functional medicine

End heartburn forever


Heartburn is a digestive symptom characterised by painful burning sensations in the chest or upper abdomen. It is so common these days that Nexium and Rennie have almost become the new Tic Tacs. Antacids are profitable so the industry is not interested in treating the actual cause. One thing is certain: if you wish to end your heartburn forever, you’ll need to tackle the underlying triggers and not just the symptoms.

True cause and mechanism of heartburn

It is commonly believed that heartburn is caused by too much stomach acid. But heartburn is more related to the incorrect functioning of the lower oesophageal sphincter (the flap that closes the stomach from the food pipe) than acid itself.

Normally, the flap remains open only when food is coming. But when too much pressure is created in the abdomen, the flap is pushed up and remains open towards the oesophagus. Since the oesophagus is not coated by a protective film like the stomach, it can take as little as acidic fumes to cause a severe burning sensation. In other words, there would be no heartburn if the flap remained closed. The four most common causes of increased abdominal pressure are:

  • pregnancy

  • abdominal obesity

  • small intestinal bacterial overgrowth (SIBO)

  • excessive fermentation of carbohydrates; often goes hand in hand with SIBO

Paradoxically, the main cause of bacterial overgrowth and excessive carbohydrate fermentation is low stomach acid. Not only is strong stomach acid necessary to signal the pancreas to release its carbohydrate digesting enzymes, but is also the first line of defence against unwanted organisms. Contrary to the popular belief, it is low stomach acid that is a major culprit of heartburn, and I’ve had great success with clients by restoring their stomach acidity.

Some of the reasons for decreased stomach acidity include:

  • eating a diet rich in processed carbohydrates (bread and other baked goods, pasta)

  • eating too much starch together with animal foods (e.g. burger in a bun, with potato fries)

  • chronic stress

  • prolonged or frequent use of medication

  • helicobacter pylori (h-pylori overgrowth happens when stomach acid is too low, and then the bacteria themselves have the ability to further reduce stomach acidity)

  • autoimmunity against the parietal cells of the stomach

Factors which can further exacerbate the symptoms include:

  • lack of protective microbes in the stomach and oesophagus

  • eating foods that relax the sphincter such as alcohol, chocolate, coffee, garlic, leeks, onions, peppermint, spicy foods, shallots, strong black tea

  • smoking, as it also relaxes the flap

  • foods that delay gastric emptying; mostly high fibre foods

While antacids take the initial edge off, they often make the problem worse in the long run by contributing to the root cause: low stomach acid. This perpetuates the vicious cycle of relying on antacids, unless dietary and lifestyle changes are implemented.

What to do

Heartburn requires dietary and lifestyle modifications. Unfortunately, a diet that is colloquially called 'healthy' often fails to improve the symptoms because e.g. wholemeal bread, bran and whole grains can significantly worsen heartburn. It’s important to note that the reaction to foods is an individual matter, so the diet should be tailored to the person’s needs. Beyond looking into the usual suspects like coffee, sweet drinks and spicy foods , the following can make a real difference:

  1. Consult your doctor about the possible removal of antacids while working on the underlying causes.

  2. Cooking vegetables and stewing fruit might be a better idea than eating them raw.

  3. Optimally, all grains should be removed until symptoms subside but if you cannot live without bread and pasta, spelt is the grain to go for. Rye can be problematic.

  4. Practice simple food combining of eating animal foods with vegetables, and starches also with vegetables. Try not to combine starch and animal foods in one meal until digestion improves.

  5. Be mindful about your milk intake. Soothing as it may initially seem, it can contribute to chronic heartburn.

  6. Fermented foods like sauerkraut or home made yoghurt (can be coconut) are associated with the reduction of symptoms.

  7. Home made stock and broth calm down the digestive tract. They can be used in soups, stews and curries, or enjoyed as a warm drink.

  8. Raw honey should be the sweetener of choice because it has soothing and antimicrobial properties.

  9. Address your stress levels and stress tolerance, practice relaxation and good sleep hygiene.

  10. See a professional to help you restore stomach acidity and address any pathogenic outgrowths. The therapy includes a dietary and lifestyle plan, along with individually tailored supplementation consisting of digestive support, targeted probiotics, antimicrobials and botanicals that soothe the digestive tract.

At GLOW, I deal with various health concerns which can successfully be supported with functional nutritional therapy and lifestyle medicine. The cornerstone of my work is uncovering and addressing the underlying causes. Online consultations from any location, visits on yachts, in villas and workplaces are available.

Article published in The Islander, July ‘19 edition.

Article published in The Islander, July ‘19 edition.

