Here are the best ways to deal with heartburn, formally known as acid reflux, more formally known as gastroesophageal reflux disease, but most simply known as GERD
We all know the saying, “the best form of treatment is prevention.” Nothing new here. Prevention and lifestyle changes are imperative to best managing acid reflux. The following are tips and tricks to prevent acid reflux:
- Avoid triggers — specific foods and drinks can cause it in certain people and everyone is different. A trigger could be a bad for you but not for me. So what are this triggers? Well, for some it can be chocolate (yes i know terrible news. But it gets worse.) Caffeine is also a trigger, one of my favorite things ever. It can also be spicy/acidic foods, some dairy products and carbonated beverages.
- Weight loss has been shown to be the best lifestyle modification for preventing symptoms.
- Avoid eating before bedtime (2–3 hours) especially high fatty foods.
- Quit smoking.
- Avoid lying down after meals.
- Bed elevation — might be better for treatment (6 inches) Not just the head cuz then you’ll be sleeping like this (demonstrate). But the entire bed. Can’t help you with how though. I’m a pharmacist, not an architect.
- And last but not least, you could be taking a medication that causes acid reflux. Speak with a pharmacist to see if you’re on a medication that might be contributing to symptoms.
When to see your Primary Care Provider?
When would it be time to see your primary care provider?
- If your symptoms last more than 2 weeks after treating with over-the-counter medications,
- if you have pain or difficulty swallowing,
- vomiting of blood,
- black tarry stools, and
- frequent nausea and vomiting.
What’s the best treatment option? Well it depends. (dun dun duunnnn)
My first recommendation is to use antacids like Tums (or the generic equivalent) as needed. Antacids are best for less frequent symptoms and immediate relief. They work within minutes! But please, be aware that there are some antacids that contain aspirin and these should be avoided because it can cause a your stomach to bleed. Alka Seltzer Original and others contain aspirin so be careful.
Here’s a list of antacids:
- Milk of Magnesia (magnesium)
- Tums (calcium carbonate)
- Maalox or Mylanta or Gaviscon — use generics!
Antacid down falls:
- they don’t taste great and can cause bloating and gas
- They only las 30 min to an hour, but you get immediate relief
- Magnesium — can cause loose stools
- Aluminum — can cause constipation
- Antacids bind to other medications, so sometimes you’d have to take it either 2–4 hours before said drug or 2–6 hours after.
H2s, can be used both as needed or every day as maintenance to avoid long term side effects of a PPI (I’ll explain this next). These take about 30 min to an hour to work but lasts up to 10 hours.
H2 blockers include:
- Zantac, Pepcid, — Use generics! How many times do i have to tell you?!
- Tagamet — avoid this one, it has too many drug interactions especially when there are other options.
If the other two types of medications don’t work, the next option is a PPI. This stands for proton pump inhibitor. Super fancy words, for now we’ll keep calling them PPIs. The PPIs are what’s been proven to work the best for management of acid reflux, but at a cost of potential side effects. There are multiple options for PPIs available, but just pick the cheapest one. There are no studies that show one works better than the other. But for you, your body might prefer one over the other. So, if one brand doesn’t work, switch to another. Again, there is no proof one works better than the other. The key is finding one that works for you. PPIs are usually taken 30 minutes to an hour before meals.
The reason I don’t recommend these as my first choice, even though they work the best, is because often people get relief form the first two options, they have the potential to interact with many other medications, and because PPIs have a lot of side effects associated with them.
PPI use is linked to:
- stomach infections (specifically clostridium difficile, C.diff for short, it can cause sever diarrhea)
- increased risk of fractures, especially in post menopausal women
- pneumonia (usually people in the hospital are at risk for this with PPI use)
- It can also lower calcium, vitamin b12 and magnesium levels.
It’s important to know you can’t crush or chew PPIs, there are some that come in capsules with granules inside that can be opened and mixed with apple sauce.
You cannot stop taking a PPI cold turkey. You need to ween off them, there is something called rebound reflux which is not fun. This can happen with abrupt stopping of this medication. Taper over 4–6 weeks. (Reach out to me for a specific plan for you). While doing this, you can use an h2 blocker/or antacids for when symptoms get bad.
It’s often recommended to use a PPI for 8 weeks. Then you could consider weening off. When you have weened off, check to see if symptoms return. If they don’t, awesome! You’re welcome. If symptoms return, it might be time for an appointment with your primary care provider.
Because drugs that treat acid reflux alter the acid levels in your digestive system, it can cause changes in absorption for some medications. This is why it’s very important to check with a pharmacist or other healthcare provider when starting.
I covered a lot in this article, so let’s recap:
- Know your triggers!
- First option for treatment are antacids or h2 blockers.
- You can use PPIs but we want to avoid long term usage due to risk of side effects
- Always involve your pharmacist, this stuff is complicated. You’ve got more important things to worry about.
As always, please do not start or change the way you use any medications without first talking with your pharmacist or other healthcare provider. If you have any other questions please don’t hesitate to email me.
Thanks for reading,