When chest pain really is heartburn, not a heart attack

First Lady of Nutrition

Reflux disease is serious, but you’ll be surprised how easy relief can be.

The most expensive digestive disorder, gastroesophageal reflux disease (GERD) inflicts with burning pain just under the breastbone on about 40 percent of American adults. Consumers spend more than $1 billion on antacids and other heartburn medicines, which often make this problem even worse.

Normally, digestion moves food down from the mouth to the rest of the GI tract. But eating too much too fast and consuming certain foods and drink — alcohol, chocolate, coffee, mints, pepper and too many refined foods (especially fatty and sugary snacks) — can turn digestion upside down.

Stomach acid (needed to break down food and kill pathogens it may contain) splashes up from the stomach into the esophagus, causing heartburn that’s a prime sign of GERD. Other symptoms include bloating, breathlessness, gas, nausea and trouble swallowing.

Overweight and obesity increase the risk for GERD — especially in women. Other factors include chronic cough, extreme flatulence, smoking and simply growing older.

Dr. Ann Louise’s take

One of the most neglected underlying causes of GERD is hiatal hernia. This condition is becoming exceedingly common, especially in people over 50.

Talk about pain that can be mistaken for heart attack! And it’s no wonder, since this kind of hernia occurs when part of the stomach pushes through a small opening (called the hiatus) up into your chest.

Remember those long party balloons? Think of twisting one in the middle and separating it into two compartments (like the chest and abdomen) — with only a small opening in between. Squeeze one compartment and air squeaks into the twist, pushing hard against the other compartment. Ouch!

Surprising solutions

Amazingly, the solution is usually quite simple. Drink a glass or two of lukewarm water. Jump up and breathe out as forcefully as you can when you land.

Your water-weighted stomach and gravity will pull downward on your stomach while your diaphragm and chest bounce back up. You can even use a rebounder (mini-trampoline) for more intensity in releasing a “stuck” stomach.

A well-trained chiropractor or naturopath can perform targeted soft-tissue manipulation to return a hiatal hernia back where it belongs. For instance, “the vertebrae in the upper part of the neck, the middle of the back, or even the ribs may be misaligned or ‘locked,’ which affects the nerves in a way that the chest wall starts to tighten,” explains Marty Gallagher, MD, DC, a chiropractor in the Pittsburgh area, who calls this condition “spinal angina.”

“The pain may be stabbing or radiating,” much like classic heart attack symptoms, “and reproduced by putting pressure on the sides of the ribs, by taking a deep breath, or by turning over in bed,” he adds. Bending forward, coughing hard, pushing or pulling, even riding in a car over a bumpy surface can exacerbate this pain.

When to seek immediate help

If your condition doesn’t respond to any of these hiatal hernia techniques, however, it’s critical to seek medical attention right away. Recent research in Clinical Cardiology suggests a link between GERD and atrial fibrillation (abnormal heart rhythm that may signal heart attack or stroke).

Men are more likely to experience classic chest pains — say after rooting for their favorite team during the “Big Game” on Sunday. But women suffer more diffuse symptoms — exhaustion, jaw or neck pain, nausea and shortness of breath — that aren’t always recognized as a heart attack.

Recognize gender differences

Currently more women — approximately 450,000 Americans annually — die of cardiovascular disease than men. And at least 8 million women in this country have heart disease, which claims more lives than the next five leading causes of mortality combined — including cancer.

Raising awareness of women’s risk of heart disease is a reason to wear red today. But GERD is also more likely to strike women. While research on gender differences in reflux remains scanty, women tend to have more severe symptoms, if less erosive esophageal damage.

Sex hormones may also play a role here, helping to explain why heartburn is so prevalent during pregnancy — striking 20 percent of expectant moms in the first trimester, 40 percent during the second trimester and 70 percent in the last trimester! Fortunately, complications of GERD are extremely rare in pregnancy.

The bottom line

A study in Gastroenterology shows that acid-suppressing medicines can have rebound effects, making heartburn and pain even worse. “Acid secretion is normal in most patients with reflux disease,” the study authors write, “and acid-inhibitory therapy makes it abnormally low.”

Surprisingly, stomach acid may be the solution — not the cause — of GERD. Try this simple home test — unless you know you have ulcers or a pre-ulcerative condition:

Take 500-550 mg hydrochloric acid (HCl) — similar to your body’s own stomach acid — with a meal, and then carefully observe how you feel. Extreme warmth means that you already have enough stomach acid and don’t need any more.

If you experience no pain or warmth, double your HCl dose at the next meal. And continue adding an extra dose — though never more than five tablets at a time — until you do experience warmth. Then take one less tablet than your maximum with food.

I’ve found HCl+2, which combines betaine hydrochloride with pepsin, most effective. After three months, try reducing your dosage.

Sufficient stomach acid is critical in preventing GERD, as well as arthritis, gallbladder disease, immune disorders and osteoporosis. The stomach has a protective coating of mucus that prevents acid from causing pain — as long as you can keep it where it belongs.

Sources:

 www.nytimes.com/2010/02/02/health/02real.html

 www.suntimes.com/lifestyles/2025208,FIT-News-heart03.article

 www.ncbi.nlm.nih.gov/pubmed/20082715

 http://womens-health.jwatch.org/cgi/content/full/2006/1116/1

 www.nlm.nih.gov/medlineplus/ency/article/001137.htm

 www.ncbi.nlm.nih.gov/pubmed/19439954

 www.ncbi.nlm.nih.gov/pubmed/19911354

 www.ncbi.nlm.nih.gov/pubmed/11253245

Dr. Ann Louise Gittleman is the award-winning author of more than 30 books on health and nutrition and guest on many TV and radio programs. She resides in Kootenai County. Info: annlouise.com