Why seniors get Heartburn (Acid Reflux), and tips on how you can manage yours

As I approached the subject of heartburn, I thought, “Hah! Heartburn! There must be a thousand mother-in-law’s-cooking jokes I can use.”

Wrong. There are almost no jokes.

Maybe that’s because heartburn or acid reflux is actually a disease – and that’s never a laugh.

If you experience mild heartburn twice a week or severe acid reflux at least once a week, you may have acid reflux.

An article in the World Journal of Gastrointestinal Endoscopy reported that, among we elderly, heartburn, or acid reflux  is the most common upper gastrointestinal disorder.

The article also said that although seniors with heartburn may have fewer symptoms, our heartburn is often is more severe.

Exactly what is heartburn (Gastroesophagael Reflux Disease) and why do so many seniors get it?

Once you have acid reflux, you’ll recognize it forever. A burning sensation in the chest or throat. Even the taste of stomach acid in your mouth.

According to the Cleveland Clinic, what we know as heartburn (acid reflux) occurs when the sphincter between the stomach and the esophagus doesn’t close properly and allows stomach acid to flow into the esophagus.

Sometimes it can feel like a dull pain in the chest – and that raises the issue of heart attack.

How do I know it isn’t a heart attack?

The fact is, says the Mayo Clinic, it’s often difficult to distinguish between acid reflux and a heart attack – even in a hospital emergency room.

If you experience dull pain in the chest and sweating, shortness of breath or arm pain, call 911 and get to a hospital ASAP. Then do the necessary follow-ups with your physician, even if the emergency room doctor and hospital lab test are negative on a heart attack.

Common triggers for Acid Reflux

A little too much wine, BBQ’d ribs, a late-evening coffee and I know I’m in for heartburn the moment I lie down to sleep.

The Mayo Clinic says some of the most common triggers for acid reflux are:

• Smoking
• Having a large or late-night meal
• Eating fatty or fried foods
• Drinking coffee or alcohol
• Even taking a single salicylic acid tablet (Aspirin ®).

Although there are many common acid reflux triggers, everybody  is different.

My son, who started having reflux a few years back when he was in his mid 50s, finds that tea is a trigger, as are some cookies, fatty fish like salmon and soya ice cream (he’s lactose intolerant as well). And while he can tolerate a beer, red wine is out.

How about you? What are your reflux triggers?

No doubt, my heartburn has become worse as I’ve aged.

That little sphincter that lets food in and is supposed to keep stomach acid from leaking up into my esophagus has weakened over time. A long time. I’m 84.

And sure, I do exercise, but no number of arm curls is going to strengthen that sphincter.

I can remember a little heartburn from time to time when I was younger. But there’s no question, no matter how tempting they are, BBQ’d ribs and some other good stuff are off the menu now.

Some medications can worsen your heartburn

According to the Mayo Clinic, asthma, which I learned six years ago that I have, often occurs together with acid reflux. Who’d have thought? In fact, each can worsen the other!

If you have this uncomfortable combo, ask your doctor to confirm that your asthma medication isn’t making your acid reflux worse.

Canada Drug Guide, which is funded by Health Canada lists the following medications as possible contributors to acid reflux:

• Anti-anxiety medications
• Sleeping pills
• Calcium-channel-blocking drugs used for heart disease and blood pressure control
• Some asthma medications
• Aspirin (salicylic acid)
• Pain medications such as ibuprofen (Advil ®, Motrin ®, naproxen)
• Products with iron content
• Antibiotics called tetracyclines.

Talk to your your doctor about your acid reflux and how to manage your discomfort while still using the meds you need.

Heartburn is more serious than just a pain.

Prolonged heartburn can cause serious, even life-threatening, complications. According to the research, the older you get the higher the possibility of prolonged, and more severe, acid reflux.

Which suggest that any senior with endless heartburn would be smart to ask their doctor about it.

Here are three complications for seniors from heartburn that the Mayo Clinic says could occur with prolonged acid reflux:

1. Scar tissue in the esophagus that narrows the passageway and makes it difficult to swallow food.
2. A painful open sore in the esophagus that also makes swallowing difficult.
3. Tissue changes in the lower esophagus that are associated with esophageal cancer.

The good news: those over-the-counter heartburn remedies work.

If you’re like most people, your acid reflux will likely respond to lifestyle changes (like – ditching the BBQ’d ribs) and over-the-counter products.

Antacids

Canada Drug Guide says that all antacids – such as Tums ®, Rolaids ® and Maalox ® – work as well as each other – none works any better, tablet or liquid. The choice comes down to your preference and price. Antacids neutralize the acid already at work in your stomach. A glass of water may work just as well.

Although there is some thinking that antacids can actually encourage your stomach to produce more acid, many people do find them effective when used on an occasional basis.

H2 Blockers

There’s another class of remedy for acid reflux called “H2 blockers.”  H2 blockers  reduce the amount of acid in your stomach. Ranitidine (Zantac®) and Famotidine (Pepcid®) are non-prescription (over-the-counter) H2 blockers..

In certain circumstances, your doctor may prescribe higher doses of an H2 blocker. These prescription products include cimetidine (Tagamet ®), ranitidine (Zantac ®), Nizatidine (Axid ®), and Famotidine (Pepcid ®).

Proton Pump Inhibitors (PPIs)

If those don’t address your heartburn symptoms, your doctor may step you up to a proton pump inhibitor (PPI) such as lansoprazole (Prevacid ®), omeprazole (Losec®), and pantoprazole (Pantoloc®). They may be more effective, but cost more.

