Heartburn

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Heartburn

What can you do when that burning sensation right under your rib cage won't go away? You belch. But there's no Ladder Company Number 9 to put out this fire. This is the inferno of that after-dinner bother--heartburn.

The cause of this post-dining fire storm is actually the hardworking sphincter in your lower esophagus. This is a muscle that relaxes to let food pass into your stomach, then quickly closes. But when it doesn't close properly, the contents of your stomach can back up--a condition known as esophageal reflux--creating burning or irritation under your rib cage. Hello, heartburn.

In pregnant women, and in everyone over age 40, the esophageal sphincter is likely to weaken a bit. Not much you can do about that. But the main causes of heartburn are usually obesity, stress and the wrong diet. And those things (unlike age) you can do something about.

There's other good news. Your esophagus can heal from the burning caused by stomach acid within seven weeks with proper care, decreasing your chances of recurring episodes. So here's some body-plumbing help that will give your pipes a soothing rest.

When to See the Doctor If you have heartburn daily or even several times a week, see your doctor, says William J. Ravich, M.D., associate professor of medicine in the Division of Gastroenterology at Johns Hopkins University School of Medicine in Baltimore. Frequent or repeated symptoms could be an indication of esophagitis, or inflammation of the esophagus. Other warning signs may indicate an ulcer according to Seven Weeks to a Settled Stomach, by Ronald L. Hoffman, M.D., director of the Hoffman Center for Holistic Medicine in New York City, sometimes the first indication of an ulcer is a lot of belching and bloating, which might lead you to think you have severe gas pains. The pain may be worse between meals when your stomach is empty, and you may feel better after you eat something. If these symptoms sound like yours, consider the possibility of an ulcer and see a doctor. If you are experiencing what you think may be heartburn accompanied by any of the following symptoms, you should be checked out by a physician fast. Difficulty or pain when swallowing Vomiting Bloody or black stool Shortness of breath Dizziness or light-headedness Chest pain or pain radiating into the neck and shoulder According to Samuel Klein, M.D., associate professor of medicine in the Division of Gastroenterology and the Division of Human Nutrition at the University of Texas Medical School at Galveston, these symptoms indicate problems far more complex than heartburn, ranging from obstruction of the esophagus to a heart attack.

Watch out for repeat offenders. Coffee, alcohol, spicy foods and citrus fruits often bring on a five-alarm blaze, according to John Sutherland, M.D., clinical professor of family practice at the University of Iowa College of Medicine in Iowa City and director of the Waterloo Family Practice Residency Program in Waterloo. And watch out for fried and fatty foods as well as tomatoes and chocolate. Any of these can "irritate your esophageal lining or relax your sphincter muscle, triggering reflux," says Ronald L. Hoffman, M.D., director of the Hoffman Center for Holistic Medicine in New York City.

Don't Forget Antacids You can reach for relief with antacids, but timing is important, says Dennis Decktor, Ph.D., scientific director of the Oklahoma Foundation for Digestive Research in Oklahoma City. "Use antacids after you eat but before heartburn occurs. Food and drink wash them away." It appears to be the coating action rather than the acid-neutralizing action of antacids that matters, according to Dr. Decktor. For this reason, he advises, "don't drink water with an antacid or you may wash the coating away." Tablets, pills or liquid? Take a chewable, Dr. Decktor recommends. When you chew, you create saliva, which helps neutralize some of the "burning" acid.

Obliterate that onion. Do you suffer after spicy meals with onions? The onions, not the spices, may be the cause, says Melvin L. Allen, Ph.D., a gastroenterology researcher at the Presbyterian Medical Center of Philadelphia. It helps to refrigerate raw onions before you slice them. It reduces their potency. Better yet, cook them!

Or opt for a different onion. "There are three types of onions that don't cause heartburn," says Stephen Brunton, M.D., director of family medicine at Long Beach Memorial Medical Center in Long Beach, California. "Try the Texas sweet onion, the Maui and the Walla Walla varieties." (You may not find these in your grocery store unless it has a large and diverse produce section, but be persistent and check your local farmer's market or food co-op.)

Try less on the plate. "Eat small meals to avoid heartburn," advises William J. Ravich, M.D., associate professor of medicine in the Division of Gastroenterology at Johns Hopkins University School of Medicine in Baltimore. It's best to eat more frequent meals of small portions, instead of three "normal" meals a day. And try to have your last meal of the day at least three hours before bedtime, since you're more likely to get heartburn when you're lying down.

Drink water with your meals. Drinking water will wash stomach acids from the surface of the esophagus back into your stomach, says Dr. Hoffman. The saliva you swallow with the water will help neutralize the acid.

Four after-dinner no-no's. Your after-dinner habits may be causing your heartburn. For greater comfort, avoid drinking, smoking, napping and strenuous lifting. After-dinner drinks tend to bring on nighttime reflux, Dr. Hoffman says, and "smoking may weaken your lower esophageal sphincter." Avoid lying down after dinner, because gravity helps food stay in your stomach where it belongs. ("Try to resist the after-dinner nap, especially after eating a heavy meal," says Dr. Sutherland.) And as for taking out the garbage after dinner, lifting heavy things after eating can also bring on heartburn, Dr. Ravich says.

Sleep on a slope. "Place the head of your bed on six-inch blocks," advises Dr. Hoffman. "This seems to reduce heartburn by minimizing the flow of reflux from your stomach into your esophagus at night." Also, if you're in the habit of lying on your right side, try sleeping on your left side instead, suggests William B. Rudennan, M.D., chairman of the Department of Gastroenterology at the Cleveland Clinic-Florida in Fort Lauderdale. "The stomach is lower when you're lying on your left side," observes Dr. Ruderman. In that position, stomach acid is less likely to make its way up into your esophagus.

Hiatal Hernia Isn't the Problem: Heartburn Is Nearly one in every three people has a hiatal hernia, a condition where the upper portion of the stomach protrudes upward through an opening in the diaphragm into the chest. This usually occurs as a result of weakening of the tissue around the diaphragm. Although hiatal hernia causes no pain and produces no symptoms, it's often confused with heartburn, says William B. Ruderman, M.D., chairman of the Department of Gastroenterology at the Cleveland Clinic-Florida in Fort Lauderdale. That's because people who have reflux heartburn often have a hiatal hernia as well. But if you're not prone to heartburn, having a hiatal hernia usually means little, says Dr. Rudennan. In fact, many people are completely unaware they have a hiatal hernia--even though it affects half of all people over age 50. "The bottom line is that it isn't necessary to do anything about a hiatal hernia," says Dr. Ruderman. "But it is necessary to take care of heartburn if you're feeling pain."

Run not, burn not. Although exercise is a great habit, running can cause "runner's reflux," says Dr. Hoffman. If that's a problem, try other forms of exercise that don't jostle the body as much--such as bicycling or working out with weights. (But avoid doing any form of exercise except a relaxed stroll right after a meal.)

Review your Rx. Some medications lead to heartburn. For example, "make sure your stomach doctor knows what your heart doctor has prescribed," says John Horn, Pharm.D., associate professor at the University of Washington School of Pharmacy in Seattle. "Certain medications for high blood pressure, particularly calcium channel blockers, can cause reflux."

Try the vomit nut. It's unappealingly named, but the so-called vomit nut, or nux vomica, is a homeopathic remedy that relieves heartburn, says Dr. Hoffman. Check your local health food store for availability and follow the directions on the bottle.