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Heartburn every day causes: Heartburn – Symptoms and causes


Heartburn or heart attack: When to worry

Heartburn or heart attack: When to worry

Severe heartburn and heart attack can be hard to tell apart. Understand how they typically differ, and learn when to get immediate help.

By Mayo Clinic Staff

You’ve just eaten a big meal and feel a burning sensation in your chest. Heartburn, right? Probably, but there’s a chance the chest pain is caused by reduced blood flow to your heart (angina) or an actual heart attack.

How much do the symptoms of heartburn and heart attack overlap?

Heartburn, angina and heart attack may feel very much alike. Even experienced doctors can’t always tell the difference from your medical history and a physical exam. That’s why, if you go to the emergency room because of chest pain, you’ll immediately have tests to rule out a heart attack.

What’s the best thing to do if you have chest pain and you’re not sure what’s causing it?

If you have persistent chest pain and you aren’t sure it’s heartburn, call 911 or emergency medical help.

Call your doctor if you had an episode of unexplained chest pain that went away within a few hours and you did not seek medical attention. Both heartburn and a developing heart attack can cause symptoms that subside after a while. The pain doesn’t have to last a long time to be a warning sign.

What is heartburn?

Heartburn is discomfort or actual pain caused by digestive acid moving into the tube that carries swallowed food to your stomach (esophagus).

Typical features of heartburn include:

  • Starts as a burning sensation in the upper abdomen and moves up into the chest
  • Usually occurs after eating or while lying down or bending over
  • May awaken you from sleep, especially if you have eaten within two hours of going to bed
  • Is usually relieved by antacids
  • May be accompanied by a sour taste in your mouth — especially when you’re lying down
  • May be accompanied by a small amount of stomach contents rising up into the back of your throat (regurgitation)

What signs and symptoms are more likely to occur with a heart attack than with heartburn?

The “textbook” heart attack involves sudden, crushing chest pain and difficulty breathing, often brought on by exertion. Many heart attacks don’t happen that way, though. The signs and symptoms of a heart attack vary greatly from person to person. Heartburn itself can accompany other symptoms of heart attack.

Typical heart attack signs and symptoms include:

  • Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back
  • Nausea, indigestion, heartburn or abdominal pain
  • Shortness of breath
  • Cold sweat
  • Fatigue
  • Lightheadedness or sudden dizziness

The most common symptom of heart attack for both men and women is chest pain or discomfort. But women are more likely than men to experience some of the other symptoms, such as jaw or back pain, shortness of breath, and nausea or vomiting. Heart problems are more common among people who have high blood pressure, diabetes or high cholesterol. Smoking and being overweight are other risk factors.

Can other digestive symptoms cause chest pain?

A muscle spasm in your esophagus may cause chest pain similar to that of a heart attack. The pain of a gallbladder attack also can spread to your chest. With gallbladder disease, you may notice nausea and an intense, steady ache in the upper middle or upper right abdomen — especially after a fatty meal. The pain may shift to your shoulders, neck or arms. Again, if you are not sure seek medical attention immediately.


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Show references

  1. Heart attack. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/signs. Accessed Jan. 31, 2017.
  2. Yelland MJ. Outpatient evaluation of the adult with chest pain. http://www.uptodate.com/home/index.html. Accessed Jan. 31, 2017.
  3. Rybicki FJ, et al. 2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate utilization of cardiovascular imaging in emergency department patients with chest pain: A joint document of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Appropriate Use Criteria Task Force. Journal of the American College of Cardiology. 2016;67:853.
  4. Hollander JE, et al. Evaluation of the adult with chest pain in the emergency department. http://www.uptodate.com/home.html. Accessed Jan. 31, 2017.
  5. Symptoms and causes of GER and GERD. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/symptoms-causes. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed Jan. 31, 2017.
  6. Warning signs of a heart attack. American Heart Association. http://www.heart.org/HEARTORG/Conditions/HeartAttack/WarningSignsofaHeartAttack/Warning-Signs-of-a-Heart-Attack_UCM_002039_Article.jsp#.WJCxbFUrJ0w. Accessed Jan. 31, 2017.
  7. Kahrilas PJ. Clinical manifestations and diagnosis of gastroesophageal reflux in adults. http://www.uptodate.com/home. Accessed Jan. 31, 2017.
  8. Biliary tract disorders, gallbladder disorders, and gallstone pancreatitis. American College of Gastroenterology. http://patients.gi.org/topics/biliary-tract-disorders-gallbladder-disorders-and-gallstone-pancreatitis/. Accessed Jan. 31, 2017.

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Heartburn | Michigan Medicine

Topic Overview

Heartburn is a feeling of burning, warmth, heat, or pain that often starts in the upper abdomen just beneath the lower breastbone (sternum). This discomfort may spread in waves upward into your throat, and you may have a sour taste in your mouth. Heartburn is sometimes called indigestion, acid regurgitation, sour stomach, or pyrosis. It is not caused by problems with your heart, although sometimes heart problems can feel like heartburn. See a picture of heartburn.

Heartburn may cause problems with swallowing, burping, nausea, or bloating. These symptoms can sometimes last up to 2 hours or longer. In some people, heartburn symptoms may cause sleep problems, a chronic cough, asthma, wheezing, or choking episodes.

Heartburn usually is worse after eating or made worse by lying down or bending over. It gets better if you sit or stand up.

Almost everyone will have troubles with heartburn now and then.

Heartburn occurs more frequently in adults than in children. Many women have heartburn every day when they are pregnant. This is because the growing uterus puts increasing upward pressure on the stomach.

Symptoms of heartburn and symptoms of a heart attack may feel the same. Sometimes your heartburn symptoms may mean a more serious problem and need to be checked by your doctor.

Dyspepsia is a medical term that is used to describe a vague feeling of fullness, gnawing, or burning in the chest or upper belly, especially after eating. A person may describe this feeling as “gas.” Other symptoms may occur at the same time, such as belching, rumbling noises in the abdomen, increased flatus, poor appetite, and a change in bowel habits. Causes of dyspepsia can vary from minor to serious.

Causes of heartburn

Heartburn occurs when food and stomach juices back up (reflux) into the esophagus, which is the tube that leads from the throat to the stomach. This process is called gastroesophageal reflux. Common causes of reflux include:

  • Incomplete closing of the valve (the lower esophageal sphincter, or LES) between the esophagus and the stomach.
  • Foods and drinks, such as chocolate, peppermint, fried foods, fatty foods, sugars, coffee, carbonated drinks, and alcohol. After heartburn occurs, the backflow of stomach juices can cause the esophagus to become sensitive to other foods, such as citrus fruits, tomatoes, spicy foods, garlic, and onions. Eating these foods may cause more heartburn.
  • Pressure on the stomach caused by obesity, frequent bending over and lifting, tight clothes, straining with bowel movements, vigorous exercise, and pregnancy.
  • Smoking and use of other tobacco products.
  • Prescription and nonprescription medicines, such as aspirin, ibuprofen, prednisone, iron, potassium, antihistamines, and sleeping pills.
  • A hiatal hernia, which occurs when a small portion of the stomach pushes upward through the diaphragm, which is the muscle that separates the lungs from the abdomen.
  • Stress, which can increase the amount of acid your stomach makes and cause your stomach to empty more slowly.

Severity of heartburn

Mild heartburn occurs about once a month. Moderate heartburn occurs about once a week.

Severe heartburn occurs every day and can cause problems such as trouble swallowing, bleeding, or weight loss. Heartburn with other symptoms, such as hoarseness, a feeling that food is stuck in your throat, tightness in your throat, a hoarse voice, wheezing, asthma, dental problems, or bad breath, may be caused by a more serious problem, such as gastroesophageal reflux disease (GERD). A persistent inflammation of the lining of the esophagus occurs in GERD and can lead to other health problems. Heartburn may also be related to an infection with Helicobacter pylori (H. pylori) bacteria.

Persistent heartburn symptoms can be a sign of a more serious medical condition, such as severe inflammation of the esophagus or cancer of the stomach or esophagus.

Heartburn is more serious when it occurs with abdominal pain or bleeding.

  • Abdominal pain, especially pain located directly below the breastbone, may be a sign of more serious problems, such as heart disease, peptic ulcer disease, gallbladder disease, a tear in the esophagus, or inflammation of the stomach (gastritis). For more information, see the topic Abdominal Pain, Age 11 and Younger or Abdominal Pain, Age 12 and Older.
  • Vomiting of blood may mean bleeding in the digestive tract, often from the esophagus or stomach. If you have bleeding in the esophagus, stomach, or part of the small intestine attached to the stomach (duodenum), stools may be dark red or black and tarry. Large amounts of bleeding can lead to shock, a life-threatening condition. For more information, see the topic Nausea and Vomiting, Age 12 and Older.

Heartburn in children

Almost all babies spit up, especially newborns. Spitting up decreases when the muscles of the esophagus, which is the muscular tube that connects the throat to the stomach, become more coordinated. This process can take as little as 6 months or as long as 1 year. Spitting up is not the same thing as vomiting. Vomiting is forceful and repeated. Spitting up may seem forceful but usually occurs shortly after feeding, is effortless, and causes no discomfort.

Children who vomit frequently after eating during the first 2 years of life have increased chances of having heartburn and reflux problems, such as GERD, later in life. Children with reflux problems also have increased chances of other problems, such as sinusitis, laryngitis, asthma, pneumonia, and dental problems. For more information, see the topic Nausea and Vomiting, Age 11 and Younger.


