Winnipeg Free Press - PRINT EDITION

Suffering heartburn? Here's how to cool it

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Nietzsche, the German philosopher, wrote: "The belly is the main reason why man does not mistake himself for a god." Heartburn reminds us we are quite human. It should also remind us that ignoring this common symptom can also be dangerous. So what should you know about it?

1. It's common and expensive.

The National Institute of Diabetes and Digestive and Kidney Diseases reports that in the U.S., 50 million people suffer from heartburn every month, and the average person with this problem spends $3,355 a year on medication and other treatments.

2. If you have heartburn, you're doing something wrong.

Don't blame the restaurant for the fire in your stomach. You're obviously eating too much, and often the wrong foods. This puts too much pressure on the lower esophageal sphincter muscle that normally slams shut and prevents gastric juices from entering the lower end of the food pipe. Large meals trigger excessive amounts of gas, and the laws of physics say something has to give.

3. Gastric crutches are not a long-term solution.

Everyone wants a quick fix these days and there are many over-the-counter remedies available, such as TUMS, Maalox, Mylanta and Rolaids, to name a few antacids. People suffering from heartburn usually get relief from these remedies that decrease the amount of stomach acid. Others may need stronger medication such as Pepcid Ac or Zantac 75. But if you're constantly taking them, you're pushing your luck.

4. Alarm bells that indicate trouble.

It's not good news if you have heartburn twice a week or more or if it recurs after weeks or months. You may have progressed from garden-variety heartburn to gastro-esophageal reflux disease (GERD). Now it's time to see the doctor. He or she may prescribe a proton pump inhibitor such as Nexium and Prevacid, that stops acid secretion.

5. GERD can be dangerous.

The constant irritation of stomach juices can result in inflammation of the esophageal lining. Most cases are mild, but if left untreated can cause scarring and narrowing of the lower end of the food tube. Using a flexible, lighted endoscope, doctors can assess the damage and, if needed, take a biopsy to determine if the changes can lead to cancer, a condition called, Barrett's esophagus.

6. So what should smart consumers do?

Realize that just as some people live beyond their economic means and squeeze their wallets too hard, others ask their stomachs to do the impossible. The only good solution is to change lifestyle. It's shocking that one proton-pump-inhibitor drug racked up sales of $6.2 billion in 2011, usually due to faulty habits.

7. Everyone needs a holiday. So do stomachs.

I'm convinced that fasting for a day now and then is a good routine. Or begin by eating smaller, less challenging meals. This means staying away from fatty, spicy and acid foods. So limit the amount of fruit juice, French fries, raw onions, garlic, chicken nuggets, high-fat brownies, liquor, wine, coffee and tea, to name a few. This routine should shed pounds and put less stress on the lower esophageal muscle. And stop smoking!

8. Relax.

Avoid tension at the dinner table. Pent-up emotions impede the normal workings of the stomach. Loosen your belt after eating. This puts less strain on the esophageal sphincter muscle. Remember that gastric juices, like water, do not flow uphill, so remain upright after a meal and forgo the post-dinner nap.

9. When can medication be stopped?

There's no agreement on this point. Some patients remain on proton pump inhibitors for long periods and have a lifelong battle with gastro-esophageal reflux disease. But I believe the best solution is to get off medication as soon as possible. And remember, if you behave yourself, tincture of time is a great healer.

10. Keep in mind the risk of heart attack.

It may be difficult during a severe attack of heartburn to know if the symptoms are due to this problem or if they indicate a coronary attack. If there's any doubt, call 911.

See to see The "Ain't So's" About Cholesterol, under cardiovascular.

Republished from the Winnipeg Free Press print edition March 28, 2013 B4

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