Holidays Can Be an Acid Test

By Jennifer Huget
Tuesday, November 4, 2008; HE06

The highly charged election season that (we hope) will finally be over when the polls close tonight has left a bad taste in many mouths.

Or maybe that bitterness is just stomach acid gurgling back up into your throat.

Chances are, you've experienced heartburn occasionally, maybe in bed after eating a large meal. Sometimes it feels like the onset of a heart attack or a burning sensation behind the breastbone. Or maybe a thickness at the back of your throat that makes swallowing uncomfortable. You might have popped some Tums and not given it another thought.

But for millions of us, the passage of caustic stomach acid up into the esophagus is a chronic pain in the throat. Acid reflux, which causes both occasional heartburn and ongoing gastroesophageal reflux disease (GERD), has become a major health concern as Americans grow fatter. Untreated, severe cases may lead to narrowing or ulceration of the esophagus or, very rarely, esophageal cancer.

Elaine Magee wants to help. A registered dietitian with a master's of public health in nutrition, she has just released a revised edition of "Tell Me What to Eat If I Have Acid Reflux" (New Page Books, $12.99).

Magee, who is married to a reflux sufferer, says more than 60 million Americans experience heartburn at least once a month. (And it's not just Americans who want her advice: The original edition of her book, released in 2001, has been reprinted in 10 languages, including Chinese and Polish.)

She offers a comprehensive overview of the medications available, from simple antacids such as Rolaids to H2 blockers (such as Pepcid and Zantac) and proton-pump inhibitors (such as Prilosec and Protonix). But her focus is really on food: what we should and shouldn't put in our mouths to keep heartburn at bay.

Her key recommendation? Eat less.

While thin people certainly suffer from acid reflux, overweight people are at far greater risk. Filling the stomach too full encourages acid to travel upward.

Reflux occurs when the sphincter muscle at the bottom of the esophagus doesn't close properly, allowing stomach contents to rise. But eating smaller meals, Magee notes, can curb the problem in the short term and lead to weight loss, which may relieve the symptoms altogether.

Magee also counsels those with acid reflux to quit smoking and to eat plenty of fiber to keep food moving through the digestive system. She recommends keeping a food journal (she provides one in the book) to record heartburn episodes. That can clarify which foods trigger discomfort and pinpoint times of day when you're most likely to be struck. That can help you learn to avoid those foods -- for many, they include tomato sauce, chocolate, coffee, peppermint and fatty or fried items -- and make lifestyle changes such as raising the head of your bed, which puts gravity to work against your rising stomach acid at night.

As for alcohol, its role is mixed. "A little is good," Magee says. "A lot is not better." She explains that while "a low dose can speed stomach emptying, drink too much and it's almost as if your stomach is confused and drunk," and your belly ends up emptying more slowly, setting the stage for reflux.

Recognizing that her book comes out just as we enter high heartburn season, starting with that belly-busting Thanksgiving meal and culminating in New Year's overindulgences, Magee includes a section of recipes (for cranberry walnut dressing, for instance) and strategies for having a heartburn-free holiday (offer to bring a fat-free dip to the office party, for example).

The author of the syndicated "Recipe Doctor" column, Magee also offers more than two dozen recipes (including five "desserts that have nothing to do with chocolate and peppermint") in which she suggests substitutes for heartburn-spurring ingredients. The book ends with strategies for eating in restaurants including fast-food outlets. (Tip: Order grilled rather than fried chicken sandwiches.)

Patricia Raymond, a gastroenterologist practicing in Chesapeake, Va., agrees with Magee that losing weight and quitting smoking can help combat cancer and other diseases, "let alone your reflux." But, she cautions, "managing reflux through lifestyle alone works only for about 30 percent" of sufferers. And since medications have proven so successful, she encourages folks to use them. Finally, she suggests that maybe we should just resign ourselves to the occasional episode.

"If one of your joys in life is to go out for pizza with the boys on Friday night," she says, then you should go ahead and indulge once in a while -- even though you know you'll pay the price later.

And, for just such situations, Magee has some advice:

"Always keep some gum close at hand," she suggests. Chewing fruity or bubblegum flavors "stimulates production of saliva, which both dilutes stomach acid and keeps things flowing in the right direction."


Check out today's Checkup blog, in which Jennifer reports on home remedies for heartburn. Sign up for the Lean & Fit newsletter by going to; search for "newsletters." And e-mail your thoughts to Jennifer at

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