Report on Heartburn

Millions of men and women experience heartburn at least once a month. Sometimes it may even hurt to lie down. The good news is that you can find relief, and sometimes in surprising places. Find out how to make changes to your lifestyle to help manage your heartburn.

Heartburn: What causes it?
What heartburn feels like can vary from person to person. But the main symptom is a burning pain in the chest that begins at the breastbone and moves up toward the throat. Heartburn symptoms can last for hours and are often worse after eating, when the stomach produces the most acid. Some people are also awakened by uncomfortable symptoms during the night. Of course, you should always check with your doctor to make sure your symptoms don't indicate a more serious condition than heartburn.

Registered dietician Julie Smith-Riley, R.D., M.S., former director of the Nutrition Navigator website at Tufts University, says, "Certain foods relax the lower esophageal sphincter, or LES. The LES is a muscle valve that sits between the stomach and esophagus, and keeps foods and stomach acids from flowing into the esophagus." Normally the LES is strong enough to keep foods and stomach acids out of your esophagus. But when it relaxes, these acids hit the lining of your esophagus, and the burning can begin.

Because your esophagus stretches all the way from your chest to your neck, you may feel pain behind your breastbone, near your heart (hence the name "heartburn").

What foods cause heartburn?
Unfortunately, your esophagus does not have the same taste in cuisine that you have. It does not reject only your least favorites, like brussel sprouts and chicken livers. Instead, it often rejects your favorite foods. "Fatty foods, caffeinated beverages, chocolate, peppermint, alcohol, and also spicy and acidic foods such as oranges and tomatoes cause heartburn," says Smith-Riley. In other words, your esophagus doesn't have your sense of fun.

How can you avoid heartburn without depriving yourself of your favorite foods?
Still, you may want to think twice before giving up all of your favorite foods. "Some foods are likely culprits to cause heartburn, but everyone reacts differently," says Smith-Riley. "People really need to pay attention to their symptoms and what foods affect them personally."

You can also change the way you eat, she says. "There are a lot of things people can do to lessen the likelihood of foods causing heartburn," Smith-Riley says. She recommends making the following changes:

• Make sure you eat slowly.
• Make sure you chew your food completely.
• Try eating certain foods separately. "If caffeine and citrus cause heartburn," says Smith-Riley, "don't have coffee and orange juice on an empty stomach."
• Substitute your favorite fatty foods with other foods that are still tasty, but lower in fat. Use leaner cuts of meat and low-fat cheese. This way, you can have your nachos and eat them too. Just use baked tortilla chips, low-fat cheese, and low-fat sour cream.
• Keep a food diary. "You might want to keep a diary or at least pay attention to foods that cause symptoms, rather than looking at a list of foods that cause heartburn. Because some of those foods on that list may not cause you heartburn personally," says Smith-Riley.

What are some other ways to reduce heartburn?
Aside from eating habits, you might want to change other aspects of your lifestyle to avoid heartburn. These changes range from lowering stress to elevating your head while you sleep. Here are the big changes:

• Lower your stress. Stress can indirectly lead to heartburn, says Smith-Riley. "Behaviors that can stem from stress, such as overeating and eating quickly, can contribute to heartburn."
• Cut back on or quit smoking. There are, of course, much bigger reasons than heartburn prevention to stop smoking. But here's one more: Smoking lowers LES pressure, which causes acid to slip into the esophagus, resulting in heartburn.
• Lose weight. "Losing a little bit of weight can also help heartburn because it takes pressure off the stomach," Smith-Riley says. Talk to your doctor about starting an exercise program that's right for you.

There are also some small lifestyle changes that you can make to help prevent heartburn. These changes are recommended by the American College of Gastroenterology (ACG):

• Elevate your head 6 to 10 inches while you sleep. A pillow won't suffice, so put a foam wedge under your mattress instead.
• Wait two hours after eating before lying down.
• Avoid tight clothing.