Lifestyle Adjustments

What can I do to treat or relieve my heartburn?

The first step toward prevention is identifying foods and behaviors that may trigger symptoms for you. Since these contributing factors vary widely from person to person, determining which ones contribute most to your heartburn is essential. See What Causes Heartburn for a list of most common triggers.

In addition, you may want to consult the NHBA Stop & Select Guide. The guide assigns a color code to foods and beverages based on the food's tendency to create acid, irritate the gastric lining and/or relax the lower esophageal sphincter. Using the guide as a reference, heartburn sufferers can assess the likelihood of a heartburn episode based on the color code of the foods and beverages consumed. Call 877-471-2081 to request a copy of the "Stop & Select Guide," download a printable version.

Avoiding lifestyle triggers can help, but if lifestyle adjustments are not enough, the next line of defense is medications. Many heartburn sufferers can find some relief from the wide variety of medicines that are available over the counter (OTC). There are additional medicines available by prescription. View our Heartburn Medications chart for information on medication options. Talk to your health care professional about the medication or treatment you currently take when heartburn occurs, whether your medication provides relief, and if so, for how long.

People who do not get complete relief through lifestyle changes and/or medication, or who require continuous use of medications, may need a more complete diagnostic evaluation.

Besides medications, what might help relieve symptoms?

Avoid common trigger foods and beverages. Foods that are fatty or greasy slow down digestion, which means that acid and food are in the stomach longer. This gives the acid a greater opportunity to move backwards into the esophagus. In addition, some foods, such as peppermint, spearmint and chocolate cause the LES to loosen or relax, thus allowing acid to enter the esophagus. Beverages containing caffeine such as coffee, tea and cola raise the level of acidity in the stomach, making stomach juices even more irritating. Alcoholic beverages, citrus juices, spicy foods and tomato products directly irritate the esophagus.
Decrease the size of portions at mealtimes — your stomach won't need to produce as much acid as with a big meal, and less acid mean less chance of acid reflux.
Eat meals at least 2-3 hours before lying down — the added time will give your acid levels a chance to decrease before putting your body in a position where heartburn is more likely to occur.
Check with your doctor to see if one of the medications you are taking might be triggering your heartburn. Some prescription and over-the-counter medications can contribute to heartburn. These commonly include high blood pressure and heart medications. Asthma medications can both lower LES pressure and stimulate acid production contributing to heartburn. Some antibiotics can be irritating to the esophagus. Talk to your doctor about alternatives if you suspect one of your medications may be contributing to your heartburn, but never stop taking any prescription medication without checking with your doctor.
Avoid exercises that require you to be upright and "bounce" against gravity, such as jogging, aerobics or rope jumping. Bouncing jostles the contents of your stomach and can cause acid to wash back up into the esophagus. Tensed or clenched stomach muscles during weight-bearing exercises can increase abdominal pressure and increase reflux of acid into the esophagus.
Try not to eat one to two hours before, during or just after exercise.
If you are overweight or obese, try to lose weight through a safe and realistic weight loss plan — Extra pounds can increase heartburn incidence. Some heartburn sufferers find their symptoms improve by losing weight. Studies have shown that even moderate weight loss can reduce symptoms a great deal.
Stop or cut down on smoking — Cigarette smoking inhibits saliva, one of the body's natural protective barriers against damage to the esophagus. Smoking also may stimulate acid production and relaxes the important valve that prevents stomach acid from entering the esophagus.
Elevate the head of your bed four to six inches using blocks — this method uses gravity to help prevent acid from creeping up the esophagus while you are lying down.
Try sleeping on your left side — some studies indicate this helps with digestion and the removal of acid from your stomach more quickly.
Don't wear tight belts or binding clothing — tight garments can increase abdominal pressure.
Try to relax. Stress does not cause reflux, but it can contribute by causing heartburn sufferers to engage in other trigger behaviors (ie. turning to high-fat comfort foods, smoking cigarettes, drinking caffeine or eating late at night). In addition, stress may increase a person's sensitivity to the pain caused by a heartburn episode.
Avoid gulping down food in a hurry. Slow down and eat less. Gulping down food in a hurry can result in eating more before you feel satisfied. Over-filling the stomach can result in reflux and heartburn.
Suck on hard candy, but not peppermint, which can aggravate heartburn. Sucking on hard candy encourages production of saliva, which acts as a natural barrier to acid. Just be sure to avoid mint candies, which can relax the LES, the muscle between the esophagus and the stomach that helps prevent the backflow of acid.

