TUESDAY Q & A: Lifestyle Changes are a Good First Step in Heartburn Treatment
DEAR MAYO CLINIC: Until recently I’d never experienced heartburn, but now I seem to have it at least twice a week. I would like to avoid taking over-the-counter medications. Is it possible to prevent heartburn by avoiding certain foods?
ANSWER: Heartburn, or acid reflux, happens when stomach acid backs up into your esophagus. It is a common problem. About 40 percent of people in the United States have some symptoms of heartburn, which is usually described as a burning pain in the chest after eating.
Treatment of heartburn depends on two issues. First, how much the symptoms bother you, and second, whether these symptoms signal an underlying esophageal injury that is happening because of the reflux. These can be two different issues, as the intensity of heartburn does not necessarily correspond to esophageal injury. In fact, people with severe esophageal injuries — such as esophagitis, where tissue in the esophagus becomes inflamed, or Barrett’s esophagus, a precancerous condition — often have mild symptoms or no symptoms at all.
Fortunately, heartburn usually does not lead to esophageal damage from reflux. Most people with heartburn just have to deal with symptoms. But it is important to identify who needs to have their reflux symptoms evaluated. In general, the people with reflux symptoms who are most at risk for injury to the esophagus are Caucasian men, older than 50, who have had heartburn longer than five years, with symptoms happening at least three times a week and symptoms that occur at night.
If you fit into this category, talk to your doctor about your heartburn. If you are not in a high-risk group, lifestyle changes, with or without over-the-counter medications, can be a good first step in heartburn treatment.
There have been many recommendations over the years about decreasing heartburn by avoiding specific foods, particularly those that contain acid. Examples include acidic juices such as orange or grapefruit juice, caffeinated beverages, chocolate and mints. Many doctors also have recommended avoiding high-fat meals, as they may make reflux worse.
But as scientists have come to understand acid reflux better, it is now clear that there is no need to completely avoid these foods unless their acid content directly leads to symptoms. In other words, if it causes you heartburn, avoid it.
Beyond that, other steps you can take to reduce symptoms include eating small meals, eating slowly, and allowing four to five hours between eating and bedtime. Eating smaller meals slowly helps because reflux is worsened when your stomach is stretched quickly to full capacity. Lying down also increases heartburn. That’s why it is important to allow plenty of time between eating and going to bed.
The bottom line when it comes to diet modification to treat reflux is to use good judgment. If you have a small piece of chocolate cake, it probably won’t be a problem. On the other hand, a piece of chocolate cake following a dinner of steak and French fries with a beer eaten quickly is bound to cause heartburn symptoms if you are prone to acid reflux.
In addition, one of the most the most important and healthiest steps you can take to lower heartburn symptoms is not smoking. The nicotine in cigarettes causes weakening of the lower esophageal sphincter, the valve that separates the stomach from the esophagus. It is critical for that valve to work properly because it protects the esophagus from stomach acid. Smoking also is more highly associated with esophagitis and esophageal cancer from reflux. If you don’t smoke, don’t start. If you do, stop. If you need help, talk to your doctor about smoking cessation programs in your area.
If these lifestyle changes do not help reduce your symptoms, if heartburn becomes bothersome enough to interfere with your daily activities or if reflux becomes more frequent, talk to your doctor about other possible treatment options for persistent acid reflux. — David Katzka, M.D., Gastroenterology, Mayo Clinic, Rochester, Minn.