Heartburn: What Triggers Your Symptoms?

Doctors call it reflux. You probably call it heartburn. But whatever it's called, no one wants to experience the unpleasant sensations of heartburn -- a burning chest pain that moves up toward the throat, and an acid or bitter taste accompanied by a feeling that whatever you just ate is coming back into your mouth or throat.

Almost everyone has had heartburn from time to time -- maybe at Thanksgiving, after overdosing on turkey and pie, and a few glasses of wine, and then lying around all day watching football. But about 20% of the U.S. population experiences reflux at least weekly. Some, who have severe, persistent heartburn, may have a more serious condition called gastroesophageal reflux disease or GERD -- which can contribute to a wide range of other health problems, including a precancerous condition called Barrett's esophagus.

One key to controlling heartburn is to know your personal triggers. Afterall, although some foods and lifestyle habits are common heartburn triggers, they don't affect all people with same way. One person with heartburn can happily eat citrus fruit, while another ends up miserable less than an hour after a big glass of orange juice.

Here are three ways to start identifying your personal heartburn triggers.

1. Know the Common Causes of Heartburn

Here are top foods and behaviors most commonly linked to heartburn:

• Eating large meals, eating later in the day, and eating fatty foods. These "top three" triggers affect almost everyone who has heartburn, says gastroenterologist Charlene Prather, MD, an associate professor of medicine at St. Louis University School of Medicine.
• Chocolate. This one, unfortunately, is also reasonably consistent, hitting most heartburn sufferers.
• Coffee and caffeinated drinks. "Some people have trouble with coffee and caffeine, while others don't," says Prather.
• Citrus products, like oranges and orange juice. While caffeine actually induces reflux, says Prather, citrus just mimics the feeling because of its acidity.
• Garlic, onions, and other spicy foods.
• Tomatoes. "They tend to be more of a problem when they're cooked than when they're raw, but both can bring on heartburn," Prather says.
• Alcohol. All types of alcohol can trigger heartburn, but red wine apparently is particularly troublesome for some people.

2. Use a Food Diary to Track Heartburn Triggers

One way to track which of these common triggers affects you most is by keeping a food diary, says Robert Sandler, MD, MPH, chief of the division of gastroenterology and hepatology at the University of North Carolina at Chapel Hill. He's also a board member of the National Heartburn Alliance. "If you think something has triggered your reflux, write it down."

Keeping a food diary can help your doctor determine what's causing your symptoms. But be sure that what you're writing down is really reflux. Many people mistake other symptoms -- stomach problems and problems in the esophagus -- for reflux.

"There is a group of functional disorders of the GI tract, and reflux is one member of that family, but there are others," says Sandler. "The typical feeling of reflux is a warm or burning sensation in the sternum that moves up toward the throat. If that's not what you're experiencing, you may not have reflux but something else."

So when keeping track of your triggers, write down what the symptoms feel like as well as what you ate and what you did beforehand.

Also, note the timing of your heartburn symptoms. "Other gastrointestinal conditions, like irritable bowel syndrome, do not necessarily produce symptoms right after eating," says Prather. "But with reflux, you'll usually experience the heartburn symptoms within an hour after you ate the food that triggered it."

3. Avoid Heartburn With 'Clean Slate Eating'

What if you go out for Italian food and eat a meal with tomato sauce and red wine, only to experience that familiar burning sensation less than an hour later? How can you tell if it was the sauce, the wine, or both? You can't, says Prather. So the most effective way of finding your personal triggers is to start with a clean slate.

"Eliminate all the foods that are known to cause heartburn from your diet, and then add them back one by one, to find out which ones are causing the most problems for you," she says.

You can also minimize the effects of a heartburn-inducing food, like chocolate, by eating small amounts, only as part of a smaller meal, and not eating too late. "You might do fine with a big meal at breakfast but find yourself miserable if you eat a lot at dinner," Prather says. "And don't exercise vigorously or lie down for a couple of hours after eating. Instead, go for a walk. That helps your stomach to empty more."

And remember, you don't have to suffer in silence. If you have occasional heartburn that doesn't trouble you too much, over-the-counter antacids can help take care of the problem. But chronic, troublesome heartburn is a sign that you should see your doctor.

"People often think heartburn is just something they have to live with," says Sandler. "But people with diabetes don't go without insulin, and people with high blood pressure don't go without their medications. For some people, heartburn is a chronic condition and it needs to be treated that way."

Published August 25, 2006.

SOURCES: Digestive Disease Statistics, National Digestive Diseases Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, December 2005. Charlene Prather, MD, associate professor of medicine, St. Louis University School of Medicine. Robert Sandler, MD, MPH, chief, division of gastroenterology and hepatology, the University of North Carolina, Chapel Hill.