For most people, heartburn is an occasional and relatively minor consequence of enjoying a good meal (or sometimes of choking down a bad one). They pop a few antacid tablets to dampen the pain and go on their merry little double cheeseburger–eating ways. For other people, however, heartburn is the basis for horrific stories. Some people lie awake all night with their insides on fire, no matter how many Tums they take. A friend of mine kept Pepto-Bismol on her bedside table during her first pregnancy because she routinely woke up in the middle of the night needing to chug it. And I have to take a daily medication to prevent heartburn because it aggravates my asthma (read: how to get rid of asthma). Stomach acid, it seems, is best kept inside the stomach.
Heartburn, also known as acid reflux, results when the exact opposite happens. The band of muscle between the esophagus and stomach, called the lower esophageal sphincter, normally relaxes just enough to let food and liquid into the stomach or to let a burp out before it tightens again. If the lower esophageal sphincter fails to contract properly for any reason, stomach acid can splash out of the stomach and into the esophagus, where it irritates sensitive tissues. This happens occasionally to almost everyone and can happen more often as a side effect of certain conditions or medications. However, very severe or very frequent heartburn can also be a symptom of gastroesophageal reflux disease (GERD), which must be diagnosed and treated by a doctor.
Getting Rid of Heartburn
If you're overweight, losing that extra weight is one of the best things you can do to relieve your heartburn. Excess fat around the abdomen puts pressure on the stomach and can force food and stomach acid back up through the lower esophageal sphincter. Because this can be the sole factor contributing to a problem with frequent acid reflux, some people notice a drastic reduction in heartburn pain after losing only a relatively small amount of weight (see: beer belly). Other factors, such as pregnancy or wearing tight clothing around the waist, can have a similar effect in people who are not overweight, so other heartburn cures include loosening your belt and giving birth.
Large meals are another common cause of heartburn. Despite what the fast food industry might like you to believe, the stomach has a finite capacity, and when it gets full, the contents can push up against the lower esophageal sphincter hard enough to open it. If you usually eat until you feel stuffed and get heartburn afterward, try limiting your portion sizes and see if your esophagus thanks you. Thirsty eaters (like me) may also try easing up on their beverage glass during meals. Liquid can contribute to an overly full stomach, too, and carbonated, caffeinated, or alcoholic beverages are doubly dangerous for heartburn sufferers.
When heartburn strikes, think back to what you've just eaten and avoid foods that seem to consistently set you ablaze. Some foods contain chemicals that can relax the lower esophageal sphincter or increase irritation to the esophagus. Alcohol and caffeine are the main culprits in the first category, and the second category includes anything spicy, fatty, minty, acidic, or carbonated. Tomatoes, onions, and chocolate are extremely common heartburn triggers, but if you want to get personal about it (and a little scientific), you might keep a heartburn journal, noting all of your recent meals and snacks whenever you have a flare-up.
Heartburn often becomes worse when sufferers are lying down because the stomach no longer has a gravity assist to keep food and acids inside. That means it's a good idea to stay upright for at least a couple of hours after eating; try not to eat dinner within two or three hours of bedtime, and don't celebrate the end of a meal by lying down on the couch. You can also elevate the head of your bed so that your whole torso (not just your head and neck) is aimed slightly upward. You can accomplish this by placing thick blocks under the two head legs of the bed or by using a large wedge-shaped pillow.
Smokers are much more likely than nonsmokers to experience frequent heartburn because cigarette smoking is detrimental to the digestive system in many ways. In terms of heartburn specifically, the nicotine in cigarettes can cause the lower esophageal sphincter to relax, leading to the type of weakened or abnormal contractions that often contribute to acid reflux. Cigarettes can also aggravate heartburn by stimulating the production of stomach acid while decreasing the production of saliva, which contains bicarbonate that could help neutralize those extra acids (read: how to get rid of a smoking addiction). In other words: Surprise! Smoking is bad for you!
If you have only occasional or mild acid reflux, over-the-counter medication will probably be enough for you. Antacids, which are available in liquid or chewable tablet form and contain bases to neutralize acid on contact, are the most common and affordable type of OTC heartburn remedy. Antacids like Tums, Rolaids, and Gaviscon work well for immediate heartburn relief but can cause constipation or diarrhea if overused. Two other types of OTC medication prevent heartburn by reducing the production of stomach acid. H2-receptor blockers such as Zantac and Pepcid should be taken about half an hour before a meal to prevent heartburn. Prilosec OTC and other proton pump inhibitors are taken daily to treat heartburn over the long term.
Most prescription-only remedies for heartburn are simply much stronger H2-receptor blockers (Tagamet, Pepcid, Zantac, and Axid) or proton pump inhibitors (Prilosec, Prevacid, and Nexium, among others). Promotility agents like Raglan belong to a third class of prescription heartburn drugs that work by strengthening the lower esophageal sphincter and other gastrointestinal muscles to keep acids moving in the proper direction. Your doctor may prescribe one of these three types of medication if you've been diagnosed with GERD or your heartburn doesn't respond to over-the-counter treatments.