The treatment of heartburn depends on how severe your heartburn is and what other symptoms you have. Home treatment measures and medicines that you can buy without a prescription usually will relieve mild to moderate heartburn. It is important to see your doctor if heartburn occurs frequently and home treatment does not relieve your symptoms.

Check Your Symptoms

Do you have heartburn?

This is a feeling of burning, warmth, heat, or pain just behind your breastbone. It is sometimes called indigestion, acid reflux, or sour stomach.

How old are you?

3 years or younger

3 years or younger

4 to 11 years

4 to 11 years

12 to 55 years

12 to 55 years

56 years or older

56 years or older

Are you male or female?

Why do we ask this question?

  • If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
  • If your symptoms aren’t related to those organs, you can choose the gender you identify with.
  • If you have some organs of both sexes, you may need to go through this triage tool twice (once as “male” and once as “female”). This will make sure that the tool asks the right questions for you.

Are you pregnant?

Yes, you know that you’re pregnant.


No, you’re not pregnant, or you’re not sure if you’re pregnant.


Do you have moderate or severe belly pain?

This is not the cramping type of pain you have with diarrhea.

Are you nauseated or vomiting?

Nauseated means you feel sick to your stomach, like you are going to vomit.

Are you having trouble swallowing?

Can you swallow food or fluids at all?


Able to swallow food or fluids


Unable to swallow food or fluids

Do you have heartburn pain?

This may be a feeling of burning, warmth, heat, or pain that starts in the upper belly and spreads upward into your throat.

How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?

8 to 10: Severe pain

Severe pain

5 to 7: Moderate pain

Moderate pain

1 to 4: Mild pain

Mild pain

Have you tried home treatment or taken any medicines for the heartburn?

Has home treatment helped with the heartburn?


Heartburn has improved with home treatment


Heartburn has improved with home treatment

How long have you had heartburn?

Less than 1 week

Less than 1 week

1 week to less than 2 weeks

1 week to less than 2 weeks

2 weeks or longer

2 weeks or longer

Do you think that a medicine could be causing the heartburn?

Think about whether the heartburn started after you began taking a new medicine or a higher dose of a medicine.


Medicine may be causing heartburn


Medicine may be causing heartburn

In the past few weeks, have you been losing weight without trying?


Has been losing weight without trying


Has been losing weight without trying

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

  • Your age. Babies and older adults tend to get sicker quicker.
  • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
  • Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
  • Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
  • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

  • Try home treatment to relieve the symptoms.
  • Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

Symptoms of a heart attack may include:

  • Chest pain or pressure, or a strange feeling in the chest.
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
  • Lightheadedness or sudden weakness.
  • A fast or irregular heartbeat.

For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms, like shortness of breath, nausea, and back or jaw pain.

Many prescription and nonprescription medicines can cause heartburn. A few examples are:

  • Aspirin, ibuprofen (such as Advil or Motrin), and naproxen (such as Aleve).
  • Antibiotics.
  • Steroids, such as prednisone.
  • Some heart medicines.

Caffeine and alcohol also can cause heartburn.

Pain in adults and older children

  • Severe pain (8 to 10): The pain is so bad that you can’t stand it for more than a few hours, can’t sleep, and can’t do anything else except focus on the pain.
  • Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it’s severe when it’s there.
  • Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

  • Call your doctor now to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don’t have one, seek care in the next hour.
  • You do not need to call an ambulance unless:
    • You cannot travel safely either by driving yourself or by having someone else drive you.
    • You are in an area where heavy traffic or other problems may slow you down.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

  • Make an appointment to see your doctor in the next 1 to 2 weeks.
  • If appropriate, try home treatment while you are waiting for the appointment.
  • If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

After you call 911, the operator may tell you to chew 1 adult-strength (325 mg) or 2 to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.

Sometimes people don’t want to call 911. They may think that their symptoms aren’t serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

  • Call your doctor today to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don’t have one, seek care today.
  • If it is evening, watch the symptoms and seek care in the morning.
  • If the symptoms get worse, seek care sooner.

Nausea and Vomiting, Age 12 and Older

Abdominal Pain, Age 11 and Younger

Pregnancy-Related Problems

Nausea and Vomiting, Age 11 and Younger

Abdominal Pain, Age 12 and Older

Home Treatment

Home treatment, such as lifestyle changes and nonprescription medicines, may be all that is needed to treat mild to moderate heartburn. But if your symptoms do not get better with home treatment, or if your symptoms occur frequently, see your doctor to find out whether other medical conditions may be causing your symptoms.

Keep a record of your heartburn symptoms before and after making lifestyle changes or using nonprescription medicines so you can discuss any improvement with your doctor. See an example of a heartburn symptom record .

Medicines to treat heartburn

If you are pregnant and have heartburn symptoms, be sure to talk to your doctor before you take any heartburn medicines. Some medicines may not be safe to take while you are pregnant. For more information, see the topic Pregnancy-Related Problems.


Many people take nonprescription antacids for mild or occasional heartburn. If you use antacids more than just once in a while, talk with your doctor.

  • Antacids such as Tums, Mylanta, or Maalox neutralize some of the stomach acid for 30 minutes to 2 hours, depending on whether the stomach is full or empty. Liquid or dissolving antacids usually work faster than tablet forms.
  • Some antacids, such as Gaviscon, have a foaming agent (alginate) that acts as a barrier between stomach acid and the esophagus.
  • Antacids such as Pepto-Bismol coat the esophagus and act as a barrier to reflux acid. Pepto-Bismol should not be used for more than 3 weeks and you should not take it if you can’t take aspirin. It may make your tongue or stools black. The black color is usually not serious. Brushing your teeth and tongue after taking Pepto-Bismol may keep your tongue from turning black. Ask your doctor if your child younger than age 12 should take this medicine.

Antacids work faster than acid reducers (h3 blockers), but their effect does not last more than 1 to 2 hours. h3 blockers can provide relief for up to 12 hours.

Antacids do have side effects. They may cause diarrhea or constipation. Also, antacids can interfere with how your body absorbs other medicines.

Be careful when you take over-the-counter antacid medicines. Many of these medicines have aspirin in them. Read the label to make sure that you are not taking more than the recommended dose. Too much aspirin can be harmful.

If you have any health risks, talk with your doctor before you start taking an antacid. If you have kidney disease, it is especially important to discuss antacid use with your doctor. Regular use of antacids that contain magnesium or aluminum can cause a dangerous buildup of magnesium or aluminum in people who have kidney disease.

Stomach acid reducers

h3 blockers

Histamine receptor (or h3) blockers decrease the amount of acid that the stomach makes, which may reduce irritation to the stomach lining and decrease heartburn. Some examples of nonprescription acid reducers are Pepcid and Tagamet. Talk with your doctor if you take an h3 blocker for more than 2 weeks.

Proton pump inhibitors

Proton pump inhibitors (PPIs), such as omeprazole (for example, Prilosec), reduce stomach acid and effectively treat severe heartburn symptoms. These acid-reducing medicines are used when your heartburn has not gotten better with other home treatment measures, antacids, or h3 blockers. You may need to use a PPI for up to 5 days before you have relief of your heartburn. PPIs are available without a prescription.

Acid reducers can sometimes change the way other medicines work. If you are taking prescription medicines, be sure to talk with your doctor before you take a nonprescription acid reducer.

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home treatment:

  • Heartburn is not relieved by home treatment and medicine.
  • Swallowing problems are not improving.
  • You continue to lose weight for no reason.
  • Your symptoms become more severe or frequent.


You can make changes to your habits and lifestyle to prevent your symptoms of heartburn. Here are some things to try:

  • Change how you eat.
    • It’s best to eat several small meals instead of two or three large meals.
    • After you eat, wait 2 to 3 hours before you lie down. Late-night snacks aren’t a good idea.
    • Chocolate, mint, and alcohol can make heartburn worse. They relax the valve between the esophagus and the stomach.
    • Spicy foods, foods that have a lot of acid (like tomatoes and oranges), and coffee can make heartburn symptoms worse in some people. If your symptoms are worse after you eat a certain food, you may want to stop eating that food to see if your symptoms get better.
  • Do not smoke or chew tobacco.
  • If you get heartburn at night, raise the head of your bed 6 in. (15 cm) to 8 in. (20 cm) by putting the frame on blocks or placing a foam wedge under the head of your mattress. (Adding extra pillows does not work.)
  • Do not wear tight clothing around your middle. Lose weight if you need to. Losing just 5 to 10 pounds can help. For more information, see the topic Weight Management.

Preparing For Your Appointment

To prepare for your appointment, see the topic
Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

  • What are your main symptoms? Report any symptoms, such as abdominal pain, a change in bowel habits, or vomiting.
  • How long have you had heartburn?
  • Have you had this problem before? If so, do you know what caused the problem at that time? How was it treated? How did you respond to that treatment?
  • Have you had any signs of bleeding from your digestive system?
  • Have you had any difficulty swallowing when you eat or drink?
  • How much tobacco do you use? How much alcohol do you drink? How much caffeine do you drink?
  • Has your weight increased or decreased more than 5 lb (2 kg) recently?
  • Have there been any changes in your diet? Are you eating certain foods more often?
  • Have there been changes in your daily schedule, such as when you eat and when you go to bed?
  • Are you taking any nonprescription or prescription medicines? Bring a list of all the medicines you are taking to your appointment.
  • What home treatment measures have you tried? Did they help? Be sure to include lifestyle changes you have made.
  • What nonprescription medicines have you taken or used to treat your heartburn? Did they help?
  • Do you have any health risks?

