Plop plop fizz fizz
A more palatable route to heartburn relief
By LOU BERGERON
People suffering from heartburn have been known to hug Lauren Gerson, MD, so overjoyed are they at hearing her words.
What does she say to them? Go ahead and eat chocolate. Indulge your passion for spicy cuisine. Drink red wine. Enjoy coffee when you want it, have that orange juice with breakfast and, what the heck, eat a grapefruit, too.
Many of Gerson’s patients walk into her clinic upset, having been advised elsewhere to severely limit their diets to help reduce their heartburn symptoms. But recent research by Gerson, assistant professor of medicine, indicates there’s no evidence to support dietary deprivation, except for the unlucky few whose heartburn is clearly triggered by a particular food.
Gerson’s advice runs counter to the long-standing recommendations of virtually every professional organization of gastroenterologists as well as the National Institutes of Health. For the past 15 to 20 years, the standard treatment for heartburn has been to cut out the aforementioned culinary joys — along with fried and fatty foods, all alcoholic and carbonated beverages, tobacco and mint — and to stop eating three hours before lying down. In addition, you’re advised to keep your weight under control. Those lifestyle changes coupled with antacids and various other medications have been the accepted first line of treatment.
But Gerson, a gastroenterologist and director of Stanford’s Esophageal and Small Bowel Disorder Center, says the stream of “very unhappy” patients referred to her clinic by outside doctors caused her to doubt the efficacy of the usual treatment advice. “The patients were on very bland diets and cutting out coffee and wine and everything that they enjoy — and basically their heartburn wasn’t getting any better,” she says. “So I decided that maybe it’s time to see if these lifestyle measures really work.”
In the May 8 issue of Archives of Internal Medicine, Gerson and two other physicians at the School of Medicine — Tonya Kaltenbach, MD, and Seth Crockett, MD — published the results of a systematic survey they conducted of more than 2,000 studies published worldwide on heartburn, also known as acid reflux or GERD (gastroesophageal reflux disease), between 1975 and 2004. They found 100 studies looking at lifestyle factors thought to be associated with heartburn. Only 16 of those studies examined how implementing lifestyle changes affect heartburn symptoms, and these studies were the focus of their article.
Their conclusion: There is currently no evidence to show that any of the dietary restrictions usually recommended make a difference. They found only two lifestyle changes for which there was clear evidence of a benefit. First, if you’re overweight, losing some pounds will reduce or even eliminate the heartburn. Second, raising the head of your bed will cut down on the amount of stomach acid that can enter your esophagus while you sleep.
Gerson says that for the most part, medication alone is adequate to treat the symptoms of heartburn. “Since I don’t have a lot of evidence that changing their diet dramatically is going to take the heartburn away, it makes more sense just to take the medicine,” she says.
That said, Gerson allows that for some patients, a minor change in diet can make sense. “If a patient comes in and states, ‘Red wine really gives me terrible heartburn,’ then it may be reasonable to say, ‘Well, you could avoid it, or you could take a medication before you drink some red wine,’“ she says.
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