The unpleasantness of acid reflux is sometimes accentuated by the doctor's orders to give up drinking wine. But a new meta-analysis of previous research on heartburn, published in the Archives of Internal Medicine, found that treating the problem through dietary restrictions may not do any good.
"Most patients with heartburn are told to cut out all these substances from their diets," said study coauthor Lauren Gerson, assistant professor of gastroenterology at Stanford University. "They become unhappy about the dietary restrictions, yet do not get improvement in heartburn."
Gerson explained that, in her own private practice, she began to notice a trend. Every time patients complained of acid reflux, Gerson's reaction was to ask about what they ate and drank, and whether they smoked. If they reported a high intake of acids, she would recommend cutting out wine, citrus and so on.
Weeks later, the symptoms tended to persist, so Gerson decided to look into the matter further. "The compelling factor was listening to the patients tell me how the restrictive diet did not help at all," Gerson explained.
Forty-four percent of Americans experience gastroesophageal reflux disease (GERD) every month, and 7 percent feel the burn every day, according to the study. The condition occurs when the sphincter between the stomach and esophagus relaxes, allowing gastric acid to pass into the throat, burning the delicate lining. A common theory was that adding more acid to the stomach--say, by drinking coffee and orange juice in the morning, having a spicy lunch, then drinking one or two glasses of wine at dinner--was like pouring bathwater into a full tub.
To see if dietary choices caused the stomach to overflow with acid, Gerson and two colleagues looked at more than 2,000 studies concerning GERD that took place between 1975 and 2004. Of those, they found 16 dealing specifically with lifestyle choices and risk of heartburn. In those 16, they found no evidence supporting the above-mentioned theory. Whether patients cut out alcohol, coffee, chocolate, spicy foods or smoking, they didn't feel better.
However, if patients were advised to lose weight, and they did, the GERD usually stopped. Raising the head of the bed higher than the foot also helped. The most effective method, Gerson and her team found, was taking medication, especially proton pump inhibitors that prevent the overproduction of stomach acid.
Gerson added that her research was meant to enable patients to make better decisions for themselves, not as a recommendation to physicians. "If a patient comes in and states, 'Red wine really gives me terrible heartburn,' then it may be reasonable to say, 'Well, you could avoid it, or you could take a medication before you drink some red wine,'" she said.
The finding that alcohol may not be linked to heartburn echoes previous research from Scandinavia that showed drinkers were not at a greater risk for acid reflux than nondrinkers. That study, however, found that heavy smoking was a risk factor and suggested patients exercise and consume more dietary fiber to help alleviate the heartburn.
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