Heartburn is a common digestive complaint which affects an estimated 15 million Americans every day, and 60 million once a month. Relief of mild heartburn is typically achieved through diet and lifestyle changes, although medication (eg. antacids) is usually necessary if the heartburn is caused by gastroesophageal reflux disease (GERD).

What is Heartburn? What Are The Symptoms?

Heartburn is a digestive problem: it has nothing to do with your heart. It occurs when small amounts of stomach acid accidentally rise up the esophagus (the food canal running from the mouth to the stomach) causing symptoms like a burning pain in the chest which rises towards the throat. Sufferers may even taste the fluid in the back of the mouth, and this is called acid indigestion. In many cases the pain and burning sensation is relatively mild, but sometimes is so severe that patients think they are experiencing a heart attack.

What Are The Causes Of Heartburn?

In general, the immediate cause of heartburn is the acidic digestive juices which leave the stomach and rise up the esophagus. The acid burns the tissue of the esophagus causing inflammation and pain - a condition called esophagitis. Heartburn may also occur in pregnancy when the baby is pressing up against the underside of the diaphragm and squeezing the stomach. An occasional episode of acid-regurgitation or indigestion is quite normal. But persistent heartburn (eg. twice a week), is usually a sign of something more serious. The two most common underlying causes of heartburn symptoms are gastroesophageal reflux disease (GERD), and hiatal hernia.

Gastroesophageal Reflux Disease

GERD is characterized by a failure of the muscular valve, known as the lower esophageal sphincter (LES), which is located at the bottom of the esophagus. The function of this valve is to keep acid in the stomach and prevent it leaking back up the esophagus. When this valve doesn’t work properly, reflux (leak-back) and heartburn can occur. Factors that contribute to gastroesophageal reflux disease include obesity, pregnancy, smoking and, in particular, hiatal hernia.

Hiatal Hernia

Hiatus or hiatal hernia is a condition in which part of the stomach herniates (protrudes) upwards into the chest through the hiatus (opening) in the diaphragm normally only occupied by the esophagus. This puts extra pressure on the LES valve preventing it from closing properly. As a result, stomach acid leaks into the esophagus causing heartburn. The underlying cause of hiatal hernia is unknown. Contributory factors include: obesity, pregnancy, constipation, abdominal muscle strain, and smoking.

Dietary Treatment For Heartburn

In cases of persistent heartburn, dietary improvements are not sufficient. So as well as advocating a digestion-friendly diet, your doctor is likely to recommend one or more of the following types of medication. Antacids to neutralize the acid in your stomach; H2 blockers or proton pump inhibitors to reduce acid production; or prokinetics to strengthen the lower esophageal sphincter and expedite stomach-emptying. However, if heartburn symptoms are mild and occur only from time to time, usually you will be advised to make the following changes to your diet.

If Overweight, Switch To A Healthy Weight Loss Diet

Obesity, especially excess fat on the chest and abdomen, is a common contributory factor to GERD and hiatal hernia, and therefore to heartburn. So if you are obese (BMI > 30), take steps to normalize your weight and thus reduce your risk or symptoms of heartburn. Choose a healthy calorie-controlled diet and customize it by following the eating tips below.

Stop Eating Large Meals

A big meal distends the stomach and causes a rise in the production of stomach acid. Both these factors lead to an increased risk of heartburn. So opt for 4-6 small meals or snacks, and allow a maximum of 3 hours between eating. In addition, choose foods that are “easier on the stomach” and more more easily digested.

Avoid Acidic Food

Reduce your intake of very acidic foods by avoiding items such as: tomatoes, tomato-based sauces, citrus fruits, rhubarb, gooseberries, unripe fruit, vinegar and acidic pickles or relishes.

Cut Down On Fatty and Spicy Food

Fried or very fatty foods, including candy, encourage indigestion and should be avoided or eaten sparingly. So go easy on butter, mayo, sausages, salami, pate, meat pies, and full-fat cheese. The same applies to very spicy food such as: black pepper, chili peppers, curry, mustard and other hot spices, as well as raw onions and garlic.

Avoid Carbonated Drinks

Fizzy or carbonated soft drinks cause belching and upward pressure on the lower esophageal sphincter (LES), increasing the likelihood of heartburn. The best drinks include: water, herbal teas or diluted non-citrus fruit juices. Please also note that some soft drinks (eg. cocoa, coffee, orange juice) are not helpful for heartburn as they can over-relax the LES, thus encouraging the backward flow of acid from the stomach.

Eat More Fiber, Especially Soluble Fiber

Constipation can lead to extra strain on abdominal muscles and increase the risk of heartburn. To prevent constipation, eat more high-fiber foods such as: oats, apples, pears, dried apricots and vegetables. When increasing fiber intake it’s also important to increase your water intake by at least 40 fl oz a day.

Reduce Alcohol Consumption

Alcohol is not helpful to heartburn for several reasons. So take steps to reduce your intake to one unit a day, or avoid it altogether. Alcohol is also a source of non-nutritious calories and can contribute to overweight.

Other Digestive Tips

For digestive disorders like heartburn, some dietitians and alternative health experts recommend patients to eat (or cook with) digestion-friendly aromatic herbs like basil, camomile, caraway, dill, fennel, rosemary and thyme. They also recommend that you end each meal with a glass of herbal tea (eg. camomile, fennel) to reduce acidity and wind.

Lifestyle Improvements To Reduce Heartburn

There are several lifestyle changes that can help to reduce the symptoms of heartburn. One obvious one is to stop smoking, as tobacco smoke increases acidity in the stomach. Other recommended changes include:

Avoid placing extra strain on your abdomen or chest. Wear loose-fitting clothes, and do not overstretch or lift heavy weights.

Do not lie down after eating, and try not to eat anything for at least three hours before going to bed. The less there is in your stomach when you come to lie down, the lower the risk of heartburn.

To minimize night-time discomfort, raise the head end of your bed by about 3 inches by using bed-blocks or by placing a solid object under the bed-legs. This helps to prevent stomach acid from leaking backwards into the esophagus. Do not use extra pillows - you simply end up with a stiff neck as well as heartburn!

Heartburn symptoms can be caused by certain over-the-counter drugs, such as aspirin, or other pain-killers or anti-inflammatories. So if you take this type of medication regularly, check with your doctor or pharmacist that it’s safe to continue.

Linda Smith B.Sc., RD, aged 51, is a qualified dietitian and nutritional consultant. She is part of the editorial team at Diet-i.com which provides a range of information about diet, nutrition and weight management to more than 5 million visitors per year.

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