Do I have to give up everything I love to control my heartburn?

With good advice from your health care professional, you should be able to develop a healthy eating plan to help control your heartburn. A healthy plan will let you keep eating the foods you love and keep doing your usual activities. Given the many recent advancements in our understanding and treatment of heartburn, even the most severe heartburn sufferers generally find that they can control their heartburn through heartburn medications and some simple lifestyle changes.

Sufferers of mild heartburn are often relieved to learn that they can control their heartburn without medication by making just a few of these lifestyle changes. Several of these modifications — such as stopping or cutting down on smoking or avoiding caffeine and fatty foods — have the added bonus of enhancing general physical well-being. So, while you may decide to cut back on some things you enjoy to control your heartburn, you'll also be taking steps on the road to better health.

Impact of Stress

How does stress contribute to heartburn?

Gastrointestinal symptoms have long been associated with stress, fear and anxiety. The perception of heartburn can increase during stress. Numerous clinical studies confirm the correlation between stress and heartburn. A recent heartburn survey reported that stress was associated with more than 50 percent of heartburn episodes.

Stress can contribute to reflux by causing heartburn sufferers to engage in behaviors that trigger acid production (ie. turning to high-fat comfort foods, smoking, drinking caffeine or eating late at night). Stressful life events (anxiety, tension, and stress) can increase sensitivity to refluxed acid, reducing the threshold to pain and increasing the frequency and/or severity of heartburn symptoms. In addition, stress may increase a person's sensitivity to the pain caused by a heartburn episode.

Impact of Exercise

Will exercise increase the incidence and severity of heartburn? How?

Very little research has been conducted to determine this link to date. However, a recent study found that 43 percent of elite athletes experienced an increase in heartburn symptoms after exercising (Oklahoma Foundation for Digestive Research).

Researchers believe that certain exercises increase abdominal pressure and push stomach contents into the esophagus, thus contributing to heartburn symptoms. For example, weight lifters seem to get heartburn from tensing stomach muscles and cyclists tend to get heartburn from hunching over handlebars. However, more research is necessary to establish a definite link between heartburn and exercise.

I suffer from heartburn but am intent on maintaining my exercise regimen. What additional tips can you offer to combat exercise-induced heartburn?

Pass up protein and fat pre-work-out—Food that's consumed less than two hours before exercising has a huge impact on the occurrence of heartburn. Pre-workout meals should be high in carbohydrates and low in fat and protein. Reserve the protein-rich meal for after the workout.
Limit foods that fan the flames —Certain foods and beverages are more apt to cause heartburn than others. Moderate your intake of citrus fruits and juices, chocolate, onions, peppermint, spearmint, fatty or spicy foods and caffeinated or carbonated beverages.
Time your meals —Exercising on a full stomach is not advisable, largely because it increases intra-abdominal pressure, which contributes to heartburn. Wait at least two hours after a meal before exercising.
Control quantity —Decrease the size of portions eaten prior to or during exercise. Reflux is more likely to occur when there is a lot of food in the stomach.
Opt for diluted sports drinks —The high concentration of carbohydrates found in most sports drinks may contribute to heartburn. Most sports drinks provide between 60 to 100 g. of carbohydrates per liter. Try diluting this in quarter intervals to see if a ¾ strength or a ½ strength solution decreases your heartburn. Watered-down solutions will also leave the stomach faster, providing more rapid hydration benefits.
Drink plenty of water before and during exercise —Water aids digestion and also prevents dehydration.

Finally, a session or two with a sports nutritionist may be helpful to fine-tune both the dietary and exercise aspects of your heartburn. To find a qualified registered dietitian in your area go to the American Dietetic Association website at www.eatright.org

What types of exercise are recommended for people with heartburn?

If you find that you experience heartburn when you exercise, talk to your trainer about alternatives to activities that increase abdominal pressure. Exercises that may increase pressure include sit-ups, jogging, weight lifting and cycling.

When is the best time to exercise so that my heartburn will be less likely to occur?

In general it's best to avoid exercising on a full stomach. In addition, if you must eat shortly before or after exercising, try small meals and foods that are less likely to cause heartburn.

Will heartburn medications induce side effects that will influence my ability to exercise?

Heartburn medications are generally safe and, if anything, would reduce exercise-related heartburn and could actually make exercise more enjoyable.