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HEARTBURN

WHAT IS IT?
Heartburn has nothing to do with your heart. Instead, it’s a problem with your stomach and esophagus-the tube that carries food from your throat to your stomach. When stomach acid leaks up, or refluxes, into the tube, you get a burning feeling above your stomach that can rise into your chest, just beneath your breastbone. That’s heartburn.Almost all of us get heartburn now and then, often just after eating. It can last from a few minutes to a few hours. Most of the time, heartburn isn’t a serious problem, though it can be painful. But about 20 million Americans have a more serious form of heartburn called gastroesophageal reflux disease, or GERD: heartburn almost every day. Left untreated, GERD can cause serious problems, such as an ulcer-a sore-or scarring in the esophagus.
You can do a lot to prevent and treat mild heartburn yourself. If you have GERD, you and your doctor can do a lot to help you recover, and to keep heartburn from doing you serious harm.
WHAT IS HAPPENING?
Every day, your stomach makes about two quarts of gastric juices, the acid and enzymes you need to digest food. This acid, hydrochloric acid, is strong enough to dissolve the foods you eat, and that means it’s also plenty strong enough to burn your esophagus. The inside of your stomach is protected from this acid by a lining of mucus. Your esophagus is protected by swallowed saliva and a muscular valve at the entrance to the stomach that should keep acid from leaking backward. The valve is called the lower esophageal sphincter (LES).
When you swallow your food, it travels down your throat and esophagus. The sphincter should open just long enough to let food through to the stomach, then shut tightly to prevent acid from backing up into the esophagus.

Sometimes the sphincter doesn’t shut tightly enough. Then stomach acid leaks back into the esophagus and you have heartburn.
WHAT CAUSES IT?
No one knows why one person tends to get heartburn and another doesn’t. But we do know that you can do plenty about most of the things that increase your risk.

THINGS YOU CAN’T CHANGE

Age
The older you are, the more likely you are to have heartburn. That’s because the lower esophageal sphincter tends to loosen with age.

THINGS YOU CAN CHANGE

Overeating
Overeating is the number-one cause of heartburn. When your stomach is too full, it presses on the sphincter and doesn’t let it close all the way.

Being overweight
You’re likely to have heartburn if you’re overweight. That’s because added weight increases pressure in the stomach against the LES.

Pregnancy
Heartburn affects almost half of all pregnant women. The growing fetus presses into the stomach and weakens the LES. Heartburn caused by pregnancy almost always goes away after the baby is born.

Hiatal hernia
A hiatal hernia occurs when the upper part of the stomach pokes into the chest through a small opening in the diaphragm. This can weaken the LES.

Alcohol
Alcohol can relax the LES, so that stomach acid splashes into the esophagus.

Diet
Spicy, acidic, or fatty foods such as onions, garlic, peppers, tomatoes, citrus fruits, peppermint, and chocolate can cause heartburn or make it worse. So can the caffeine in coffee, soda, tea, and some foods.

Medications
Over-the-counter painkillers, such as aspirin and ibuprofen, can irritate the lining of the stomach and esophagus, which can cause heartburn or make it worse. So can many prescription drugs, including some antibiotics, cortisone, and arthritis medications.

Cigarette smoking
Smoking directly leads to heartburn in many people. That’s because smoking weakens the LES and increases production of stomach acid. Second-hand smoke can also cause heartburn in some.

Tight clothing
Tight pants, girdles, and belts put pressure on the stomach and lower esophageal sphincter and can lead to heartburn.

Exercise
Activity right after a meal can put pressure on the sphincter, forcing it to open at times.
WHAT YOU CAN DO FOR YOURSELF
Fortunately, you can do a lot to help prevent or relieve heartburn.

Immediate relief
The first step is to earn what foods or activities tend to give you heartburn and stay away from them if you can. If you do get heartburn and need relief right away, try the following:

For heartburn now and then, many doctors advise over-the-counter antacids or acid blockers. Antacids take the sting out of stomach acid. Liquid antacids may work better than tablets. Acid blockers-also called H2 blockers-make the stomach produce less acid.
Try drinking some ginger tea. Ginger soothes the stomach.
If you’re lying down and have heartburn, sit up. Or try lying on your left side, which puts your stomach lower than your esophagus, making acid less likely to back up.
During pregnancy
To help prevent heartburn when you’re pregnant, eat smaller meals more often. That way some food is always in your stomach to soak up acid, and your stomach never has the pressure of one large meal. If this doesn’t help, ask your doctor about an antacid.

