'A Women's Guide to a Healthy Stomach'

May 10, 2011

Jacqueline L. Wolf, M.D., has created a guide on gastrointestinal health explaining the causes and cures for women's most embarrassing, urgent and common stomach problems. "A Women's Guide to a Healthy Stomach" has everyday solutions for acid reflux, heartburn, bloating, constipation, gas, diarrhea, and irritable bowel syndrome.

Are heartburn and GERD the same thing?

Not always! In most cases, heartburn is caused by acid refluxing up into the esophagus and causing a burning feeling, but it could also be caused by an ingested food or medication causing a burning on its own without acid participating. GERD is the process of any fluid or food coming up the esophagus, not just acid. It could be bile, recently eaten food or drink.

To prevent heartburn:

  • Avoid caffeine (tea, caffeinated and decaf coffee, chocolate)
  • Avoid carbonated beverages
  • Avoid alcohol
  • Avoid citrus, tomatoes, mint, garlic
  • Avoid cigarettes

Heartburn prevention and treatment:

The most important treatment for heartburn is lifestyle modification. Take a multipronged approach:

1. Sleep sensibly. The head of your bed should be elevated about six to eight inches.

2. Time your eating. The timing and volume of dinner can also contribute to reflux or heartburn. If you have a lot of food just sitting in your stomach and not emptying out, where will it go? Nowhere but up! I recommend the European style of dining (minus the late night dinner)--eat our biggest meal at lunch, and don't eat too much at dinner or before bed. After all, gravity helps keep the food and acid where they belong. Try to eat at least three to four hours before lying down, if at all possible.

3. Watch what you eat. Caffeine increases acid output in the stomach and also reduces the pressure in the LES, where the esophagus enters the stomach. Caffeine doesn't lurk only in tea or coffee. You'll also find it in soda, migraine medication and chocolate. Colas and other carbonated drinks are very acidic, and the carbonation can cause burping, sending more acid up into the esophagus. Garlic, onions, mint, fatty foods and alcohol can also cause lower pressure in the LES; tomatoes and citrus fruits are also culprits. Fatty foods and high-fiber foods are slow to empty from the stomach. Many people drink milk, thinking that this might neutralize the acid and help. Unfortunately, milk may stimulate acid and can potentially make things worse.

4. Don't smoke! Smoking is bad for your esophagus, not to mention your lungs. It may curb your appetite, but it also can decrease your LES pressure and decrease saliva, which helps neutralize acid.

5. Lose weight. Obesity increases your risk for not only heartburn and reflux but also ulcers in the esophagus and cancer of the esophagus. Your body mass index is directly related to the number of reflux events you have: the heavier you are, the more acid reflux events you'll have. This may be due to increased pressure on the stomach or more episodes of relaxation of the LES.

6. Avoid tight clothing. Luckily for all of us, corsets are no longer in style. However, body shapers, like Spanx, are in. These can cause a lot of pressure on the stomach, as anyone who's ever wriggled into one can attest. By increasing pressure on the stomach, food and acid may reflux up through a weak LES.

7. Analyze your meds. Medications oft en cause burning or inflammation in the esophagus. Prime off enders are potassium and tetracycline. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen and aspirin can cause ulcerations in the stomach, duodenum or small intestine and can also cause inflammation in the esophagus. If you must take medication, note that coated aspirin might help; taking your medication with misoprostil (used for ulcer prevention), with a proton pump inhibitor (PPI) or with food is also helpful.

Does GERD cause bad breath?

Yes! How exactly GERD causes bad breath is unclear. Recently, it was shown that there is a specific bacterial flora (microbiome) in the lower part of the esophagus that can change if there is inflammation (esophagitis) in the esophagus. A small study showed that it's possible a change in the bacteria of the esophagus could be responsible for the bad breath in those with GERD.

About 10 to 30 percent of people have regular bad breath.

What causes bad breath?

About 80 to 90 percent of bad breath is caused by a source in the mouth. less saliva production.

If your mouth holds no answers, it's time to look elsewhere. Severe liver disease and kidney disease can be sources of bad breath but are usually associated with other symptoms. If you have reflux symptoms, then you could try an over-the-counter medication such as an H2RA or a PPI for two weeks to see if that eliminates your reflux and halitosis.

There are two possible approaches: change the bacteria in the gut or change the food on which the bacteria thrive. To change the bacteria in your gut, probiotics could be helpful, though it's a trial-and-error process.

A more radical way to change the bacteria in your gut might be a short course of antibiotics. However, which antibiotic to use is uncertain, and to be honest, the effectiveness of this approach hasn't been verified. Diet modification is another option.

How do medications work to cure my heartburn?

There are three types of medications to treat heartburn. Antacids remedy the occasional heartburn, neutralizing the acid made in the stomach. They work quickly and can give fast relief, but they don't last long and may need to be taken frequently.

The second type of therapy for heartburn is H2 (histamine type 2) blockers. Acid is made by the parietal cells in the stomach. Histamine is a primary stimulus to this cell to secrete acid. If the receptor for the histamine is blocked on the cell, then less acid will be released. Some acid will still be made in the stomach with this type of medication, though, so H2 blockers might not help everyone; it's been shown to help 10-24 percent of people who don't get better naturally or through use of a placebo. Also, H2 blockers don't help heal severe inflammation of the esophagus very well. However, for mild symptoms, they can be worthwhile to decrease acid and symptoms. If they don't work after six weeks, then you should change to the third type of therapy, proton pump inhibitors (PPIs). PPIs are the most potent form of therapy. These drugs directly block the secretion of the acid in the parietal cell when this cell is turned on to secrete acid. Think of the cell as a faucet--when it's on, it leaks acid; when it's off , it doesn't. PPIs bind to the switch, turning the cell to the "off " position, thereby stopping (if completely effective) acid production.

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