Counseling Sheet

Agatha M. Thrash, M.D.
Preventive Medicine

One of the commonest times for heartburn to occur is after the person has been lying down for some time.

One of the important things a person with heartburn can do is to lie on the left side. Lying on the right side makes heartburn worse. When lying on the right side, the esophagus is below the stomach.

• Avoid eating while driving, working, or playing.
• Eat slowly, take small bites, and chew thoroughly.
• Avoid foods that provoke distress, such as red wine, coffee, fried foods, spicy foods, and chocolate.
• Stop smoking.
• Eat at least 3-4 hours before going to bed.
• Elevate the head of the bed 6 inches.
• Watch your weight. Being overweight increases intra-abdominal pressure.
• Don't overeat.
• Don't use fatty foods.
• Don't eat just before lying down.
• Put wooden blocks under the head of your bed to elevate it at least 6 inches.
• Avoid tight-fitting clothes.
• Avoid constipation and any other condition that increases abdominal pressure.
• Check all your medications, as many are capable of causing heartburn.
• Cut out alcohol and caffeinated drinks (coffee, tea, colas, and chocolate) as they cause heartburn.
• Don't smoke.

Probably everyone has suffered from heartburn at one time or another. It comes about from reflux of acid stomach contents into the lower end of the esophagus, which is ill-equipped to handle such an insult. The result is a burning pain, usually starting beneath the lower end of the breastbone, and often causing a spasm of the esophagus. The pain can progress up to the nape of the neck. At times, it may resemble angina pain. However, it differs in that it is not provoked by exercise, often lasts for a long time, does not radiate to the jaws or arms, and is not associated with sweating and weakness. Yet some cases are so difficult to differentiate that special diagnostic procedures may be required.

The cause of heartburn is an irritation of the stomach and esophagus due to alcohol, eating too much, foods that don't agree, eating between meals, lying down after meals, bending over especially to lift something heavy, taking pills or tablets without water, and eating foods that cause the upper portion of the stomach to dilate so that stomach contents can run back into the esophagus.‍

High-salicylate foods to limit or avoid if you struggle with heartburn:

• Almonds
• Apples
• Apricots
• Aspirin
• Blackberries
• Boysenberries
• Cherries
• Cider
• Cider vinegar
• Cloves
• Cucumbers
• Currants
• Dewberries
• Gooseberries
• Grapefruit
• Grapes
• Lemons
• Melons
• Mint
• Nectarines
• Oranges
• Peaches
• Peppers
• Pickles
• Plums
• Potatoes
• Prunes
• Raisins
• Raspberries
• Root beer
• Strawberries
• Tomatoes
• Wintergreen oil
• Yellow #5
• Tatrazine

A diaphragmatic (hiatus) hernia is a common cause. Many drugs cause paralysis of the sphincter muscle that prevents backflow of stomach contents. One inhaled puff of cigarette smoke will paralyze the sphincter for 20 minutes or more, so all smokers have heartburn.

‍Treatment‍

See Counseling Sheet on Hiatus Hernia. Avoid heavy use of antacids and the potent stomach acid blocking medications. They have many potential complications. Strictly avoid all of the aggravating factors.