Note that there are serious risks associated with taking PPIs for heartburn.

Many physicians will prescribe PPIs for their clients for years yet long term use has been linked to a heightened risk osteoporosis and bone fracture. The Government of Canada specifically notes: “healthcare professionals are reminded that PPIs should be prescribed at the lowest dose and shortest duration of therapy appropriate to the condition being treated”

The Government of Canada also warns that there is a possible association between the use of proton pump inhibitors (PPIs) and an increased risk of Clostridium difficile-associated diarrhea.

US Pharmacist states quotes a study byLambert AA, Lam JO, Paik JJ, et al. that found that outpatient PPI use is associated with a 1.5-fold increased risk of community-acquired pneumonia, with the highest risk within the first 30 days after initiation of therapy. PPI therapy also increases risk for hospitalization for community-acquired pneumonia.

In addition to the above, there is evidence that PPIs can actually cause rebound symptoms. And that there can be a clinically meaningful increase in acid production, above pre-treatment levels, when treatment is stopped.

Be sure to discuss these issue with your doctor if he or she prescribes a PPI. And be sure to be checked regularly for these negative effects if you do need to stay on PPIs.

Prefer “natural” solutions to your heartburn?

You may find that “natural” lifestyle changes can reduce your heartburn.

• Watch what you eat – give fatty foods a pass.
• Watch when you eat – late-night meals are a no-no.
• Watch how much you eat – we all overdo it from time to time, especially at large family celebrations. But if you do, get ready to pay the  price.
• Watch your weight – obesity increases your risk for heartburn
• Ditch or at least moderate your alcohol and caffeine intake.

If your heartburn is frequent, try raising the head of of your bed. It’s got to be a least six to eight inches. Just piling up pillows is not effective and may be uncomfortable. You have to lift your torso, not just your head.

Heartburn remedies for seniors

As a senior, you may prefer traditional acid-reflux remedies

Two of the acid reflux remedies below have some scientific validity. The others? Some people swear by them, but there’s no scientific proof that they work.

• Baking soda, sweetened with a little honey. It will temporarily neutralize stomach acid. Try a heaping teaspoon in a tall glass of water, sweetened with honey or sugar because it taste awful. Don’t overuse it unless you enjoy belching, bloating, stomach cramps and slight pain or discomfort. There has been some scientific validation for this approach.
• Chew gum. Chewing gum immediately after a meal for 30 minutes to an hour  produces a real decrease in acid reflux symptoms according to independent scientific studies and can help soothe the throat by encouraging saliva production. My son swears by sugarless Juicy Fruit ®. Definitely stay away from peppermint, mint, or spearmint flavour – they only make things worse.
• Apple cider vinegar (a tablespoon)  mixed with honey and water is believed by some to alleviate heartburn symptoms. There’s not much research that says this is so.
• Try a cup of warm ginger tea. There’s no evidence that confirms it works on acid reflux, but it may have a calming effect on your digestion. Be sure the ginger tea contains no caffeine. And many people find it’s a good idea to avoid drinking anything for at least a couple of hours before bed time.
• Probiotic supplements. You can get probiotics in yogurt. Or buy a supplement. Some researchers have theorized that daily use of a supplement can make the lining of the gastrointestinal tract stronger, thereby protecting it from bacteria and excess acid.

Gaviscon – a different kind of acid reflux treatment

Although he’s not a senior, my son swears by Gaviscon.

This product creates a protective barrier between the top of your stomach and your esophagus (throat).

This barrier prevents stomach acid from splashing back up (refluxing) into your esophagus, essentially performing the function of your Lower Esophageal Sphincter (LES). Blocking acid reflux, in turn, prevents the painful sensation of heartburn.

The foam is activated when it comes into contact with stomach acid.

The Alginic acid in Gaviscon® tablets is derived from extract of brown seaweed. The raw material source is 100% natural, non-toxic and safe for human consumption. (note that this product is available in Canada. The American version of Gaviscon is not a foaming product).

And then there’s yoga for acid reflux. Yes, yoga!

Yoga acid reflux treatment for seniors

I saw CNN’s program Chasing Life, in which its health expert Dr. Sanjay Gupta (a neurologist) travels to countries where people live exceptionally long and healthy lives and tries to learn what enables them to do so.

In India, Dr. Gupta interviewed its prime minister, Narendra Modi, who practices and promotes yoga. During the interview, he demonstrated a yogic treatment for acid reflux.

Strange as it seems, this is it. All I can tell you is that I’ve used it five times, four while lying on my side about to go to sleep, when I felt a reflux attack coming on. It worked.

1. Place a finger over one nostril. Either side of your nose.
2. Curl your tongue the long way:
3. Inhale through your nose and exhale through your mouth as necessary to tame the acid reflux.

My first try, I breathed three times, the second four, the third seven. The fourth time, I inhaled and exhaled about nine times.

I have no idea why this should have worked. But it did. Every time. Next time you feel an acid reflux attack coming on, give it a try.

Worst case, it won’t work and you can pop an antacid as usual.

There are many approaches to yoga and heartburn on the Internet. Although I did a form of yoga over forty years ago, most of what I’ve looked at is more yoga than I feel like doing these days. That doesn’t mean you can’t try them. It would be best to join a yoga group and get proper instruction.

Acid reflux, GERD or  heartburn. Whatever you call it, there are many ways to manage it.

Handle it right and you may yet be able to enjoy your meals again. Bon appetit!