Dear HEALTHbeat subscriber,

Maybe it was that new cuisine you tried last night or overindulgence at a holiday meal, but at one time or another, most of us have dealt with the unpleasantness of heartburn. For most people it’s a thankfully rare occurrence. But for 19 million Americans, gastroesophageal reflux disease, or GERD, is a chronic problem. This issue of HEALTHbeat explores the most common causes of GERD and gives you eight ways to manage this bothersome condition. Also in this issue, Dr. Walter Willett, Harvard Heart Letter editorial board member, discusses whether grapes and grape juice have the same heart-healthy properties as wine.

Wishing you good health,


Nancy Ferrari
Managing Editor
Harvard Health Publications
HEALTHbeat@hms.harvard.edu

What is GERD?

The ring-like muscles of the lower esophagus that prevent foods you swallow from returning from the stomach back into the esophagus is called the lower esophageal sphincter (LES). When your stomach is full, a tiny amount of food can sneak back into the esophagus when you swallow — that’s normal. But in people with GERD, substantial amounts of stomach acid and digestive juices backwash into the esophagus.

Heartburn and “acid indigestion” are the most common result. A burning pain is typical, and when it’s accompanied by burping or bloating, it points to GERD as the cause. But there are “hidden” signs of GERD that are noticed in the lungs, mouth, and throat:

Mouth and throat symptoms

• A sour or bitter taste in the mouth
• Regurgitation of food or fluids
• Hoarseness or laryngitis, especially in the morning
• Sore throat or the need to clear the throat
• Dental erosions
• Feeling that there is a “lump in the throat.”

Lung symptoms

• Persistent coughing without apparent cause, especially after meals
• Wheezing, asthma.

Causes

Poor function of the LES is responsible for most cases of GERD. A variety of substances can make the LES relax when it shouldn’t, and others can irritate the esophagus, making the problem worse. Other conditions can simply put too much pressure on the LES. Some of the chief culprits in GERD are shown below.

Therapy: Lifestyle

Some people with GERD need to turn to medications to relieve symptoms and prevent possible long-term damage to the esophagus. But simple lifestyle modifications can control heartburn and other GERD symptoms. Here are eight tips:

1. Don’t smoke. It’s the first rule of preventive medicine, and it’s as important for GERD as for heart and lung disease.
2. Avoid foods that trigger GERD (see “Common causes of GERD symptoms,” above).
3. Consider your medications. If you are taking certain painkillers, antibiotics, or other medications that can irritate the esophagus or contribute to GERD, ask your doctor about alternatives, but don’t stop treatment on your own.
4. Avoid large meals and try to be up and moving around for at least 30 minutes after eating. (It’s a good time to help with the dishes.) Don’t lie down for two hours after you eat, even if it means giving up that bedtime snack.
5. Use gravity to keep the acid down in your stomach at night. Propping up your head with an extra pillow won’t do it. Instead, place four- to six-inch blocks under the legs at the head of your bed. A simpler (and very effective) approach is to sleep on a large, wedge-shaped pillow. Your bedding store may not carry one, but many maternity shops will, since GERD is so common during pregnancy. And because GERD is also so common in general, you won’t be the only man or woman looking for a pillow in a maternity shop.
6. Chew gum, which will stimulate acid-neutralizing saliva.
7. Lose weight.
8. Avoid tight belts and waistbands.

For more information on digestive disorders, order our Special Health Report, The Sensitive Gut, at www.health.harvard.edu/SG.

Q: For the health of my heart and arteries, how does regular consumption of red wine compare with grape juice or the equivalent in grapes?

A.You are asking a question that science hasn’t caught up with, especially when it comes to grape juice and grapes. Let’s start by looking at what you get with each of these.

Grapes of all colors are chock-full of antioxidants and myriad other phytonutrients. Some that have been identified as possible cardioprotectors are flavonoids such as resveratrol and quercetin, procyanidins, tannins, and saponins. But keep in mind that the grapes you find in the grocery store aren’t necessarily as hearty as those used for making wine and grape juice. And unless you eat the seeds along with the grapes, you won’t get the nutrients sequestered there. Wine and grape juice contain substances leached from seeds, which are crushed during the pressing process. Grapes offer a small amount of fiber, which is good for the heart and digestive system, something neither wine nor grape juice deliver. It takes about 8 to 10 ounces of grapes (nearly two cups worth) to make a glass of wine or grape juice.

Grape juice (not to be confused with grape-flavored “drinks,” which are mostly sugar water) delivers slightly more antioxidants and other phytonutrients than its equivalent in grapes. Red wine, like grape juice, is a rich brew of antioxidants and phytonutrients. And it contains alcohol, something not found in either grapes or grape juice.

What is known about the ability of different forms of the grape to protect the heart? A few small studies have shown that red and purple grape juices reduce the stickiness of platelets, a key player in blood clotting. Grape juice also slightly raises HDL, reduces inflammation, and improves the ability of blood vessels to relax. (The “dose” in these studies was two 8-ounce glasses of purple grape juice a day.) So far, though, there is no evidence that drinking grape juice has an effect on the things we really care about, like fewer heart attacks or longer lives. University of Connecticut researchers have shown that mice fed the flesh of grapes are just as protected against experimentally induced heart attack damage as mice fed grape skins. Whether that translates to humans remains to be seen. In fact, there is reason to believe that the amount of flavonoids in one to two glasses of grape juice is far short of what would be needed to have important health benefits. Also, don’t forget that grapes are high in natural sugars, which are fine in small to moderate amounts. But consuming large amounts, which is easy to do in the form of juice, could well increase your weight, not to mention your risk of type 2 diabetes and heart disease.

In contrast, there is solid evidence that alcohol in moderation offers some protection against heart disease and ischemic (clot-caused) stroke and that it probably reduces premature deaths in healthy people as well as those with diabetes, high blood pressure, and other chronic conditions. Although red wine initially looked to be special in this regard, any alcohol-containing beverage — red wine, white wine, beer, cordials, and spirits such as gin or Scotch whisky — offers similar protection. Alcohol may do this by raising HDL (good) cholesterol, hindering the formation of artery-blocking blood clots, easing inflammation, or by some other as-yet-undiscovered route. The key is moderate drinking. This means no more than two drinks a day for men and one a day for women.

There are better ways than grapes or alcohol to protect your heart. You know the list: exercising, following a healthful diet, not smoking, maintaining a healthy weight, easing stress.

If you enjoy wine, then savor it. If the rich flavor of grape juice gets your engine running in the morning, bottoms up with a small glass. If you love snacking on grapes, crunch away. These are beverages and foods to enjoy, not heart-protecting medicines to take on some arbitrary schedule.

This Question and Answer first appeared in the March 2007 Harvard Heart Letter, available at www.health.harvard.edu/heart.

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