Tips for empty stomach heartburn?

August 17, 2012 10:19 PM

I'm fairly certain I have GERD & I am making an appointment with a specialist, but in the meantime, what are your tricks for avoiding or quashing ye olde heartburn?

It's pretty much a foregone conclusion I have GERD. I have persistent, as in every damn day, heartburn for months on end (years, if I'm being truly honest) and I'm calling to make an appointment with a specialist tomorrow. This is a medical issue on both sides of my family, eventually progressing to esophageal & stomach cancer on the paternal side with more than one relative including my own father (who knows if that's genetic, environmental, or a combination of both). Anyways, at the moment I am using Zantac and Tums to keep symptoms at bay, but it's probably only 75% successful, if that. Assume I'm airing on the side of optimistic/minimizing. The thing that kills me is the heartburn I get from an empty stomach. It's not that I don't eat or that I'm eating super acidic or aggravating foods, but the periods when I'm in between meals and have no desire to eat have me flummoxed because I have no idea what to do to stop the pain. What are your tricks to keeping empty stomach heartburn at bay? Chugging water & skim milk doesn't seem to do much, except on a psychological level perhaps. You are not my doctor and this is no way a replacement for medical care, I'm just looking for behavioral things I can do to minimize discomfort until I consult with a doctor and have more tangible solutions (and I already know through the experience of my parents that even those behavioral changes/tricks directed by a doctor can be imperfect). Ideally, I'm looking for preventative behavioral changes, but I'll settle for tactics to employ when I'm in distress. Thank you in advance!

posted by katemcd to health & fitness (35 answers total)

Avoid:

Caffeine (seriously, quit it right now)
Alcohol (wine for me, mostly)
Chocolate
Spicy/acidic foods like hot sauce and tomatoes

Stop:

Drinking whilst eating (wait until after the meal)
Eating then lying down
Eating too much in one sitting
posted by two lights above the sea at 10:31 PM on August 17, 2012

I notice it when I drink too much coffee and not enough water. So I'm 2nding the caffeine avoidance.
posted by thorny at 10:32 PM on August 17, 2012

Have you tried taking a PPI like Prevacid or Prilosec? Zantac is an H2 blocker and is not the best choice for chronic GERD. It's clear it's not working for you at least. A doctor might e able to dose you properly to combine both an H2 and a PPI - have you made an appointment yet?

Have you done all of the standard things like eliminate trigger foods, eat regularly and raise the head of your bed? With your family history I'd be quite concerned about getting this under control STAT. Get thee to a gastroenterologist!!
posted by PorcineWithMe at 10:32 PM on August 17, 2012 [1 favorite]

Get a bed wedge or raise the head of your bed- helps lower heartburn when you're asleep. Also I used to have terrible heartburn, and Papaya enzymes were much, much more effective than Tums. I like the American Health brand. Amazon.com sells them.
posted by Aliera at 10:38 PM on August 17, 2012 [2 favorites]

When I get heartburn, I find going for a walk often helps relieve it. I'm not sure why!
posted by Joh at 10:39 PM on August 17, 2012

Prilosec worked well for me, though it takes three or four days to really kick in. In my experience the store brands have worked just as well. I was prescribed Nexium a couple of times and that was like magic. Pepto bismol helped me too.

When I first had GERD troubles and they were really bad (felt like a hot poker in my stomach), it helped to eat things like saltines pretty constantly, just to keep something bland in my stomach.

(Also, consider whether maybe something innocuous you're eating is aggravating it. My normally very-under-control reflux ramped up at the end of last year and required daily prilosec for months. I had some other symptoms at the same time that seemed to indicate lactose intolerance, so I tried lactase supplements. Not only did the obvious lactose symptoms go away, but I've hardly had to take prilosec in ages, and when I have it's been for just a week instead of several weeks at a time. If you're already prone to GERD, even a very slight food intolerance may be making things worse than they might otherwise be.)

