Most doctors tell patients who suffer from the searing, shooting pain of heartburn to avoid spicy foods, alcohol and chocolate. But new research has shown that for the majority of heartburn sufferers, switching to a bland diet doesn't eliminate pain-causing acid reflux.
SURPRISING NEW RESEARCH
Heartburn occurs when acid from the stomach backs up into the esophagus through a relaxed lower esophageal sphincter (the valve that prevents stomach acid from entering the esophagus). For decades, physicians have told heartburn patients to stop eating foods that can cause the sphincter to exert less pressure—namely, spicy, fried or fatty foods, as well as citrus, caffeinated or alcoholic beverages.
However in my own practice, most of my patients who severely limited their diets for heartburn relief still had reflux. With this in mind, my colleagues and I set out to determine whether food avoidance actually has any benefit.
In an analysis recently published in Archives of Internal Medicine, we reviewed more than 2,000 studies published between 1975 and 2004 and found no evidence that removing specific foods or beverages from the diet would eliminate heartburn in most people.
A small percentage of heartburn sufferers do have triggers.
Example: Red wine causes immediate heartburn in sensitive patients, possibly because of its acid content. Such people should avoid red wine and/or take preventive medication.
Some so-called heartburn triggers, such as caffeine-rich coffee and chocolate, as well as tea and cola, have been linked to relaxation of the esophageal sphincter. However, our findings suggest that the sphincter would relax regardless of the types of food eaten. Therefore, avoiding caffeinated foods won't eliminate heartburn.
We found the same to be true for spicy foods, citrus, alcoholic beverages and even smoking—no studies have shown that eliminating these "triggers" caused an actual reduction in heartburn symptoms. More research is needed to determine systematically if food avoidance can benefit heartburn sufferers, since very few published studies have been designed to examine this question.
LIFESTYLE CHANGES
Although diet had no effect on reflux relief, our research found that there are two factors that could reduce the incidence of heartburn—weight loss and elevating the head of the bed. Try these approaches—and other proven strategies—for four to six weeks before taking heartburn medication, which can cause headache, diarrhea and other side effects.
- Weight loss. Excess body weight places additional pressure on the abdomen, which may cause the lower esophageal sphincter to relax.
Researchers have found that normal-weight adults in the Nurses' Health Study who gained 20 pounds developed acid reflux or worsened existing symptoms. Risk increased with greater weight gain.
Fortunately, studies have shown that weight loss brings relief. Portion control is more important than the foods you select.
- Raise your head at night. Elevating the head of the bed at least six inches by putting blocks or bricks under the frame guards against heartburn by helping keep acid out of the esophagus. If you don't feel comfortable raising the bed frame, buy a foam wedge pillow six to eight inches thick to place under your pillow. Wedges can be found in pharmacies or online at sites such as www.medslant.com (800-346-1850)...or www.foamcenter.com.
Typical cost: $20 to $90.
- Avoid large meals. Overeating can aggravate heartburn, since the stomach produces more acid for digestion. Additionally, fatty foods can delay emptying of the stomach, and that can lead to reflux.
- Stop eating three hours before going to bed. Late-night eating may cause problems for some people. A few studies have shown that heartburn didn't disappear when patients skipped late-night meals, but the pH level of acid in the esophagus improved, indicating that less acid was present.
- Exercise. Staying active can help you lose weight, which can offer relief. Some people find that vigorous physical activity worsens heartburn—exercise can slow stomach emptying and interfere with gastrointestinal absorption, but low-impact exercise, such as walking, typically does not have that effect.
HEARTBURN MEDICATIONS
If the above steps don't work within several weeks (or longer if you're trying to lose weight), try...
- Antacids. Start with fast-acting over-the-counter (OTC) antacids, such as Tums or Mylanta. Use them for intermittent reflux, not for long-term treatment (six weeks or more).
Warning: The calcium in Tums can cause constipation, and the magnesium in Mylanta can cause diarrhea. Check with your pharmacist if you're taking other medications—antacids can interfere with the absorption of some drugs.
- H2 blockers. When antacids aren't strong enough, consider an H2 blocker, such as famotidine (Pepcrd) or ranitidine (Zantac), both of which are available OTC. Side effects, such as headache and diarrhea, are uncommon.
- Proton pump inhibitors. If heartburn isn't squelched by other medications, try a proton pump inhibitor such as omeprazole (Prilosec) or lansoprazole (Prevacid). Side effects, including headache and diarrhea, are rare.
A recent study examined whether the use of proton pump inhibitors was linked to infection with Clostridium difficile, a bacterium that can cause diarrhea, fever and abdominal pain. These drugs reduce the amount of stomach acid, so researchers thought some C. difficile bacteria that would normally be killed in the stomach could survive, causing intestinal proL{ems. Additional research is needed.
DRUG-FREE ALTERNATIVES
Some people who want to relieve heartburn without medication try consuming papaya juice or ginger. No studies have examined the relationship between these products and heartburn, but ingesting them shouldn't cause health problems.
SCREEN FOR CANCER
Long-term heartburn sufferers are at increased risk of developing Barrett's esophagus, a precancerous condition caused by years of acid being regurgitated into the esophagus. Barrett's can lead to esophageal cancer. People with chronic reflux lasting more than six to 12 months should get an endoscopy (in which a flexible, lighted tube is used to examine the digestive system) to screen for Barrett's and esophageal cancer.
