What is heartburn?
Heartburn is the feeling of burning, “heat”, which starts from the xiphoid process and reflects upwards in the chest, to the cervix or even the lower jaw.
What are the causes of heartburn?
Heartburn usually occurs an hour after eating. It is aggravated, especially after large meals, lying down, by foods that reduce the pressure of the lower esophageal sphincter and by substances that cause direct irritation of the esophageal mucosa.
What diseases is it associated with?
“Heartburn” is usually not a major problem for our health. We can all have “burning” in the chest sometimes, usually after large meals or increased consumption of alcoholic beverages.
But when our quality of life begins to be affected with two or more episodes of heartburn per week, then we may be suffering from a condition called gastroesophageal reflux disease (GERD).
Gastroesophageal reflux disease (GERD)
Gastroesophageal Reflux Disease is characterized as a condition when it becomes the cause of endoscopic damage to the esophageal mucosa. If there is no immediate treatment it can lead to:
- Barrett’s esophagus
- esophageal stricture
- esophageal cancer
What lifestyle changes are recommended?
People with heartburn symptoms may apply quite simple, daily lifestyle and diet modification measures such as:
- Avoid lying down for 2-3 hours after a meal
- Lying on the left side may help some patients
- Elevating the head and trunk during sleep (elevating the top of the bed – not elevating with a pillow)
- Avoid physical activity immediately after meals
- Avoiding slouching, carrying and lifting heavy objects immediately after a meal
- Avoid tight clothing, corsets and belts
- Abstinence from smoking
- Reduction of anxiety and stress
- Weight reduction in overweight or obese people
- Avoiding foods that irritate the stomach e.g. alcohol, cocoa, caffeinated drinks fried, sauces, fatty, fried, legumes, dairy
- Good chewing of food
- Frequent and small meals
- Avoiding water and other liquids during the meal
Heartburn and diet
Many people with heartburn symptoms report worsening of their symptoms after eating certain foods. But since “offensive” foods are different from person to person, it would be helpful for the patient to keep a food and symptom diary. The assessment of the above diary by the dietitian will form the basis for determining the type and quantity of food that can be tolerated by each patient.
The main foods that are often “to blame” for the appearance of heartburn symptoms and should be avoided are:
Foods high in fat
Limiting fat intake is one of the basic dietary recommendations. Fat reduces lower esophageal sphincter pressure and worsens episodes of postprandial gastroesophageal reflux. Rich in fatty foods or snacks, such as french fries, junk food, butter, croissants, puff pastry, syrupy sweets, etc. should be avoided. In addition, whole milk and whole yogurt as well as cheeses such as Gruyere and Parmesan should be avoided.
Opt for baked, grilled or steamed foods without butter or sauces and avoid fried foods altogether. Fried foods have been observed to intensify the burning sensation.
Caffeine intake may worsen the heartburn symptom due to the relaxation it causes in the lower esophageal sphincter. If you feel a strong feeling after consuming them, prefer corresponding drinks without caffeine such as decaffeinated coffee.
Drinking carbonated soft drinks has been linked to nighttime heartburn. Fizzy drinks, because of the carbonation, can lead to relaxation of the esophageal sphincter and increased secretion of gastric acid in the stomach. Therefore, they should be completely avoided from your diet and especially with the simultaneous consumption of food. Prefer a glass of water but not during the meal.
Patients with GERD often complain of heartburn after drinking beer and other alcoholic beverages such as white wine, red wine, whiskey and vodka. Total abstinence from alcohol is recommended, or go for low-alcohol drinks in case you can’t avoid it completely.
Citrus fruits and Citrus juices
Citrus fruits such as orange, tangerine, grapefruit, lemon, pineapple as well as citrus and tomato juices have been found to increase reflux symptoms due to their acidity. It is recommended to limit the above fruits and juices and to replace them with fruits or juices of lower acidity such as peach, apricot, apple, banana.
Chocolate contains an ingredient called methylxanthine, which has been shown to increase the reflux of gastric juices, reducing pressure on the lower esophageal sphincter. However, complete avoidance of chocolate is not recommended for all patients.