It will be easier to make lifestyle changes if your family understands the reasons for the changes. Take a friend or family member to the appointment with you, and discuss diet and sleeping habits with your doctor.

Remember to take your heartburn symptom record to your doctor visit. Be sure to note any lifestyle changes you have made or nonprescription medicines you use.


Current as of:
February 26, 2020

Author: Healthwise Staff
Medical Review:
William H. Blahd Jr. MD, FACEP – Emergency Medicine
Kathleen Romito MD – Family Medicine
Adam Husney MD – Family Medicine
E. Gregory Thompson MD – Internal Medicine

Current as of: February 26, 2020

Healthwise Staff

Medical Review:William H. Blahd Jr. MD, FACEP – Emergency Medicine & Kathleen Romito MD – Family Medicine & Adam Husney MD – Family Medicine & E. Gregory Thompson MD – Internal Medicine

Why Is My Heartburn Getting Worse?

Those who suffer from frequent heartburn can usually see the pain and discomfort coming. For some, heartburn might be triggered by certain types of food, like dairy, or rich foods that are high in fat. For others, it’s not necessarily the type of food that’s consumed, but the amount of food and even the time of day it is consumed. Regardless of what triggers your heartburn, one thing is for sure, heartburn can be quite debilitating for many, and it just happens to get worse the older you get.

What Is Heartburn?

Despite its name, heartburn doesn’t have anything to do with your heart. It’s actually a function of the stomach and esophagus, but the pain and discomfort can be felt in the lower chest, causing people to equate it with their heart, thus the name. It is also commonly known as acid reflux. Heartburn is a burning sensation that is caused by acid in your stomach flowing back up through the esophagus instead of staying in the stomach where it’s intended to. The acid causes a burning sensation that can spread from the throat through the chest. Although it can be very uncomfortable, it’s not always a cause for alarm. Having heartburn from time to time is perfectly normal, although if it becomes more frequent, it could point to a condition called gastroesophageal reflux disease (GERD).

What Is GERD?

GERD isn’t officially diagnosed until you experience acid reflux  symptoms more than twice a week. The American College of Gastroenterology reports that more than 60 million Americans suffer from heartburn once a month, with more than 15 million experiencing it every day.

Who Gets Heartburn?

At some point, it can be assumed that everyone will experience the symptoms of heartburn to some degree. However, it’s actually a condition that tends to worsen as you age. There are many reasons why this occurs. One of the culprits of heartburn includes weight gain, which many older men and women can attest to dealing with as they age. This weight gain can cause the esophageal sphincter to weaken, thus causing it to not function properly when you’re trying to digest food. 

Similarly, your muscles weaken as you get older, which includes the esophageal sphincter. Since it’s meant to remain closed at all times, aside from when you’re swallowing, a weak one can cause your stomach acid to flow the wrong direction. Additionally, the elderly population tends to take more medications, both prescription and over the counter, some of which list heartburn as a potential side effect.

Do I Need To Visit My Doctor About My Heartburn? 

If you’re experiencing heartburn every once in a while, you’re probably ok to go without a visit to Cary Gastroenterology. There are over the counter medications you can take that should give you relief pretty quickly. Over the counter medications are not intended for long term use and, should you find yourself taking them frequently, you should do so under the supervision of a physician. If you start to notice that you’re experiencing the pain more often or that it’s getting increasingly more uncomfortable, make an appointment to come see us. There are a number of things we can recommend that don’t require medication, including weight loss, an adjustment in diet and exercise, changes in medications, and even different sleeping positions.

When is Heartburn Considered Gastroesophageal Reflux Disease?

Jun 26, 2019 12:00 AM

It’s that familiar burning or painful sensation in the chest that pretty much everyone has experienced often enough to immediately declare it a case of heartburn. However, some people aren’t sure if what the heartburn they feel is normal (caused by overeating) or a more serious, common condition known as gastroesophageal reflux disease (GERD).

Heartburn Is Normal

Heartburn by itself is fairly easy to understand, being simply a painful burning in chest or throat due to acid from the stomach that moves upward into the esophagus. Everyone can experience heartburn at one time or another because there is a normal level of acid from the stomach that can reflux into the upper body. A number of common activities, including overeating, can cause heartburn.

Although heartburn can be annoying and occasionally painful enough to make it hard to sleep or do other activities, it is usually not a cause for concern. There are times when heartburn may persist for a 24-hour period or more, but it does not yet qualify as acid reflux disease.

When Heartburn Becomes Acid Reflux

There is a fairly simple way to know if heartburn is caused by gastroesophageal acid reflux disease, commonly known as acid reflux. As Andrew Gawron, MD, a gastroenterologist with University of Utah Health puts it, “The definition of gastroesophageal acid reflux disease is when reflux of stomach contents into the esophagus cause troublesome symptoms or complications that impact the quality of life.”

In other words, if heartburn is frequent enough that it causes problems that make your quality of life diminished, you may have acid reflux disease. This might mean that you’re unable to sleep at night because of pain, or you might go so far as to find that acid is eating away at the lining of the throat or esophagus. In some cases, GERD can also predispose someone to a pre-cancerous condition in the esophagus called Barrett’s esophagus.

Treating Acid Reflux

Roughly 40% of Americans will suffer from acid reflux disease at one time or another. Luckily, for the most part, it is something that can be treated with simple lifestyle and dietary changes. One of these changes includes weight loss. Being overweight or obese increases abdominal pressure and is associated with reflux.

Another lifestyle change involves diet. However, according to Dr. Gawron, “There’s no magic diet. There are major culprits that we think of, like alcohol, coffee, caffeine, chocolate, spicy foods, that people enjoy to excess and can cause acid reflux. I tell patients they have to choose whether or not they want to avoid foods that cause them symptoms.”

There are also over-the-counter medications known as histamine antagonists and proton pump inhibitors that can be very effective at reducing the amount of acid produced and help to reduce inflammation in people with pathologic acid reflux disease.

Beyond Acid Reflux

When heartburn becomes frequent and problematic, it is usually a symptom of acid reflux disease. When heartburn is accompanied by “warning” signs, such as bleeding, weight loss, or vomiting, it is critical that patients see a specialist, as conditions such as cancer will need to be ruled out.  In these situations, it is important to see a doctor as soon as possible.

Tips on Living with Heartburn & Indigestion

Heartburn is the term commonly used to describe the digestive condition called acid reflux. It occurs when the lower muscles of the esophagus don’t work as they are supposed to, resulting in the backflow of food and stomach acids into the throat. According to the National Institute of Diabetes and Digestive and Kidney Disease, 20% of Americans suffer from acid reflux daily. A study conducted by the Healthcare Cost and Utilization Project showed that 4.7 million hospitalizations in 2010 were related to acid reflux.


The most commonly reported symptom of heartburn is an uncomfortable pain or burning in the middle of the chest after food consumption. From infants and young children to adults and elderly patients, heartburn can affect anyone at any time in their life. Some symptoms last for minutes, while others last for hours. Patients who suffer from chronic heartburn don’t have the protective layers needed along the lining of the esophagus to beat powerful digestive acids of the food and drinks they consume. Since certain foods and medications can cause the condition, it can also be acute.


Common Signs and Symptoms of Heartburn


Patients who suffer from heartburn may experience the following symptoms:

  • A burning sensation in the chest behind the breastbone after eating
  • Chest discomfort when being over or lying down
  • A burning sensation in the throat
  • A sour or acidic tasting fluid in the back of the throat
  • Difficulty swallowing
  • The feeling of food sticking in the chest or throat
  • Bad breath
  • Nausea
  • Vomiting


Causes of Heartburn


Heartburn is caused when the lower esophageal sphincter becomes weak or relaxes when it shouldn’t. This can be caused by:

  • Increased pressure on the abdomen from overeating, being overweight, or pregnancy
  • Lying down too soon after eating
  • Frequently drinking alcohol, caffeine, or carbonated beverages
  • Smoking
  • Stress
  • Certain medications, including:
    • Painkillers
    • Antihistamines
    • Sedatives
    • Antidepressants
    • Calcium channel blockers
    • Certain medications used to treat asthma
    • Anti-inflammatory drugs
    • Aspirin
  • Trigger foods, including:
    • Onions
    • Peppermint
    • Chocolate
    • Coffee
    • Citrus
    • Tomatoes
    • Spicy foods
    • Foods high in fat
    • Greasy foods


Is Indigestion Different from Heartburn?


Unlike heartburn, indigestion affects the lining of the stomach in the upper abdomen. Commonly referred to as an upset stomach, the medical term for indigestion is dyspepsia. Patients frequently report an uncomfortable and painful feeling in the stomach during or shortly after eating. According to the National Institute of Diabetes and Digestive and Kidney Disease, 1 in 4 people in the United States suffer from indigestion each year. While indigestion is not considered a medical disease, it can be a sign of certain digestive tract diseases or conditions.


Common Signs and Symptoms of Indigestion

The most common signs and symptoms of indigestion include:

  • A feeling of fullness in the abdomen
  • Pain or burning in the upper abdomen
  • Heartburn
  • Bloating
  • Gas
  • Nausea
  • An acidic taste in the mouth
  • Constipation
  • Diarrhea
  • Decreased appetite
  • Belching
  • A rumbling or growling stomach


What Causes Indigestion?

