Tips to Extinguish Heartburn Pain

Podcast Transcript

John Horton: Hey there, and thanks for joining us for another Health Essentials Podcast. I'm John Horton, your host. Today, we're going to talk about a pretty fiery topic, heartburn. Let's start with some basic facts. When it comes to heartburn, there's an inferno raging across the United States. An estimated 60 million Americans deal with a five-alarm fire in their chest at least once a month. For 15 million people, it's a daily flare up.

So, is there any way to make that stop? That's what we're going to find out from gastroenterologist Claire Beveridge, who answered our 911 call to douse those internal flames. Dr. Beveridge is one of the many experts at Cleveland Clinic who pop into our weekly podcast to offer tips to help you live a bit healthier. Now, let's see if we can turn down the heat on your heartburn. Dr. Beveridge, thank you so much for joining us today. It's great having you on the show.

Dr. Claire Beveridge: Thank you so much for having me. I really appreciate it.

John Horton: Yeah, yeah. So, as we heard at the start, with the numbers that we see as far as people who have heartburn, I'd imagine this is a pretty common thing that you hear in the office.

Dr. Claire Beveridge: I do, I do. We see reflux in up to 30 percent of patients. And in my clinic, since I'm mostly seeing swallowing issues and reflux issues, more than half of my patients definitely come to me with heartburn complaints.

John Horton: Wow. Well, that's a lot. So, given how popular this question is, let's dive right in. And the two big issues, I mean, one, what causes heartburn and is it avoidable?

Dr. Claire Beveridge: So, what causes heartburn is the valve between your food pipe and the stomach gets weak, and so then food and liquid can come back up and that's what causes that acid feeling, and the heartburn, and the regurgitation feeling that can happen. In terms of what causes that weakness in the valve, sometimes, we don't fully know why, but some things that we see is with older age, with more weight, other conditions like being pregnant, those can all be associated conditions.

John Horton: Yeah. So, how does that happen, I mean that valve just kind of, like any other valve, it just gets weak over time?

Dr. Claire Beveridge: Yeah, muscles can get weak over time and then it just won't keep a nice barrier there for the food and liquid to stay in the stomach.

John Horton: Well, it's hard to believe that there's something that keeps it down. I guess you don't think of your body working that way. Is there just a natural process where it does kind of keep everything in that lower part where you want it to be?

Dr. Claire Beveridge: Yeah. So, the esophagus is really just a food pipe, right? So it does have some contraction to it and muscles to it. But for the most part, it just works by gravity to allow food and liquid to come down. But at the end of the food pipe, you do have the valve right there, which the tone there and the pressure there can be supported by a few other things, like your diaphragm and your stomach, to kind of help keep that tone there so it prevents things from coming back up.

John Horton: OK. You had mentioned age, and that's something, I know when I was younger, I had no problems, I could eat anything and never felt any heartburn. And now, seems like the older I get, the more you have that like “oof” every once in a while. What's the reason for that?

Dr. Claire Beveridge: Yeah, it's probably a couple different reasons. But just as with everything, as we get older, some of the muscles just get weaker so that valve is going to get weaker. And then, it's not uncommon to gain some weight as we get older also. So when you have this pressure on the outside that's pushing on your stomach, sometimes that'll lead to the food not just going down into your intestines but actually coming back up into the food pipe.

John Horton: OK. Are there other things, I heard medications, can that be an issue with it?

Dr. Claire Beveridge: Some medications can relax the sphincter there. Other things that can contribute would be if you have slow emptying of the stomach, something called gastroparesis, that if the stomach just isn't able to empty as quickly as it used to, then things are hung up in the stomach and then it's going to go the path of least resistance which sometimes means coming back up.

John Horton: Uh, and nobody wants that. So, how can we avoid it? I mean, are there some tips that you can offer to kind of help keep heartburn at bay for people?