Spicy- Hot Foods
Spicy foods have been observed to increase heartburn. The most common ingredient in these meals is onion. Also, meals containing curry may worsen symptoms.
In the table below you can see which foods to avoid and which to prefer to deal with heartburn and avoid discomfort.
|Dairy products||Whole milk (fresh, evaporated, powder), whole yogurt, graviera parmesan
Gruyere, feta, parmesan
|Skimmed milk. low-fat yogurt
Katiki, anthotyro, sour myzithra, cottage cheese, low-fat yellow cheese
|Vegetables||Tomato, onion, garlic||Boiled potatoes, carrots, cabbage, broccoli|
(orange, lemon, grapefruit, pineapple)
|Apple, pear, banana, peach, apricot|
|Eggs||Egg yolks||Egg whites|
|Meat – Fish||Pork with visible fat, beef with visible fat, lamb, offal, sausage||Lean meat, roasted or boiled chicken without skin, fish|
|Fat||Fatty foods, sauces, butter, mayonnaise, chips, bacon, olives, fatty dressings, cream||Olive oil (moderate amounts)|
|Sweet||Chocolates, syrupy sweets, pastes, ice cream, candies||Jelly, rice pudding|
|Drinks & Drinks||Citrus juices, soft drinks, alcoholic beverages, caffeinated beverages (including tea and chocolate), mint||Chamomile, ginge|
Heartburn and pregnancy
Heartburn is a fairly common phenomenon during pregnancy and occurs in 17%-45% of pregnancies.
Previous studies have shown that 22% of women experience heartburn in the 1st trimester, 39% in the 2nd trimester, and 60-72% in the 3rd trimester.
In most cases, they are due to pressure on the stomach from the uterus, which combined with the relaxation of the lower esophageal sphincter by pregnancy hormones causes reflux of gastric contents into the esophagus.
The situation is treated with:
- Reducing the amount of food you eat at a time
- Avoid liquids during meals
- Avoid lying down immediately after a meal
- Dress in casual clothes.
Cowries and herbs
Herbs with gastroprotective and analgesic properties to treat heartburn are:
Chamomile (Marticaria recutita)
Chamomile, known since ancient times for its medicinal and therapeutic properties (anti-inflammatory, antimicrobial, antispasmodic, anti-insomnia, immune stimulation, relief from itching, burning, irritation, tympanic acid, colic, etc.) is one of the most widespread herbs of the Greek land.
Chamomile, today, is traditionally used for various medical purposes, such as disorders of the gastrointestinal or digestive system (flatulence, flatulence, heartburn, peptic ulcers, colitis, gastritis, gastroesophageal reflux, etc.).
But there is not a sufficient number of reliable studies to document whether or not it is beneficial for the patient’s health.
Studies have shown that Chios Mastic provides relief from retrosternal heartburn in people suffering from gastroesophageal reflux disease.
Specifically, the consumption of mastic appeared to contribute to the reduction of heartburn, heartburn and indigestion after administration of mastic for 3 weeks to 75% of patients (dose 1 g. day) in a study carried out at the General Hospital of Chios
Also, Chios mastic has been studied for its action against Helicobacter pylori. The results showed that mastic at a concentration of 125 μg/ml killed the Helicobacter in 50%, while a concentration of 500 μg/ml eradicated the Helicobacter in 90% of of samples.
Ginger _ _
Ginger is often used to treat and relieve symptoms of indigestion such as heartburn, flatulence, bloating, stomach pain, nausea. It works by making the digestive process more efficient, increasing gastric motility and neutralizing toxins and acids in the digestive tract.
Small changes in diet and lifestyle are the main factors that contribute to the treatment of heartburn. Also, reducing weight in overweight or obese people as well as reducing anxiety and stress could improve quality of life and reduce symptoms. The contact with the attending physician for the appropriate treatment and with the dietitian for the improvement of the diet are the most important factors in dealing with the symptoms.