Bij brandend maagzuur kunt u gerust chocolade of specerijen eten.*
Uit een analyse van meer dan 2.000 studies over brandend maagzuur blijkt dat het advies om onder deze omstandigheden geen chocolade, wijn, vet, sinaasappelsap of scherpe specerijen te gebruiken, niet gestoeld is op wetenschappelijke feiten. Uit geen enkel onderzoek blijkt dat de genoemde zaken het probleem doen verergeren of een herstel doen belemmeren.
Chocolate,
Wine, Spicy Foods May Be OK For Heartburn, Stanford Study Finds
Patients
have been known to hug Lauren Gerson, MD, so overjoyed are they at hearing her
words. What does she say to them? Go ahead and eat chocolate. Indulge your
passion for spicy cuisine. Drink red wine. Enjoy coffee when you want it, have
that orange juice with breakfast and, what the heck, eat a grapefruit, too.
Gerson says that for most heartburn patients, there's insufficient evidence to
support the notion that eating these foods will make heartburn worse - or that
cutting them out will make it go away.
Many of Gerson's patients walk into her clinic upset, having been advised
elsewhere to severely limit their diets to help reduce their heartburn symptoms.
But recent research by Gerson, assistant professor of medicine at the Stanford
University School of Medicine, indicates there's no evidence to support a need
for dietary deprivation, except for the unlucky few whose heartburn is clearly
triggered by a particular food.
Gerson's advice runs counter to the long-standing recommendations of virtually
every professional organization of gastroenterologists, including the American
College of Gastroenterology, as well as the National Institutes of Health. For
the past 15 to 20 years, the standard treatment for heartburn has been to cut
out the aforementioned culinary joys - along with fried and fatty foods, all
alcoholic and carbonated beverages, tobacco and mint - and to stop eating three
hours before lying down. In addition, you're advised to keep your weight under
control. Those lifestyle changes coupled with antacids and various
over-the-counter and prescription medications have been the accepted first line
of treatment.
But Gerson, a practicing gastroenterologist and director of Stanford's
Esophageal and Small Bowel Disorder Center, said the stream of "very
unhappy" patients referred to her clinic by outside doctors caused her to
doubt the efficacy of the usual treatment advice. "The patients were on
very bland diets and cutting out coffee and wine and everything that they enjoy
- and basically their heartburn wasn't getting any better," she said.
"So I decided that maybe it's time to look and see if these lifestyle
measures really work."
In a May issue of Archives of Internal Medicine, Gerson and two other physicians
at the School of Medicine - Tonya Kaltenbach, MD, and Seth Crockett, MD -
published the results of a systematic survey they conducted of more than 2,000
studies published worldwide on heartburn, also known as acid reflux or GERD (gastroesophageal
reflux disease), between 1975 and 2004. They found 100 studies looking at
lifestyle factors thought to be associated with heartburn. Only 16 of those
studies examined how implementing lifestyle changes affect heartburn symptoms,
and these studies were the focus of their article.
Their conclusion: There is currently no evidence to show that any of the dietary
restrictions usually recommended make a difference. They found only two
lifestyle changes for which there was evidence of a clear benefit from making a
change. First, if you're overweight, then losing some pounds will reduce or even
eliminate the amount of heartburn you suffer. Second, raising the head of your
bed will cut down on the amount of stomach acid that can enter your esophagus
while you sleep.
But Gerson noted a conundrum in her counsel. Although there is no evidence that
ceasing consumption of the suspect foods will reduce heartburn, some of the
studies did show that certain of the foods (such as chocolate and carbonated
beverages) can reduce the pressure exerted by the esophageal sphincter, the
control valve that keeps the food you've swallowed and your digestive acids down
in your stomach, where they belong.
Heartburn is most commonly caused when the esophageal sphincter relaxes more
often than it is supposed to, allowing stomach acid to flow up into the
esophagus. That causes a burning sensation behind the breastbone or acidic fluid
surging up into the mouth. So it might seem logical to think that if a
particular food has been shown to cause a loosening of the sphincter, then
eliminating that food from your diet would allow the sphincter to tighten up,
thus reducing your heartburn. But, no, said Gerson, that doesn't necessarily
seem to be the case, because simply eliminating a certain food doesn't fix the
main problem of the esophageal sphincter relaxing too readily.
Gerson's experiences with her patients back that up.
"It's very rare to see a patient who says, 'Oh, I just changed my diet and
everything got better,'" she said, "though this might be the case for
patients with milder heartburn symptoms who never walk into the doctor's office
for advice."
The cause of the conundrum lies in the nature of the studies that have been done.
They generally looked at whether a particular food decreased the pressure
exerted by the sphincter or increased the acidity in the stomach, but not at
whether taking that food out of a patient's diet made any difference.
For example, Gerson said, "There were 14 studies that examined the effect
of coffee on sphincter pressure and acidity in the esophagus, and none of them
demonstrated a change after coffee consumption. To date, no one has done a study
where they took patients and told them to cut coffee out for several days to see
if their sphincter pressures or acid profiles markedly improved."
Gerson and her co-authors said that to really sort out how effective, or
ineffective, dietary and lifestyle changes are in combating GERD, future
research has to be designed to specifically look at the effects of implementing
those measures.
Most physicians treating a heartburn sufferer will generally put them on a
medication, in addition to any lifestyle changes they recommend. These days
that's usually a proton pump inhibitor, which reduces the amount of acid
secreted in the stomach.
Gerson said that for the most part, medication alone is adequate to treat the
symptoms of heartburn. "The main reason they probably have heartburn is
that their sphincter muscle is relaxing too much and taking the medicine will
decrease the amount of acid that's going into their esophagus," she said.
"Since I don't have a lot of evidence that changing their diet dramatically
is going to take the heartburn away, it makes more sense just to take the
medicine," she added.
That said, Gerson allowed that for some patients, a minor change in diet can
make sense. "If a patient comes in and states, 'Red wine really gives me
terrible heartburn,' then it may be reasonable to say, 'Well, you could avoid it,
or you could take a medication before you drink some red wine,'" she said.
According to the ACG, more than 60 million Americans experience heartburn at
least once a month and estimates are that more than 15 million suffer from it
daily. For the great majority of those sufferers, Gerson's recent findings could
free them from the bonds of dietary self-denial. She is considering doing
studies of her own to learn more about what effects dietary changes actually
have - or don't have - on heartburn.
"It probably wouldn't be that hard to recruit volunteers for a study of
chocolate," Gerson noted. "People like to eat chocolate."
###
Stanford University Medical Center integrates research, medical education and
patient care at its three institutions - Stanford University School of Medicine,
Stanford Hospital & Clinics and Lucile Packard Children's Hospital at
Stanford. For more information, please visit the Web site of the medical
center's Office of Communication & Public Affairs at http://mednews.stanford.edu/
(Aug. 2006)
(Opm.
Als u last heeft van brandend maagzuur kan venkel helpen. Als
u wilt liggen na het eten, ga dan op uw linkerzij liggen. Uit onderzoek is
gebleken dat er op deze manier minder kans is op brandend maagzuur dan wanneer u
op uw rechterzij gaat liggen. Een gasbel sluit dan de doorgang naar de slokdarm
af waardoor de maaginhoud minder gemakkelijk de slokdarm inloopt.