The most common causes of indigestion include:

  • Stress
  • Smoking
  • Drinking too much alcohol, caffeine, or carbonated beverages
  • Eating too fast
  • Eating too much
  • Chewing with your mouth open which causes you to suck in excess air
  • Eating food your body doesn’t react well to
  • Certain medical conditions, including:
    • Acid reflux
    • Anxiety
    • Depression
    • Ulcers
    • Gallbladder inflammation
    • Esophagitis
    • Hiatal hernia
    • Food poisoning
    • Irritable bowel syndrome
    • Heart disease
    • Thyroid disease
    • Stomach cancer
    • Gastroparesis
    • Pancreatitis
  • Certain medications, including:
    • Steroids
    • Aspirin
    • Antibiotics
    • Thyroid medications
    • Blood pressure medications
    • Cholesterol medications
    • Pain medications


Risk of Leaving Chronic Heartburn and Indigestion Untreated


While indigestion and heartburn are not dangerous when they occur occasionally, many patients report chronic symptoms. Chronic heartburn and indigestion can be a significant problem for your overall health when left untreated. The risk of avoiding treatment with these two digestive issues includes:

  • Damage to the esophagus from the backflow of acid. This can lead to more serious gastrointestinal conditions, such as:
    • Esophagitis
    • Esophageal ulcers
    • Esophageal stricture
    • Barrett’s Esophagus
  • Increased risk of esophageal cancer
  • Tooth decay
  • Stomach ulcers
  • Abnormalities of the pancreas
  • Poor quality of life


Everyday Tips for Living with Heartburn and Indigestion


If you suffer from chronic heartburn, the following lifestyle and health changes will not only help you live with the condition but also help you combat the issue:

  • Avoid going to bed with a full stomach. Eat at least 2-3 hours before you lie down. This will give your body enough time to digest your food and lower the acid levels in your esophagus.
  • Eat slowly. This will help you to avoid overeating and digest your food properly.
  • Avoid overeating. If this is an issue, eat smaller meals every 4-5 hours.
  • Avoid trigger foods that worsen your heartburn.
  • Maintain a healthy weight.
  • Quit smoking.
  • Avoid alcohol.
  • Keep a food log to help identify what foods can trigger the symptoms.
  • Raise the head of your bed, so your chest is higher than your feet when lying down.
  • Drink more water.
  • Time your exercise with meals. Avoid overexerting yourself too close to food consumption.
  • Reduce stress.


There are several medication options to help ease the symptoms of heartburn if lifestyle changes don’t work. Over-the-counter antacids help stamp out acids in the stomach. While these medications work instantly, they aren’t long-lasting. h3 blockers, such as Pepcid and Zantac, are also available over-the-counter. They slow down the acid production in the stomach. If over-the-counter medications don’t work, talk to your healthcare provider about prescription medication options. In some cases, a surgical procedure called fundoplication may be necessary. During this procedure, a surgeon wraps the stomach around the bottom of the esophagus to strengthen it and keep acid where it belongs.


If you suffer from indigestion, the following lifestyle and health changes will not only help you live with the condition but also combat the issue:

  • Avoid chewing with your mouth open or talking while eating. This will reduce the risk of taking in too much air while you eat.
  • Be aware of triggers.
  • Keep a food diary to help identify foods that might give you indigestion.
  • Eat slowly and consume less.
  • Avoid drinking with meals. Try to limit your beverage intake to 20 minutes before or after you eat. If you must drink while you eat, avoid carbonated beverages. Stick to room temperature water.
  • Quit smoking.
  • Exercise at the right time. Exercising too close to when you eat can increase the risk of indigestion.
  • Drink herbal tea. Peppermint, ginger, or chamomile teas help neutralize the acids in the stomach.
  • Pay attention to your body. Notice what your eating and lifestyle habits are when you have indigestion.
  • Drink milk or water to ease the acids in your stomach.
  • Take problem medications with food.


Over-the-counter medications, such as Prilosec, Prevacid, and Nexium, are available to help ease the symptoms of indigestion. If lifestyle changes and over-the-counter medications don’t help, and indigestion becomes chronic, speak to your healthcare professional. Since indigestion can be a sign of a variety of medical conditions, it’s best to get the opinion of your healthcare provider to rule out a more severe disease.


When to Go to the Nearest Urgent Care


Symptoms of both heartburn and indigestion can last for minutes or hours. If symptoms persist or become more serious, get in touch with your healthcare provider, or visit the nearest urgent care facility. Severe symptoms include:

  • Black, tarry stool or presence of blood in the stool
  • Chronic vomiting or blood in the vomit
  • Loss of appetite
  • Trouble swallowing
  • The feeling of lightheaded, dizziness, or passing out
  • Jaundice
  • Severe pain in the abdomen, chest, or throat


Since heartburn and indigestion can both give you symptoms of discomfort, burning, or pain in the chest, it may be difficult to distinguish these issues from signs of a heart attack. If either condition comes with the following symptoms, go to the nearest emergency room immediately:

  • Shortness of breath
  • Sweating
  • Severe chest pain
  • Pain that radiates to the jaw, back, neck, or arm


If you have symptoms of heartburn or indigestion that worsen or become bothersome, we’re here to help. iCare is a hybrid, freestanding emergency room, and an urgent care center dedicated to immediate care, emergency or not. Our urgent care facility is open daily from 7 AM- 8 PM, and our emergency room is open 24 hours a day, seven days a week. Both are staffed by professional healthcare providers with years of experience treating common medical conditions, including heartburn and indigestion. With a team dedicated to quality, friendliness, and speed, we’re here to provide thorough and attentive care to all our patients. Give us a call at (203) 407-8668 or stop by one of our locations in Frisco, Fort Worth, or Argyle today.

Heartburn and GERD: Overview – InformedHealth.org


Many people have heartburn every now and again after eating a large meal, and will be familiar with the unpleasant burning feeling in their chest, just behind their breastbone. Occasional acid reflux is normal too. Up to 20 out of 100 people living in Western countries regularly have problems like heartburn or regurgitation. Although both of these can be unpleasant, they don’t usually lead to other health problems. But if you have very frequent or severe heartburn and often have acid reflux, you may have what is known as “gastro-esophageal reflux disease,” or GERD for short. The word “gastro-esophageal” means that the stomach and food pipe (esophagus) are affected.

The passage between the food pipe and stomach is closed most of the time. It only opens when the mixture of chewed food and saliva reaches it. It closes again once the food has entered the stomach. This ensures that the contents of the stomach don’t flow back.

If the stomach is stretched a lot – for instance after a large meal – the sphincter (circular muscle) at the entrance to the stomach might temporarily loosen. Gas or stomach contents might leak up into the food pipe as a result. The sphincter may also sometimes open for no apparent reason. The digestive fluid in the stomach contents irritates the lining of the food pipe, and that is felt as heartburn. If stomach juices stay on the lining of the food pipe for some time, the food pipe might become inflamed and painful.


In some people, stomach contents regularly leak into their food pipe, or a relatively large amount leaks out. It is considered to be GERD if this causes frequent or severe heartburn or acid reflux that affects your quality of life, or if your food pipe has become inflamed.

Heartburn is felt as a burning pain that spreads from the upper stomach, or from the area behind the breastbone, up into the throat. As well as acid reflux and heartburn, GERD is sometimes associated with problems swallowing. Other possible symptoms include a burning sensation in your throat, a bad taste in your mouth, and stomach noises. People who have GERD often feel very full. They may also feel nauseous and like they need to vomit.

Other possible symptoms include a dry cough, asthma, toothache, and a husky or hoarse voice. These occur if the stomach juices get into the windpipe and irritate the airways, or get into the mouth and attack the teeth.

Causes and risk factors

The food pipe becomes narrower just before it reaches the stomach. This narrow part is normally kept shut by the muscles in the food pipe and diaphragm. But this doesn’t work properly in GERD. It is often not clear why.

In some people it is caused by a hiatal hernia (also known as a hiatus hernia). The diaphragm is a sheet of muscle that separates the chest and abdominal cavities from each other. The food pipe passes through a small hole in the diaphragm and enters the stomach just below it. In people who have a hiatal hernia, the upper part of the stomach pushes up through the hole in the diaphragm and into the chest cavity. As a result, the diaphragm can no longer help to close the entrance to the stomach.

There is some debate about whether being overweight, smoking and drinking alcohol can affect the sphincter or the risk of reflux and heartburn. Many of those affected say that their symptoms are triggered or made worse by stress – or by certain foods or drinks. The symptoms may also get worse after physical activities or through certain positions, such as bending forward or lying down.

Sometimes reflux symptoms and heartburn are caused by a problem with the food pipe. For instance, the food pipe might not move rising stomach juices back down into the stomach fast enough, or it might react very sensitively. The symptoms can also be made worse by medications such as birth control pills and certain drugs against high blood pressure.


GERD is usually a chronic condition and is typically characterized by recurrent attacks. In other words, you may have a symptom-free phase for a while, followed by a phase with more severe symptoms, followed by another symptom-free phase, and so on.

The food pipe doesn’t always become inflamed. In up to 2 out of 3 people with reflux symptoms, the membranes lining the food pipe are normal.


