By Mary Brophy Marcus, USA TODAY
Platters piled with buttery cookies, bowls of nuts, boxes of chocolates, fancy seasonal toddies — the holidays are a heartburn nightmare waiting to happen.
"At holiday time, versus any other time, the simple abundance of food and the temptation to overeat is probably one of the biggest problems," says Katherine Zeratsky, a dietitian at Mayo Clinic's Dan Abraham Healthy Living Center.
Many people have occasional bouts of heartburn, but if you have episodes more than twice a week, you may be one of the 20% of adults who suffer from gastroesophageal reflux disease (GERD), and are especially prone to flare-ups, say medical experts. But there are effective ways to avoid such spells, and to treat the discomfort, experts say.
GERD happens when the ring of muscle at the bottom of the esophagus — the valve-like lower esophageal sphincter that creates a barrier between the esophagus and stomach — is relaxing more frequently than it should. That allows stomach acids to back up into the esophagus which can cause discomfort and burning in the chest and throat.
ON THE WEB: Info on GERD from the Mayo Clinic
"Reflux is epidemic," says gastroenterologist Rahul Shimpi, an assistant professor of medicine at Duke University Medical Center, who says the rise in obesity is linked to its increase.
According to the National Institute of Diabetes and Digestive and Kidney Diseases, GERD leads to 18.3 million ambulatory care visits, 3.1 million hospitalizations, and 64.6 million prescriptions each year in the USA.
While the classic reflux sufferer is overweight and middle age, Shimpi says, "I see reflux in people of all ages, shapes and sizes now."
Even children are affected. A recent Kaiser Permanente study of more than 690,000 children found that extremely obese children have a 40% higher risk of GERD, and moderately obese children have a 30% higher risk compared to normal-weight children.
Symptoms can vary from person to person. While "heartburn" is traditionally recognized as the most common one, some experience a cough, asthma symptoms, or trouble swallowing, says laryngologist Jamie Koufman, Director of the Voice Institute of New York and author of Dropping Acid: The Reflux Diet Cookbook & Cure, published this year.
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"Reflux comes in more than one form. There's a whole subset that have silent reflux — people with chronic coughs, allergies, a sensation of a lump in the throat, hoarseness," says Koufman, who believes reflux can cause asthma-like symptoms.
Pregnancy or a hiatal hernia can increase chances of reflux, too, says Shimpi. He says lifestyle habits, including using tobacco and caffeine, which can decrease the pressure in the muscle at bottom of the esophagus, can influence it.
Steering clear of certain common reflux "trigger" foods can help, too, says Zeratsky. Many are holiday buffet regulars: fatty cheeses, alcoholic beverages, minty flavored drinks and desserts, creamy beverages such as eggnog, hot chocolate, and caffeinated drinks.
Minnesota Vikings NFL guard Anthony Herrera says he had to cut back on his beloved hot sauce after chronic acid indigestion got so bad it woke him up in the middle of the night.
"Being from the Caribbean, my mom, every time she comes up, brings me my favorite hot sauce. But I've had to change a lot of my eating habits now," says Herrera, who limits his favorite spicy foods and eats more veggies now. A paid spokesperson for Prilosec OTC, he takes the drug, a proton pump inhibitor when his reflux acts up.
Koufman believes the high-acid content of many pre-packaged snack foods and beverages is feeding the reflux epidemic, too. Her book promotes a low-fat, low-acid diet rich in fresh produce.
Lose weight if needed, eat smaller more frequent meals, wear loose-fitting clothes and avoid lying down for a few hours after a meal or drinking liquids, Koufman also suggests.
Some medications, including calcium channel blockers for high blood pressure and sedatives for insomnia and anxiety, can increase or exacerbate GERD as well.
When problems are severe, occurring daily and not responding to over-the-counter medications and lifestyle changes, it's time to see a healthcare provider, says Eric Esrailian, assistant professor of digestive diseases at the David Geffen School of Medicine at UCLA.
Doctors can rule out more serious illness and may prescribe one or a combination of medications, which may include:
•Over-the-counter antacids: These include Maalox, Mylanta, and Tums, which neutralize stomach acid and may provide quick relief. But antacids alone won't heal an inflamed esophagus damaged by stomach acid.
•H2 receptor blockers: These reduce acid production and are available over-the-counter and in prescription strengths. They include cimetidine (Tagamet HB), famotidine (Pepcid AC), and ranitidine (Zantac 75).
•Proton pump inhibitors (PPIs): These block acid production and heal the esophagus. Available over-the-counter and by prescription, they include lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec OTC).
"The most pressing issues for a lot of patients are, 'Can I take these medications, and for how long?' " says Esrailian, who says that patients may tolerate drugs differently.
He says some data suggest the PPIs might impact bone density. "You need acid in your stomach to absorb calcium," Esrailian says. But more research is needed, he says.
"There's been postulated links between proton-pump use and community acquired pneumonia," adds Shimpi.
The use of PPIs during pregnancy is also associated with a doubling of the risk of cardiac birth defects, according to a new study from University of Pennsylvania School of Medicine scientists.
Scientists are exploring why some people appear more prone to reflux-linked complications, such as Barrett's esophagus, and others don't, and who is most likely to progress to more serious problems, says Esrailian.
If you find yourself sneaking down to the fridge at midnight to pick over party leftovers, try a slice of lean chicken or a few veggies instead of a cup of eggnog and chips, says Zeratsky. Your holidays will be a lot sweeter.
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