Burnout survival kit


We all go through moments of stress which is a normal part of life that helps us grow. But chronic stress has a destructive effect on the whole body, often without people even realising that it is the main culprit of their health issues. Eventually, it leads to a burnout called adrenal fatigue, adrenal insufficiency or hypoadrenia. Stress isn’t just ‘in the head’. It is an actual physiological mechanism which involves approximately 1400 various biochemical reactions. In other words, poor stress tolerance requires a holistic approach and not just stress management techniques.


Stress is body’s response to a stressor. For some, it might be of emotional origin (e.g. trauma), mental (e.g. workload), while others are faced with physiological stress (e.g. chronic inflammation). Regardless of the source, the response is always the same and involves the adrenal glands.

The adrenals and cortisol

During stress, the adrenals release a stress hormone cortisol which helps us fight or flight by providing instant energy. Technically speaking, it raises blood glucose levels so that we have fluel to deal with the stressor. But when stress is ongoing and the adrenals fire cortisol all the time, it eventually ‘exhausts’ the glands, leading to the so called adrenal fatigue - inability to produce sufficient cortisol. It causes a burnout because without cortisol blood sugar cannot be raised any longer... Unless you eat something sweet, have caffeine or alcohol. These, however, cause a blood sugar roller coaster which is a big stressor itself. So unless your diet and lifestyle are balanced, you can get into a vicious cycle of further depleting the adrenals.


When standard blood test shows low cortisol, it already means a pathological state, namely Addison’s disease. In other words, It’s not a great test to indicate burnout as such because cortisol may test normal in the blood but will be functionally low. Instead, 24-hour cortisol cycle salivary or urine test with four samples taken is a better diagnostic tool. Tests are available in most labs but they are not cheap and symptoms are often sufficient to assume an imbalance.

Can you identify yourself with any of these symptoms?

  • Extreme fatigue

  • Decreased ability to handle stress

  • Loss of tolerance (to situations, things, people)

  • Underactive thyroid

  • Inability to lose weight , especially around the middle

  • Low or no libido, poor sexual performance

  • Low blood pressure, fainting

  • Dizzy upon standing up

  • Cravings for salt, sugar, caffeine or alcohol

  • Anxiety and/or depression

  • Reduced immunity

How to restore the adrenals for optimal stress tolerance

1. Reassess your diet:

The adrenals need a regular influx of certain nutrients to function optimally. Therefore, have three solid meals a day, with breakfast being the most important one. All meals should be based on vegetables, quality animal protein and cholesterol. Yes, you read that right. Cortisol is made of cholesterol so the more building block is provided with diet, the more supported the adrenals are. Butter, pastured eggs, quality bacon, seafood, fattier pieces of ethically sourced meat and grass fed dairy are all good sources. Carbohydrates should come from fruits and root vegetables. Fizzy drinks, fruit juice, baked goods, chocolate bars and the like should be avoided because they wreck havoc on your blood sugar. Remember, fluctuating blood glucose is the most undesirable state for the adrenals, regardless of the source of stress. Reduce caffeine and switch to coconut water, highly mineralised water or alternatively water with a pinch of quality salt - these are all great adrenal tonics.

2. Reassess your lifestyle:

  • Prioritise sleep: often those with adrenal fatigue burn the candle at both ends and are unable to fall asleep because they missed their optimal falling asleep window. Slowly adopt a new habit by going to bed 15-30 minutes earlier each week. Reading books can help tremendously.

  • Get organised: predictability means safety and safety is relaxing. Organise your to-do lists in the order of priority, try a day planner or get a virtual personal assistant, if you can afford it. Deal with priorities and delegate the rest. Not everything can be controlled but get advantage of what you can.

  • Stop intense cardio for a while and swap to walking, yoga, pilates, hiking or similar. High intensity exercise raises cortisol which can be even more destructive.

3. Take care of your overall health: cortisol receptors can be found on most cells in the body. Many chronic illnesses are associated with a prolonged stress response. And the other way round – ongoing health issues are stressors themselves and can burn us out without any apparent emotional stress involved. This is when one feels stressed but doesn’t know why.

4. Supplementation: there is a wide array of various adrenal supporting supplements. The most common ones include adaptogens, glandulars, pregnenolone, vitamin C and B vitamins. Supplementation should always be tailored individually because without the expertise, one may further deplete the adrenals (’s common to take the ashwagandha which tends to lower cortisol levels).

4. Most importantly, see a specialist: At GLOW, I deal with various health concerns which can successfully be supported with functional nutritional therapy and lifestyle medicine. The cornerstone of my work is uncovering and addressing the underlying causes which can be both, emotional and physiological. Online consultations from any location, visits on yachts and workplaces are available.

Article published in The Islander, June ‘19 edition

Article published in The Islander, June ‘19 edition