms, use 1/8 to 1/4 teaspoon of powdered root or liquid extract dissolved in 4 table­spoons of water after meals and at bedtime; or 1 to 2 tablets of DGL liquorice, chewed thoroughly after meals or as needed, up to 8 tablets per day. Caution: do not use whole liquorice for more than six weeks. Avoid it if you have high blood pressure, diabetes, heart, thyroid, kidney or liver disease, or if you're pregnant or breastfeeding.

Aloe (Aloe vera)
Aloe gel contains large sugar molecules called mucopolysaccharides. These special sugars have been shown to help heal burns, ulcers and inflamed intestinal walls. Side effects are uncommon, but be sure to obtain a pure source of aloe pulp (not the rind, which can cause stomach cramps and diarrhoea). Also, many commercial aloe juices contain citric acid, which can aggravate reflux. The best form of aloe for treating heartburn is a food-grade freeze-dried powder. Typical dosage: 1/4 to 1/2 teaspoon in 4 tablespoons of water just after meals or any time symptoms occur. Increase to I or more teaspoons if necessary.

Cabbage (Brassica oleracea)
Cabbage juice is not just a folk remedy - a medical study has shown that regular consumption can heal stomach ulcers. The active ingredient is an amino acid called L-glutamine, which appears to work by nourishing cells lining the oesophagus and stomach so they repair themselves. Another advantage to cabbage, like its first cousin broccoli, is that it contains cancer-preventing agents called glucosmolates. Typical dosage: 120 to 225 millilitres of juice after meals.
If taking the juice gives you wind, instead take 1/2 to 1 teaspoon of L-glutamine, mixed in 4 tablespoons of water, just after eating.

Calendula (Calendula officinalis)
A time-honoured remedy for wounds, mouth sores, ulcers and gastritis, calendula is so gentle it is often given to children for upset stomach. Its astringent and anti-inflammatory properties make it particularly useful for treating heartburn and reflux. Typical dosage: 1 to 2 cups of tea as needed (steep 1 to 2 teaspoons of dried flowers in 225 to 450 millilitres of hot water for 10 to 15 minutes); or 15 to 30 drops of tincture four times per day after meals.