Posture
Try not to lie down for two to three hours after eating. If you must, lie on your left side to keep your stomach lower than your esophagus.

Clothing
Don’t wear tight clothes that squeeze your middle, such as jeans, girdles, or belts.

Eating habits
Don’t overeat. Overeating puts more pressure on the lower esophageal sphincter. A big meal also makes the stomach produce extra acid, which means there is more acid to leak into your esophagus. And if you eat too much day after day, you’ll gain weight, which makes the problem even worse. What’s best?

Eat smaller meals (four or five a day) instead of three larger ones. This keeps food in your stomach and soaks up acid.
There’s no special diet to prevent heartburn-just stay away from foods you know cause you problems.
Use herbs such as basil, cilantro, bay leaves, dill, and parsley instead of spices to add flavor to meals.
Don’t eat just before bedtime.
Cut the fat
Fats can cause heartburn or make it worse. A meal with lots of fat in it, for example a hamburger and fries, is hard to digest. A fatty meal makes the stomach produce extra acid and slows emptying of the stomach, raising the chances for acid reflux. And if you often eat lots of fat, chances are you’ll gain weight. A low-fat diet, on the other hand, is not only good for your stomach and your waistline, it’s good for your heart.

Simple things you can do to cut fat and cholesterol:

Read food labels to know what you’re getting. The important things to look for are calories, calories from fat, total fat, saturated fat, and cholesterol. The American Heart Association advises keeping your fat intake under 30 percent of your total calories each day. That could mean only 750 calories a day, or even fewer, from fat. (Just one tablespoon of butter has about 100 calories.)
Build your meals around fruits, vegetables, and grains. They have little fat and no cholesterol and are loaded with vitamins, minerals, and fiber.
If you eat red meat, make it a once-in-a-while treat, not a regular item, and keep it lean. Look for cuts graded “select,” which means they have the least fat. Other low-fat cuts include pork loin, lean center-cut ham, venison, veal chops or roast, and lamb flank. Before cooking chicken, remove the skin and fat. Don’t use chicken injected with salt and fat-read the package label to make sure it isn’t. Eat no more than six ounces of meat, poultry, or fish a day. Keep servings to three ounces-a cut of meat about the size of a deck of cards, half a skinless chicken breast or leg, or three-fourths cup of flaked fish.
Don’t fry foods. Bake, broil, steam, or saute with water or broth in a nonstick pan.
If you eat dairy foods, go for low- or nonfat versions such as skim or 1 percent milk, and choose nonfat yogurt, ice milk, or sherbet instead of ice cream.
For salads, try an oil-free dressing. If you use oil, make it one high in unsaturated fats, such as canola, safflower, sunflower, or olive.
Read the labels on frozen dinners to see how much fat they contain. Aim for meals that have less than 10 grams of fat per serving.
Don’t smoke
Smoking is one of the worst things you can do to your body. Not only does it cause heart disease and cancer, it also causes heartburn. Nicotine makes the body release more stomach acid. It also relaxes the lower esophageal sphincter. Sucking on a cigarette or cigar puts air into your stomach, raising stomach pressure and adding to the problem. Smoking also slows healing. That’s a big problem if your heartburn has given you an ulcer. If you smoke and have heartburn, do what you can to kick the habit. And stay away from smoky places.

Be careful with pain relievers
Instead of aspirin or ibuprofen, which can irritate the stomach, try acetaminophen. But if you’ve been taking aspirin or ibuprofen regularly, talk with your doctor before switching.

Sleep better
The way you sleep can prevent heartburn. For a good night’s sleep, raise the head of your bed four to six inches by putting bricks or phone books under the legs. Or put a foam-rubber wedge under your pillows. Don’t just use more pillows, though; this bends your waist, increasing pressure on the lower esophageal sphincter.

