In our Ask a Clinician series, Adryan (they/them) dives into commonly asked questions from our community and beyond related to virtual healthcare topics and much more–especially as they relate to the queer and transgender communities. Disclaimer: any information in this column is purely educational and is not to be used as medical advice.
For this installment, they interviewed FOLX clinician Kim (they/she), FNP, drawing upon their experience in nutrition. The two specifically discussed the connection between chest compression (via chest binding) and gut health.
In the Western world—most countries of the United States, European Union, United Kingdom, Norway, Iceland, Switzerland, Canada, Australia, and New Zealand—approximately 10 to 20 percent of people reported having symptoms of heartburn or reflux at least once weekly, according to a 2005 systematic review on GERD, or gastroesophageal reflux disease. In the same research, of the 10 to 20 percent, 6 percent reported having symptoms more than twice weekly.
Transgender men, trans masculine people, nonbinary folks, and others who bind their chest may experience heartburn and other digestive symptoms. Read on to learn more about better binding practices from a FOLX Health clinician.
What’s the difference between occasional heartburn versus GERD?
Heartburn describes a symptom of a burning sensation in the upper abdomen or chest.
Reflux describes the mechanics that cause the sensation of burning: gastric fluid flowing backward into the esophagus, the body’s food pipe. Mechanically, reflux accounts for when the valve (sphincter) between the esophagus and the stomach isn’t working properly and doesn’t squeeze the contents of the esophagus back down to the proper pathway to the stomach for digestion.
Gastroesophageal reflux disease (GERD) is the more severe and long-lasting medical condition in which someone experiences symptoms of reflux. These symptoms are bothersome and often lead to complications over time.
What causes heartburn and reflux symptoms?
Many people experience reflux with common triggers: specific food/beverages, certain medications, smoking, or certain bodily positioning (such as lying down after eating). Some may experience reflux as a result of pressure–both on the inside and outside of your body. This pressure can be caused by constipation, overeating or eating quickly, stress, chest binding/shaping garments, or having a hiatal hernia. Reflux can happen from an overgrowth of bad gut microbes or magnesium deficiency. Even prescribed medications, including acid blockers/preventers, can trigger reflux. Everyone has different triggers, so it’s important to pay attention to how your body reacts to common triggers. Someone might not experience heartburn from food or smoking at all, for example, but might experience symptoms from consistently binding their chest.
Common food and drink triggers often include fried food, spicy foods, citrus, nightshades like eggplant and tomato, caffeinated drinks like coffee, processed foods, and alcohol. Anything you have a sensitivity, allergy, or intolerance to can cause problems, such as wheat, dairy, or gluten. Again, everyone’s triggers are different, so pay attention to which common trigger foods and drinks cause heartburn (or not) for you.
Common medication triggers include non-steroidal anti-inflammatory medications, such as ibuprofen, Motrin, naprosyn, aspirin; antibiotics; progesterone; iron supplements; and even some blood pressure medications.
Smoking or vaping nicotine products can lead to reflux by relaxing the esophageal/stomach valve, decreasing the digestive properties in saliva, and irritating the lining of the esophagus. Additionally, nicotine’s impact on tissue regeneration is well-known (a good reason to quit smoking six weeks before top surgery). If you use a nicotine patch, removing it at night may help reduce reflux symptoms.
Certain bodily positioning makes it easier for stomach acid to move up into the esophagus, such as lying down after eating. For instance, if you’ve recently consumed a meal, your stomach acid is active; lying horizontally can cause the acid to slide into different parts of your body than standing or sitting upright.
Another trigger revolves around pressure on the inside and outside of your body. Pressure on the inside of your body can look like having a mid-section that is larger than your hips. Pressure on the outside of your body includes tight or restrictive clothing, chest and abdominal compression garments, sports bras, corsets, and shapers. Chest compression doesn’t necessarily cause reflux symptoms, but adding pressure from the outside of our bodies can limit the ability of the esophageal/stomach valve.
When it comes to constipation, if we don’t have a bowel movement every one to two days or don’t empty our bowels completely, residual feces sit in our intestines and ferment. This residue causes a build-up of gas in our abdomen. The build-up can cause bloating, internal pressure, and reduced ability to digest foods and absorb nutrients and medications.
Additionally, overeating and/or eating quickly can contribute to heartburn for a few reasons. If we aren’t taking time to chew thoroughly, we are limiting the enzymes needed to break down food. It takes about 20 minutes for the body to release the enzymes needed for digestion and then signals the release of ghrelin, the “I’m full” hormone. If we overeat, our metabolism wants to speed up, causing “meat sweats” and may make us feel tired. When we eat more quickly than our body can process, a traffic jam ensues, leading to bloating, adding more internal pressure and reducing our body’s ability to digest fully.
Extreme psychological stress signals to our bodies that it may not be safe to digest food and instead focus on slowing down other functions to protect our core. The nerves in the stomach are then on alert, making it difficult to signal the process of digestion.