A lot of people who have reflux and heartburn worry about the possible health consequences. But it usually doesn’t get worse. Sometimes reflux can lead to changes in the mucous membranes lining the lower end of the food pipe. This is known as “Barrett’s esophagus.” It is estimated that 5 out of 100 people who have reflux will develop this condition after some time.

Barrett’s esophagus is associated with a somewhat higher risk of esophageal (food pipe) cancer. It is estimated that esophageal cancer will develop within the next ten years in

  • at most 1 out of 1,000 people who don’t have Barrett’s esophagus, but in

  • 10 out of 1,000 people who do have Barrett’s esophagus.

Another possible complication is esophageal stricture, which is where the food pipe becomes narrower. This happens if the food pipe is very inflamed and that leads to scarring. The scar tissue can make the entrance to the food pipe narrower and sometimes make it noticeably harder to swallow.


GERD can usually be diagnosed based on typical symptoms. It is therefore important to describe your symptoms to your doctor in as much detail as possible, and tell him or her when and how often they occur. If someone is thought to have GERD, doctors sometimes suggest that they have a “trial treatment” known as a PPI test to see if they respond. The test involves taking proton pump inhibitors (PPIs) for about two weeks. If the medication relieves the symptoms, then it is very likely that GERD is causing them.


People with severe heartburn or GERD can often relieve their symptoms by changing some of their lifestyle habits. For instance, they might try to avoid certain types of food, or drink less alcohol. This is not always easy to do, but it can be worth the effort. There are also medications that can relieve the symptoms. If this doesn’t provide enough relief, surgery might be considered.

Everyday life

Reflux and heartburn can be very distressing. The symptoms can affect your sleep and prevent you from enjoying food and drinks as much as you used to. GERD can affect your general wellbeing and everyday life. Some people stop participating in social activities and call in sick a lot.

Although treatment isn’t always pleasant and might take some time to work, a lot of people find that they feel better afterwards and that their GERD is no longer such a problem.

Further information

When people are ill or need medical advice, they usually go to see their family doctor first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.


  • IQWiG health information is written with the aim of helping
    people understand the advantages and disadvantages of the main treatment options and health
    care services.

    Because IQWiG is a German institute, some of the information provided here is specific to the
    German health care system. The suitability of any of the described options in an individual
    case can be determined by talking to a doctor. We do not offer individual consultations.

    Our information is based on the results of good-quality studies. It is written by a
    team of
    health care professionals, scientists and editors, and reviewed by external experts. You can
    find a detailed description of how our health information is produced and updated in
    our methods.

Gastroesophageal Reflux Disease: More Than Heartburn

Please note: This information was current at the time of publication. But medical information is always changing, and some information given here may be out of date. For regularly updated information on a variety of health topics, please visit familydoctor.org, the AAFP patient education website.

Information from Your Family Doctor


What is gastroesophageal reflux disease?

Gastroesophageal reflux disease (or GERD, for short) is what happens when liquids and food in your stomach go “the wrong way,” or back up into your throat. When this happens, the foods and liquids can irritate your throat.

Your esophagus isn’t made to handle the acid in your stomach. This acid may also irritate your throat.

What are the common signs of GERD?

The most common sign is heartburn. Heartburn is a pain in the middle of your chest. The pain from heartburn can be very strong. Sometimes the pain can be so strong that you think you’re having a heart attack.

GERD can cause other signs, too. You can even have GERD without having heartburn.

Sometimes GERD can cause problems in your throat. It can make you feel like you have a lump in your throat or like you always have to clear your throat. It can also cause hoarseness. You might be more hoarse when you first get up in the morning.

GERD can give you a burning feeling in your mouth. It can cause you to have a sore throat or to have trouble swallowing. You may feel like food is sticking in your throat. GERD may also make you feel like you’re choking or that your throat is tight. A dry cough is another sign. GERD can also cause bad breath. It can even cause pain in your ears.

If you have any of these signs, you may have GERD. Be sure to tell your doctor about any of these signs.

How is GERD diagnosed?

Your doctor will ask you questions about your signs and do an exam. Many times, doctors can be fairly certain a person has GERD just by the signs. If your doctor thinks your signs are caused by GERD, medicine may help. If the medicine helps, you and your doctor will know that GERD was the cause of your problems. You may not need to have any special tests.

How is GERD treated?

Medicines can help stop the food and liquids from going back up into your throat. But you also have to make changes in your diet and your lifestyle.

How should I change my diet?

If you don’t eat certain foods, your throat problems may get better. Here’s a list of foods you should try not to eat (or only eat them once in a while and eat just a few bites):

  • Tomato-based foods, like spaghetti sauce, chili and pizza

  • Spicy foods

  • Garlic and onions

  • Mint flavoring, like peppermint and spearmint

  • Citrus fruits, like oranges and grapefruit

  • Drinks with caffeine, like coffee, tea and cola

  • Chocolate

  • Fatty (and fried) foods, like french fries and donuts

What lifestyle changes help GERD?

Here is a list of lifestyle changes that may help your GERD:

  • Stop smoking if you smoke.

  • Don’t drink alcohol.

  • Lose weight if you’re overweight.

  • Eat smaller meals.

  • Wear loose-fitting clothes.

  • Avoid eating and drinking about four hours before going to bed.

  • Avoid lying down within three hours of a meal.

  • Raise the head of your bed by putting blocks of wood under the bedposts (just using extra pillows won’t help).

What medicines help GERD?

One kind of medicine that helps includes cimetidine (brand name: Tagamet), ranitidine (brand name: Zantac), famotidine (brand name: Pepcid) and nizatidine (brand name: Axid). You take this medicine two times a day.

Proton pump inhibitors also help; they include omeprazole (brand name: Prilosec) and lansoprazole (brand name: Prevacid). You take them once a day.

Another medicine that helps is sucralfate (brand name: Carafate). You take it four times a day.

Can’t I just take over-the-counter drugs for heartburn?

The amount of medicine in the over-the-counter drugs for heartburn (like Pepcid, Zantac and Tagamet) is lower than the amount in the prescription form of these medicines. And before you try an over-the-counter medicine, it’s important to see your doctor. Your doctor will help you get a medicine that works well for you.

Fatal heartburn: how esophageal carcinoma and cancer begin | Healthy life | Health

Our expert – Professor of the Department of Propedeutics of Internal Diseases of the I.M.Sechenov First Moscow State Medical University, Chief Scientific Secretary of the Russian Gastroenterological Association Alexander Trukhmanov .

Of course, not everyone who has ever experienced heartburn (and there are 40% of them among us) is at risk of cancer. But, according to statistics, if it occurs more often than once a week, at night, the chance of getting a malignant neoplasm increases 10 times.

Cancer of the esophagus in mortality statistics is in ninth place. And the number of patients is constantly increasing. So, in 2011, 7400 people were diagnosed with such a diagnosis in Russia. Of these, 6,800 have died. In the world of 400 thousand people who were diagnosed with cancer in 2011, 330 thousand died. For comparison, statistics on breast cancer: out of three patients who are diagnosed, two survive, since oncologists have the opportunity to cure women.

Esophageal carcinoma is extremely difficult to treat.But the insidious ailment can be prevented, because it takes tens of years for the cells to degenerate.

When customs are to blame

Half of all cancer cases are attributed to national traditions and dietary habits that damage the esophagus.

That is why such a diagnosis is made so often in Central Asia and the Far East. Risk factors include:

  • Lack of trace elements in drinking water (eg, selenium deficiency).
  • Addiction to chewing tobacco.
  • The food is too hot. One of these harmful drinks is the national Central Asian tea, to which pieces of fat are added. Floating on the surface, they raise the temperature of the liquid above 100 degrees. The fiery mixture literally burns the esophagus.
  • Strong alcohol.

Another reason is accidents when a person receives chemical burns. Most often, very young children suffer, who try to taste everything, including home chemicals.

If the valve is not closed

The second half of cases is caused by gastroesophageal reflux disease, in which the contents of the stomach – acid and pepsin – are thrown out of it and enter the esophagus, causing burns to the cells.

To avoid heartburn, it is important not to overeat. Our stomach is able to accept 500 ml of food – with a proper snack, 1500 ml – with a plentiful feast.But, if you do not know the measures and stretch it to 4 liters, this will increase the pressure in the stomach and increase the risk of reflux.

In a healthy person, during the pharynx, the upper esophageal sphincter relaxes, and food continues to move along the esophagus.

Then it enters the stomach through the lower esophageal sphincter, after which the elastic valve closes. Now food should not get back into the esophagus. But, if the patient has a defect in the barrier and the motility of the gastrointestinal tract is impaired, the pathway remains open and heartburn occurs.

In this case, you should contact a gastroenterologist. And then the statistics are the most optimistic. If patients are examined on time, only a few of them will develop a precancerous condition, and cancer will occur in general in hundredths of a percent. And if you treat a precancerous condition or oncology at an early stage, then five years after the operation, almost all patients survive.

By the way
If you have frequent heartburn, your doctor will most likely recommend a series of tests.Most often carried out:

– pH-metry – measurement of acidity in the stomach and esophagus;

– manometry – a study that allows you to assess the contractile activity of the esophagus;

– gastroscopy, but it is not always prescribed, but only when heartburn is accompanied by disturbances in the passage of food or sudden weight loss.

