Fight heartburn with food
Changing what, when and how you eat could help you avoid medication, says Jane E. Brody
Many people would rather take a drug than change their habits to control a persistent ailment. Yet, every medication has side effects. Drugs considered safe when first marketed can turn out to have hazards, that become apparent only after millions of people take them for a long enough time.
Such is the case with a popular class of drugs called proton pump inhibitors, or PPIs, used to counter an increasingly common ailment: acid reflux, which many people refer to as heartburn or indigestion.
These medications are now linked to a growing number of complications, ranging in seriousness from nutrient deficiencies, joint pain and infections to bone fractures, heart attacks and dementia. While definitive evidence for most of the risks identified thus far is lacking, consumers plagued by acid reflux would be wise to consider an alternative approach, namely diet and lifestyle changes.
Eating big meals, lying down before a meal is digested, and exercising too soon after eating can also trigger symptoms. Reflux sufferers are often advised to eat five or six small meals a day rather than one or two big ones, and to avoid eating within three hours of bedtime.
But while certain common foods - raw onions, garlic, citrus juices, coffee and chocolate - are likely to cause reflux in most people with the condition, specialists suggest keeping a food and drink diary for a week or two to help identify a person's trigger foods.
A food does not have to be obviously acidic to be troublesome. High-fat foods are problematic for many people because they take a long time to digest. Many commercially produced foods and drinks are treated with acid-containing substances to enhance flavour and shelf life. Accordingly, a "healing" diet should consist almost entirely of natural, unprocessed foods, especially lean protein foods like light-meat poultry, fish, egg whites and low-fat dairy, beans (combined with whole grains), and non-acidic vegetables and fruits.
High-fibre foods are very helpful. Fibre enhances digestion, reducing pressure on the lower oesophageal sphincter, and can aid in weight loss and maintenance. Try to eat a pound of vegetables each day, half of which are cooked and the other half eaten raw, as well as half a pound of fruit. Good sources include broccoli, carrots, beets, green leafy vegetables, apples, berries, bananas, avocados and pears. Other helpful fibre-rich foods include almonds, walnuts, lentils, chickpeas and lima beans.
If adopting the above measures fails to fully control acid reflux, a proton pump inhibitor may also be needed. But a PPI should be used in the lowest effective dose at the correct time and for the shortest possible period, experts say. They should be taken 30 to 60 minutes before eating breakfast or dinner (or both), but not used as an "antidote" to consuming acidic foods.