At the bottom of heartburn
Spicy or greasy foods, onions, chocolate -- all can take a painful, post-meal toll in the form of heartburn or acid indigestion. When these problems occur often, as they do for millions of Americans, they become known as gastroesophageal reflux disease, or GERD.
Whether the discomfort is occasional or chronic, choosing food and drink more carefully can ease the symptoms. So too, perhaps, can a supplement most commonly associated with sleep.
At the root of the problem is a bit of faulty plumbing. When the muscle at the bottom of the esophagus -- the lower esophageal sphincter -- relaxes too much, stomach contents can back up into the esophagus, irritating it and leading not just to heartburn, irritation and acid regurgitation, but also coughing, hoarseness and chest pain.
Fatty foods, chocolate, peppermint and onions cause heartburn directly, stimulating the release of certain gastric hormones that reduce pressure on the esophageal spinchter. Large meals also cause the muscle to relax by distending the stomach. Acidic foods, such as coffee, orange juice and tomato products, and spices don’t affect the sphincter directly but can irritate the esophagus further. Alcohol can add insult to injury by increasing stomach acid secretion.
Food isn’t the only contributing element. Obesity has long been considered a risk factor for GERD. One study, published in JAMA in 2003, found that the odds of experiencing reflux symptoms increase with weight gain, and that the relationship is stronger in women than men.
Among obese women, the researchers reported, premenopausal study subjects were more likely to have symptoms than those who had reached menopause -- and postmenopausal women taking estrogen replacement were more likely to experience GERD symptoms than those who were not.
The authors hypothesize that estrogen increases the synthesis of nitric oxide, a molecule that signals relaxation of the lower esophageal spinchter.
Most treatments include dietary changes along with medication. But one group of researchers may have found a new way to relieve symptoms.
Nitric oxide production and stomach acid production are both inhibited by melatonin, a hormone often sold in supplement form as a sleep aid. So researchers in Brazil studied the effects of a supplement cocktail containing melatonin in 351 subjects with moderate to severe heartburn or regurgitation.
Half of the subjects randomly received the supplement blend; the other half took omeprazole, a commonly prescribed acid-suppressing medication.
The results, published in the Journal of Pineal Research, indicated that after seven days, all the subjects in the supplement group reported marked improvement, compared with 66% of subjects after nine days on omeprazole.
The best treatment strategy should be discussed with your doctor, who will probably advise you to avoid offending foods and beverages, keep your meals small and stay upright for a few hours after eating. Weight loss is often recommended to prevent GERD symptoms, although it is unclear whether relief comes from weight loss itself, or because dieters tend to consume smaller, low-fat meals.
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Susan Bowerman is a registered dietitian and assistant director of the UCLA Center for Human Nutrition.
