What to eat and avoid for heartburn

Heartburn, often called acid reflux, occurs when small amounts of acid from the stomach leak up into the oesophagus (food pipe). The symptoms are a burning sensation in the chest, an unpleasant sour taste in the mouth, bloating or nausea, and sometimes a cough or a hoarse voice.

Audrey started to experience heartburn during her pregnancy: "The baby was large and, since I'm tiny, the bump started pushing up into my stomach. Every time I ate a meal, I felt burning and an acid taste. I couldn't take any medication due to the pregnancy so I just had to eat tiny meals to try to control it. However, it's left me with permanent scarring of my oesophagus which causes wheezing and pain even 18 years after my son's birth."

What causes heartburn?

There's a circular band of muscle at the bottom of your oesophagus where it joins the stomach, which acts as a sphincter. This one-way valve lets food and drink into the stomach, but not back out again. However, if it leaks, the acidic stomach contents reflux upwards into the oesophagus causing heartburn and irritation.

It's often not clear why the sphincter leaks, but certain factors do increase your risk. These include:

• Being overweight or heavily pregnant - this presses on the stomach and encourages the acid contents to move upwards into the oesophagus.

• Smoking - nicotine is thought to relax the sphincter allowing acid to escape. Smoking also reduces saliva in the mouth. Swallowing saliva helps to protect your oesophagus from stomach acid.

• Drinking too much alcohol - this stimulates stomach acid and can cause inflammation.

• Stress and anxiety.

• Some types of medicines, such as anti-inflammatory painkillers (eg, ibuprofen).

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Diet culprits

Given that so many people experience heartburn, there is surprisingly little research on what foods cause or help the condition. Advice is typically based on patient experiences.

"Many people who suffer from heartburn mention that foods which exacerbate their discomfort include spicy foods, fatty foods, chocolate, alcohol and coffee," says Dr Laura Stewart, a consultant dietician. Other common foods include onions, garlic, citrus fruits, fizzy drinks, peppers, cucumber, coffee, tomatoes and red wine.

She adds: "For those who suffer from heartburn it is best to avoid these foods as well as any others that may affect you."

Keeping a diary can help identify problem foods. Write down what you eat and drink for at least four days and note the time. Then add in comments when you experience symptoms. A pattern can often develop where certain foods or drinks trigger heartburn. Then try avoiding these foods for a couple of weeks and check if there has been any improvement.

A study in Italy found that people with heartburn and reflux were most likely to experience problems with lettuce, coffee, tuna, asparagus and eggs. Given that it's often recommended as a solution, it was unexpected that more than half of the group reacted to milk. This may be because full-cream milk contains fat which can stimulate stomach acid. Experts suggest that skimmed milk or low-fat yoghurt may be a better option for those prone to heartburn.

Diet heroes

What about helpful foods? Stewart says: "It's worth trying low-fat foods and mild foods cooked without spices. Eating small, frequent meals can help to alleviate discomfort after eating. Other ideas to consider are losing weight if you are overweight, stopping smoking, sleeping with the head of the bed slightly raised, and wearing looser clothes."

Dr Michael Cumming, a GP from Fife, adds: "Green vegetables can help reduce stomach acid as these are alkaline and neutralise stomach acid. There is some evidence that ginger can help reduce inflammation and ease symptoms, either as a tea or added to recipes. Reducing portion sizes and not eating late at night can also help to manage heartburn."

Medical websites suggest swapping acidic citrus fruits for milder ones such as bananas and melon, and eating a high-fibre diet rich in whole grains and vegetables. It's also worth chewing sugar-free gum (which stimulates saliva) or trying a course of probiotics (friendly bacteria), which are available as supplements or drinks.

Should I ignore heartburn?

Heartburn may seem like a mild nuisance rather than something to be worried about but, if you're over 50 years and have been experiencing acid reflux for some time or feel the need to keep using over-the-counter antacid tablets, it's worth getting it checked out.

Cumming warns: "Heartburn can be a sign of an underlying health complaint such as a gastric ulcer or oesophageal cancer and shouldn't be ignored, especially in older people. Suffering in silence when you have long-term heartburn symptoms could lead to potentially serious conditions being diagnosed later, when they are more advanced with complications, and are harder to treat."

Top 5 diet tips

1. Lose weight if you are overweight. Try to keep your waist smaller than 94 cm (37 inches) for men and 80 cm (31.5 inches) for women.

2. Eat smaller meals and have fruit or unsalted nuts as snacks.

3. Keep a diary to discover which foods and drinks set off symptoms.

4. Avoid eating a couple of hours before bedtime and prop up the top of your bed with blocks or higher pillows.

5. Try to eat more green vegetables, whole grains and ginger, and chew sugar-free gum after meals.