What helps heartburn? Causes, tips and nutrients

You've just had a rich, heavy meal, and then it starts: a burning behind the breastbone, sometimes with a sour taste rising into your mouth. In Western countries, up to 25 out of 100 people get these symptoms again and again¹. It's mostly harmless, but it's a nuisance. This article explains what helps heartburn, what studies say about the well-known tips and when you need medical advice.

What is heartburn, and what are the symptoms of reflux?

Where the oesophagus (gullet) meets the stomach, there's a valve, a ring of muscle called a sphincter. It opens when you swallow and closes again afterwards. If it slackens, for example when the stomach is very full and stretched after a large meal, stomach acid rises and irritates the lining of the oesophagus¹. You feel this as a burning that moves from the upper abdomen or from behind the breastbone up towards the throat¹.

If this happens very often or very severely, it's known as gastro-oesophageal reflux disease (GORD). Besides heartburn, typical symptoms include acid regurgitation (sour-tasting burps), difficulty swallowing, a burning feeling in the throat or a bad taste in the mouth¹. A dry, tickly cough or hoarseness can also be part of it, when stomach acid irritates the airways¹.

What causes heartburn?

Why this valve doesn't close properly often remains unclear. In some people, the cause is a hiatus hernia, where part of the stomach slides up through the diaphragm¹. Experts are also looking at whether being overweight, smoking and alcohol play a part¹. Many people with heartburn notice that stress, certain foods, bending over or lying down make their symptoms worse¹.

Some medicines can also make heartburn worse¹. So don't stop a prescribed medicine on your own: mention your symptoms to your GP instead.

What helps heartburn in everyday life?

Not every tip has been studied well enough to say how much it helps². They're still worth a try, because they cost little. The clearest evidence is for losing weight if you're overweight and for measures against heartburn at night³.

• Lose weight if you're overweight: in two studies, after people lost weight, the proportion of time with acid in the oesophagus fell, for example from 8.0% to 5.5%³.
• Eat smaller portions: very large or high-calorie meals can trigger symptoms².
• Find your triggers: people with heartburn often don't tolerate certain foods well, for example coffee, chocolate, fatty or spicy food, citrus fruit or fizzy drinks². Try leaving them out for a while and see what changes.
• Less alcohol, no smoking: both can help². In a large observational study, people of normal weight had fewer reflux symptoms after they stopped smoking³.
• Stay upright: during and after a meal, stay upright for a while rather than lying down straight away⁴.

Not every tip helps everyone. Slim people who eat a low-fat diet can get heartburn too², and it often takes some patience to find out what your personal triggers are².

What can you do about heartburn at night?

Many people wake up at night with a burning feeling in the oesophagus². If that sounds familiar, it's worth looking at the time between your evening meal and going to bed. In a study of 147 reflux patients and 294 people for comparison, those who went to bed less than three hours after their evening meal had about 7.5 times the odds of being in the reflux group compared with those who waited four hours or more⁵. This shows a link, but it doesn't prove cause and effect.

In studies with measurements, acid stayed in the oesophagus for longer while lying down after a late evening meal than after an early one³. Raising the head end of the bed reduced the proportion of lying time with acid contact from 21% to 15%³. Some people also prefer to lie on their left side, because the valve at the entrance to the stomach then sits higher².

How can you reduce stomach acid?

If everyday measures aren't enough, medicines may be an option. Proton pump inhibitors slow down the production of stomach acid and are considered the first-choice drug treatment in the clinical guideline for doctors^2,4. In studies, after two to eight weeks, 70 out of 100 people taking them had hardly any heartburn left, compared with 25 out of 100 taking a dummy treatment (placebo)².

There are also medicines that bind acid in the stomach (antacids) and others that reduce the release of stomach acid in a different way². Some of these are available from a pharmacy without a prescription². Which medicine suits you, and how long you take it, is best discussed with your GP or pharmacist.

Magnesium for heartburn: what's behind it?

Magnesium is an ingredient in some remedies for heartburn and acid regurgitation⁶. These antacids are designed to bind and neutralise stomach acid². A magnesium food supplement isn't intended for this, and there's no authorised health claim for magnesium in relation to heartburn⁷.

The authorised health claims cover other areas: magnesium contributes to normal muscle function and to normal functioning of the nervous system⁷. In addition, magnesium contributes to a reduction of tiredness and fatigue⁷. If you'd like to top up your magnesium intake for these reasons, our article comparing the different forms of magnesium explains the options.

If you already take a heartburn remedy that contains magnesium, ask your pharmacist whether an additional supplement is right for you. Don't take more than the recommended daily amount, and if you take any medicines, get medical advice first.

When should you see a doctor about heartburn?

Occasional heartburn after a big meal is mostly harmless¹. If you get it very often or badly, or it doesn't improve despite the changes you've made, have it checked by a doctor. See a doctor promptly if you notice any of these warning signs⁴:

• Difficulty swallowing
• Unintentional weight loss
• Signs of bleeding in the digestive tract, for example blood in your stools

Frequently asked questions about heartburn