Friday Q&A: On Treating Heartburn; Selecting the Best Doctor; Insomnia; & How to Triage Your Medical “To-Dos”

You ask the best questions!

It’s Friday Q&A time! Click here to submit your questions for future posts!

The first question (about treating heartburn) is free for everyone. The remaining questions (about selecting a doctor; insomnia; and prioritizing medical concerns) are for paid subscribers.

You can check out my recent Q&As about:

• Choosing a Doctor; Ozempic Downsides; Long COVID & Caregiver Burnout

• Ozempic; Alcohol; Hormones & Breast Cancer; & How to Ask for Help

• How Long to Take Antidepressants; Aging & Acceptance; Shame at the Doctor's Office & Sleep.

Photo by Victoria Shes on Unsplash

Let’s dive in!

QUESTION #1

Dear Dr. McBride, What is the best medication to treat heartburn? (Please don’t tell me to quit my morning coffee!!) - Kathy

Dear Kathy, 

First let’s acknowledge “heartburn” (aka “reflux”) stems from excessive amounts of stomach acid. When stomach acid rises into the esophagus, it can cause upper abdominal or chest aching, burning or generalized discomfort. Stomach acid can even “spill” into the upper airways and cause asthma-like symptoms. The common triggers are acidic foods and drinks (i.e., citrus, alcohol, and caffeine — sorry!), excess abdominal weight, certain medications (i.e., Advil, Motrin, Aleve), emotional distress, hunger, and lying down shortly after eating a heavy meal. 

The ideal treatment for heartburn is removing the trigger. The best medication to treat it depends on the person and the underlying cause. For many people, simply eating a smaller and earlier dinner (ideally without wine) makes a big difference. For others, dropping 5-10 pounds can help direct the flow of stomach acid Southward with gravity, instead of Northbound into the chest. Yet for others, medication is appropriate. To review the basic options:

• Antacids: Tums, Rolaids, and Maalox work by neutralizing the acid in the stomach. They provide quick relief and can be used as needed. 

• H2 blockers: Pepcid (famotidine), Zantac (ranitidine), and Tagamet (cimetidine) reduce the amount of acid the stomach produces. They are used to treat occasional heartburn and can be taken as needed.

• Proton pump inhibitors (PPIs): Medicines like Nexium (esomeprazole), Prilosec (omeprazole), and Prevacid (lansoprazole) block the production of acid in the stomach. They are more powerful than H2 blockers and are often used for more severe cases of heartburn. 

In general, lifestyle modification is always preferable to medication, but you can also do both. For example, you might be able to keep drinking coffee (I would!) and just limit it to one cup. You might get by with an occasional Pepcid for flare-ups. There are pros and cons to each of these approaches, so be sure to talk with your doctor for more specific advice.

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QUESTION #2

Thank you so much for your newsletter. My question is, how do I find a physician who integrates mind/body/spirit? Now that the pandemic is waning, I feel I need a physician who will listen and actually help me rather than just prescribe. - Cazzie