FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

TIPS TO HELP YOU AVOID THANKSGIVING HEARTBURN

Question: Every time I eat a big meal, I suffer with heartburn afterwards. How can I prevent heartburn this Thanksgiving?

Answer: According to folklore, the first Thanksgiving was held in 1623. I wouldn't be surprised if that wasn't also the date of the first case of Thanksgiving heartburn. Today, both the Thanksgiving tradition and the heartburn tradition live on.

The words heartburn, indigestion, and sour stomach all describe the same condition: a heavy, burning feeling under the breastbone. It's brought on by irritation to the esophagus. This is the tube that connects the mouth with the stomach.

Where this tube enters the stomach, there is a band-like muscle that encircles it. When all is working properly, this muscle only relaxes its grip on the esophagus to let food pass into the stomach, and then it promptly squeezes shut again after the food has passed. A failure of this mechanism allows stomach acid to back up into the esophagus, which is made of tissue different from the stomach. The strong stomach acid is desirable in the stomach, but it causes considerable irritation to the esophagus. It is this irritation that actually causes heartburn pain.

Question: I usually drink milk, eat a mint or take an antacid, like Maalox, to relieve my heartburn. Is that the best treatment?

Answer: Contrary to popular belief, drinking milk or eating a mint only gives brief relief from heartburn, and actually, these things can make heartburn worse. Milk temporarily soothes the esophagus as it passes through, but once in the stomach it can cause the production of more acid and, thereby, make heartburn worse. Peppermint will relax the muscle that closes the esophagus, and the relaxed muscle may allow more stomach acid to back up past it, thus worsening the heartburn. The use of a liquid antacid is the best of your choices. It soothes the esophagus as it passes through it, and then it reduces the amount of acid in the stomach. However, I think there are still better choices.

The best way to treat simple cases of heartburn is to put gravity to work for you. Stand up to reduce the pressure in the abdomen that is forcing the stomach acid to ìback upî into the esophagus. Drinking a glass of cold water can help to wash the acid back into the stomach.

Better still, avoid heartburn in the first place. Don't eat large meals that over-fill your stomach. You will still be able to enjoy a Thanksgiving feast, but make sure to take a break between appetizers, the main course and dessert. This will let your stomach empty a little and reduce the pressure working against the muscle closing off the esophagus.

When eating the main course, you can sample all those traditional favorites, but do so in reasonable quantities. Also, watch your intake of certain foods that can raise the stomach's acid level or relax the muscles closing off the esophagus. These foods include chocolate, peppermint, onions, peppers, mustard, orange juice and tomato juice as well as caffeinated beverages and alcoholic drinks. Also, decaffeinated coffee and aspirin can cause stomach problems.

Although it's not usually a serious problem, you should be concerned if you get heartburn frequently. The constant back-flow of acid into the esophagus can lead to ulcers or other damage.

I hope you can avoid heartburn this Thanksgiving, and (on behalf of all of us at the Ohio University College of Osteopathic Medicine) I'd like to take this opportunity to pass along our best wishes for a happy holiday season!

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.