If you've suffered through even one painful, fire-in-your-chest bout of heartburn, you know there's just about anything you'd do to stop it in its tracks (or turn back the clock on those hot wings).
Heartburn (which 60 million people in the U.S. experience once a month, per the American Gastroenterological Association) is a symptom of acid reflux, says Marie Borum, M.D., director of the division of gastroenterology and liver diseases at George Washington University. This refers to acid sneaking up into your esophagus through your upper esophageal sphincter (the group of muscles at the top of the esophagus), usually after eating. Acid reflux doesn't always lead to heartburn, but when it does, you know.
What Causes Acid Reflux
Lucky for us, the culprits behind the nasty feeling are usually lifestyle factors, so you can avoid triggers for the most part. Certain foods and drinks—think anything fatty, peppermint, alcohol, chocolate, and caffeine—lead to acid reflux because they relax your sphincter. Spicy foods, tomato products, and citrus fruits can also lead to heartburn, although some research suggests that in these cases, heartburn is due to the foods themselves rather than reflux, says Borum, since they have a high acidity level.
It's not just about what you eat, though—your noshing habits also play a big role. That fiery feeling usually sets in after you've dug into a big meal because you're challenging your sphincter, says Borum. It naturally tightens and loosens on its own, but having a big meal in your stomach increases the chances that acid will creep up when it relaxes naturally.
And late-night snackers, take note: Lying down within a few hours after you eat is another trigger. "Things can sort of slip up into the esophagus just because gravity isn't working with you," says Borum. Other risk factors include obesity and weight gain, medications that relax your smooth muscles (like calcium channel blockers for heart disease), and smoking.
How to Stop the Burning
Usually, the healthiest and most effective treatment for heartburn and acid reflux is lifestyle and dietary modifications, says Borum. Dealing with the triggers head-on should be your first line of defense, even if it means cutting back on the coffee or eating smaller meals.
When that's not enough, there are a series of steps you can take to try to ease things. Borum suggests starting by popping an antacid, like tums, or an H2 blocker (a medication that blocks the production of stomach acid), such as Zantac or Pepcid. You can take 'em as needed.
If you've given lifestyle changes, H2 blockers, and antacids a shot to no avail, proton pump inhibitors (PPIs) like Prilosec and Prevacid, which reduce the amount of acid being produced in your stomach, may be your best option. But "while they are great medications for acid-related disorders," says Borum, "it's come to the point where we've recognized that PPIs have their own potential side effects." Recent studies have found that long-term PPI use can cause bone metabolism issues, leading to decreased bone density. It's also important to check magnesium and vitamin B12 levels while on the medication, because PPIs can lead to malabsorption.
Even though the risks are relatively small for a course or two, "it's recommended that you try to use [PPIs] at the lowest possible dose for the shortest period of time," says Borum. "I think it's important that after eight weeks [of using them] it's reassessed to determine whether [PPIs] are really your best medication."
If you've got severe or persistent heartburn (say, more than a couple of times a week), consider talking to your primary care doc or a gastroenterologist—they may suggest trying a different PPI or performing an endoscopy (a nonsurgical procedure during which your digestive tract will be examined with a flexible tube) to get to the root of the problem. If your acid reflux is persistent, you could have gastroesophageal reflux disorder, for instance, and your M.D. can help you come up with a treatment plan once he or she’s examined inside your esophagus.
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