Tuesday, 27 December 2016

December 2016: heartburn



WHAT CAUSES



A burning sensation radiating up from your stomach to your chest and throat. Bloating, belching, a sour taste. It's typically most bothersome at night, and tends to occur in connection with certain activities, such as: after eating a heavy meal; bending over; lifting; lying down, especially when lying on our back.
Too much stomach acid? 

Too little, more likely. Which is why treating it with the usual medications often in the long run has the opposite effect. They may soothe the pain today, but will cause major trouble later.

Why the confusion?
The contents of our stomachs must be acidic to trigger the release of food into the small intestine. When acid is too low, it won’t trigger this release. As a result, the trapped food shoots back up into the esophagus.
Our acid may be too low to digest the food, but it’s still too acidic for the delicate tissue of the esophagus. Hence that fiery pain of heartburn and acid reflux. We have too little stomach acid, but it is going where it’s not supposed to go [1].
To counteract this discomfort the doctor will prescribe antacids or proton pump inhibitors, PPIs. Antacids neutralize, but don’t affect secretion of new acid; PPI’s suppress the secretion of gastric juice entirely [2].
However, as explained above, most people who are taking these medications actually have too little stomach acid – not too much! The actual cause of low stomach acid is not addressed and often things get worse.

Stomach acid is very important for our digestion. It triggers the pancreas to secrete digestive enzymes, and makes the gallbladder secrete bile.
Enzymes and bile help ensure proper nutrient absorption. They also protect against infections and parasites, and help the large intestine to function properly.
Chronically low stomach acid hinders these organs in their work and often leads to larger problems throughout the digestive tract [3].
So lowering it via antacids or PPIs is, in most cases, the very last thing we should do. 

But what should we do instead?
If you are already using PPIs, never stop taking them cold turkey. Wean yourself off gradually: see [4].
And to slowly heal your gut naturally, try the following.
  • As soon as you wake up, drink 1 tsp. unpasteurized/raw apple cider vinegar in warm water. You can add lemon. Or drink 125ml warm water 30 minutes before each meal and after meals. Or sip with meals, in a little bit of water.
  • Add naturally fermented foods such as unpasteurized sauerkraut (from wholefood shops!) kimchi or other vegetable ferments [5].
  • Some find that eliminating dairy, coffee, tea and high fat/spicey foods prevents symptoms. So does leaving out alcohol and nicotine.
  • Chew your food well. Only eat while sitting down, not on the run!
  • Try reduce stress. Take 3-5 deep breaths before you start eating and let them out slowly.
  • Don’t drink with, or close before a meal, and not within one hour after it. Drinking more than 125ml water with a meal dilutes the stomach acid which is already short. 
  • Teas of slippery elm bark or ginger root help. 
  • Raw honey: 1 tsp. twice a day on an empty stomach heals your stomach lining and encourages production of gastric juices [6].
  • Take digestive bitters 15-20 minutes prior to meals with water. 
  • Use quality, unprocessed seasalt to encourage acid production. Ask in a wholefood shop. Leaving off ‘table salt’ is a good idea anyway [7].
  • Avoid eating too much processed food and sugar. 
  • You can, temporarily, take a hydrochloric acid supplement. See how: [8]
To see all this explained in more detail, visit one or more of the following:



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Do you foresee trouble keeping your new year's resolutions?  The Healthy Home Economist has some good advice. See [9].
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EAT:
veg: Brussels', beet, sprout tops, cabbage, celeriac, celery (with Stilton!), corn salad, Jerusalem artichokes, carrots, salsify, kale, kohlrabi, landcress, leeks, parsnips, pumpkin/squash, rocket, spinach, swede, turnips, winter radish, endive, winter purslane.
meat: wood pigeon, pheasant, wild duck, goose, grouse, partridge, venison. For (Christmas) game recipes, see www.gametoeat.co.uk/
fish: coley, megrim, clams, crab, cuttlefish, mussels, oysters, scallops, whiting.

PLANT:
Shallots are traditionally planted on the shortest day. You can still plant garlic.
If you leave veg in the ground, apply a thick mulch (straw, bracken or newspaper) for protection, and so as to get them out easily.

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RECIPES

To find out what you can do with celeriac, see [10].

Here are two recipes with the Italian kale type, cavolo nero. Interestingly, one cooks it for 10, the other for 45 minutes. Strangely, both are lovely. 

