Heartburn and acid indigestion: 9 home tips that really help (and baking soda, with caution)

A big dinner, a spicy sauce, lying down right after eating... and then comes the burning that rises from your stomach into your chest and sometimes leaves a sour taste in your mouth. That's heartburn, the main symptom of gastroesophageal reflux. It's estimated that around one in five adults in Western countries experiences it at least once a week.

Why it happens

Between the esophagus and the stomach there's a ring of muscle, the lower esophageal sphincter, that acts like a valve: it opens to let food through and closes to stop stomach acid from coming back up. When that valve relaxes at the wrong time, or when there's a lot of pressure in the abdomen, acid rises and irritates the esophagus, which isn't built to handle it.

Things that make it more likely: large, fatty or spicy meals, alcohol, smoking, excess weight, pregnancy, tight clothing and some medications, such as certain anti-inflammatory drugs.

The changes that help most

1. Wait before lying down

Leave at least 2 to 3 hours between dinner and bedtime. Lying down on a full stomach is one of the most common causes of nighttime reflux.

2. Raise the head of your bed

Lifting the head of the bed about 15 to 20 centimeters (6 to 8 inches), with blocks under the legs or a wedge under the mattress, reduces nighttime reflux. Stacking pillows doesn't work as well because it bends your abdomen.

3. Sleep on your left side

Several studies have found that sleeping on your left side is linked with fewer reflux episodes than sleeping on your right, probably because of the stomach's position.

4. Eat smaller meals

Spread your food over smaller, more frequent portions, and eat slowly.

5. Identify your triggers

Not every food affects everyone the same way. The most common triggers are fried food, fatty meals, chocolate, mint, coffee, fizzy drinks, alcohol, citrus, tomatoes and spicy food. Keeping a simple food diary for two weeks helps you pinpoint yours, rather than cutting out everything.

6. Lose weight if you need to

Excess belly fat increases pressure on the stomach. A study of more than 10,000 nurses found that lowering body mass index was associated with fewer reflux symptoms.

7. Quit smoking and limit alcohol

Both relax the esophageal sphincter and irritate the lining.

8. Wear loose clothing

Tight belts and waistbands press on your abdomen, especially after meals.

9. Chew sugar-free gum

Chewing gum after eating boosts saliva production, which helps neutralize acid and wash it out of the esophagus. Skip mint flavors if you notice they bother you.

Popular remedies, one by one

• Baking soda: it neutralizes acid quickly (half a teaspoon in a glass of water). But it's very high in sodium, isn't suitable for people with high blood pressure, heart or kidney failure, or for pregnant women, and shouldn't be used regularly. Taking it on a very full stomach can cause bloating. It's an occasional fix, not a treatment.
• Milk: it soothes for a moment, but its fat and protein can trigger more acid afterward. The effect is short-lived.
• Apple cider vinegar: hugely popular online, but there are no solid studies supporting it, and because it's acidic it can make irritation worse for some people.
• Ginger: it can help with nausea; in large amounts it causes heartburn in some people.
• Chamomile: a mild tea can be relaxing; evidence for heartburn is thin, but it's safe for most people.
• Aloe vera: some products are marketed for reflux, but aloe containing latex is a laxative and shouldn't be taken without professional advice.

What about medication?

Over-the-counter antacids relieve occasional episodes. If you find yourself needing them often, see your doctor: there are other treatments, such as proton pump inhibitors (omeprazole and similar drugs), which should be used with medical advice and periodic review, because long-term unsupervised use isn't free of side effects.

Warning signs

See a doctor promptly if you have difficulty or pain swallowing, a feeling that food is getting stuck, vomit containing blood or material that looks like coffee grounds, black stools, unexplained weight loss, anemia, or heartburn that appears for the first time after age 55. Also if symptoms last more than two or three weeks despite making changes.

Be careful: chest pain with sweating, shortness of breath, pain spreading to the arm, jaw or back, or dizziness can be a heart attack, not heartburn. In that case, call emergency services immediately.