Donít let heartburn take the ho-ho-ho out of your holidays
† By Les Riess, MD
Mounds of cookies, platters of cold cuts, cups of eggnog and glasses of wine -- itís the holiday season. At this time of year, when weíre not shopping, it seems like weíre eating and drinking. The stress of the holidays, combined with over-indulgence at the table is the perfect recipe for that painful, burning sensation in the upper abdomen known as heartburn.
While it might be difficult to avoid all holiday-related stress, certain foods and drinks are more likely to bring on heartburn than others. These include: coffee, chocolate, peppermint, alcohol, fried foods, fatty foods, sugary foods and citrus fruits and juices. In addition, heartburn can be exacerbated by the use of tobacco, sudden weight changes, lying down, bending over and, of course, stress.
Itís true that certain foods and activities often help initiate a bout of heartburn, however the condition is really caused by a muscle called the lower esophageal sphincter (LES). The job of the LES is to maintain a constant pressure at the lower end of the esophagus in order to keep it closed -- and keep stomach juices in the stomach where they belong. Weakness in the LES, or undue upward pressure caused by a large meal can cause it to open slightly, allowing a reflux of stomach contents to re-enter the esophagus, causing the pain and sour taste associated with heartburn.
You neednít worry too much if you experience heartburn occasionally. Most people do. In fact, about 20 percent of all adults have heartburn at least once a month. Heartburn that occurs about once a month is considered mild. A frequency of once a week is considered moderate. Daily heartburn is considered severe. Heartburn often increases during pregnancy when the stomach is pressed upward and pressure on the LES becomes greater.
Many people successfully treat their heartburn symptoms without seeing a health professional. There are home treatment measures, lifestyle changes and non-prescription medications that can be very useful. Some home treatment measures include diet changes: avoid foods that are fried, fatty or high in sugar content; decrease consumption of alcohol, coffee (even decaf), chocolate and peppermint; and increase intake of fresh fruits (non-citrus) and vegetables. Also, eat smaller, more frequent meals, and avoid eating right before going to bed. Eliminate excessive bending, lifting, abdominal exercises and tight belts. Lifestyle changes such as losing weight, stopping smoking and decreasing stress can also help decrease heartburn.
If home treatment and lifestyle changes arenít enough to eliminate heartburn from your life, you may want to try non-prescription medications. These come in two forms: antacids and acid blockers. Antacids neutralize stomach acid and work faster than their acid blocker counterparts. A liquid antacid works more quickly than an antacid in tablet form. Their effect lasts for about one to two hours.† Antacids have side effects. These can include diarrhea or constipation. Antacids can interfere with the absorption of other medications, so you should check with a health professional if you are taking any prescription medications.
Acid reducers, now available over the counter, were previously only available with a prescription. These medications decrease the amount of acid that the stomach makes. Acid reducers generally provide relief for longer periods of time than antacids. However, they take longer to work. Like antacids, acid reducers can change the way other medications affect you, so check with your health professional before taking one.
Most often, heartburn is a mild condition that can be safely treated at home. Sometimes, however, it becomes more serious and requires the attention of a health professional. If your symptoms occur frequently (more than twice a week) and last longer than four weeks, an evaluation by your physician is warranted. Frequent heartburn that is not lessened by home treatment or lifestyle changes might be a condition known as gastro esophageal reflux disease, or GERD. With GERD, a persistent inflammation of the lining of the esophagus occurs and can lead to other health problems such as swallowing difficulties, bleeding, weight loss or a persistent cough (from acid being regurgitated into the lungs).
There are a number of treatment methods for GERD. In addition to the home treatments, lifestyle changes, antacids and acid blocking medications outlined previously, other prescription medications, which increase the strength of the LES muscle, are available. Endoscope surgery to strengthen the LES muscle may also be considered in some cases.
In general, heartburn is a fairly common condition for most adults and usually isnít a serious health concern. Taking it easy on the stress and enjoying everything in moderation should help you to keep your heartburn in check, leaving you free to enjoy the holidays this year.
Dr. Riess is a board certified family practice physician at Raiter Clinic in Cloquet.