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Mon August 13, 2012
Got Heartburn? Maybe You Should Rethink Your Drink
Originally published on Mon October 15, 2012 9:05 am
Many of us experience heartburn, or reflux, from time to time — and when we do, we're quick to point the finger at heavy, fatty meals. But that burning, uncomfortable feeling may also be the result of what we're drinking: namely, coffee and other caffeinated beverages, and alcohol.
"Alcohol has a direct effect" on heartburn, says Kevin Ghassemi, a gastroenterologist at the University of California, Los Angeles. "Temporarily, of course."
The reason, he explains, is a ring of muscle — called the lower esophageal sphincter — located at the junction between the stomach and the esophagus.
"The muscle is supposed to be closed, except when food is passing into the esophagus," explains Ghassemi.
But alcohol can relax the sphincter muscle and create an opening. When this happens, stomach acid "can come back up into the esophagus, and that's reflux," Ghassemi says. That's what creates the burning sensation.
It's a similar story with caffeine. "The caffeine that's in coffee or other caffeinated beverages also will relax the sphincter muscle," he says.
Clearly, not everyone gets reflux after drinking alcohol or caffeine. Some people are predisposed: They may have a weak or faulty sphincter muscle to begin with. Being overweight or obese increases significantly increases the risk.
Cutting back on coffee or alcohol may — or may not — help. Often times, Ghassemi says, people with chronic reflux need prescription medicines to treat the problem.
If your heartburn is occasional, you may want to try some other tweaks to your diet.
But don't accept the conventional thinking that spicy foods and acidic foods such as tomato sauce and citrus are necessarily problematic.
"People are afraid of ... orange juice and tomato sauce, and really there's no clear link between these foods and acid reflux," says Karthik Ravi, a gastroenterologist at the Mayo Clinic.
Some people may notice that acidic foods don't agree with them, but Ravi says there's limited evidence that these foods increase acid secretion, and many heartburn patients do fine after eating them.
Ravi published a study that found alkaline foods — such as burgers and shakes, which are not acidic at all — also led to heartburn in people prone to the condition.
"What that tells us is, you know, it doesn't really matter what you eat ... because you're really refluxing acid that your stomach itself is making," Ravi says.
It's more likely that the fat in a heavy meal will exacerbate the problem. Why? Fatty foods stay in the stomach longer. And the more you eat, the fuller your stomach gets — and the more hospitable the conditions become for reflux.
Ravi tells his patients to use the law of common sense. We're all different, so if a particular food bothers you, by all means avoid it.
But in general, Ravi's advice comes down to this: Eat what you enjoy, but slow down, slim down your portions, and avoid large, fatty meals.
"There's more of a focus on modifying how you eat than necessarily what you eat," he says. And taking a mindful approach to eating is best.
"Eating smaller meals and eating a little more slowly is going to help with your reflux symptoms," Ravi says.
RENEE MONTAGNE, HOST:
This is MORNING EDITION from NPR News. Good morning. I'm Renee Montagne.
DAVID GREENE, HOST:
And I'm David Greene.
Today in Your Health, getting the right amount of calcium. But first, heartburn. Lots of us experience it. And for a growing number of Americans, reflux is a chronic problem. What you're eating and drinking can play a role in triggering the uncomfortable condition, but as NPR's Allison Aubrey explained, not in the way you might think.
ALLISON AUBREY, BYLINE: The two middle-aged guys I'm about to introduce you to - both suffer from heartburn. But what triggers their attacks seems to be very different. Brian Kobul(ph), who recently celebrated a milestone birthday had a bad case of reflux the night of his birthday dinner.
BRIAN KOBUL: It was a very heavy meal. Yes, it was. Yes.
AUBREY: Paint the picture. Were there a lot of people there? Like what was on the menu?
KOBUL: It was at a steakhouse, lot of steak, potatoes, very unhealthy food. Yeah.
AUBREY: And by 1 A.M., when he finally made it to bed, he remembers that burn that started right behind his breastbone.
KOBUL: The, you know, burning, you know, up and down, up and down, you know, rising and falling.
AUBREY: One contributor to the heartburn was likely the heavy meal. But Kobul suspects something else was at play, too.
KOBUL: I think it was probably more what I was drinking with it, actually, the, you know, liquor.
AUBREY: There was bourbon and other types of whiskey. Dr. Kevin Ghassemi is a gastroenterologist at UCLA. He has treated lots of people with heartburn, or reflux. Now, Kobul is not his patient, but he says this hunch about alcohol as a trigger for heartburn is spot on.
DR. KEVIN GHASSEMI: That's correct. It's not surprising. Alcohol has a direct effect, temporarily, of course.
AUBREY: Ghassemi says in the body there's a ring of muscle at the junction between the stomach and the esophagus. It opens and closes like a valve.
GHASSEMI: The muscle is normally supposed to be closed, except when the food is passing through the esophagus.
AUBREY: But he says as alcohol relaxes this muscle it can create a gap or opening, in essence breaking the seal that protects the esophagus from the acid in the stomach. And when this happens...
GHASSEMI: The acid can come back up into the esophagus, and that's reflux.
AUBREY: That's what creates the burning sensation.
GHASSEMI: And so this gentleman is more likely to have reflux because the sphincter muscle is relaxing more frequently.
AUBREY: Now, clearly not every gets reflux after drinking alcohol. Some people are predisposed; they may have a weak or faulty sphincter muscle to begin with. Being overweight increases the risk, too.
Now, Kobul's buddy, Jamie Chan, suffers with heartburn. too. And he's got another habit that may be a trigger: coffee.
JAMIE CHAN: I probably drink four cups, four or five cups a day.
AUBREY: And has anybody ever told you that that's a trigger for heartburn?
AUBREY: Physician Kevin Ghassemi says it works similar to the booze.
GHASSEMI: The caffeine that's in coffee or other caffeinated beverages also will relax the sphincter muscle.
AUBREY: Making reflux more likely. But Chan says his heartburn isn't bad enough to give up coffee.
CHAN: And what am I going to use as a stimulant instead of the caffeine?
CHAN: That's the tradeoff.
AUBREY: Cutting back on coffee or alcohol may or may not help. Oftentimes, Ghassemi says, people with chronic reflux need prescription medicines to treat the problem.
Now, lots of people have heard that certain foods can cause heartburn. At the top of the list are spicy and acidic foods, such as tomato sauce. But researcher Karthik Ravi of the Mayo Clinic says there's limited evidence that these foods actually increase acid secretion. And many heartburn patients do fine after eating them.
DR. KARTHIK RAVI: People are kind of afraid of drinking of orange juice or tomato sauce, things like that. And really there's no clear link between those types of foods and acid reflux.
AUBREY: He's published a study that found alkaline foods, thinks like burgers and shakes that are not acidic at all, also led to heartburn in people prone to it.
RAVI: So really, what that tells us is, you know, it doesn't really matter what you eat and if you think of it as acidic or not, because you're really refluxing acid that your stomach itself is making.
AUBREY: And the stomach makes acid regardless of what you eat. It's more likely that the fat in a heavy meal will exacerbate the problem, because fatty foods stay in the stomach longer and can prompt more acid production. Ravi tells his patients to use the law of common sense. We're all different, so if a particular food bothers you, by all means avoid it. But in general, Ravi's advice is this: eat the foods you enjoy.
RAVI: There's more of a focus on modifying how you eat rather than necessarily what you eat.
AUBREY: He says, slow down and cut your portions. And it may also be good for the waistline.
Allison Aubrey, NPR News. Transcript provided by NPR, Copyright National Public Radio.