Ask Doctor K: Diet, lifestyle changes can ease discomfort of heartburn

DEAR DOCTOR K: Can lifestyle changes help relieve my heartburn?

DEAR READER: Heartburn is an uncomfortable burning sensation that radiates up the middle of your chest. It results from a condition called gastroesophageal reflux disease, or “reflux.” With GERD, stomach acid surges up into the esophagus, the “swallowing tube” that connects our mouth to our stomach.

Our stomachs make acid to help digest food. The lining of our stomachs is built to resist injury from the acid. The lining of the esophagus, however, is easily injured by acid.

To protect the lining of the esophagus from acid, there is a circular ring of muscle where the esophagus joins the stomach. It’s called the lower esophageal sphincter, or LES. The ring opens to allow food we’ve swallowed into the stomach. Then it clamps down, preventing acid from reaching the esophagus.

In GERD, the LES doesn’t clamp down enough. As a result, stomach acid squirts up into the lower esophagus. This irritates the lining, causing the sensation of burning.

Fortunately, diet and lifestyle changes can help prevent reflux. Here are some things you can try:

– Eat several smaller meals throughout the day, rather than one or two big meals. A stomach full from a big meal (and acid) is more likely to cause GERD.

– Relax when you eat. Sit down and eat slowly. Stress increases stomach acid production.

– Remain upright after eating. Try not to bend over or strain to lift heavy objects for at least three hours after eating. This raises pressure in your stomach, which causes stomach contents to reflux up into the esophagus.

– Avoid eating within three hours of going to bed. Do not eat bedtime snacks. Food (and acid) in the stomach refluxes more easily when you’re lying down.

– Lose weight. Excess pounds increase pressure on the stomach and can push acid into the esophagus.

– Loosen up. Avoid tight belts, waistbands and other clothing that puts pressure on your stomach.

– Avoid foods that can trigger reflux: high-fat foods, spicy dishes, tomatoes and tomato products, citrus fruits, garlic, onions, milk, carbonated drinks, coffee (including decaf), tea, chocolate, mints and alcohol. They all relax the circular muscle and make reflux more likely.

– Stop smoking. Nicotine stimulates stomach acid production. It also impairs the function of the muscle that keeps food and acidic juices in the stomach.

– Chew (sugarless) gum. It increases saliva production, soothing the esophagus and washing acid back down to the stomach.

– Discuss your medications with your doctor. Certain drugs, including aspirin and other NSAIDs, oral contraceptives, narcotics, certain antidepressants and some asthma medications can cause heartburn.

– Raise your bed’s head. Elevate the head of your bed by placing a wedge under your upper body. Don’t elevate your head with extra pillows. That makes reflux worse by bending you at the waist.

– Exercise wisely. Wait at least two hours after a meal before exercising.

– Try herbal remedies. Certain herbs, including chamomile, ginger and licorice, may help relieve heartburn symptoms.

(This column ran originally in October 2014.)

Dr. Komaroff is a physician and professor at Harvard Medical School.