Heartburn
Heartburn
23 Ways to Put Out the Fire
Drop this book. Run to the fridge. Prepare two bologna sandwiches with gobs of mayonnaise, and tomatoes, and peppers. Have some beer. Pull out that cold pizza from Friday night. Yum yum. Help yourself to some ice cream with chocolate sauce. Don't forget the coffee, extra cream. Now down it all as fast as you can—then hurry back!
All done?
Good. Now we're ready to talk heartburn.
What's heartburn? Just hold on a couple of minutes and you'll know.
What causes it? It could be a number of things, but in most cases, it's acid reflux. That is, some of the digestive juices normally found in your stomach back up out of your stomach into your esophagus, the pipe between your stomach and your mouth. These juices include hydrochloric acid, the corrosive substance used in industry to clean metal.
Whereas the stomach has a protective lining so that it doesn't succumb to the acid, the esophagus has no such lining. That's why upwardly mobile stomach acid burns, sometimes so badly that you may think you're suffering a heart attack.
What causes stomach juices to rise? You guessed it—that sharklike attack on the refrigerator is the most common cause. But it's not the only one.
Unfortunately, some people suffer from heartburn even without overindulging. For all of you sufferers who need to understand a little bit more about how heartburn works—and how to squelch the fire—we turn to the experts.
Don't overdo it. Stomach acids can be forced up into the esophagus when there's too much food in the belly. Fill the belly more, and you'll force up more acid. There can be many reasons for heartburn, but for the occasional sufferer, it's usually eating too much food too fast, says Samuel Klein, M.D., assistant professor of gastroenterology and human nutrition at the University of Texas Medical School at Galveston.
Antacids Do Help Over-the-counter digestive aids are generally effective and safe. One would hope so; Americans pay billions of dollars a year for these medications. The antacids that got the highest marks from our experts were many of the most common names—all those whose labels say they're made from a mixture of magnesium hydroxide and aluminum hydroxide. (One constipates and the other tends to produce diarrhea; combined, they counter each other's side effects.) Although the mix may be relatively free of side effects, it still is not a good idea to stay on these antacids for more than a month or possibly two, says Francis S. Kleckner, M.D. They are so effective that they could be masking a serious problem that warrants a physician's care, he says. Our experts agree that liquid antacids, although not as convenient as tablets, are generally more effective. |
|
Don't lie flat. Yes, you feel miserable, and you're inclined to recline. Don't! If you do, you'll have gravity working against you. Stay upright and the acid in your stomach is more likely to stay in your stomach. "Water doesn't travel uphill and acid doesn't either," says Francis S. Kleckner, M.D., a gastroenterologist in Allentown, Pennsylvania.
When you finally do lie down, elevate the head of your bed 4 to 6 inches. You can do this by putting blocks under the legs of the bed itself or by slipping a wedge under the mattress at the head of the bed. (Extra pillows, however, cannot be expected to do the trick.) Keeping the bed on a slant will discourage the heartburn from returning.
Take an antacid. "An over-the-counter antacid such as Maalox or WinGel will generally bring fast relief from occasional heartburn," says Dr. Klein. (For more on antacids, see "Antacids Do Help" above.)
Don't make your problem worse with bad advice. You might have heard that some things, like milk or mints, are good for heartburn. Make sure the guy who gave you this advice doesn't try to sell you a bridge somewhere. What's wrong with milk and mints? Mints are one of several foods that tend to relax your lower esophageal sphincter, or LES, the little valve whose job it is to keep acid in your stomach—and the little lid that can often protect you even when you do overindulge.
And what's wrong with milk? It's this: Fats, proteins, and calcium in milk can stimulate the stomach to secrete acid. "Some people recommend milk for heartburn—but there's a problem with it," says Dr. Klein. "It feels good going down, but it does stimulate acid secretion in the stomach."
Other foods that can relax your sphincter, and should be avoided to alleviate or prevent heartburn, include beer, wine, and other alcoholic beverages, and tomatoes.
MEDICAL ALERT
It Could Be an Ulcer If you're experiencing heartburn regularly for no apparent reason, it's time to call your doctor, says Samuel Klein, M.D. How regularly? As a rule of thumb, "two or three times a week for more than four weeks," says Francis S. Kleckner, M.D. Although heartburn is most usually caused by simple acid reflux, he cautions that it can also be a sign of an ulcer. Heartburn accompanied by any of the following symptoms, says Dr. Klein, should be checked out by a physician fast. It could mean you're having a heart attack. - Difficulty or pain when swallowing
- Vomiting with blood
- Bloody or black stool
- Shortness of breath
- Dizziness or light-headedness
- Pain radiating into your neck and shoulder
In addition, know that heartburn caused by simple acid reflux is normally worse after meals. If your heartburn worsens before meals, it may be a sign of an ulcer. |
|
Go easy on the caffeine. Caffeinated drinks such as coffee, tea, and cola may irritate an already inflamed esophagus. Caffeine also relaxes the sphincter.
Shun the world's worst-for-you dessert. What's the number-one food to avoid when you're suffering from heartburn? Chocolate. The sweet confection deals heartburn sufferers a double whammy. It is nearly all fat, and it contains caffeine. (For chocolate addicts, however, here's good news. White chocolate, while just as fatty, has little caffeine.)
