Heartburn

Such painful pleasures

Damien McCrystal

IT is Friday lunchtime. You have a bit of a hangover and decide to go for a curry to help you get over it. On arriving at the restaurant, to quench your intense thirst you order a vodka and tonic (drip). Your poppadoms, covered in chutney and chopped raw onions (drip, drip), are washed down with white wine (bloop). After a couple of mouthfuls of very spicy chicken Madras curry (swirl), you decide to switch drinks from wine to ice-cold lager (tremor). When the food is finished, you light a cigarette (simmer), then order a cup of coffee (gurgle) with accompanying complimentary chocolate (bubble) and, because it is Friday, a glass or two of Cognac (boil).

By now there are small geysers erupting in your stomach every few minutes, perhaps constantly. You leave the restaurant, and as the fresh air hits you so do the effects of the alcohol. But two unpleasant changes in your physiology are taking place. First, the alcohol will have interfered with the normal pattern of oesophageal convulsions, which continue to push food and drink into your stomach after you have swallowed. The booze relaxes your muscles and makes this pattern irregular, leaving the spices and other irritants in the oesophagus longer than they should be.

Second, and more importantly, your lower oesophageal sphincter, the valve which keeps your stomach's natural hydrochloric acid out of the oesophagus, also relaxes and parts like continental plates shifting to allow the eruption of lava.

The acid needs no further invitation and begins to spurt upwards. If you are walking briskly back to work, a little stressed from having lingered too long over lunch, it will spurt even harder. If you, understandably, decide on a light snooze on the sofa in your office before heading home, more acid floods in and rises nearer to your throat. It might get all the way there, in which case you will probably cough and inhale a little into your lungs.

Your stomach has natural protection against both the acid it creates and that which you put in it. The oesophagus has no such protection, and the acid immediately starts to scorch it. That is heartburn or, as physicians call it, gastro-oesophageal reflux. It can be extremely painful, especially in the lungs. To an extent, you have brought it upon yourself. Everything you have ingested either imports fresh acid into your stomach or encourages the stomach to produce excess supplies of its own. Some do both. The brisk walk at the end will have increased the effects significantly, and the slight stress might offer a small contribution. If you have eaten and drunk large amounts, that makes it worse, If your belly swells to the point that your waistband is uncomfortably constricting, it is worse still.

If you suffer heartburn often, and fail to treat it, eventually your oesophagus will be damaged, perhaps permanently. In the worst cases, the cells become so injured that they begin to change, exposing you to a greater risk of oesophageal cancer, So, what to do? In America, where an estimated 60 million people regularly squirt stomach acid, the National Heartburn Alliance (no, honestly) makes the quite disgusting suggestion that you should keep a Personal Reflux Record' to help you identify 'trigger' foods and drinks.

These tend to include all citrus fruits, chocolate, peppermint, spearmint, tomatoes or tomato-based products, raw onions, garlic, black pepper, vinegar, fatty or spicy foods, coffee, citrus juices, caffeinated or carbonated beverages' and, of course, alcohol. It is a profoundly depressing list, for it includes more than just a few of my favourite things. Fizzy drinks could be cut Out, I suppose, apart from the one which goes with vodka, and I could reduce my intake of tomatoes and even mint (unless with roast lamb). But the other things are fundamental to my enjoyment of life.

One thing that should help, though, is to avoid the alcoholic drinks which are most likely to trigger an attack. Chief among these is definitely champagne. The moment it touches my tongue, my stomach responds in anticipation, brewing up a great vat of acid ready to hurl upwards. Not only is it made of white wine — the second-worst culprit — but it is also fizzy.

An oenophile luncheon companion, with whom I have shared many packets of Rennies over the years, gives the considered opinion that all champagne should be spurned, but if it cannot be avoided, then Dom Perignon, Taittinger and Pol Roger are the least acidic.

Among non-fizzing whites, we are in agreement that Burgundies are the worst. He favours Loires but I have recently discovered white Cotes du Rhones, and they are remarkably low on acid production.

As for the reds, again Burgundies, particularly those which are not aged, are liquid fire, So are many of the wines of Spain and Italy, and the price you pay seems to make no difference. Claret, however, is king of reflux-avoidance.

Neat whisky can be very painful, but in the days when I drank lots of it I found that, mixed with tap water, it was more likely to soothe than upset. This is perhaps because tap water contains quantities of acid-neutralising calcium.

Brandy can be vicious on an already raw oesophagus. Mixing it with tap water also helps here but may offend your host who has just poured you a balloon of rare old Cognac. His irritation can produce stress which cancels out the beneficial effects of the water. Brandy mixed with port is said to soothe a troubled tummy, but after repeat ed trials I know it does not work for me.

Guinness is one of the most wonderful drinks in the world but may be likened to molten tar for the effect it has on its way through you, particularly after consecutive days of drinking it. Combined with champagne in Black Velvet, it is a recipe for intense pain.

The only alcohol I ever found to actively alleviate heartburn is Pernod. Immediately on drinking it, I would feel better — so much so that, increasingly, I came to rely on it. But it got the better of me, which culminated in a harsh and painful collision with a wall and then several months of rueful abstinence. Pernod is recommended only in emergencies.

All that said, it's really not all your own fault. Sympathetically, the National Heartburn Alliance says, 'Too many heartburn sufferers believe that they are to blame for this painful malady. While it is true that certain lifestyle habits and the foods you eat may aggravate your heartburn symptoms, many people make significant lifestyle changes to prevent heartburn and still experience heartburn. Heartburn is a medical condition with real biological causes, and heartburn sufferers need not compound their discomfort with shame and guilt.'

Ws a heartwarming message.