Dr. Claire Beveridge: Yeah. I think the biggest thing is lifestyle changes, so weight can contribute. And then for some patients, they also realize that certain foods or things that they drink may trigger that heartburn feeling. And if that's something that they can avoid in their life and makes their symptoms go away, then to try to avoid those. So, some things that can do it would be caffeine, mint, carbonated beverages, alcoholic beverages, spicy foods, things with citrus or acid, so red sauces are a classic thing that I hear about. And then, also, just as we were talking about how the food pipe works by gravity, so being careful with when you lay down after eating or drinking. So we say to try to hold off on that for about two to three hours after eating or drinking before you recline, or to even try to keep your head a little bit elevated to kind of allow at least some gravity to help with things staying in the stomach.

John Horton: Yeah. So, scrap that post-meal nap for a little bit.

Dr. Claire Beveridge: Yes, or sit upright in your post-meal nap in your recliner.

John Horton: That's doable, too. My grandfather used to be able to fall asleep in a chair perfectly upright.

Dr. Claire Beveridge: Yeah, exactly.

John Horton: I don't know how he did it, but he had mastered that move. As far as with those foods and whatever, is there an age where it starts to hit you a little bit more, or it can be different for anybody?

Dr. Claire Beveridge: It can be different for anybody. So, it's really just listening to your body and seeing about that. And I rarely recommend a full elimination of the reflux diet just because quality of life isn't very good with that. And we know that eliminating all the things that could possibly cause your heartburn is not necessarily effective, but instead, to keep an eye on what is your specific food trigger. So maybe red sauce is fine for you but spicy food is not good or fatty foods are not good, so just keeping an eye on what you eat and when you feel the symptoms.

John Horton: And I take it you know when it happens, it's a pretty immediate response.

Dr. Claire Beveridge: It's a pretty immediate effect, yes.

John Horton: OK. So if Taco Tuesday's bugging you, you're going to know right away.

Dr. Claire Beveridge: Exactly.

John Horton: All right. Since everybody's looking for a quick fix, what sort of medications are there out there that you can take to kind of tamp those flames down a bit?

Dr. Claire Beveridge: Yeah. I definitely have some patients who, they know their food triggers but it's not something that they're going to be able to avoid in their diet just because of family reasons or they just really like the food. So yeah, sometimes medications have a really nice role in terms of controlling heartburn. And it depends on how frequently your symptoms are happening. So if it's an occasional, then using over the counter antacids or using things like famotidine or ranitidine can be really helpful, either as needed or preemptively, 10 to 20 minutes before you've had your trigger food. If it's something that's happening more frequently for you and is on a weekly or maybe daily basis, then taking a daily medication like the proton pump inhibitors, so omeprazole, pantoprazole, those kinds of medications.

John Horton: OK. Is there a risk of overdoing it? I know you hear about people taking Prilosec and Pepcid and things like that. I mean, can you overdo it, too?

Dr. Claire Beveridge: You can't overdo it. I mean, the way that I always think about it is don't take a medication if you don't need it. Right? So I really like to focus for patients on only taking medications if it's really causing symptoms and it's something that you need. There are a lot of concerns when it comes to proton pump inhibitors specifically. You go on Google and you research it, and all of a sudden you hear, "Oh gosh, dementia, kidney problems, all of these issues that can happen with proton pump inhibitors."

There's a really big difference between something being associated and something causing it. So just as we were talking about, as we get older, it's really common to get reflux. But also as we get older, it's really common to get kidney problems and dementia and other issues. Bone loss is another major concern that I hear about. There was a really nice study that was done in 2019 to see, do these medications actually cause these problems? And they followed patients over three years and didn't see that those medications cause any of those issues except for maybe a slight increased risk of getting GI bugs or enteric infections.

John Horton: OK, all right. For those who don't know, what is a proton pump inhibitor?

Dr. Claire Beveridge: The proton pump inhibitors are those medications that you're referring to, the Prilosec, the omeprazole, the pantoprazole, those kinds of medications that you can get over the counter but can also be prescribed for you by your doctor. And it's the stronger medication than the ranitidine, famotidine, and it's something that you would take every day, not as needed.

