Take the bite out of holiday heartburn

My husband’s family is Scottish Canadian. Frugal, reserved, hard-working, tough as the granite they farmed in Eastern Ontario. Thrive on dry humor.  

One thing they do with abandon: Christmas dinner. Every year, we cross the Peace Bridge to his family home, to herb-studded roast beef, glazed ham, bricks of cranberry jelly and fruit cakes, strawberry trifle in brandy and sherry, egg nog, Yule Log. And my absolute favorite: Yorkshire pudding (egg batter baked in beef drippings).  

It’s a hard day’s night of eating – and heartburn.  

Heartburn presents differently in different people: burn, bile taste, hoarseness, lump in mid-throat, difficulty swallowing, coughing, worsening asthma or nothing.

To treat reflux, over-the-counter medications work as well as prescription ones. You have three choices.

1. Alkalinizing liquid: antacid.
2. H-2 receptor antagonists (H2RA): cimetidine, famotidine, nizatidine and ranitidine.
3. Proton pump inhibitors (PPI): omeprazole, esomeprazole, pantoprazole, rabeprazole, lansoprazole and dexlansoprazole.

Which one to pick? For one to a few days or intermittent use, try antacid and/or H2RA. They work fast. But taken regularly, H2RA loses some effect.

PPI is the bull, but takes days for peak effect. It’s better for severe, frequent reflux, long-term use. I’d start with omeprazole (20 mg, starting at $11 for a month).

So why with these wonderful drugs would you still get reflux? First, keep in mind, you may not have reflux. Call your doctor. Second, even though drugs can neutralize stomach acid or reduce acid production (incompletely), they cannot reduce the frequency of reflux.

Chronic reflux is an attack dog which needs a muzzle and a leash. Drugs are the muzzle, holding back bark and bites. Lifestyle changes are the leash, reducing the frequency of attacks. The basics:  

1. Weight: Weight gain worsens reflux. Losing a few pounds can significantly reduce reflux episodes.
2. Gravity: For nighttime symptoms, avoid eating three hours before bedtime. Tilt your bed, head up. Also, sleeping on your left side might help.
3. Food choice: More controversial. While fatty food consistently burns, people have unique heartburn triggers: smoking, alcohol, spices, caffeine, tomato sauce, chocolate ... stress. My advice: listen to your gut.

Recently I came across an interesting study on heartburn. I rarely jump at the first whistle. Nutritional studies, especially, have a lot of false starts.

This study touched on the Mediterranean diet (my favorite), which is all about vegetables, fruits, whole grains. It’s 90 percent plant-based, limiting meat to 3 ounces, 3 times a week with minimal dairy products. The study compared a group on daily omeprazole to a group on alkaline water and the Mediterranean diet. After six weeks, reflux symptoms improved equally between the two groups – about 60 percent.

If you seek PPI alternatives or additional relief, try the Mediterranean diet for a few weeks. Can’t hurt.  

The first time I had Yorkshire pudding, I was fired up. Had friends over for a proper Scottish meal. The venue featured haggis, which is steamed, minced sheep offal (lungs, heart, liver) mixed with oats and onions, stuffed in sheep stomach. My father-in-law heard and asked me straight-faced, “Do you hate your friends?”