Lauren Gerson sees a lot of heartburn patients who have stopped eating spicy food, at the instruction of other doctors, but still have heartburn.
"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," said Gerson, a gastroenterologist at the Stanford University Medical Center.
And so she and colleagues reviewed more than 2,000 studies on the topic done from 1975 to 2004. Only 16 of the studies even examined how implementing lifestyle and diet changes affect heartburn symptoms, so Gerson's team focused on those.
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Their conclusion: There is no evidence to show that any of the dietary restrictions usually recommended make a difference.
The results, announced today, were detailed in the May issue of the Archives of Internal Medicine.
Gerson message to patients: "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."
More than 60 million Americans experience heartburn at least once a month, according to the American College of Gastroenterology. About 15 million suffer from it daily.
The researchers found two lifestyle changes for which there was evidence of a clear benefit. Overweight people who lose a few pounds reduce or even eliminate heartburn, and raising the head of a bed reduces how much stomach acid enters your esophagus during sleep.
More research needs to be done to see what effect certain foods have on the esophageal sphincter muscle, which when it relaxes more often than it is supposed to allows stomach acid to flow up into the esophagus. It could be that cutting certain foods could help prevent this problem, but so far there is no clear link, the researchers say.
Heartburn is often treated with medication that reduces the amount of acid secreted in the stomach. Gerson said that for the most part, medication alone is adequate to treat the symptoms.
"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."
The advice might not apply to all patients, however.
"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.
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