Exercise
Don’t exercise right after eating; wait 30 to 60 minutes. Right after a meal you have the most acid in your stomach, and that means more acid to cause heartburn. And a lot of movement after eating can raise the pressure on the lower esophageal sphincter while also relaxing it, which makes heartburn even more likely.

Regular workouts are important, though. They keep you healthy and fit, and help keep your weight down.

Control your weight
If you weigh more than you should, start dropping those extra pounds. Losing even a few extra pounds can help. That’s because extra weight reduces the holding power of the lower esophageal sphincter and raises your risk of a hiatal hernia.

Taking off weight may sound daunting, but it doesn’t have to be. The best approach? Combine smart eating with exercise.

Here are some tips for a program that works:

Check with your doctor to find out how much you ought to weigh.
Take your time. It’s better to lose weight slowly-no more than 1 percent of your body weight each week. The more gradually you lose weight, the easier it is to keep it off.
Be realistic. Don’t shoot for a weight you can’t maintain.
Keep an eye on your total calories and make a point of cutting down on fats.
“Fat-free” and “low-fat” foods can be a trap. They don’t give you the fat, but many of them make up for it with sugar, so they’re high in calories.
Stay as active as you can.
Don’t stress out
Many people think stress causes heartburn. That’s not quite true. Stress doesn’t cause heartburn, but can make it worse. If you find that stress bothers your stomach, here are some things that may help:

Exercise. People who exercise often feel less anxious and more relaxed.
Laugh more. Studies show that laughter releases stress-busting hormones.
Don’t be a perfectionist. Set reasonable goals and question whether everything you do has to be the best.
Control your anger. When you’re angry, ask yourself three questions: Is this problem important? Is my anger justified? Can I do anything to fix the problem? If the answer to any of the three is no, take a few deep breaths and tell yourself to calm down. If any answer is yes, don’t seethe silently; figure out something you can do to change the situation.
Take breaks during a hectic day to calm down. It doesn’t matter what you do-walk around, chat with someone, water some plants-as long as it’s a time-out. Aim for at least 20 minutes a couple of times a day.
Keep a pet. They may shed and slobber, but studies show their owners have fewer health problems than people without pets.
Relax through yoga, deep breathing, stretching exercises, or meditation.
WHAT YOUR DOCTOR CAN DO FOR YOU
If you can’t prevent or relieve heartburn with lifestyle changes, or if you need to take over-the-counter drugs for your heartburn nearly every day, talk to your doctor about other remedies, including prescription drugs and surgery.

Acid or H2 blockers
These help ease the symptoms of heartburn by limiting the amount of acid going into the stomach.

Pro
H2 blockers help limit damage to the esophagus from stomach acid, giving injured tissue time to heal.
Con
Side effects can include constipation or diarrhea, blurred vision, dizziness, headache, nausea, and joint or muscle pain.
Takes 30 minutes to be effective.
Promotility agents
These help clear acid from the esophagus. They may also help speed food through the stomach, so there is less pressure to force acid into the esophagus.

Pro
Can decrease heartburn symptoms, especially at night.
Con
Side effects can include constipation or diarrhea, drowsiness, nausea, headaches, and tiredness.
Proton pump inhibitors
These also help reduce the amount of acid in the stomach and help heal an inflamed esophagus.

Pro
Can decrease stomach acid as much as 90 percent, by some estimates.
Con
Side effects are rare, but can include stomach pain, constipation or diarrhea, dizziness, gas, skin rash, fatique.
Fundoplication
The most common surgery for severe heartburn is called fundoplication. In this operation, the doctor wraps part of the stomach, called the fundus, around the lower end of the esophagus. This helps the lower esophageal sphincter work better.

A new version of the surgery uses a laparoscope. This device, like a small telescope, lets doctors see into the abdomen while they operate. The surgery is performed through a few tiny cuts. This speeds recovery and lowers the risk of infection.

Hiatal hernia surgery
If a hernia is the cause of your heartburn, surgery to fix the hernia can often cure the heartburn. The surgeon also tightens the lower esophageal sphincter. The operation is not always a complete cure. And a hernia can come back. Also, surgery may tighten the sphincter too much, causing frequent bloating or trouble swallowing.

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November 2013
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