— DEAR MAYO CLINIC: Until recently, I’d never experienced heartburn, but now I seem to have it at least twice a week. I would like to avoid taking over-the-counter medications. Is it possible to prevent heartburn by avoiding certain foods?
ANSWER: Heartburn, or acid reflux, happens when stomach acid backs up into your esophagus. It is a common problem. About 40 percent of people in the United States have some symptoms of heartburn, which is usually described as a burning pain in the chest after eating.
Treatment of heartburn depends on two issues. First, how much the symptoms bother you and, second, whether these symptoms signal an underlying esophageal injury that’s happening because of the reflux. These can be two different issues, as the intensity of heartburn does not necessarily correspond to esophageal injury. In fact, people with severe esophageal injuries — such as esophagitis, where tissue in the esophagus becomes inflamed, or Barrett’s esophagus, a precancerous condition — often have mild symptoms or no symptoms at all.
Fortunately, heartburn usually does not lead to esophageal damage from reflux. Most people with heartburn just have to deal with symptoms. But it is important to identify who needs to have their reflux symptoms evaluated. In general, the people with reflux symptoms who are most at risk for injury to the esophagus are Caucasian men, older than 50, who’ve had heartburn longer than five years, with symptoms happening at least three times a week and symptoms that occur at night.
If you fit into this category, talk to your doctor about your heartburn. If you’re not in a high-risk group, lifestyle changes, with or without over-the-counter medications, can be a good first step in heartburn treatment.
There have been many recommendations over the years about decreasing heartburn by avoiding specific foods, particularly those that contain acid. Examples include acidic juices such as orange or grapefruit juice, caffeinated beverages, chocolate and mints. Many doctors also have recommended avoiding high-fat meals, as they may make reflux worse.