The best remedies for heartburn

Relief for heartburn symptoms

A night of rich food, wine, coffee and dessert may sound great-but not if it results in heartburn. The condition, which more than 60 percent of Canadians will experience at some point in their lives, occurs when gastric acid in the stomach backs up into the esophagus. “[The result] is a burning pain behind the breastbone that can rise to the back of the throat, along with sour-tasting acid in the mouth,” says Dr. Richard Fedorak, a professor in the department of gastroenterology at the University of Alberta. “More rarely, the esophagus can spasm and cause a choking sensation that is sometimes misinterpreted as a heart attack. If you are concerned, go to the hospital immediately.”

Under normal circumstances, a valve between the stomach and the esophagus called the lower esophageal sphincter (LES) prevents acid from entering the esophagus when the stomach is using it to digest food and beverages. But when the valve becomes weakened, the acid can come up the LES and into the esophagus, causing irritation and discomfort. Symptoms are usually the worst in the evening (when the concentration of acid in the stomach is at its peak), and lying down or bending over from the waist after a meal can exacerbate them (since that allows the acid to pool in the esophagus instead of staying in the stomach). Because we produce less saliva-which neutralizes acid-during sleep, heartburn can also interfere with a good night’s rest.

This problem affects roughly the same number of women as men. People who smoke, are obese or have a family history of heartburn are the most likely to suffer from it, says Fedorak. Pregnant women often experience the condition in their third trimester (when the uterus puts pressure on the stomach ), and certain medications, such as beta-blockers, sedatives and tricyclic antidepressants, are also triggers.

What you consume matters, too, since certain food and drinks weaken the LES. If you experience heartburn, avoid chocolate, peppermint, alcohol, caffeine, soft drinks, citrus fruit and juices, tomatoes and tomato sauces, and fried, spicy and fatty foods. You can also prevent heartburn by eating smaller meals and not eating within three to four hours before bedtime; also, avoid bending over, lying down or exercising just after eating. Quitting smoking and losing weight (even 10 to 15 pounds, if you are overweight) may improve, if not completely eradicate, symptoms, adds Fedorak.

Although occasional heartburn is common, if it occurs regularly, the lining of the esophagus can be damaged over time. Complications include erosive esophagitis (an uncomfortable, chronic inflammation of the esophagus); painful or bleeding esophageal ulcerations; asthma; and Barrett’s esophagus (an advanced stage of erosive esophagitis that is a precursor to esophageal cancer). “If you are getting heartburn more than three times a week or waking up in the night with coughing, wheezing, choking or asthma (which can be symptoms of inflammation), you should see a doctor,” advises Fedorak.

If symptoms are infrequent, consider one of these over-the-counter remedies.

To neutralize acid

Examples: Pepto-Bismol Original Liquid; Alka-Seltzer Heartburn Relief; Diovol Liquid; Tums Regular Strength

How they work: Ant­acids are available in liquid and tablet formats, and most work by neutralizing gastric acid in the stomach, says Kristin Ferguson, managing pharmacist with Loblaw Companies Ltd. in Port Hope, Ont. Although all perform a similar function – reducing acidity – they contain different active ingredients. Alka-Seltzer tablets (which must be dissolved in water and drunk) contain sodium citrate; Diovol (available in both tablet and liquid formats) contains magnesium and simethicone; and Tums chewable tablets contain calcium carbonate. Pepto-Bismol, which contains bismuth subsalicylate, is sold in tablet and liquid forms, and coats the lining of the stomach and esophagus to reduce acid irritation. 

Need to know: “These medications aren’t preventive,” says Ferguson. “Take them up to four times a day at mealtimes and bedtime.” Expect relief of symptoms for up to two hours. The biggest side effects from all types of antacids are diarrhea and constipation (which one you may experience just depends on the individual, says Ferguson). Gas is also common, although it is more often associated with the tablets. To avoid interactions with other medications you might be taking, take antacids at least two hours apart from other medications. If you are pregnant or have kidney disease, check with your doctor before taking antacids.

To stop acid from entering the esophagus

Examples: Gaviscon Soothing Liquid; Gaviscon Tablets; Liquid Maalox Nighttime Antacid + Acid Reflux Barrier

How they work: These medications form a foam barrier on top of the contents of the stomach that physically protects the esophagus from irritating gastric acid. Called alginates, they provide one to two hours of relief, since their active ingredient, alginic acid, is not significantly absorbed by the body.

Need to know: Because the protective barrier of alginic acid isn’t preventive, these medications need to be taken with meals, up to four times a day as needed. If you take them in tablet form, they must be chewed thoroughly and swallowed with a glass of water. “Although the side effects may include nausea, gassiness and vomiting, they’re considered quite safe since they aren’t going into the bloodstream,” says Ferguson. If you take other medications, separate those dosages from alginic acid remedies by at least two hours to avoid interactions. Although the lack of absorption makes them a safer choice for pregnant women and people with kidney disease than other types of heartburn medications, always check with your family doctor before taking them.

To reduce acid production

Examples: Zantac 75; Pepcid AC Acid Controller

How they work: Known as H2 (histamine) blockers, these medications work by binding to the histamine receptors that are in the acid-producing cells of the stomach, says Ferguson. “They reduce acid production by going right to the source.” Available in non-chewable tablet form, they prevent rather than treat the symptoms of heartburn, since the active ingredients-ranitidine in Zantac and famotidine in Pepcid AC-require 30 to 60 minutes before they take effect.

Need to know: Take 75 to 150 mg of Zantac, or 10 to 20 mg of Pepcid, up to twice a day (30 to 60 minutes before meals) if needed. You’ll experience relief of heartburn symptoms for eight to 12 hours. Side effects may include constipation and diarrhea. Although both medications are considered safe, there have been some reports of dizziness and abdominal pain with Zantac. “It’s also safe to combine an antacid with an H2 blocker so that you get immediate and longer-term relief,” adds Ferguson. (Or take Pepcid Complete, a two-in-one antacid and acid blocker.) You can take H2 blockers for up to 10 days, but speak with your doctor if you need to continue taking them after 10 days-long-term use is associated with vitamin B12 deficiencies and poor calcium absorption. As with the other remedies, separate dosages from other medications by at least two hours, and get medical advice before using these treatments if you are pregnant or if you have kidney disease.

Home remedies for heartburn

For mild heartburn, try easing the uncomfortable ache with one of these simple home remedies.

Baking soda: The sodium in baking soda is a natural antacid. Dissolve 1/2 teaspoon in a 1/2 glass of water and drink this every two hours (but don’t drink it more than three to four times per day). Although safe in most people, those who have kidney problems or hypertension should consult their doctor before trying this.

Chewing gum: You can increase saliva production (which naturally combats acid in the esophagus) by chewing sugar-free gum after a meal.

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