Humans have suffered from heartburn for all of history. Hippocrates warned in 400 BC that eating cheese after a full meal could cause indigestion, especially if accompanied by wine.380 Centuries ago, doctors called it dyspepsia, from Greek words meaning difficult to digest. These days, drug companies stress an even scarier name: gastroesophageal reflux disease (GERD).
Whatever you call it, heartburn is unpleasant. It can ruin the memory of a great dining experience. And trying to sleep with a burning sensation in the middle of your chest can be difficult at best and impossible at worst. Reflux can also lead to more serious conditions. The longer irritating stomach contents stay in contact with the delicate tissue of the esophagus, the more damage they do. Repeated exposure to this noxious nastiness can cause scarring, stricture, and abnormal cell growth. Most worrisome of all is the risk of esophageal cancer.
Let’s be perfectly clear. Anyone who experiences prolonged bouts of heartburn must be seen by a competent gastroenterologist for a thorough workup. This is not a do-it-yourself project!
The underlying cause of GERD is more mysterious than you would think. Commercials for antacids or powerful prescription reflux drugs often blame heartburn on excess stomach acid, as if Mother Nature made a giant mistake. But we’re supposed to have acid in our stomachs. Starting some 350 million years ago, virtually all animal species evolved sophisticated systems for creating strong stomach acid.381 Halibut make hydrochloric acid in their stomachs. So do dogs, cats, cows, birds, frogs, snakes, and salamanders. Just because drug companies have figured out ways to shut down acid production with medications such as omeprazole (Prilosec), lansoprazole (Prevacid), and esomeprazole (Nexium) does not mean this is the only way to combat heartburn.
Stomach acid is essential for digesting food and facilitating the absorption of certain nutrients. The acid environment in the stomach also creates a barrier against infection. We swallow germs every day from our food and other sources. But it is hard for bacteria to survive in the stomach if there is a hostile acidic environment. Trying to prevent the creation of stomach acid is like fighting back the tide. We’re not at all certain that long-term acid suppression is always such a good idea.
Persistent symptoms of pain, burning, or pressure behind the breastbone should be investigated by a doctor to rule out a serious condition. For an occasional attack of indigestion, however, there are lots of things you need to consider. Before pulling out the heavy artillery of acid-suppressing drugs, there are many options to contemplate. Here is a quick snapshot:
- Avoid foods or drugs that might make the lower esophageal sphincter lazy and let gastric juice creep back into the esophagus. There are few good studies, but some possible culprits include chocolate, carbonated beverages, smoking, diazepam, and progesterone.
- Cut back on carbs. Although the data are preliminary, there is some suggestion that the typical high-carbohydrate American diet may be contributing to reflux.
- Keep your eyes on itopride. This prescription drug works differently than acid-suppressing drugs to relieve indigestion and heartburn. Its success in Japan and India and a fascinating report in the New England Journal of Medicine (February 23, 2006) have us looking forward to FDA approval.
- Saliva is the body’s natural buffering agent and fire extinguisher for heartburn. Chewing gum or sucking on hard candy can help relieve symptoms.
- Chamomile or ginger tea also can wash acid out of the esophagus and back into the stomach where it belongs. These traditional remedies also may help calm an upset stomach.
- Other herbal products that can be helpful include fennel seed (in capsules or tea) or flaxseed tea.
- Home remedies such as sipping diluted apple cider vinegar or even swallowing yellow mustard may help. Each person is different, though, so trial and error will be the only way to find out if a home remedy will work for you.
- Baking soda remains a time-honored solution for occasional heartburn. Dissolve 1/2 teaspoon of powder in 4 ounces of water. For those on sodium-restricted diets because of congestive heart failure or high blood pressure, this is not an option.
- If you need an antacid, calcium carbonate remains one of the cheapest and most effective in the pharmacy. Tums Ultra contains 1,000 milligrams of calcium carbonate and is a cost-effective option.
- In our opinion, a sensible first choice for an OTC acid-suppressing drug is Pepcid Complete. It combines the immediate action of antacids (calcium carbonate and magnesium hydroxide) with the longer-acting H2 antagonist famotidine. Short-term use should be safe.
- If you feel you must take a powerful acid-suppressing PPI, we would opt for Prilosec OTC. If you have great insurance coverage, you might save money if your doctor prescribes generic omeprazole instead. We think a little vitamin insurance is appropriate whenever acid-suppressing drugs are taken for any length of time (vitamin B12, vitamin C, and vitamin E).