Ease the (heart)burn this Thanksgiving

An expert in GERD and esophageal disorders from Yale New Haven Health shares heartburn tips.

Amir Masoud, MD

 

Acid reflux, commonly known as heartburn, is an extremely prevalent disorder affecting up to a fifth of the US population. With Thanksgiving and the holiday season fast approaching, there is an anticipated rise in reflux symptoms as overeating can strain the digestive system.

Amir Masoud, MD, Yale Medicine gastroenterologist, Yale New Haven Health’s Digestive Health service line shares his recommendations for reducing or preventing reflux so you can enjoy the holidays and make happy memories that do not involve waking up at 2 am with chest pain!

Reflux happens

After eating, the stomach is filled with the food and liquids, along with air, that has been swallowed. This is met with stomach relaxation, or “accommodation,” allowing the stomach to hold more volume. As the stomach relaxes, pressure may build necessitating a venting, or pressure relief. This typically occurs in the lower esophageal valve, or sphincter, which relaxes for a short time, to release some of the air. This is what we normally call “belching,” or “burping.”

Heartburn and pain occur when acid comes up from the stomach through the relaxed valve and into the lower part of the esophagus. The stomach makes a strong acid that breaks down food so the body can absorb nutrients. When this acid enters the esophagus, it can cause pain by irritating and “burning” the esophageal lining. If the valve malfunctions, is weak, or relaxes too much, more acid reflux occurs.

“This can mean anything from heartburn after eating a big bowl of pasta to not being able to tolerate liquids because of significant regurgitation,” says Dr. Masoud.

Reflux is not a cause for panic.

“Even people without any symptoms can have 40-50 reflux episodes a day,” says Dr. Masoud. “After every meal, you’ll have esophageal sphincter relaxation. Sometimes this doesn’t cause symptoms and sometimes it does. The fact that you have reflux is not the problem, the symptoms are the problem. In fact we define GERD as the troublesome symptoms arising from reflux, not the presence of reflux in general.”

First line of defense

“People typically first try dietary modification,” says Dr. Masoud. “This includes cutting out trigger foods such as chocolate, coffee and alcohol.”“If you eat a heavy meal make sure it is small,” says Dr. Masoud “Fat, protein and fiber take longer to digest, leaving acid in your stomach longer. Eating small meals leads to less gastric distension, fewer reflux episodes, and ultimately fewer symptoms. This line of defense can be quite effective.”

Treatment options

In the first century AD Pliny the Elder, a Roman philosopher, wrote about “coral powder” to treat the fire within the chest. Coral contains calcium carbonate – an ingredient present in some over-the-counter medications used today. The history of painful reflux may be long, but suffering with it doesn’t need to be.

“The easiest way to target the acid is with those chalky antacids,” says Dr. Masoud. “Antacids raise the PH and neutralize acidity. You still have reflux – but it isn’t burning. These tablets offer temporary relief because they do not completely neutralize gastric acidity.”

Other options include proton pump inhibitors (PPIs), a class of medication for heartburn which work by blocking the production of stomach acid.

“When you have a less acidic stomach it becomes less efficient,” says Dr. Masoud. “In addition to helping with digestion, stomach acid is one of the body’s defenses against pathogens such as bacteria. So taking PPIs could potentially put someone at a higher risk of food poisoning or, for example, traveler’s diarrhea.”

An apple a day keeps reflux away

“After eating a large meal eat something high in pectin like a raw apple or pear,” says Dr. Masoud. “The pectin can gum up the acid and displace the acid layer further down, away from the lower esophagus.”

Have you thanked your saliva lately?

“Staying well hydrated can also help prevent heartburn,” says Dr. Masoud. “Saliva plays an anti-reflux and heartburn role by neutralizing acid in the esophagus and pushing it down (think like a slow trickling water fall). Drinking plenty of water can also change the PH of the stomach contents and make it less acidic.”

“Avoid carbonated beverages, which are acidic and contain gas which leads to more gastric distension and transient lower esophageal sphincter relaxations, the major mechanism at play when it comes to reflux.”

Over-the-counter products

“The best over-the-counter products are the ones with alginate,” says Dr. Masoud. “Alginate is a seaweed extract that comes into contact with stomach acid and turns into a gel-like layer, pushing acid away from the lower esophageal valve and reducing the number of reflux episodes.”

Something else to be thankful for

We all have esophageal acid exposure, but usually at levels that don’t cause problems.

“The body regenerates fast enough to mitigate long-term complications,” says Dr. Masoud. “Addressing acid reflux is about enhancing quality of life and managing symptoms. In only the rarest cases can reflux develop into a bigger problem with more serious complications but, for the vast majority of us, it can be managed without much difficulty.”

If you are experiencing severe heartburn on a regular basis or have concerns at all, please speak to your doctor.