Good luck with the doctor! Make sure they do an H. pylori test -- if that's the cause, all you'll need is a round of antibiotics!
posted by Blue Jello Elf at 10:40 PM on August 17, 2012 [1 favorite]

This is all great, keep it coming! Not threadsitting but I don't drink caffeine regularly (probably one of the very few people in America who can't remember the last time I had coffee, caffeinated soda, or tea), I already take lactase enzyme when having dairy, and I don't notice it so much at night as during the day, as in those awkward hours between breakfast/lunch and lunch/dinner. I also don't eat greasy or fried foods, but probably consume more cheese than I should. Good call on the H. pylori test! I have a lab slip which includes testing for that very thing! Thank you all! I suspect the only thing that will solve this is prescription meds (and yes, giving up my one last vice, an occasional glass of wine *sigh*). For those who have tried Prilosec vs. Prevacid have you noticed a discernible difference? I took Zantac at the time because I could not wait 1-4 days for it to kick in, but could probably switch now.
posted by katemcd at 11:22 PM on August 17, 2012

Oh and no spicy foods either. I joke that being of Irish heritage, mild salsa is the equivalent of four-alarm chili for me. If anything, I'm more of a sour girl, but even that is very limited.
posted by katemcd at 11:25 PM on August 17, 2012

Don't make any assumptions about what may or may not trigger it for you. My doctor says she's pretty much heard it all at this point. For example, I can eat super-spicy foods with impunity (well, not last thing at night) but bell peppers, especially green ones, are my kryptonite. People sometimes miss a trigger because they assume that couldn't possibly be a problem.

I'm puzzled by the no drinking while eating thing -- or did two lights above the sea mean no alcohol while eating?
posted by wintersweet at 12:00 AM on August 18, 2012

Straight aloe vera juice, nothing with additives. My fiancé swears by it for his acid reflux and heart burn. Trader Joe's sells it in big jugs.
posted by amapolaroja at 12:03 AM on August 18, 2012

Since you have discomfort between meals, try eating smaller snacks more often.
posted by Cranberry at 12:05 AM on August 18, 2012

Prilosec works great as a long term solution. For quick short-term results to eliminate immediate heartburn, take zinc. (This has been studied.) You can even use both approaches simultaneously.
posted by wolfdreams01 at 12:55 AM on August 18, 2012

Something we have in the in UK is alginate preparations that you take after eating to form a physical barrier to reflux until your next meal. The one that is most effective here is called Gaviscon Advance and we recommend it a lot for people with persistent reflux reaching to their voicebox who have a hoarse voice. If you could get this and it works for you it should be an immediate help because it forms a physical plug at the top of your stomach and it doesn't have the side-effects of long term PPIs or H2 blockers. If you did take this you would have to stick to three meals a day only with no eating or drinking in between - the moment you put something else into your stomach it breaks up the plug and the effect is gone.

Other things that we recommend for people with reflux that I haven't seen specifically mentioned above:
* Avoid all citrus including juices, marmalades and soft drinks
* Avoid other acidic foods like tomatoes, most fruits, onions, bell peppers, anything pickled
* Avoid soda
* Halve all your portions and eat more frequently (unless you're taking an alginate, see above)
* Lose weight if you are more than middle of the ideal BMI range
* Don't wear anything that is tight around your middle
* Avoid anything high fat, including any fried food, cheese, pastry, butter, olive oil etc. This includes in cooking. It also includes fatty meats
* Avoid all chocolate
* As mentioned above - alcohol, caffeine, spicey foods, raising the head of your bed, sitting upright while eating and for half an hour afterwards, not eating for 3 hours before bed.

As people said above - these won't all apply for every person and you might want to avoid it all immediately to try to get some relief, but you might then want to experiment with putting things back in. I had never had heartburn in my life until I made a delicious cake with a pink grapefruit marmalade glaze, and then I suffered for a week until I figured out what was causing it.

