Illustration by Gianpaolo Pagni
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Health Report
Heartburn Cooldown
By Nichele Hoskins, July & August 2008
Head off the agony with a few lifestyle changes
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You eat a spicy pizza and suddenly the acid in your tummy washes up, igniting what feels like
a small fire in your chest. You’re miserable, but you have plenty of company: about 60 percent of Americans experience heartburn, or acid indigestion, at some point each year, according to the American Gastroenterological Association. Yet almost 33 percent of us experience it weekly, and more and more folks are suffering daily. That’s when something more than heartburn is going on—it’s called gastroesophageal reflux disease (GERD), or acid reflux—and the fallout can be ugly.
In addition to setting off chronic coughing, hoarseness, and nausea, among other problems, acid reflux can severely irritate and damage the lining of the esophagus, if left untreated; after years of such irritation, it may even lead to esophageal cancer. (See “Heed the Red Flags,” below.) In the past ten years hospitalizations for GERD-related disorders of the esophagus have more than doubled, and sufferers are spending billions of dollars each year for over-the-counter and prescription drugs in a quest for relief—$1 billion in simple antacids alone, according to the American College of Gastroenterology.
If you’re plagued by heartburn, this is what you can do to get relief and stave off the more serious problems that can come down the road.
Eat small Consuming tiny meals throughout the day rather than large ones, which can overwhelm your digestive system, is a good approach, says Ruth Kava, Ph.D., R.D., director of nutrition at the American Council on Science and Health. Eating slowly helps, too.
Sit up Avoid eating right before lying down, to prevent stomach acids from surging up, especially if you suffer from GERD. Instead, have your last meal two or three hours before bedtime. And try sleeping with your head slightly elevated—about six to nine inches—Kava says. You can place wooden or cement blocks under the legs of your bed at the head end, or insert a foam wedge (available at drugstores) between the mattress and the box spring to raise your body from the waist up. Wedge pillows are widely available as well.
Loosen up Wearing clothes that are tight around your waist can aggravate your symptoms. The easy solution: Dress in roomy attire. That means women should probably avoid those body-tightening pantyhose that help hold in their tummy.
Slim down. Sorry to say, but if you’ve put on a few extra pounds, that could be part of the problem. Too much fat around your middle can push up acid into the esophagus, says Kava, who notes that increasing numbers of acid reflux cases are being linked to rising obesity rates.
Puff less Nicotine triggers more acid production, so if you smoke, work hard to stop.
Don’t stoop Picking up a little litter is a noble thing, but try to avoid bending for long periods, especially after eating.
Chill out Manage your stress, especially around the time you eat, because it’s a big digestion bad guy, says Dean Neary, N.D., a naturopathic physician and the chair of the physical medicine department at Bastyr University in Seattle. We tend to think of digestion as a matter of plumbing. In fact, the whole process is managed by your nervous system. That’s why your brain can upset your gut as easily as your gut can upset your brain. To calm the mind, Neary suggests meditation, tai chi, guided imagery, or yoga.
Possible Culprits
Coffee
Chocolate
Citrus fruits
Alcohol
Soda
Spicy foods
Garlic
Onions
Tomatoes
High-fat foods
Play detective If these tactics don’t alleviate your symptoms, you’re going to have to investigate further. Normally when you eat, a valve in your esophagus opens up to let the food pass and then closes to keep the juices confined to the stomach. But sometimes this valve opens spontaneously, or doesn’t close when it’s supposed to—and that’s what causes the acid backwash that irritates the esophagus and what typically produces that burning sensation below the breastbone. The catch: Some foods are more likely than others to weaken the valve, says Kava (see “Possible Culprits,” at right). Aspirin and many other nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen and naproxen, can have the same effect. (Acetaminophen, the key ingredient found in Tylenol, is the exception to these pain medications, because it does not irritate the stomach.)
To really get to the bottom of acid reflux, says Kava, try eliminating these potential triggers one at a time. Keep a food diary for a month, jotting down what and how much you eat and how you feel afterward. You may be able to identify what’s causing the problem on your own.
Remember, you don’t have to tolerate heartburn just because you’re older. “Once you start putting good foods in your body, de-stressing, and generally taking care of yourself, the outcome is going to be better health,” says Neary.
Heed the Red Flags
If your symptoms are sudden or severe, get to an emergency room. Heart attack symptoms can masquerade as heartburn, says Alexandra Gutierrez, M.D., a gastroenterologist at the University of Alabama at Birmingham. Also, what you think is normal heartburn may be chronic acid reflux, ulcers, or other gastric ailments. Here’s how to know if it’s something serious.
Could it be....
Heart Attack?
Genuine heart attack symptoms tend to cause tight pain in the chest, sometimes radiating from the chest down the left arm or worsening if you bend over, so call your doctor if you are
experiencing:
- Pressure, squeezing, or tightness in the center of your chest that lasts for more than a few minutes
- Pain that spreads to one or both of your arms, your back, neck, or jaw
- Shortness of breath
- Pain that stays in your chest or begins there and radiates to your jaw, neck, or left arm
- Pain that occurs when you exercise
Chronic Reflux?
Gastroesophageal reflux disease typically starts when stomach acids rise into the esophagus, causing a burning sensation in your chest or throat. It’s when you experience this more than twice a week for several weeks that it becomes a potential danger. To manage your symptoms, your doctor will likely prescribe acid-blocking medications. But diagnostic tests may be needed if you don’t get relief—or if you show symptoms such as:
- Anemia
- Weight loss
- Pain when swallowing
- Nausea and vomiting
Ulcers?
Ulcers are craterlike sores that can crop up from the esophagus
to the small intestine. Most ulcers are caused by a bacterium called Helicobacter pylori, which can be treated with antibiotics. Ulcers can also be caused by pain medications, such as aspirin or ibupofren, that erode the stomach lining. Esophageal ulcers, however, are more directly associated with chronic GERD. And while all ulcers can come without serious symptoms, take note of:
- A burning pain in your abdomen between your navel and breastbone
- Nausea or vomiting
Easy Dose It
If you’re one of millions of Americans who regularly take drugs for heartburn relief, consider this: while many of the medications have been around for years and are tried-and-true, certain ones can be risky for some people.
Proton pump inhibitors (PPIs), such as prescription-based Nexium and Prevacid, plus over-the-counter Prilosec—which sharply reduce stomach acid and offer relief for a day (though they take several hours to start working)—can decrease the amount of calcium your body absorbs. And that may be a problem for those who have, or who are at high risk for developing, osteoporosis, says Cynthia Yoshida, M.D., a gastroenterologist in private practice in Charlottesville, Virginia. Markedly reduced stomach acid
has also been linked to an infectious diarrhea (caused by the bacteria Clostridium difficile) among some older patients.
Still, says Yoshida, the benefits of most of these medications often outweigh the risks. PPIs, in particular, may help prevent esophageal
ulcers and scarring, and also reduce bleeding or complications from stomach ulcers.
“The key,” she says, “is to make sure your doctor knows when
you’re taking any medication on a regular basis—whether it’s over-the-counter or by prescription.” Antacids like Mylanta and Maalox may offer quick relief for mild symptoms, for example, but if you find yourself taking them routinely, she says, you may be masking a more serious problem. The same is true for constant use of more potent H2 blockers (or acid blockers) such as Pepcid and Zantac.
Nichele Hoskins, a freelance writer based in Birmingham, Alabama, is a health-and-fitness editor at Heart & Soul magazine.
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