If you suffer from gastro-oesophageal reflux disease (GORD), the disorder commonly known as heartburn, your doctor has probably told you to quit smoking and to stop drinking alcohol, coffee and tea.

While the advice on stopping smoking still tops the list of things to do to prevent the problem, a new study questions whether alcohol, coffee and tea have any effect on GORD. The study also found that dietary fibre and regular exercise could protect against heartburn. Moreover, it adds a new culprit to the list of things to avoid: table salt.

The study, which appears in the November issue of Gut, surveyed more than 3000 people with severe heartburn and compared them to more than 40,000 people who did not have heartburn.

"Our large, population-based study provides firm evidence in support of our hypothesis that tobacco smoking causes symptomatic [GORD], and some evidence that dietary fibres in bread and physical exercise protect against this disorder," the authors wrote.

"If these findings are confirmed in additional studies, the results are very different from what we've been telling patients," said Dr Roshini Rajapaksa, a gastroenterologist at New York University Medical Center.

For example, she said, coffee, tea and alcohol are thought to be major triggers for acid reflux, and most people are advised to avoid these things. But this study did not find an association between coffee, tea or alcohol and acid reflux. Also, she said, table salt hasn't been previously implicated as a trigger for acid reflux, but this study found the odds were 70% greater that someone who regularly used table salt would develop acid reflux compared to someone who wasn't so liberal with it.

For the study, nearly 60,000 people from the Norwegian county of Nord-Trondelag were asked if they suffered from heartburn. If they had, they were asked to rate their heartburn as either mild or severe. Almost, 3200 people responded that they had the condition, while 15,233 said they had mild heartburn symptoms during the past 12 months. The remaining 40,210 said they had no symptoms of heartburn.

The researchers compared the lifestyles, including dietary intake, smoking history and exercise habits, of those with no symptoms to those with severe symptoms.

Smoking was found to be a major risk factor for having severe heartburn; the odds were 70% higher that smokers would have acid reflux than nonsmokers. The researchers also found that people who used table salt often were 70% more likely to suffer from heartburn than people who skipped the extra salt.
Contrary to popular belief - and to the results of other studies, according to Rajapaksa - coffee, tea and alcohol appeared to have no association with an increased risk of acid reflux.

The study did find that some lifestyle factors could have a protective effect. Eating high-fibre bread instead of white bread, and exercising for 30 minutes at least once a week, decreased the odds of getting heartburn.

Rajapaksa said the findings on salt were especially surprising because salt has not been implicated in the past. However, she said it's possible that people who are adding a lot of salt to their food may also be eating greasier, less healthy foods, which may increase their risk of heartburn.

If heartburn is a problem for you, Rajapaksa recommended eating smaller meals, not eating close to bedtime, and avoiding foods that you know give you heartburn. If those measures do not work, however, she said you may need medication to control your symptoms.

Originally posted week beginning 8 November 2004

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