Given the times when you say the heartburn is worst I think an alginate might be your best bet.
posted by kadia_a at 1:21 AM on August 18, 2012 [2 favorites]

I cut sugars and grains out of my diet a while ago and it had a nice side benefit of completely eliminating my heartburn. The only time I get it now is if I cheat, especially with grains.
posted by platinum at 1:40 AM on August 18, 2012

Just got over a horrible pregnancy-related bout of heartburn/reflux. Did some desperate googling and came across pickles/pickle juice as a remedy. It worked! Maybe about an 80% improvement fairly quickly, which was many times better than the TUMS.
posted by smalls at 3:54 AM on August 18, 2012

Had an ongoing issue with this about 6-7 years ago and tried things like Prilosec. Interestingly Gaviscon (with the alginate) cleared it up within a month and it never came back. I have no problem now with spicy foods and can even drink coffee as long as it's black... absolutely no cream or milk (I read somewhere online about the coffee advice coming from a Korean war military doctor). Maybe that was the root cause. Dark chocolate can bring it back temporarily, though, so I avoid that.
posted by crapmatic at 4:17 AM on August 18, 2012

The prescription dose of Omprazole (Prilosec I think) is 40 mg. The OTC dose is 20 mg. So you could try doubling the OTC dose once per day. That's what I've been on since my upper GI about 5 years ago. I can eat or drink anything I want know.
posted by COD at 5:47 AM on August 18, 2012

I had legendary GERD for ten years and then I went on a calorie controlled diet using MyFitnessPal, an app for Android, as a way to keep time. Five weeks after I started my heartburn is gone. I am convinced that heartburn can be caused by triggers but it can also be caused my over-eating. As long as I do not over eat, I can eat whatever I like except chocolate, which is my one big trigger. I have lost 40 pounds, so there is also less pressure on my abdomen and have used rolaids just four times in the last 50 days.
posted by parmanparman at 6:19 AM on August 18, 2012

I use generic ranitidine once per day. No caffeine after breakfast, avoid citrus and hot spicy foods. Ice water for minor flare ups. Use tums type antacids sparingly, long term effects not favorable apparently.
posted by coldhotel at 6:30 AM on August 18, 2012

I concluded that high stomach acidity was rooted in general tissue acidity and decided that monitoring my heartburn et al was a means to indirectly track progress on resolving this deeper issue. Some things I did which I think might help you:

I took a lot of calcium. The body strips the bones of calcium to keep the blood ph on track, do chronic acidity tends to use up calcium.

I ate a heaping bowl of lettuce at least five days a week.

As an emergency measure, I sometimes drank diet tonic water. Don't overdo this. Really large amounts of tonic water can lead to cinchoism (basically, drug side effects of taking quinine, includes headache and nausea), which is not pleasant. And overalkalinizing your stomach can lead to vomiting.

I figured out which fats and oils I tolerated well and which I didn't. I did my best to eat the ones that helped and avoid the ones that hurt. One thing that might help you is to avoid peanut oil. It is very pro-inflammatory/acidifying. And the impact of oil seems to be very long lasting, more so than most foods.

I worled on hydration, which was impacted by the right oils but also by salt and other minerals. I found my acid reflux was worse when I wasn't properly hydrated and hydration was more complicated than just drinking enough water. This fits somewhat with suggestions other people have made: Caffeine is dehydrating, so that might be why it is a trigger for some people.
posted by Michele in California at 8:10 AM on August 18, 2012 [1 favorite]

Kombucha really helps me. My favorite is GT's Gingerade which we get at Whole Foods. I avoid milk and carb-heavy foods which seem to make things worse. I also am much better when I exercise and drink lots of water.
posted by oneirodynia at 10:07 AM on August 18, 2012

Reduce your stress level by light exercise and meditation.

Sleep on your left side (if you are ever bothered with reflux after lying down)

Don't cross your legs after you eat.

I find drinking water gives me reflux.
posted by Tullyogallaghan at 10:13 AM on August 18, 2012

In 2005-2006 I began to have recurring heartburn/GERD. It grew in intensity and frequency until it was both acute and chronic. On a couple of occasions I threw up (once due to seasickness and once due to alcohol overindulgence) & became aware of blood in my stomach. Convinced that bad dietary habits had led to an ulcer, I determined to dealt with it by managing my diet, which consisted almost entirely of avoiding aggravators (types, timing, and quantity of food consumption) and consuming antacids. I was semi-successful at the former but relied heavily on the latter. By the end of 2011 I was going through about 75g of Tums-style antacids weekly (~20 500mg tablets daily). Sometimes as much as double that rate. If I was scrupulous about the avoidance part I could decrease my antacid consumption after a few days, but flare-ups were still somewhat likely on an empty stomach.

