Many foods can be the cause of heartburn, even peppermint

Here's a heaping helping of yuletide irony: Among the foods most often blamed for causing heartburn is peppermint.

That's right: If your Christmas traditions include downing a shot or two of Maalox to quell the fire in your belly, that innocent little candy cane just might be the culprit.

Holiday heartburn can be caused by all sorts of other things, of course. Spicy foods. Fatty foods. Any food, if eaten to excess. Stress. Enjoying too many alcoholic beverages.

Suffering a bout of heartburn doesn't have to become a holiday tradition. Think of it this way: By the time the big ball drops on New Year's, we'll already have spent almost six weeks abusing, overtaxing and otherwise testing the limits of our digestive system.

Given that, Dr. Frank Nemec figures it's not inappropriate to think of the Christmas holidays as heartburn season.

"Patients are eating more fatty foods and heavier meals," the Las Vegas gastroenterologist says. "Usually, they have some seasonal weight gain in the winter months -- most people tend to lean out more in the summer (as they) become more active.

"Plus, there's all the temptations of the season -- there are candies and that sort of thing -- and the types of foods we eat this season, like peppermint, can aggravate (stomach acid) reflux."

Heartburn is an umbrella term that describes "a sensation of a burning feeling below the sternum," Nemec notes, that's "usually worse after heavy meals or when you lie down."

In many cases, heartburn is a symptom of a condition called gastroesophageal reflux disease, commonly known as GERD.

GERD -- or acid reflux -- occurs when "acid that's supposed to be in your stomach ... goes into the esophagus, where it shouldn't be," says Dr. Christian Stone, chief of the division of gastroenterology at the University of Nevada School of Medicine. "And when it's there, it causes a burning pain and can damage your esophagus."

When you swallow, the lower esophageal sphincter, a ring of muscle at the lower end of the esophagus -- the tube through which food travels from the throat to the stomach -- relaxes to allow food into the stomach. Then, the muscle is supposed to tighten up again to keep acids in the stomach from traveling back into the esophagus.

But, in some cases, the muscle doesn't work as it should and allows stomach acids to flush back into the esophagus, where it causes irritation and heartburn.

Not all heartburn is caused by GERD, Stone adds. However, it's this slushing of acid into places where it shouldn't be that causes such "classic heartburn" symptoms as "a burning in the chest behind the breastbone, frequently after meals."

Certain medical conditions also can aggravate, or make one more susceptible to, heartburn. For example, hiatal hernia -- a common condition among older people in which the esophagus "is basically folded back in on itself" -- can make it easier for stomach acids to "bubble up and stick in the esophagus," says Dr. Ronald Hedger, associate professor of primary care at Touro University Nevada College of Osteopathic Medicine.

Other behaviors or situations can play a part as well, Stone says. Eating large meals. Eating fatty meals, because fatty foods empty from the stomach more slowly. Lying down after eating, which short-circuits gravity's tendency to keep acids in the stomach, where they belong.

Then, certain foods -- including garlic, spicy foods, coffee, chocolate and peppermint -- and smoking can cause that "inappropriate relaxation" of the lower esophageal sphincter that allows acids to spill back into the esophagus, Nemec said.

Yet, "different foods affect people differently," Hedger adds. "You may be able to eat a turkey dinner and feel just great and go lie down and go to sleep. I may eat it and get heartburn because my system is a little different than yours.

"So the problem is, people want to continue eating foods that cause them the heartburn -- or want to continue smoking, which can cause heartburn -- and yet don't want the heartburn."

A case of occasional heartburn may be eased by something as simple as sitting up, if reclining, or swallowing a bit of water, Nemec says. "A lot of times, if a person has just sporadic episodes of heartburn, just drinking some water to help get the acids down into the stomach will help."

If that doesn't work, an over-the-counter antacid such as Maalox or Mylanta might. These work by neutralizing stomach acids, Nemec says, and have the benefits of being inexpensive, easily available and, particularly in liquid form, fast-acting.

But, Stone says, "if you need to take those multiple times a day, you're probably better off reducing the acid inside the stomach by means of an over-the-counter medication such as Zantac or Prilosec."

Such drugs reduce the production of acid in the stomach and are to be taken before eating or at the start of the day. Some are available in both over-the-counter and prescription forms, Nemec notes, and over-the-counter versions will work for many patients at reasonable cost.

However, if these don't work, and if the heartburn doesn't go away, reoccurs repeatedly or worsens, it's time to see a doctor to determine if other medical issues may be involved.

For one thing, certain heart conditions can mimic heartburn (and patients should seek help immediately if they experience such symptoms as heaviness in the chest, sweating or shortness of breath).

Nemec says "there are patients who have heartburn-type symptoms that aren't related to reflux," but to such conditions as gall bladder disease or esophageal spasms, for example.

Another reason to seek medical help: Acid reflux has been linked to a condition called Barrett's esophagus, a change in the cells lining the esophagus that can "predispose (patients) to cancer of the lower esophagus," Nemec says. "When patients do have Barrett's esophagus, they require closer monitoring."

But for occasional bouts of heartburn, Hedger suggests that sufferers keep a food diary to record what they have eaten and when they have experienced symptoms. That, he says, can uncover specific foods, or specific eating habits, that can be eliminated to prevent heartburn.

"We also recommend lifestyle changes, and probably the most important is weight reduction," Nemec says. "When you have a lot of adipose tissue, or fat tissue, in the abdomen, it presses on the stomach and allows acid to reflux into the esophagus and aggravate symptoms."

Avoid alcohol after dinner and avoid snacking at night. Note, too, Stone says, that drinking milk to quell heartburn is a myth.

"Milk doesn't reduce acid in your stomach," he says. "When you drink milk, you actually produce acid. Whenever you eat anything, your stomach makes acid. It's supposed to do that."

To prevent nighttime heartburn, elevate the head of your bed to "help gravity keep acid in your stomach," Stone says.

And here's a strange suggestion that somehow seems particularly fitting for the holiday party season: Don't wear clothing that's too tight.

"Clothing that's too tight can cause constriction," Hedger says, and create a greater likelihood of reflux.

Contact reporter John Przybys at jprzybys@review
journal.com or 702-383-0280.