Fatal errors

Nevertheless, we are in no hurry to see a doctor, we are self-medicating and very often make mistakes.For example, we take drugs for heartburn that inhibit the motor function of the gastrointestinal tract (GIT), the so-called antispasmodics. But they only relieve the spasm and can relax the sphincter. But the release of stomach contents is caused by the fact that the sphincter no longer works; on the contrary, it is necessary to stimulate its contraction. In this situation, a competent doctor, after the examination, will prescribe stimulants of the motility of the gastrointestinal tract – prokinetic drugs.

It is wrong to take with heartburn and enzyme preparations.Artificial enzymes will help digestion, but will not restore the motor function of the gastrointestinal tract, but will make its muscles even more lazy. They need to be trained in the same way as, doing physical education, we exercise the muscles of the press, arms and legs. To do this, it is important to eat at exactly the same time. So we give the digestive organs a regular load, support not only the motor, but also the secretory function of the gastrointestinal tract.

See also: How to get rid of heartburn →

Interventions for heartburn during pregnancy

What is the problem?

The purpose of this review is to evaluate the effectiveness of interventions to reduce heartburn during pregnancy.Interventions include dietary advice, lifestyle changes, medications and complementary therapies.

Why is this important?

Heartburn is a burning sensation in the upper part of the digestive tract, including the throat. This is one of the most common symptoms in pregnant women. Heartburn can be troublesome at any stage of pregnancy. Heartburn is caused by pregnancy hormones affecting the muscles that hold food in the stomach and cause stomach acid to flow back up, reaching the throat. Symptoms can be frequent, severe, and disturbing, but serious complications are rare. Many interventions have been suggested. Lifestyle changes have been suggested to treat mild symptoms. Women are often advised to eat smaller meals, chew gum, avoid eating late at night, raise the head of the bed, and avoid foods and medications that cause heartburn. An abstinence from alcohol and tobacco is recommended to avoid reflux symptoms and to avoid exposing the fetus to these harmful substances.For more alarming reflux symptoms, medications are sometimes used. Medicines commonly used to treat pregnancy heartburn include antacids, drugs that stimulate the movement of the muscles in the gastrointestinal tract to prevent acid from staying in the stomach for too long.

What evidence have we found?

We found four small studies that provided data for 358 women. We estimated that the risk of bias was low for the women enrolled in the studies and for the researchers in terms of their knowledge of whether they were in the treatment or control (or placebo) group. It was unclear whether there was a risk of bias in how decisions were made to assign women to the treatment or control / placebo group, in those who viewed the results, and in general, whether all results were presented.

Two trials compared drugs with placebo or no treatment. One trial investigated the effects of a drug (sucralfate) versus dietary and lifestyle recommendations. Another trial evaluated acupuncture versus no treatment.

Women who received medication reported complete relief (relief from heartburn) more often than women who received no medication or received a placebo, or women who received diet and lifestyle counseling ( moderate quality evidence ). We found no difference in partial relief of heartburn or in side effects between treatment groups ( very low-quality evidence ). We also found that women who received acupuncture reported improved quality of life in terms of improved sleep and eating ability, and there was no difference in the incidence of side effects compared to women who did not receive acupuncture.

What does this mean?

From the little evidence that is available, it seems that medications can help relieve heartburn, but there is not enough evidence to tell which medication is better. Acupuncture appears to help women eat and sleep better when they have heartburn.

Further research is needed to fully evaluate the effectiveness of interventions for relieving heartburn during pregnancy. Future research should also turn to other drugs, such as histamine type 2 receptor antagonists, motor stimulants, proton pump inhibitors, and alginates that suppress reflux, to treat heartburn during pregnancy.More research is needed on acupuncture and other complementary treatments for heartburn during pregnancy. Future research should also consider any adverse outcomes, treatment satisfaction, and measure the quality of life of pregnant women in relation to interventions.

What rules must be followed to get rid of heartburn – Rossiyskaya Gazeta

Everyone has probably experienced heartburn at least once in his life. As a rule, this is a relatively harmless consequence of overeating or eating inappropriate food.But sometimes heartburn is a symptom of diseases that require serious treatment. Why does an ailment arise and how to eat so that it does not cause discomfort, aif.ru was told by Ph.D., therapist, gastroenterologist, psychiatrist, psychotherapist, specialist in the field of psychosomatics Irina Pichugina.

But first, let’s figure out what is considered to be heartburn. This is a burning sensation behind the breastbone, which occurs due to hydrochloric acid secreted in the stomach. This acid is needed to digest and move food into the duodenum, as well as to detoxify some food components.

For most people, heartburn occurs after a heavy meal and mainly when a person who has just eaten immediately takes a horizontal position. It also appears against the background of autonomic dysfunction, provoked by severe or chronic stress.

But in some people, lifestyle can lead to the development of gastroesophageal reflux disease: as doctors call chronic heartburn. In this case, the disease may be a consequence of an increase in the number of casts or higher casts of bile and pancreatic juice into the esophagus.It is worth noting that similar symptoms can cause cardiovascular diseases and diseases of the spine, therefore, these pathologies must first be excluded.

Only a doctor can determine the true cause. If a person still has an increase in the throwing of acidic contents into the esophagus, then these rules must be observed:

1. Bring weight and nutrition back to normal: exclude overeating, eat slowly and in small portions several times a day. Remember that the last meal should be no later than 2 hours before bedtime.Moreover, after eating for 2 hours, it is necessary to be in an upright position, that is, standing or sitting, and also to exclude heavy physical labor and sports.

2. Sleep with your head elevated.

3. Give up bad habits.

4. Normalize the daily routine.

Also, the doctor advised to follow a certain diet for heartburn: exclude spicy, salty, acidic foods. But pay attention to milk, cottage cheese dishes, dried bread, low-fat soups, boiled meat, cereals, lean fish, boiled potatoes, carrots, zucchini, cucumbers, berries and fruits (except for sour ones).

Primary care for adult asthma

This patient guide is based on the Estonian guidelines for the management of asthma in adults at the primary level, approved in 2014, and the topics discussed there, together with recommendations. The recommendations for the management were drawn up on the basis of an analysis of the evidence-based medicine literature and taking into account the needs in Estonia and the possibilities of healthcare.

A patient guide helps to cope with the disease, to understand the nature of the anxiety disorder, different risk factors, possible causes of asthma exacerbation, gives recommendations on lifestyle and self-help that will help alleviate the disease, explains the peculiarities of asthma treatment, the effect of different groups of drugs, and the importance of continuous treatment …The aim is also to ensure that the asthma patient is aware of his illness and, if possible, productive cooperation with the attending physician.

The patient guide looks at the nature of asthma, the different risk factors, everyday problems associated with the disease, treatment options and treatments from the patient’s perspective. Both family and pulmonary doctors, who deal with asthma diagnostics, asthma counseling and treatment, and asthma patients, who amended the guidelines from the patient’s point of view, contributed to the development of the treatment guidelines.

The physician is advised to give the patient written prescriptions for the treatment of asthma, this will help to better remember the treatment regimen. These guidelines are well-suited to both personalized advice and a written source of patient information.

D Main recommendations

  • Be physically active, as any movement helps to cope with the disease. Find the type of movement and load that suits you.
  • Keep track of your weight
  • Give up all types of tobacco products, and also avoid secondhand smoke
  • Avoid inhalation of irritants and known allergens as much as possible, both indoors and outdoors.
  • Learn the names of the drugs you are prescribed or carry information about them with you.
  • Follow your doctor’s daily recommendations and treatment regimens.The doctor can be asked to write separately on paper the names of the drugs and the time of their administration.
  • Monitor inhalation techniques with your FHN / Asthma Nurse. Do this also if you have been using the inhaler for a long time.
  • Do not change the dose or frequency of medication yourself. Always consult your doctor on this topic.
  • Remember to rinse your mouth after each inhalation. Always inform your doctor about any side effects you experience.
  • Inform your doctor about any other medications you use and if you have any side effects with them.
  • Know the symptoms of an exacerbation of the disease. Ask your doctor for written guidance on flare-up symptoms and home first aid.
  • If you feel uncomfortable, follow the doctor’s recommendations for home first aid. When increasing the dose of medication, be sure to monitor the maximum allowed doses and the maximum allowed frequency of administration.
  • In case of deterioration of health, always contact your doctor to find out the tactics of further treatment. If you feel unwell quickly or if you have trouble breathing, call an ambulance or go to the hospital emergency department.
  • Keep track of the content of the medication in the inhaler so that there is no situation when the inhaler is empty and you do not have a new prescription. Ask your doctor for a new prescription before the inhaler is empty.
  • To assess your asthma at home, use an asthma control test, which you can get, for example, from your family nurse. You can always complete the same test at a visit to your family doctor or nurse. The test is provided in Appendix 1 of this patient guide.

Asthma is a chronic inflammatory disease of the airways, the prevalence of which has increased dramatically throughout the world in recent years (Braman 2006), with occasional periods of difficulty breathing due to narrowing of the lower airways.The narrowing of the airways goes away partially or completely, either on its own or with treatment. It is believed that many people do not really know they have asthma and therefore do not receive proper treatment. At the same time, in most patients with asthma, with the help of treatment, complete control over the disease can be achieved, and thus the quality of life and performance can be maintained.