At the beginning of 2012 I checked into a hospital with a sudden leg infection and a fever of almost 104 F. Broad-spectrum antibiotics were liberally pumped into me. The problem was brought under control and I was released in a few days....and it's about 8 months later now, and my stomach acid problem is all but a memory. (As a bonus, my skin was really smooth for a while too.) The same bottle of antacids I used to go through in a week now lasts me a solid two months, if not longer. Trigger events are normal ones: Fatigue, too much coffee, or the (predictably) the conjunction of the two. Overeating & then going to bed. The events are rare instead of chronic, and a full order of magnitude less severe. (That is, if the maximum pain I experienced when the problem was at its worst was a 10, I now never experience anything over a 1.) Consequently, the antacid dose I need to deal with them is much smaller. My stomach is happy when empty. I am, as far as I can tell, cured.

Maybe your problem is bacterial.
posted by perspicio at 10:26 AM on August 18, 2012 [2 favorites]

I find drinking water gives me reflux.
posted by Tullyogallaghan at 12:13 PM on August 18 [+] [!]

Me too. Water is a major trigger for me, though I can drink caffeine all day long. Literally. Coffee, tea, & diet soda are my basic liquid intakes. Also, lettuce... I can't eat lettuce or cabbage or many other salad-type stuff, for nuthin'. So I second wintersweet when they say don't assume that because you don't eat the classical heartburn triggers you're not consuming foods that will cause your heartburn to flare.

I've found that grazing rather than eating big meals helps.

Lying on my left side makes mine worse, not better, but reclining rather than lying down makes it better, so seconding a sleeping wedge or using your adjustable bed if you have one (mine's a lifesaver).

I haven't found a medication yet that relieves my reflux for any length of time. I just had to make major dietary & lifestyle changes to get rid of mine. The relief from constant pain was worth the effort.
posted by patheral at 10:57 AM on August 18, 2012

I have chronic heartburn and what works best for me is 150 mg of generic Zantac, twice a day, once as soon as I get up, and then again at supper time. And then I don't let my stomach get empty.

Foods that exacerbate symptoms for me are largely dairy related. I used to not be able to eat onions or peppers, but that disappeared a few years ago. Orange juice is bad for me and dark chocolate can sometimes give me a flare up (oh horrors). Raw almonds are my go-to mid-meal and if I get "breakthrough" symptoms.

If eating almonds or a small meal don't help, I take Gaviscon. It is immediately soothing. I also often take one before bed, just as a preventative.

In the past I have taken Nexium and Prevacid on a daily basis, but both left me with a bloated, distended, painful, rock-hard gut. I am now experimenting with taking Nexium once a week and slowly reducing the Zantac. I still get some digestive distress the first day, but then the several days heartburn free are pretty sweet.

Reducing stress and belly fat also help, but those are both longer term fixes I am working on.
posted by looli at 11:48 AM on August 18, 2012 [1 favorite]

Re the suggestion of an infection: High acidity promotes infection. The relationship is probably a complex two-way thing. In brief, I would certainly agree that any medical condition involving high acidity and/or inflammation could also involve infection.
posted by Michele in California at 12:13 PM on August 18, 2012

Pepcid used to make a product called Pepcid Complete which was a chewable tablet, of which you only required one, to control heartburn for 24 hours or so. I think it has some Tumsy stuff to ease the pain right away and then some more Pepcidy stuff to protect you for awhile. It never once failed to end my heartburn within like 90 seconds.

And now you can't get it anymore. No idea why, but it makes me sad. I think they had problems at the factory or something.

What you can get, however, is drug store knock-offs. Don't know where you are, but I know that here in Texas Walgreens, CVS Pharmacy, and HEB all make their own version. I think Wal-Mart does too. You can find them in the antacid section, usually in a white bottle with a red top, and usually with 'Complete' in the name to remind you what they are generics of.

They work about %70 as long as the real stuff, but they still unfailingly knock out my (frequent and assertive) heartburn within 90 seconds. It's like a SuperTums or something.

I've tried the pill-a-day Pepcid or Prevacid and they work well except I suck at remembering to take pills in the morning because I take all my other pills at night. For most people, however, that's probably a negligible issue.

