Do you suffer from heartburn?
If you experience burning pain behind your breastbone, especially after eating or at night, or an acidic or bitter taste in your mouth, or throat irritation, you may have gastroesophageal reflux disease (GERD).
"The terms GERD and heartburn are interchangeable," says Elizabeth Ferrer, RD, LD/N, CNSC, a clinical dietitian with the University of Miami Health System. "Both refer to what happens when the lower esophageal sphincter muscle relaxes and allows stomach acid to flow up into the esophagus. This acid reflux or backwash irritates the lining of the esophagus and creates the sensation we call heartburn. When the sphincter muscle functions properly, it blocks stomach acids from entering your esophagus."
Some people are more affected by GERD at night. They may experience disrupted sleep, a chronic cough, or laryngitis. If they have asthma, it may get worse.
A few dietary and lifestyle changes, if followed consistently, might relieve your heartburn. If these steps aren't sufficient, you should see a doctor.
What foods and beverages aggravate heartburn?
Ferrer: It depends on the individual; however, acidic and fatty foods may trigger heartburn.
The top six culprits are:
- Caffeine. This does not mean you cannot enjoy a cup of coffee or tea first thing in the morning; just don't drink it on an empty stomach. Eat a slice of whole-grain toast with almond butter, oatmeal, or eggs and toast with your morning cup.
- Citrus fruits and juices. Oranges, grapefruit, and pineapple are incredibly irritating; sweeter oranges are less so.
- Tomato juices and sauces. Fresh tomatoes are fine because they are mostly water. Tomato juice and sauces used for pasta, pizza, and other dishes have a higher concentration of acidity.
- Chocolate. Similar to caffeine, chocolate acts as an irritant by relaxing the lower esophageal sphincter.
- Carbonated drinks. Soda, sparkling or mineral water distend and bloat the stomach, which increases pressure on the lower esophageal sphincter. Carbonated beverages are more troublesome if you drink them with a large meal or rich foods.
- Alcohol. Beverages containing alcohol are highly acidic, but you can moderate the effect by eating a bland alkaline snack with your drink. Have a few almonds, crackers, and nut butter or one to two ounces of low-fat cheese with your glass of wine.
Spicy, fried, or fatty foods also aggravate GERD. Smoking and certain medications such as aspirin can make heartburn worse, too.
We now know what not to consume or to consume in moderation. Do any foods relieve heartburn?
Ferrer: Several alkaline foods and beverages help ease GERD symptoms. Non-fat or low-fat milk and yogurts act as buffers against stomach acid. Many studies show that ginger root tea promotes the gastric contractions that close off the sphincter and aid digestion. A small amount of lemon juice and honey diluted in warm water also has an alkalizing effect.
Foods that help prevent acid reflux include:
- Fiber-rich foods such as leafy greens, lettuce, broccoli, cucumber, cauliflower, celery, oatmeal, couscous, brown rice, starchy vegetables (potatoes, carrots, sweet potatoes), and nuts.
- Fruit, including bananas, melon, apples, and watermelon.
Besides diet, what other actions improve heartburn symptoms?
Ferrer: Healthy eating habits are one of the essential lifestyle modifications you can make. Stop eating two or three hours before bedtime or laying down. Take time to sit down and relax while eating instead of grazing. It helps if you elevate the head of your bed with a wedge pillow, extra pillows, bed risers, or blocks. Obesity increases the likelihood of GERD, so maintain a healthy weight and engage in physical activity three to four days a week. Also, decrease your stress because the digestive tract is connected to your brain. Eat mindfully by asking yourself, "Why am I eating, am I really hungry, what am I eating, and how much am I eating?"
If you still have heartburn after changing your diet and lifestyle and trying over-the-counter or prescription medications, what's next?
Ferrer: Heartburn occurring twice or more a week should be evaluated by a gastroenterologist. Left untreated, chronic GERD can lead to narrowing of the esophagus, ulcers, and Barrett's esophagus, which can cause esophageal cancer. While diet and lifestyle changes are important, they are not always enough to alleviate GERD.
Nancy Moreland is a contributing writer for UMiami Health News. She has written for several major health care systems and the Centers for Disease Control and Prevention. You can also find her writings in the Chicago Tribune.
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