Air movement in the respiratory tract

The movement of air in the body begins through the nose or mouth.If you inhale, air travels to the lungs through the trachea and lung tubes (bronchi). The bronchi end in small bubble-like formations (alveoli), where oxygen and carbon dioxide are exchanged. Oxygen is absorbed from the alveoli into the blood, and the carbon dioxide generated in the body passes from the blood to the alveoli. When released, the air is expelled from the lungs together with carbon dioxide. Normally, when breathing, all airways are open and air moves through them freely and unimpeded.

What happens in the airways in asthma?

With asthma, the airways are inflamed, irritated and narrowed, and the movement of air in them is difficult.This is due to asthmatic inflammation, which creates edema in the mucous membrane and an increase in mucus secretion. Inflammation of the mucous membrane and the narrowing of the bronchi caused by it is a protective reaction against various external stimuli. In asthma, the airways are more sensitive than usual and react easily to various stimuli. Airway constriction can be caused, for example, by irritating odors, cold weather, severe stress, and contact with animals or pollen.

The main symptoms of asthma are:

  • choking feeling
  • lack of air (which can also occur at night)
  • wheezing and wheezing, especially on deep exhalation
  • cough that occurs more often during the night and / or early morning
  • chest tension or heaviness (Sistek et al, 2006).

Asthma symptoms can be milder or more severe, and last from several hours to several days if asthma is not diagnosed and the symptoms are not treated. An asthma attack is a condition where all the symptoms of asthma – breathing problems, wheezing, coughing, shortness of breath, and a feeling of heaviness in the chest – develop very quickly. The manifestation of symptoms (especially the first time) can cause feelings of fear, uncertainty, helplessness. There can be several reasons for triggering an asthma attack: excessive physical activity, various environmental factors, stress or contact with allergens.

What are the causes of asthma?

In Estonia, 5-8% of the adult population or 70,000-112,000 people suffer from asthma (Merenet al 2005). Both genetic (non-modifiable) and environmental (modifiable) risk factors contribute to the incidence of asthma in adults. Asthma onset in adulthood is most common in women. The following factors influence asthma:

  • genetic predisposition, which is greater in those people whose relatives are already ill / have had asthma, allergic rhinitis and atopic dermatitis.
  • early childhood respiratory tract infections that may contribute to asthma at an older age
  • 90,021 exposure to environmental allergens and chemicals used at home and at work (Tarlo et al 2008).

    90,021 smoking and being overweight (Lim et al 2010).

Important to remember:

  • Genetic susceptibility is an important risk factor if relatives have already had asthma.
  • Give up all types of tobacco products (cigarettes, electronic cigarette, cheek tobacco, hookah, cigarillo, pipe tobacco, cigars), as well as secondhand smoke.
  • If you have decided to quit smoking, ask your family doctor for advice, he will be able to refer you to an appointment with a support for ex-smokers. Drinking alcohol should be moderate.
  • Watch your weight. Talk to your doctor if you change your eating or dietary habits.
  • Don’t forget to move! Every day should include at least some physical activity.

Tell about them to your doctor.Tell about them even if these symptoms have already passed by the time of the visit to the doctor.

To diagnose asthma , your doctor must thoroughly familiarize yourself with your health data. The doctor should also clarify what diseases you have suffered and whether you have any allergies. If, based on the history, the diagnosis of asthma still remains in question, additional tests should be done.

There is no single and specific way to diagnose asthma, and it cannot be diagnosed only on the basis of a questionnaire.Usually, the doctor begins by listening to the lungs with a stethoscope, which helps determine if there is inflammation in the airways. In the case of asthma, whistling, wheezing and / or prolonged exhalations are heard in the lungs while listening. If the above symptoms were not found during listening, this does not mean that the diagnosis of asthma has been ruled out.

If your doctor suspects you have asthma, they may order you to have a spirographic examination. If the spirographic examination did not show signs of asthma, but you still have asthma symptoms that occur day or night for an unknown reason, then you will be prescribed a trial treatment or referred to a pulmonologist for a consultation.


Spirography is an examination of the respiratory tract, during which the volume and speed of movement of inhaled and exhaled air, as well as the filling of the pulmonary tract, are assessed. Thus, we are dealing with the study of pulmonary function.

Spirography is painless and does not cause any significant harm to your well-being. In some cases, frequent, strong inhalation / exhalation can increase the pressure in the chest, abdomen and intraocular pressure and thus cause discomfort.There are contraindications for spirography, which the doctor or nurse will inform you about before the examination. The doctor and nurse will give you precise instructions on what to watch out for before coming for an examination:

  • If you are using an adjuvant with bronchodilators (bronchodilators), or the so-called inhaler-pitter, the doctor will advise you not to use it from 4 to 24 hours before the examination, depending on the duration of the medication.
  • Avoid physical activity
  • Do not smoke
  • Do not come to the examination with a full stomach, but you can have a little snack two hours before the examination.

Spirographic examination

  1. Before the examination you will be weighed and measured, the data will be entered into the computer
  2. During the examination, your nose will be covered with a clothespin to prevent breathing through your nose and a special mouthpiece will be placed in your mouth.The mouthpiece is held in your mouth and you will breathe through it throughout the examination, with your back and neck straight (see Figures 1 and 2).
  3. First, the doctor or nurse will ask you to breathe in and out several times through the mouthpiece at a calm pace.
  4. Next, you will need to inhale as deeply as possible and then exhale as fast as as you can until the lungs are completely cleared. This may take a few seconds. The nurse will tell you how long you will need to breathe at this rate.
  5. You may be asked to inhale as deeply as possible and then exhale as long as possible until the lungs clear.
  6. Such breathing cycles are usually carried out several times – at least three times, but usually no more than eight times. If your lung function is impaired, you will need to take fast acting bronchodilators and after 15 minutes a new spirographic examination will be performed.

What do spirography results show?

Spirography measures the volume and / or speed of air that a person can inhale and exhale.Most often measured:

  1. The amount of air you can exhale forcefully for one second after maximum inhalation. This is called the forced expiratory volume in 1 second (FEV 1 ). If the airways are in order, a person can exhale most of the air in the lungs within one second.
  2. The maximum volume of air that you can exhale forcefully after a maximum inhalation. This volume is called forced vital capacity (FVC).

As a result of calculating the results of spirography, the above two indicators are compared with the control indicators. Your age, height and gender affect your lung capacity and are taken into account when calculating your results. Asthma may be signaled when the FEV 1 / FVC ratio is less than the reference. Low values ​​indicate that your airway is narrowed, which is a typical symptom of asthma. Typically, spirography is repeated after you take a breath-relaxing medication.If you have asthma, your maximum expiratory volume will be increased during the post-medication examination. If the spirographic examination does not give results that would clearly indicate asthma, then the doctor may prescribe you a trial treatment with inhaled glucocorticoids. The physician will evaluate the effect of the trial treatment after four weeks: asthma will be indicated by an increase in FEV 1 of at least 200 ml or a significant improvement in clinical symptoms.

It may happen that spirography is contraindicated for you.In this case, PEF-metry or measurement of the peak expiratory (exhaled) air velocity is used exclusively for diagnostics, against the background of a trial treatment. Peak expiratory flow is measured using three measurements in a row with a PEF meter, of which the largest is taken (Quanjer et al 1997). During the measurement, the patient can stand or sit and the back and neck must be straight (McCoy et al 2010). The PEF meter is used to determine the maximum expiratory air velocity (see.(See also the chapter “Controlling asthma”).

If your complaints and clinical symptoms make it possible for the doctor to suspect you have asthma, but the results of spirography and trial treatment do not confirm the diagnosis, then the doctor will refer you to a pulmonologist.

If your cough lasts longer than eight weeks, an X-ray examination may also be done, although in general cases it is not done to diagnose asthma (Laboratory diagnosis and treatment of the most common community-acquired infectious diseases and diagnostic algorithms for family doctors 2015).

No allergens need to be identified for diagnosis (Primary Health Care for Asthma in Adults, Estonian Treatment Guidelines 2014). If the doctor nevertheless suspects that your asthma symptoms are caused by an allergy, that is, you have allergic asthma, then skin tests or a blood sample should be done to clarify possible allergens.

Important to remember:

  • Asthma is diagnosed based on symptoms and results of examination and treatment
  • Tell your doctor about the manifestations of breathing problems in different situations, as well as your options for the reasons that may cause them.
  • Asthma symptoms:
  1. wheezing and wheezing in the chest, especially when exhaling deeply
  2. Occasional breathing difficulties
  3. shortness of breath and a feeling of heaviness in the chest
  4. coughing attacks, which occur more often at night and / or early in the morning
  • If asthma is suspected, a spirographic examination is carried out, if necessary, together with a test for bronchodilators
  • If asthma cannot be diagnosed on the basis of a spirogram, but asthma remains suspect based on clinical symptoms, your doctor may prescribe a trial treatment with basic inhaled asthma medications or refer you to a pulmonary specialist.
  • For each patient, the doctor decides separately whether he needs additional examinations. Every patient does not need them.

Various options are used to treat asthma. It is important to know that there is no one best treatment that works for everyone. The disease progresses differently from patient to patient, and for the medication to work, asthma treatment depends on your personal needs.

The goal of treatment is to achieve and maintain good asthma control and improve the quality of life of the asthma sufferer. It is desirable to achieve this result with the lowest dose of drug / drugs and with the least side effects.