The Alternate Route
Remedies from the Garden Walk into your favorite health food store and chances are you'll find a number of herbs that are reputed to fight heartburn. Daniel B. Mowrey, Ph.D., a psychologist and psychopharmacologist who has been researching herb use in medicine for 15 years, has looked at the evidence thoroughly and has come to the conclusion, that, yes, some herbal remedies do relieve and prevent heartburn. Gingeroot. This, says Dr. Mowrey, is the most helpful. "I've seen it work often enough that I'm convinced," he says. "We're not sure how it works, but it seems to absorb the acid and have the secondary effect of calming the nerves," he says. Take it in capsule form just after you eat. Start with two capsules and increase the dosage as needed. You know you've taken enough, says Dr. Mowrey, when you start to taste ginger in your throat. Bitters. A class of herbs called bitters, used for many years in parts of Europe, is also helpful, Dr. Mowrey says. Examples of common bitters are gentian root, wormwood, and goldenseal. "I can vouch that they work," says Dr. Mowrey. Bitters can be taken in capsule form or as a liquid extract, just before you eat. Aromatics. The aromatic herbs, such as catnip and fennel, are also reputed to be good for heartburn, "but the research on these is sporadic," says Dr. Mowrey. Some you should forget about. A group of herbs that includes irish moss, plantain, and slippery elm is often recommended, but "I have the least confidence in these," he says. Apple cider vinegar. Outside the herb family, an oft-touted remedy for heartburn is 1 teaspoon of apple cider vinegar in 1/2 glass of water sipped during a meal. "I've used it many times—it definitely works," says Betty Shaver, a lecturer on herbal and home remedies at the New Age Health Spa in Neversink, New York. It may sound bizarre to ingest an acid when you have an acid problem, admits Shaver, but "there are good acids and bad acids," she says. |
|
Clear the air. "It doesn't matter whether it's yours or someone else's tobacco smoke—avoid it," says Dr. Kleckner. It will relax your sphincter and increase acid productions.
Swear off fizzy drinks. All those little bubbles can expand your stomach, having the same effect on the sphincter as overeating, says Larry I. Good, M.D., a gastroenterologist in Merrick, New York, and an assistant professor of medicine at the State University of New York at Stony Brook.
Feed that hamburger to the dog. If you've just knocked off a triple cheeseburger with fries and a double milkshake, that probably explains your pain. Greasy, fried, and fatty foods tend to sit in the stomach for a long time and foster surplus acid production. Avoidance of fatty meats and dairy products will almost certainly discourage repeated attacks, says Dr. Good.
Check your waistline. The stomach may be compared to a tube of toothpaste, says Dr. Kleckner. If you squeeze the tube in the middle, he says, something's going to come out of the top. A roll of fat around the gut squeezes the stomach much as a hand would squeeze a tube of toothpaste. But what you get is stomach acid.
Loosen your belt. Think again of the toothpaste analogy, says Dr. Kleckner. "Many people can get relief from heartburn simply by wearing suspenders instead of a belt," he says.
If you're lifting, bend at the knees. If you bend at the stomach, you'll be compressing it, forcing acid upward. "Bend at the knees," says Dr. Kleckner. "It's not only a way to control acid, it's also better for your back."
Check your medicine cabinet. You may find the source of your grief lurking within it. A number of prescription drugs, including some antidepressants and sedatives, may aggravate heartburn. If you're suffering heartburn and are on any prescription drug, "review it with your physician," says Dr. Kleckner.
Think mild, for spice isn't always nice. Chili peppers and their spicy cousins may seem like the most likely heartburn culprits, but they're not. Many heartburn sufferers can eat spicy foods without added pain, says Dr. Klein. Then again, some can't.
Be cautious about, but not afraid of, the Florida sunshine tree. Acidic foods like oranges and lemons may seem like trouble, but the acid they contain is kid stuff compared to what your stomach produces, says Dr. Kleckner. He suggests you let your tummy decide on these foods.
Vow to eat dinner earlier tomorrow night. "Never eat within 2 1/2 hours before bedtime," says Dr. Kleckner. A bulging stomach and gravity working together are a sure way to force stomach acid upward into the esophagus.
Take life a littler easier. "Stress," says Dr. Klein, "may cause an increase in acid production in the stomach. Some good relaxation techniques might be of help in reducing your level of tension, allowing you to rebalance your unbalanced body chemistry."
PANEL OF ADVISERS
Larry I. Good, M.D., is a member of the Long Island Gastrointestinal Disease Group in Merrick, New York. He is also an assistant professor of medicine at the State University of New York at Stony Brook.
Francis S. Kleckner, M.D., is a gastroenterologist who practices in Allentown, Pennsylvania.
Samuel Klein, M.D., is assistant professor of gastroenterology and human nutrition at the University of Texas Medical School at Galveston. He is also an editorial adviser to Prevention magazine.
Daniel B. Mowrey, Ph.D., of Lehi, Utah, is a psychologist and psychopharmacologist who has been researching the use of herbs in medicine for 15 years. He is author of The Scientific Validation of Herbal Medicine and Next Generation Herbal Medicine.
Betty Shaver is a lecturer on herbal and other home remedies at the New Age Health Spa in Neversink, New York.
