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RENEE MONTAGNE, HOST:

This is MORNING EDITION from NPR News. Good morning. I'm Renee Montagne.

DAVID GREENE, HOST:

And I'm David Greene.

Today in Your Health, getting the right amount of calcium. But first, heartburn. Lots of us experience it. And for a growing number of Americans, reflux is a chronic problem. What you're eating and drinking can play a role in triggering the uncomfortable condition, but as NPR's Allison Aubrey explained, not in the way you might think.

ALLISON AUBREY, BYLINE: The two middle-aged guys I'm about to introduce you to - both suffer from heartburn. But what triggers their attacks seems to be very different. Brian Kobul(ph), who recently celebrated a milestone birthday had a bad case of reflux the night of his birthday dinner.

BRIAN KOBUL: It was a very heavy meal. Yes, it was. Yes.

AUBREY: Paint the picture. Were there a lot of people there? Like what was on the menu?

KOBUL: It was at a steakhouse, lot of steak, potatoes, very unhealthy food. Yeah.

AUBREY: And by 1 A.M., when he finally made it to bed, he remembers that burn that started right behind his breastbone.

KOBUL: The, you know, burning, you know, up and down, up and down, you know, rising and falling.

AUBREY: One contributor to the heartburn was likely the heavy meal. But Kobul suspects something else was at play, too.

KOBUL: I think it was probably more what I was drinking with it, actually, the, you know, liquor.

AUBREY: There was bourbon and other types of whiskey. Dr. Kevin Ghassemi is a gastroenterologist at UCLA. He has treated lots of people with heartburn, or reflux. Now, Kobul is not his patient, but he says this hunch about alcohol as a trigger for heartburn is spot on.

DR. KEVIN GHASSEMI: That's correct. It's not surprising. Alcohol has a direct effect, temporarily, of course.

AUBREY: Ghassemi says in the body there's a ring of muscle at the junction between the stomach and the esophagus. It opens and closes like a valve.

GHASSEMI: The muscle is normally supposed to be closed, except when the food is passing through the esophagus.

AUBREY: But he says as alcohol relaxes this muscle it can create a gap or opening, in essence breaking the seal that protects the esophagus from the acid in the stomach. And when this happens...

GHASSEMI: The acid can come back up into the esophagus, and that's reflux.

AUBREY: That's what creates the burning sensation.

GHASSEMI: And so this gentleman is more likely to have reflux because the sphincter muscle is relaxing more frequently.

AUBREY: Now, clearly not every gets reflux after drinking alcohol. Some people are predisposed; they may have a weak or faulty sphincter muscle to begin with. Being overweight increases the risk, too.

Now, Kobul's buddy, Jamie Chan, suffers with heartburn. too. And he's got another habit that may be a trigger: coffee.

JAMIE CHAN: I probably drink four cups, four or five cups a day.

AUBREY: And has anybody ever told you that that's a trigger for heartburn?

CHAN: No.

AUBREY: Physician Kevin Ghassemi says it works similar to the booze.

GHASSEMI: The caffeine that's in coffee or other caffeinated beverages also will relax the sphincter muscle.

AUBREY: Making reflux more likely. But Chan says his heartburn isn't bad enough to give up coffee.

CHAN: And what am I going to use as a stimulant instead of the caffeine?

(LAUGHTER)

CHAN: That's the tradeoff.

AUBREY: Cutting back on coffee or alcohol may or may not help. Oftentimes, Ghassemi says, people with chronic reflux need prescription medicines to treat the problem.

Now, lots of people have heard that certain foods can cause heartburn. At the top of the list are spicy and acidic foods, such as tomato sauce. But researcher Karthik Ravi of the Mayo Clinic says there's limited evidence that these foods actually increase acid secretion. And many heartburn patients do fine after eating them.

DR. KARTHIK RAVI: People are kind of afraid of drinking of orange juice or tomato sauce, things like that. And really there's no clear link between those types of foods and acid reflux.

AUBREY: He's published a study that found alkaline foods, thinks like burgers and shakes that are not acidic at all, also led to heartburn in people prone to it.

RAVI: So really, what that tells us is, you know, it doesn't really matter what you eat and if you think of it as acidic or not, because you're really refluxing acid that your stomach itself is making.

AUBREY: And the stomach makes acid regardless of what you eat. It's more likely that the fat in a heavy meal will exacerbate the problem, because fatty foods stay in the stomach longer and can prompt more acid production. Ravi tells his patients to use the law of common sense. We're all different, so if a particular food bothers you, by all means avoid it. But in general, Ravi's advice is this: eat the foods you enjoy.

RAVI: There's more of a focus on modifying how you eat rather than necessarily what you eat.

AUBREY: He says, slow down and cut your portions. And it may also be good for the waistline.

Allison Aubrey, NPR News.

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