Lifestyle changes could help curb heartburn

Published by Contra Costa Times

Posted on Sun, November 30, 2003

By Dr. Steven C. Tremain

"GIVE ME THE PURPLE PILL." That's what I hear from patient after patient.

"The purple pill" is the advertised nickname for certain proton pump inhibitors, a class of medicines that includes Prilosec, Nexium, Protonix and Prevacid. They are used to treat gastroesophageal reflux disease, or GERD, which is also called heartburn. PPIs are effective medicine, but for some people they are more remedy than they really need or is good for them.

Medication is a popular way to treat heartburn, although only one of many ways. Severe cases may even require surgery. But most cases don't need either surgery or a medicine as powerful as PPIs. Often, heartburn can be treated with lifestyle changes such as weight loss or changes in eating and drinking habits.

I have a client, we'll call him Bob, who is one of the many who come in thinking the purple pill is the only cure for their heartburn. As with many of us, Bob's largest meal is dinner. Furthermore, with a busy work schedule and a long commute like many Contra Costans, Bob often can't eat dinner until 8 p.m. or later. A glass of wine often accompanies his dinner. He then settles into his recliner, channel-surfs and goes to bed about 10 to get up early for the morning commute. This lifestyle is an open invitation to heartburn, and thus his desire for the purple pill.

What Bob and many others don't realize about PPIs, though, is that by reducing stomach acid they produce a drastic change in body chemistry that can cause side effects. The ones we know about now are headaches and diarrhea, and rare cases of allergies, an inflamed pancreas or failure of blood production.

Bob can avoid those side effects by taking care to eat a meal with only a moderate amount of fat at least three hours before bed. Having that glass of wine may be fine, but not within a few hours of reclining.

Consuming products that contain alcohol, chocolate, caffeine and natural mint flavor can increase the risk of acid reflux for two to three hours. These substances work on the stomach muscles to allow food and stomach acid to creep back up into the esophagus (the muscular tube that connects the mouth to the stomach), which causes heartburn.

Stomach acid causes heartburn, but it is necessary for digestion, and possibly for breaking down cancer-causing chemicals in food. Rather than undergo the huge change in body chemistry that comes with the purple pill, Bob should first try smaller, less fatty dinners without alcohol, and raise the head of his bed six inches. Losing weight might help the most. If necessary, less powerful medicines such as Pepcid, Zantac or Tagamet 200 may help as well. He can always use a PPI such as Prilosec if this doesn't work. And for a persistent problem, Bob did the right thing by consulting his physician.