Anybody can get heartburn, even the skinniest person you know, but the more excess weight you carry the more likely it is, researchers have long suspected.
Now a new study offers some surprising news: Gaining just a few extra pounds can boost your heartburn risk, even if your body mass index (BMI) is still within the so-called healthy range.
Another recent study offers somewhat reassuring news: If you lose that excess weight, it may be one of few lifestyle changes you'll need to make to find heartburn relief. Yes, you might be able to keep sprinkling those hot pepper flakes on your pizza!
Heartburn, a burning, painful feeling felt around the middle of your chest, affects about 60% of people at some time each year.
That discomfort is caused when stomach juices, full of acid, flow backward, up into your esophagus. At the root of the problem is the lower esophageal sphincter. When this muscular ring is too relaxed -- or not working correctly -- it can't keep stomach acid in its place.
But heartburn isn't just about the discomfort. If severe or persistent -- and left untreated -- it can lead to the more serious condition of gastroesophageal reflux disease (GERD). And that in turn can boost your risk of esophageal cancer or ulcers of the esophagus.
Weight Gain and Heartburn Risk
While medications are readily available to treat heartburn, lifestyle changes are likely to be advised first. That's where your weight comes in.
"Any excess body fat gives you excess risk for having heartburn," says Brian C. Jacobson, MD, MPH, assistant professor of medicine and a gastroenterologist at Boston University Medical Center, Massachusetts.
Exactly why this is true isn't certain, but one speculation is that surplus fat around the belly causes increased pressure against your stomach, causing fluid to rise up.
"We can say for sure that men and women have a higher risk of heartburn when they are obese [compared to those of normal weight]," Jacobson says. But gaining just a bit of weight, even if your BMI still falls within the normal range, can boost your heartburn risk, too, reports Jacobson and colleagues in The New England Journal of Medicine.
The recent study focused on women (though Jacobson suspects findings hold true for men, too) who self-reported their weight at age 18 and then compared it to their weight when they were 52 to 77 years old.
Women with a normal BMI (under 25) at the start of the study, who then had an increase in BMI of more than 3.5 points, had a nearly three times greater risk of getting acid reflux symptoms than did those with no weight changes.
That means, for instance, if a 5-foot-4-inch woman with a starting weight of 120 pounds (a BMI of 20.6) gains 21 pounds, boosting her BMI to 24.2, she nearly triples her risk of frequent symptoms, although she is still not officially overweight.
In all, Jacobson's team evaluated 10,545 women; 22% said they had heartburn at least once a week.
"There may be more to putting on 10 pounds than just having to buy new pants," Jacobson says, hoping his study will be another motivator helping people to keep weight down.
To start losing excess weight, he says, "people sometimes need a kick in the pants or sometimes a burn in the chest."
Lose Weight, Lose the Heartburn
Another study, published in the Archives of Internal Medicine, found that weight loss and elevating the head of the bed are the most effective lifestyle interventions for reducing heartburn.
Lauren Gerson, MD, MSc, director of the Esophageal and Small Bowel Disorders Center at Stanford University School of Medicine, and her colleagues, evaluated 16 clinical trials looking at the impact of lifestyle changes on heartburn, including:
- Losing weight.
- Avoiding foods and drinks that trigger heartburn.
- Changing sleeping position.
- Avoiding late-night eating.
- Avoiding cigarettes.
"The only thing that matters is losing weight and elevating the head of the bed," she says. While changing the other habits might improve the acid levels in the esophagus, there was not enough evidence that changing them also improved heartburn.
Gerson set out to do the study after patients referred to her complained that despite following a bland diet their heartburn symptoms didn't improve. "People were very annoyed that their diets were so limited and their heartburn [was] no better."
If certain spicy foods or some beverages are known to trigger your heartburn, of course, it's wise to avoid them, she tells patients. But for those whose heartburn gets no better with a bland diet, she has a simple two-step plan:
- Lose weight.
- Elevate the head of the bed.
"Being overweight is an independent risk factor for heartburn," Gerson says. So if your heartburn isn't improving despite several lifestyle changes, maybe it's time to talk with your doctor about a sensible weight loss and exercise plan to get you below a BMI of 25.