Next, let’s discuss hiatal hernias. Hiatal hernia is when part of the stomach slides upward into the intestine, which can cause symptoms similar to GERD. Digestive juices are propelled upward back into the esophagus. Hiatal hernias are common, which can be worsened or possibly caused by abdominal pressure.
When it comes to the overgrowth of bad microbes, bad microbes—or unhelpful and harmful bacteria or yeast—can take over our gut and ferment and reduce the good bacteria and flora needed for healthy balance and function. H. Pylori, another form of harmful bacteria, may cause problems like gastric cancer due to the acid imbalance in our digestive system.
Common acid blockers and acid preventers can end up causing reflux! Depletion of natural acid with proton-pump inhibitors (PPIs) or Histamine Type-2 Receptor Antagonists (H2RAs/H2 Blockers) increases gastrin and leads to a cycle of acid spilling into the esophagus. Oftentimes, the problem of reflux is not too much acid in the stomach; instead, there is too little acid and too much gastrin!
Many of us suffer from a magnesium deficiency. Magnesium plays a central role in digestion by making digestive acids and enzymes break down anything ingested (foods, medications, liquids) and also helps protect the lining of the esophagus, according to research. Additionally, having a magnesium deficiency can lead to constipation, or slow flow, which can worsen reflux symptoms.
What are the specific risks for those who bind when it comes to heartburn and overall gut health?
When it comes to pressure on the outside of the body, compressing or binding chest tissue and the abdomen will cause added pressure to the outside of the body. If the binder sits below the end of the sternum (chest bone), this can add pressure and thus increase reflux symptoms.
While binding doesn’t necessarily cause a hiatal hernia, increased pressure in the abdomen from compression or masculine weight redistribution may increase the chances of a hiatal hernia.
If I experience heartburn, what do I do about it?
If you’re someone who binds their chest, take a binder break! I suggest taking a mid-day if possible. Zip-up products are much easier and more discreet to take a break.
It’s also important to consider the size and fit of your binder or compression garment. We believe in Health at Any Size, and all folks should be able to access a binder that works for them. Our sizes change frequently, and binders and garments are not one-size-fits-all.
If you find yourself “stuck” and need to send a signal to get some help, or find yourself profusely sweating when taking your binder on or off, it probably doesn’t fit. It may be the wrong garment type or size for your body. If you can’t take a big deep breath or cough comfortably in your binder, it’s too tight. Many times, the material type and stretch will impact the fit more than the size.
It can take lots of trial and error before finding the right binder, especially when shopping online. Consider a more loose swim top or rash guard while comfortable or at home to provide some binding without adding pressure to your chest and abdomen. If comfortable, eating without your binder will help with digestion. However, if this isn’t possible, try helpful tricks like not drinking while eating and chewing gum (but not too much, as it can cause bloating) after meals.
Additionally, pay attention to your symptoms. Find what may have led to your symptom and stop the issue in its tracks. When it comes to food and drink triggers, mindful eating will go a long way. Here are some tips to get started:
- Sit down for a meal.
- Take a few deep, cleansing breaths before you eat.
- Chew all the way! Chewing and increasing saliva is the first step in the digestion process. Without chewing adequately, you won’t be able to digest (or enjoy) food thoroughly.
- Try to avoid drinking liquids while you eat. Drinking water reduces the acid and ability to digest. If you must drink, keep it minimal to sips rather than gulps.
- Avoid straws, which can prevent bloating!
Lastly, consider working with a qualified practitioner to use supplements including but not limited to bitter herbs, rose oil, hydrochloric acid, pepsin, slippery elm, aloe vera juice, apple cider vinegar, etc. It’s important to work with a qualified practitioner to recommend specific supplements, since folks respond differently to different supplements.
Is heartburn medically dangerous?
Our gut microbiome is an extremely important ecosystem. It ensures the release of neurotransmitters for cognitive functioning and mental health, as well as maintains a healthy immune and metabolic system. Affecting this ecosystem by reducing the acid that helps keep us healthy can be dangerous. Likewise, if we have too little acid in our gut, more gastrin is produced and the balance is skewed, leading to a cascade of problems in every aspect of our health.
Aside from the potential impact on immune function and brain health, repeated exposure to acid in your esophagus can cause inflammation–leading to stomach lining damage over time. Reflux is one warning signal to help us identify a problem.
When should I see a medical provider about this issue?
If your symptoms are constant and persistent, despite avoiding triggers and employing other measures above, I recommend consulting with a qualified clinician to prevent long-term and far-reaching health consequences.
Reflux is not always a disease requiring medication. In fact, certain medications like a PPI or H2RA can make the problems far worse over time. If you’re already taking acid blockers or reducers, consult with a qualified clinician to prevent rebound reflux, which includes worsening symptoms when stopping the medication. Always check with your prescriber before stopping or adjusting prescription medications.
While reflux is a common symptom related to the digestive system, this can also be a signal for a problem outside the digestive system, such as a heart attack. If you are concerned about chest pain or a life-threatening situation, please seek emergency help.
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