Common Heartburn Triggers

What triggers heartburn can be, well, a burning question. Here's what you need to know about the common causes of heartburn and what you can do to prevent the pain.

Heartburn triggers: What's burning you?

The specific triggers for heartburn differ from person to person. Mama Mia's marinara may always spell trouble for you, but your spouse may lick the plate clean and sit back with a satisfied belly and a smile.

What can lead to heartburn may surprise you. Stay away from foods you know will give you heartburn. It's not just about the food you eat. How and when you exercise and what you take to relieve your aches and pains may also cause that burning feeling. The key to taming the flame is to understand what triggers your own personal symptoms.

Heartburn triggers: Large meals and fatty foods

A big greasy burger and supersized serving of fries right before bedtime is a good way to fuel the flame of heartburn. Fatty foods, large portions, and late- night meals are the top three triggers that affect many people with heartburn.

Heartburn is most common after eating a large meal. A belly full of too much food stretches the stomach, causing you to feel "stuffed." Stomach stretching, or distention, puts pressure on the LES, the ring of muscle that keeps stomach acids from moving in the wrong direction. So juices from your last meal may come back to haunt you. This can happen when eating large amounts of any food, not just foods known to trigger your heartburn symptoms.

Fatty foods are big no-nos if you suffer from heartburn. High-fat foods sit around in your belly longer. This makes your stomach produce more acid, irritating your digestive system. And fatty and greasy foods lead to a lazy, relaxed LES. So not only do you have more irritating stomach acids, you're more likely to have the contents splash back up your throat. Ouch!

Heartburn triggers: Heartburn and diet

A number of foods and drinks can cause the LES to relax. Food and drinks that commonly trigger heartburn include:

• alcohol, particularly red wine
• black pepper, garlic, raw onions, and other spicy foods
• chocolate
• citrus fruits and products, such as lemons, oranges and orange juice
• coffee and caffeinated drinks, including tea and soda
• peppermint
• tomatoes

However, unless these foods are causing you heartburn you don't have to avoid them. To prevent heartburn after meals:

• Don't overeat. Eat five or six small meals each day, instead of several large meals.
• Don't eat before bedtime. Allow 2 hours to digest your food before lying down. This allows time for the food to pass out of the stomach and into the small intestine, rather than having it back up into the esophagus. Lying down makes digestion difficult and makes heartburn more likely.

Heartburn triggers: Heartburn and exercise

Need an excuse to skip the sit-ups? Crunches and ab work can trigger heartburn. Body positions that involve bending over increase pressure on the abdomen, thrusting stomach acids back up into the esophagus. So you feel the burn -- but not the type you'd expect from going to the gym. Keep in mind that leg lifts also work the abdominal muscles and may aggravate heartburn symptoms too.

Activities such as headstands and yoga moves like downward dog can reverse the natural flow of stomach contents and may trigger heartburn. Jarring exercises, such as jogging or aerobics, can slosh stomach contents around and upward if you have a weak LES.

Heartburn is no reason not to exercise. In fact, weight loss from exercise can actually help heartburn. But never exercise on a full stomach. Doing so increases abdominal pressure, which makes heartburn more likely. Food takes several hours to digest so it really is a matter of what works for you. Most experts recommend waiting about two hours after eating before working out.

Heartburn triggers: Heartburn and medications

Many different medications can trigger heartburn, or make heartburn worse. An aspirin here or there is not likely to lead to that fiery feeling. But regular use of aspirin or a popular class of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs) may irritate the esophagus. NSAIDs include ibuprofen, naproxen, and prescription Cox-2 inhibitors such as Celebrex. These drugs are often used to treat arthritis.

Several different types of blood pressure medicines can also cause heartburn. Many blood pressure and heart disease medicines, including calcium channel blockers and nitrates, relax the LES muscle, making it easy for your stomach acids to retreat backwards.

Several other types of medications are known to relax the LES muscle and lead to heartburn. They include:

• An asthma medicine called theophylline, taken by mouth
• Sedatives
• Narcotic painkillers
• Progesterone, a hormone found in some birth control pills
• Medicines for Parkinson's disease
• Tricyclic antidepressants
• Certain supplements such as iron and potassium

Chemotherapy drugs and a class of osteoporosis medicines called bisphosphates can injure the lining of the esophagus and make heartburn more likely. Taking your osteoporosis medicine with a big glass of water and avoiding lying down for 30 minutes to an hour helps to prevent problems.

Always tell your doctor if a new prescription or over-the-counter medicine gives you heartburn or makes your heartburn worse. Your doctor may be able to suggest alternatives.

Tracking heartburn triggers

Heartburn can limit your menu choices, interrupt your sleep, and interfere with your daily activities. Keeping tabs on what you eat and when you eat will help your doctor determine what's causing your symptoms. Then together, you can figure out how to prevent them. You can track heartburn triggers by keeping a heartburn diary. Make sure you include notes about portion size -- and be honest! If you have pain after eating a certain food, write that down, too.

Your diary should include the following information for each day:

• what you eat and drink, and when
• time and type of exercise
• medicines you take and the time you take them
• if you have pain, and if so, when your pain started (for example, did the heartburn happen after you ate breakfast or took an aspirin?)
• what the pain feels like
• what makes it feel better

Remember, understanding your heartburn triggers and learning how to avoid them can help you dodge the discomfort of heartburn. An episode of heartburn every now and then is usually nothing to worry about. But call your doctor if you have heartburn frequently or if severe heartburn that interferes with your daily activities. You may need further evaluation of your heartburn of a medication to help prevent it. If you have trouble swallowing or develop black stools, see your doctor right away. These could be signs of a more serious condition. If your heartburn is severe or not relieved with medication, you may need an endoscopy.

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