John Horton: OK, wow. OK, so that's it. Are those over the counter or are those just prescription?

Dr. Claire Beveridge: They are over the counter; they can also be prescribed prescription. And what I tell patients is that it takes two weeks to feel any benefit from that medication and eight weeks to feel maximum benefit. So, not to give up too quickly. And it's also really important how you take the medication. We say to take it on an empty stomach, but eat something 30 to 60 minutes later. So, I say generally 30 minutes before breakfast, 30 minutes before dinner if you're taking it twice a day.

John Horton: OK. All right. When should somebody reach out to their doctor? Because it sounds like a lot of people struggle with this and probably just do it at home. Is there a point where you really need to talk to somebody and try to find a better solution?

Dr. Claire Beveridge: Yeah, really good question. In general, you should always feel comfortable talking with your doctor about any symptom that you're having, even if you feel like it's a nothing symptom. But the times that I would definitely recommend to talk with your doctor about it is when you feel that it's particularly severe or it's happening frequently, that you're really needing to pop those antacids, those over the counter medications, it's happening weekly, daily, it's disrupting your sleep. Other times that it's really important to talk with your doctor would be if this is the first time you're noticing these symptoms over the age of 60, if you're having difficulty with swallowing, meaning something is getting stuck or slowly moving down, if you're having any signs of bleeding like red or black in the stool … those would be some times to definitely talk with your doctor.

John Horton: Can heartburn be a sign of something a little more severe, like a symptom, a little warning signal?

Dr. Claire Beveridge: It can. It can be a sign of other conditions. So, heartburn doesn't have to be caused by reflux. It could be caused by, just as we were saying, your stomach emptying slowly maybe, that gastroparesis, an allergic condition of the esophagus called eosinophilic esophagitis. It could even, while rarely, but it can be associated with cancer.

John Horton: OK. But this is where you want to put people's minds at ease. I think the majority of cases it's just, you probably overdid it a bit on the spicy sauce on your tacos or pasta or whatever you're eating.

Dr. Claire Beveridge: Majority of times it's related to food, having reflux, and even some of those other conditions I was talking about, the slow emptying, the allergic condition. Those are benign conditions but require different types of treatments than the over the counter antacids.

John Horton: So, get an understanding of it, pay attention to it, and then live on.

Dr. Claire Beveridge: Yes, yes. Generally, what we say is if someone has the classic symptoms of reflux without those kind of warning signs that I was talking about, the weight loss, the difficulty with swallowing, we often just try the medications first. And if the medications work, wonderful, we've done our job, we continue to follow you. If it doesn't work, then that's a time that we need to investigate a little further to see, is it another disease that may be causing your symptoms and how can we help you with that?

John Horton: That's great advice, Dr. Beveridge. We've covered so much ground here. Is there anything that we missed or anything you want to add?

Dr. Claire Beveridge: I would just say don't be shy talking with your doctor about heartburn. And then, the main things that I see can really help in terms of these symptoms would be those lifestyle changes. So weight loss takes a while, right? But other things that you can do that can have some more immediate effect would be avoiding your food triggers, would be keeping your head of bed elevated at night, avoiding lying down those two to three hours after eating or drinking, and then the timing of medications. I'll have patients who come to me saying that their proton pump inhibitor, that pantoprazole, that Prilosec isn't working for them. And then we talk about the timing, to take it on an empty stomach and eat something 30 to 60 minutes later. And then they come back to me and they tell me that they're fixed and they feel better. So, timing is really, really important.

John Horton: Dr. Beveridge, thank you so much for joining us today and making some time in your schedule, and look forward to talking with you again.

Dr. Claire Beveridge: Thank you so much for having me.

John Horton: All right. Bye-bye. Heartburn definitely qualifies as one of the hottest issues we've covered here on the podcast. If you're dealing with the condition, hopefully the advice from Dr. Beveridge can help cool things down a bit. Till next time, be well.

Speaker 3: Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.