"[Brand] Complete" tablets work so well for my otherwise pretty painful issue that I haven't had reason to seek any further, more permanent solutions. I do get worried that the products will disappear off the shelf forever, but hopefully that won't happen soon or at all.
posted by TheRedArmy at 12:14 PM on August 18, 2012

Three things I haven't seen mentioned yet:

1. Yogurt can be your best friend. It has a natural anti-acid ability as well as helpful bacteria which can lead to a much more settle stomach over time (especially when taken with a PPI).

2. Talk with you doctor about the possibility of a small hiatal hernia or a problem with your lower esophageal sphincter. These are common issues that can cause backflow. Having constant acidity can lead to esophoghitis (speaking from experience...it's not a fun).

3. Have a bottle of maximum strength maalox for the really bad days. It may be overkill, but is much more effective than tablet anti-acids and will get the acidity out of our esophagus quickly to prevent further damage. (PPIs are safe to use with this...but they are not fast acting, they simply reduce overall acid production and take a week to really kick in)

Other than that, a prescription for pantoprazole is what you'll likely want to go for when talking with a doctor...it's basically Prilosec but will have better coverage under any prescription plans you may have (mine is no co-pay and unlimited refills for life as long as I have my prescription plan). The suggestion on elevating your head is spot on...you may want to use a bedrest pillow if your bed has a headboard or is up against a wall, it's much more stable than stacking regular pillows. Be sure to drink a glass of water right before bed.
posted by samsara at 12:55 PM on August 18, 2012 [2 favorites]

Oh also, I only got to try this once and could never find it in stores...Galviscon was pretty amazing stuff as it's an anti-acid that creates a foam layer that keeps things down.
posted by samsara at 1:00 PM on August 18, 2012

Have you read this article by Mark Bittman about GERD and dairy here and after a huge response, more here? Could be worth a try.
posted by biscuits at 8:04 PM on August 18, 2012 [1 favorite]

I would agree with the folks above that if Zantac is not working for you, omeprazole/Prilosec could be a good next step to try. It's available over the counter, if that was not clear from the comments earlier, so you don't need to wait until you see a specialist to start. I assume you won't be able to get in with a specialist for a while yet.

Prilosec takes some time to work (days) once you start taking it regularly. For immediate relief that's a bit more heavy duty than Tums, in the ER we usually use a mixture of Maalox and viscous lidocaine. I'm not actually sure if you can get the right form of viscous lidocaine over the counter to replicate this (I suspect you can't), but I think 20ml of Maalox alone is worth trying.

I think this article from WebMD is a pretty good summary of heartburn prevention tips.
posted by treehorn+bunny at 8:44 PM on August 18, 2012 [1 favorite]

Oh, also, I wanted to give you a link to a Medscape article (sorry it may be a little jargon-y) about presentation of peptic ulcer disease (versus GERD which is what most people are discussing here). I wanted to mention this because you specifically noted that you get the pain in between meals, and classically that's associated with duodenal ulcers. Unfortunately not everything in medicine presents like it's supposed to in the textbooks, but it may be interesting to you nonetheless.
posted by treehorn+bunny at 8:49 PM on August 18, 2012 [1 favorite]

I swear that this worked for me and everyone I've suggested it to. Found it in an old homeopathic book==red delicious apples. Totally has to be red delicious, no other type will do. Just one straight off the apple, peel and all after every meal. It worked for me in two days, others in three. Really--try it!
posted by msleann at 11:13 PM on August 18, 2012 [1 favorite]

Chewing gum after meals significantly helps reduce GERD.
posted by Ery at 11:10 AM on August 19, 2012

Just popping in to say thank you to everyone. I'd favorite all of these, but that probably defeats the purpose of favorites. ;) Being pretty well-versed in GERD & stomach issues, some of what is mentioned above I've done or is a non-issue, so I'm more interested in the unusual, atypical approaches that aren't as commonly known. Of course, the best solution will probably come from the gastroenterologist, but until I have my appointment, I will give several of these a shot and see if I have any results. Thanks again for all of your suggestions!
posted by katemcd at 10:03 PM on August 23, 2012