A beginner's guide to indigestion and heartburn

Almost half of all adult North Americans have indigestion occasionally, but for some, it is a daily trial.  As these guidelines will suggest, heartburn caused by reflux can usually be controlled with a few lifestyle changes, starting with adopting a low-fat diet that includes a balance of protein, starches and fibre-rich vegetables and fruits.

The most common symptom of ­indigestion is heartburn, a burning chest pain that occurs when stomach acid and other contents flow backward, or reflux, into the oesophagus. Unlike the stomach, the lining of the oesophagus has no protective lining of mucus-producing tissue, so the acid produces irritation and even ulcerations.

Obesity and pregnancy may lead to heartburn because of increased intra-abdominal pressure, which tends to force the stomach fluids up into the oesophagus. A hiatal hernia is another possible cause.

• Coffee, including decaffeinated brands, promotes high acid production; so do tea, cola drinks and other sources of caffeine.
• Citrus fruits and juices can also cause problems.
• There is no evidence that spicy foods — except possibly, red and black pepper — cause indigestion, but people who find that a spicy meal is followed by discomfort would be better off shunning such seasonings.
• Reflux is made worse by foods such as chocolate or peppermint that relax the sphincter muscle connecting the oesophagus to the stomach.
• Avoid large meals, especially late in the day.
• Try not to eat in the two hours before bedtime.
• Sit up straight after meals; bending over or lying down increases pressure on the stomach and promotes reflux.
• Stop smoking; nicotine relaxes the sphincter muscle.
• Limit alcohol intake to an occasional glass of wine or beer.
• The use of non-prescription antacids to treat heartburn by neutralizing stomach acid is questionable; the problem is not too much acid, but acid in the wrong place.  If you find that they do help, follow instructions and never take them for longer than recommended.

• Small meals at regular intervals.

• Alcohol, caffeine, and coffee in all forms.
• Tomato-based and other acidic foods.

• Fatty foods.
• Eating within 2 hours of bedtime.
• Tobacco use of any kind.