Tips on eating to prevent heartburn

For people with digestive diseases, eating the right foods can be tricky. James East, M.D., a gastroenterologist at Mayo Clinic Healthcare, located in London, explains how to avoid common mistakes, address symptoms before they occur and enjoy your diet.

What causes indigestion and heartburn?

Indigestion is discomfort or pain in the upper abdomen. It's commonly referred to as an upset stomach. Indigestion can be triggered by a number of factors, such as:

  • Fatty, greasy or spicy foods
  • Caffeine, chocolate, alcohol or carbonated beverages
  • Overeating
  • Anxiety
  • Smoking
  • Certain medications, such as some antibiotics, pain relievers and iron supplements

Indigestion is very commonly caused by functional or nonulcer dyspepsia, a condition related to irritable bowel syndrome. However, it can be a symptom of other underlying digestive diseases, such as:

Compared with indigestion discomfort, heartburn pain occurs higher in the chest, behind the breastbone.

"Heartburn is caused by acidic stomach contents moving into the gullet (oesophagus), which is much less resistant to acid," Dr. East says. "This results in irritation and damage to the lining of the oesophagus, literally a burn, that causes pain."

Heartburn can be caused by many of the same factors that cause indigestion listed above. However, more foods are linked to heartburn, such as:

  • Onions
  • Citrus fruits
  • Tomato-based foods
  • Peppermint

Chronic heartburn is called gastro-oesophageal reflux disease (GORD). In the U.S., it is called gastroesophageal reflux disease (GERD).

"The ring of muscle at the bottom of the gullet usually squeezes tightly except when we swallow food; however, it can get weaker with age, or disrupted if patients develop a hiatal hernia," Dr. East explains. "Conditions that slow gastric emptying, such as gastroparesis, or increase pressure within the abdomen, such as obesity or pregnancy, also can make reflux more likely."

How else can foods irritate your digestive system?

Foods that seem completely safe can be risky for people with digestive diseases, Dr. East says. And a food or behavior that might be OK for one type of disease may pose problems for another.

For instance, foods lacking fiber, such as processed foods, dairy products and meat, can make chronic constipation worse. While some foods high in fiber — raw fruits and vegetables — should be avoided by people with gastroparesis. The condition causes food to move slowly, or not at all, through the digestive tract. People with this condition should also avoid large meals, alcohol and carbonated drinks.

For those with inflammatory bowel disease, certain foods and drinks can worsen symptoms. These include alcohol, dairy products, caffeine and large meals.

People with swallowing disorders (dysphagia) might have issues swallowing foods with thick textures, such as caramel or peanut butter, or thin consistencies, such as juice or coffee. Large meals can also cause problems.

How do you prevent digestive discomfort?

"Lower fat food options are helpful for many digestive diseases, as are nonalcoholic beverages," Dr. East says. "Decaffeinated beverages are helpful for some patients, as is a reasonable level of portion control."

You can go on the offensive and take antacids or even acid-suppressing drugs to reduce symptoms before they occur. However, Dr. East says, these shouldn't be an excuse to overindulge. These medications reduce acid. They can't reduce the volume of food in your stomach, which can trigger reflux.

"Moderation in both food and alcohol and enjoying the range of dishes available is a better strategy than additional medication," Dr. East says.

Coping with anxiety and reducing your stress also can help.

"Anxiety and stress play a major role in gastroenterological symptoms, especially irritable bowel syndrome, which is a disorder of the brain-gut axis," Dr. East says. "Our brain and gut have very dense neural connections. Being stressed or anxious can lead to gut nerves being oversensitive. where they fire off pain signals, such as cramping or bloating, at much lower levels of stimulation than would typically be required, known as visceral hypersensitivity."

Try stress-reduction techniques such as cognitive behavioral therapy, hypnotherapy or mindfulness he says. Your physical position also can make a difference.

"Classical triggers for reflux include a large fatty meal late in the day, with alcohol, and then lying down flat," Dr. East says. To avoid heartburn, do the opposite. Have the main meal in the middle of the day. Do not eat within three hours of bedtime. Avoid fatty foods. Drink moderate amounts of alcohol, and consider raising the head of the bed.