Have frequent heartburn? Take Nexium. An advertising blitz for that little purple pill helped it become the No. 2 best-selling prescription drug in the U.S., with sales of $6.3 billion last year—and let's not forget the billions spent on its over-the-counter cousin, Prilosec. Now, though, researchers are warning that this category of heartburn drugs, called proton pump inhibitors, may do more harm than good, at least for people with garden-variety heartburn. A series of new studies, published Monday in the Archives of Internal Medicine, found that daily use of these drugs, which suppress the production of stomach acid, increases the risk of infection with an intestinal bacteria and increases the risk of fractures in postmenopausal women. Previous research has shown that they also increase the likelihood of contracting pneumonia.
"About 60 to 70 percent of people taking these drugs have mild heartburn and shouldn't be on them," says Mitchell Katz, director of the San Francisco Department of Public Health who wrote an editorial that accompanied the new studies. "It's not just a question of unnecessary costs, but unnecessary side effects." Where PPI's do help, he says, is for the treatment of bleeding ulcers, infection with the ulcer-causing bacteria Helicobacter pylori, or management of Zollinger-Ellison syndrome, a rare condition that causes the stomach to produce excess acid. They are also warranted in cases of severe reflux, where an endoscopy reveals damage to the esophagus.
For everyone else, however, "there's no question that these drugs will relieve indigestion and reflux," says Katz, "but, beyond symptom relief, there's no long-term benefit to taking them, while there are some long-term risks." One study found a 74 percent increase in risk of infection with a harmful intestinal bacteria called Clostridium difficile for those taking a daily prescription-strength PPI, while another found a 25 percent increased risk of fractures in postmenopausal women who used PPI's. Both findings were considered to be modest increases in risk—but still enough, says Katz, to encourage folks with mild heartburn to forgo the drugs and double their efforts to make symptom-relieving lifestyle changes such as these:
1. Avoid heartburn-triggering foods. These vary from person to person, but common offenders include orange juice, chocolate, tomato sauce, spicy foods, mint, garlic, and vinegar. Fatty, greasy foods, like cheeseburgers and fries, are also heartburn instigators.
2. Stay upright for a few hours after you eat. Sitting up works with gravity to keep food and stomach acid from flowing up into your esophagus. Better yet, move about a bit to help speed digestion. "Our grandparents had it right when they headed out for a walk after a large meal," he says.
3. But abstain from exercise right after eating. Intense workouts slow digestion, making reflux more likely. Better to exercise first thing in the morning or a few hours after a meal. If you still experience heartburn symptoms after a workout, drink extra water. Staying hydrated helps improve digestion to keep symptoms at bay.
4. Eat smaller meals. To avoid heartburn, aim to eat up to six mini-meals a day, as opposed to three large ones. The worst? Eating a large meal right before bed. Try to abstain from food or drinks within an hour or two of bedtime. Even a tall glass of water before lying down can trigger symptoms in susceptible individuals.
5. Go easy on caffeine and alcohol—and avoid cigarettes. All three can relax the esophageal sphincter muscle, which normally keeps stomach acid from splashing up into the esophagus. Carbonated beverages can also cause this problem.
6. Don't eat too quickly. Try chewing slowly and putting your fork down between bites. Hot soups are a good appetizer because they take longer to consume.
7. Wear looser-fitting clothes. Tight belts, waistbands, and pantyhose constrict the stomach, sometimes triggering reflux.
8. Find ways to relax. Stress may increase stomach acids, raising the likelihood of heartburn.
9. Aim to lose a few extra pounds. The pressure of excess weight—especially around the abdomen—increases the chance that stomach acid will backwash into the esophagus.
10. Try chewing gum. This can boost the production of saliva, which neutralizes stomach acid.
11. Bend with your knees. Bending over at the waist tends to promote heartburn symptoms.
12. Elevate the head of your bed. Place blocks or bricks under your bedposts to raise the head of your bed 6 inches. Elevating your head and chest during sleep helps prevent nighttime reflux. A wedge pillow may also work.