CROSTONE with CAVOLO NERO and BEANS
1 bunch cavolo nero, 120ml dried beans* or 400g tinned (ideally cannellini or borlotti), 2 garlic cloves, pepper, 4 sage leaves, 4 tbsp extra virgin olive oil, seasalt, extra olive oil to serve, 8 slices of sourdough bread.
Drain the beans. Tear thick ribs off cavolo, cut finely. Sautée in 2 tblsp oil, adding tiny bits of water every so often, to prevent browning. Do this for ab. 10 minutes, until al dente.
Meanwhile, heat beans carefully in oil with sage and 1 chopped garlic, adding a bit of water so it won't burn. 
When cavolo and beans are ready, toast the bread. Rub toast with the last garlic. Top bread with cavolo, then beans. Drizzle oil on top, add pepper and some seasalt. Serve immediately.
*If using dried beans, soak in water overnight. Next day, cook in water with 2 tblsp olive oil, sage and 1 garlic. Don’t add salt yet or they'll stay hard. Cover, simmer until cooked, add salt.

BRAISED CAVOLO NERO with ORANGE serves 6-8
300-350g cavolo nero weighed after removing the tough stems, 120ml freshly squeezed orange juice, 2 diced onions, 4 minced garlic cloves, chilli/cayenne pepper (optional), olive oil, salt.
Cut cavolo into bite-size pieces. Sauté onion, garlic, salt, red pepper until soft, 4-5 mins. Increase heat, add orange juice, bring to a simmer. Add a few handfuls of kale and, as it wilts, continue to add a handful at a time, stirring constantly, until all the kale is in. Continue to cook, stirring occasionally, until all the kale is wilted - 10 mins? Season, serve immediately.

LAMB with CHRISTMAS SPICES for 6
2 chopped large onions, 4 sliced garlic cloves, 5cm shredded root ginger, 2 tbsp olive oil, 1½ kg lamb neck fillets cut into chunks, 2 cinnamon sticks, 8 cloves, 6 cardamom pods, good pinch saffron, 2 bay leaves, 2 tsp ground coriander, 3 tbsp ground almonds, 850ml beef stock, 250g dried apricots.
Fry onions, garlic and ginger in oil for about 15 mins. Add lamb and stir-fry until browned. Add spices, cook over the heat to release their flavours, then add almonds. Pour in the stock, season. Cover pan and simmer for 45 mins, stirring occasionally. Add apricots, simmer 15 mins more until lamb is tender. Thin with a little water if the sauce gets too thick. To freeze, cool, then pack into a container or bags. Keeps for 3 months. 

RED CABBAGE the DUTCH WAY 
Red cabbage, large cooking apple (or 2), onion, bay leaf, cloves or ground allspice, raisins, butter, water, salt. 
Bring 2cm water to the boil, add the sliced cabbage, chopped onion, a bay leaf with a couple of cloves stuck in it (or some ground allspice), and raisins to taste. Cook slowly for 20 minutes, then add the chopped apple and a bit of salt. After 10 more minutes everything is cooked: take out bay and cloves. Pour off any liquid, or leave it in and use flour to thicken it. Add butter and stir, heat through. You might want to add a bit of vinegar and sugar (are you sure?): that depends on you and on the apple! 

MARINADE for TWO PHEASANTS
100ml soy sauce, 4tblsp balsamic vinegar, bay leaves, chopped onion.
Mix everything and steep the pheasant - best cut in pieces - in it for a few hours or overnight. Cook as usual. It should take less long and have more taste!

Jerusalem artichoke's best friends are sage, thyme, butter, bacon, bay, cream, breadcrumbs, cheese and anything smoked. Or try this:
SAUTÉED JERUSALEM ARTICHOKES with GARLIC and BAY
600g Jerusalem artichokes, olive oil, bay leaves, 2 cloves garlic, splash cider vinegar, salt, pepper.
Wash or peel the artichokes, cut into thin slices. Fry slowly until golden, then add bay leaves, 2 sliced garlic cloves, vinegar, salt, pepper, a tiny bit of water, and cover. Cook till they have softened, checking every so often whether they need just a drop more water. Remove lid and bay. Continue cooking for a couple of mins to crisp them up one last time, serve straight away.
They go well with both meat and fish or in soups or warm salads.

For more recipes, see old December issues.
[2] I find it useful to know that PPIs, as one of the most widely sold drugs in the world, are an excellent source of income for their producers. 
[6] If you are going to eat honey for health, raw is best. Manuka honey is expensive, but not necessarily better than other honey, provided this is raw. Unspecified table honey is often adulterated. See http://www.thehealthcloud.co.uk/manuka-vs-raw-honey/.
[7] See the Thought of October ’15 or http://thoughtforfood-aw.blogspot.co.uk/2016/10/october-2015-salt-ii.html.