Have heartburn? Don't start skipping wine with dinner just yet. A team of Scandinavian researchers has found that drinking alcohol, tea or coffee--typical suspects in cases of acid reflux--may not be linked to the condition.
On the other hand, smoking and a high salt intake appear to be risk factors for chronic heartburn, the researchers reported. A diet high in fiber, combined with regular exercise, may help prevent the problem.
The study, which was published in the December issue of the medical journal Gut, compared more than 3,100 individuals with acid reflux to more than 40,000 people without it. Acid reflux, or chronic heartburn, occurs when stomach acids bubble up into the esophagus, creating a burning sensation.
The researchers, from medical centers in Sweden and Norway, had sought to explore the causes of chronic heartburn using a larger group of subjects than previous studies on the subject had. Originally, the team had hypothesized that smoking, alcohol and coffee cause acid reflux.
Their study looked at the lifestyles of volunteers from the larger Nord-Trondelag Health Study in Norway, which took part in two phases, from 1984 to 1986 and from 1995 to 1997. That research gathered information from patients at local medical centers and from the general, "healthy" population at large, covering different socioeconomic classes.
The Sweden-Norway team excluded acid-reflux subjects who reported symptoms only once a week or a few times a month, focusing solely on those who experienced heartburn at least once a day.
All participants underwent physical exams and completed extensive written questionnaires on lifestyle factors, such as how much coffee and tea they drank, how much salt they added to their meals, how often they ate salted fish (which is popular in Norway), the amount of fiber they consumed in the form of different breads, their smoking habits and their education and income levels.
Volunteers were asked to report how frequently they consumed alcohol within an average two-week period: no days, one to four days every two weeks, five to 10 days every two weeks or more than 10 days every two weeks. They did not record how much alcohol they consumed on those days, nor whether they drank mainly wine, beer or spirits.
When the scientists compared the two groups of participants, they found that the people with acid reflux ate less fiber and more salt, exercised less and smoked more than the healthy population. For example, the people who always added salt to their meals had a 70 percent higher incidence of acid reflux than those who didn't add salt. Subjects who ate high-fiber breads daily had a 50 percent lower incidence than people who ate low-fiber diets.
Alcohol showed little, if any, significant effect on the risk of heartburn in the study. Subjects who drank anywhere from one to 10 days every two weeks had 10 percent fewer cases of acid reflux than nondrinkers. People who drank more than 10 days every two weeks had the same incidence of heartburn as nondrinkers.
Drinking tea showed no effect on rates of acid reflux, while coffee consumption appeared to have a protective effect; people who consumed one to three cups of java a day had a 30 percent lower chance of heartburn than people who didn't drink coffee. Exercising at least once a week for more than 30 minutes also seemed to help, reducing the chance of heartburn by 50 percent compared with people who reported no physical activity.
However, the scientists cautioned against changing personal habits based solely on these findings. "A potential weakness of the study is that reflux was assessed by symptoms only, with a high risk of misclassification of the outcome," they wrote. They noted that further studies that examine heartburn through more objective methods, such as pH measurement of stomach acids or endoscopy, could yield better results.
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