Asthma is well controlled if:

  • Symptoms do not appear during the daytime , or they appear only briefly and no more than two days a week
  • Symptoms do not appear at night , or they appear no more than two episodes per month
  • Asthma does not limit physical activity
  • The patient does not need for seizure treatment (fast acting bronchodilators) or uses these drugs no more than twice a week.
  • Indicators of pulmonary functions remain within normal limits (at least 80% of indicators for the last five years).
  • There are no more serious exacerbations , or they appear no more often than once a year.

If asthma is suspected or has already been diagnosed, it is very important that you tell your doctor about your health condition. Together with your doctor, you will find the treatment plan that best suits you.

Before visiting a doctor, track:

  • Your breath
  • Could certain activities trigger an asthma attack or respiratory distress
  • Do you have breathing problems at work while at home
  • You feel better

Record any occurrences noted as your doctor will need your exact descriptions.To track your asthma status, you can complete the asthma control test. This is a simple questionnaire that sums up asthma information (Jia et al 2013) and you can ask your FHN for a printed copy (see Appendix 1 of the Patient Guide).

Your doctor may ask you what symptoms you have, when they start, and how often they occur. You will be asked about other health data and may be asked if any of your relatives have asthma.Information about whether your relatives have had any breathing problems, lung diseases or allergies.

For your doctor, you can make a list of the medicines, supplements and vitamins you are taking.

Non-drug treatment

When treating asthma, lifestyle is important in addition to medication. Try to avoid upper respiratory irritants and known allergens.

The most important respiratory irritant is tobacco smoke.Smoking is one of the most important health risks. Quitting smoking will help you to significantly improve your asthma control.

Physical inactivity is an important risk factor (Lim et al 2012). Exercise that suits you is highly recommended for asthma. Regular exercise promotes better oxygen uptake and can improve quality of life and asthma control (Carson et al 2013; Heikkinen et al 2012).

Influenza vaccination is not contraindicated for patients with asthma (Primary Asthma Treatment in Adults, Estonian Treatment Guidelines 2014).

Important to remember:

  • Lead a healthy lifestyle – you need appropriate physical activity, achieving and maintaining a normal weight, quitting smoking.
  • Avoid upper respiratory irritants and known allergens.
  • Reducing the number of dust mites does not affect the course of asthma.
  • You can get the flu vaccine.
  • It is important for the patient to keep a diary of observation of their health, this is useful for both the patient and the doctor.

Drug treatment

The goal of the pharmacological treatment of asthma is not only to relieve symptoms, but also to achieve the necessary asthma control with as few side effects as possible.

Asthma treatment is divided into basic treatment , which is used regularly to keep asthma under control, and attack treatment , which is used to quickly relieve asthma attacks according to needs. For patients with mild episodic asthma, physicians recommend treatment of seizures β 2 short-acting agonists; for patients with persistent asthma, physicians prescribe continuous baseline treatment and, if necessary, treat the seizures.

Basic treatment

The baseline treatment of is inhaled or inhaled medications that aim to both relieve symptoms and prevent asthma exacerbations and preserve lung function. Treatment is usually started with inhaled glucocorticosteroids or hormonal treatment. These medications have anti-inflammatory effects and reduce swelling and irritation in the walls of the lower airways, thus relieving breathing problems.

Basic treatment uses a phased approach, starting with the lowest dose of drugs, if possible with the drugs of the first choice. If the first-line drugs fail to control asthma, the doctor will prescribe a dose of the next level of baseline treatment. If asthma can be controlled for at least three months, the doctor may return the dose to the previous level. The doctor regularly monitors the effect of the medication and can change the dose of the medication if necessary.If one medicine does not give the desired effect of controlling asthma, then the doctor may additionally recommend another medicine. Usually β 2 are used for this – long-acting agonists. You can use two different inhalers, but it is more convenient if the two medicines are combined in one inhaler.

β 2 – Long-acting agonists (bronchodilators) help open the airways, making breathing easier. Drugs that relax the bronchi can help prevent shortness of breath and wheezing.These medications do not help with exacerbations of asthma.

There is also a group of less commonly used medicines that can be taken by mouth in pill form.

If within one month of using the basic treatment the desired result has not been achieved, then the doctor should first assess your inhalation technique and how much you adhere to the treatment plan and the recommended lifestyle. If necessary, the treatment regimen is changed – for example, the dose of the drug, the drugs themselves, or the frequency of their administration.If your asthma is properly controlled for at least three months, your doctor may recommend a reduction in baseline treatment. If control is not achieved by a combination of two drugs in increased doses, the family doctor will refer you to a pulmonologist for a consultation.

Treatment of seizures

Treatment of seizures with bronchodilators is effective in relieving existing asthma symptoms, but these seizure medications do not help prevent flare-ups of asthma.

β 2 Short-acting agonists , also called fast-acting bronchodilators , help relieve asthma symptoms. They relax the muscles in the walls of the airways, help open the airways, and make breathing easier. This reduces chest tension associated with asthma, wheezing and coughing. Their action is short-lived and sometimes, if symptoms worsen, they need to be reused.Ask your doctor to write down for you what is the exact maximum number of doses for how long you can use without danger to health. In case of exacerbation of asthma, glucocorticosteroid tablets are used. Your doctor will prescribe the treatment regimen for you. In addition to the pills, you need to continue to take the inhaled drug from the basic treatment.

Before starting treatment for asthma, your doctor should assess the severity of your asthma. The dose of the drug and the frequency of its use depend on this. Next, you need to find a suitable inhaler with your doctor and nurse and learn the inhalation technique.The inhalers are convenient to use, easy to carry and easy to deal with.

In the case of pharmacological treatment, the inhalation technique is very important, the attending physician or nurse will introduce you to it. Choosing the right inhaler for you is also very important.

There are several types of inhalers, so it is very important to learn a new technique when receiving the first medicine or when changing it. The best way is a visual test, which can be done, for example, during a FHN appointment.

Teaches the correct inhalation technique by a family doctor or nurse

Both powder inhalers and metered dose inhalers are used. Medications used in both metered dose inhalers and powder inhalers work the same way. Examples of different inhalers are given in Appendix 2 of this patient guide.

NB! Unfortunately, many asthma patients use the inhaler incorrectly. In case of improper use of the inhaler, the medication will not be beneficial.

1. Inhalers with dispensers

From these inhalers, the medication is released by pressing the canister and direct inhalation (see Appendix 2 of the patient manual).

Metered dose inhalers are used both for treating seizures and for taking basic medications.

How to use a metered-dose inhaler?

  1. Remove the cap from the inhaler.
  2. Shake the inhaler.
  3. Hold the inhaler upright, your ring finger will help you release the medication from the inhaler.
  4. Hold the mouthpiece of the inhaler near your mouth and exhale deeply.
  5. Place the mouthpiece in your mouth, gripping it firmly with your lips, and lift your chin up slightly. At the same time, when you inhale deeply and evenly, press the canister to release the dose of medication.
  6. Inhale long and deeply so that the medicine goes deep into the lungs.
  7. Remove the mouthpiece from your mouth, close your mouth and hold your breath for 10 seconds.
  8. Breathe out through the nose and repeat if necessary.
  9. After inhalation of medication, rinse your mouth.
  10. Avoid contact with eyes.

If you have read the technique manual, try using the medicine yourself in front of a doctor or nurse. The first time using the medicine at home, do it in front of a mirror.

If you have any questions about the use of the medication, be sure to ask your doctor or nurse, as taking the medication correctly will help you keep your asthma under control.

If the use of the inhaler is complicated or you cannot use it due to your health condition, then be sure to inform your doctor about this, who will prescribe the type of treatment that suits you.

Cleaning the inhaler

The inhaler should be cleaned at least once a week. This is necessary so that the medicine does not clog the mesh of the inhaler mouthpiece.

Intermediate reservoir for drug use

An intermediate reservoir (or spacer) is a container that collects medicine and allows you to inhale the medicine slowly and deeply once or twice.The intermediate reservoir reduces the likelihood of the drug settling on the tongue or mouth, and helps more of the drug get into the lungs. The intermediate reservoir is suitable for those who find it difficult to inhale and inject at the same time.

Although the remainder of the medication remaining in the intermediate reservoir is harmless, it should still be flushed regularly after every 1 to 2 weeks. The easiest way is to rinse with warm water. After rinsing, the reservoir must be air-dried, never wiping it with a towel.

2. Powder inhalers

Powder inhalers contain doses of medicine in the form of a fine powder, which, when inhaled, enters the lungs. When using a powder inhaler, you do not need to inhale and release the medicine at the same time, but the intake must be more intense. Therefore, a dry powder inhaler may not be suitable for elderly patients or people with weakened nerves or muscles.

Powder inhalers (see.Appendix 2 of the treatment guidelines) are also used both in the treatment of seizures and as a basic treatment, depending on the medication they contain.

There are mainly 2 types of powder inhalers used:

  1. Multi-dose inhalers that include up to 200 doses.
  2. Single dose inhalers – If used, the medication capsule must be replaced before each use. It must be remembered that the capsules must not be swallowed! The medicine works only if inhaled!

The use of a powder inhaler depends on the specific type and brand of manufacture.The following are general principles for the use of such inhalers. When taking your prescribed medications, it is very important that you read the leaflet and consult with your doctor or nurse about the appointment.

How to use a powder inhaler?

  1. Remove the cap of the inhaler and release the dose of medication.If you have an inhaler to which you need to attach the capsule, follow instructions
  2. Keeping the mouthpiece to one side, exhale deeply (not into the mouthpiece).
  3. Place your front teeth around the mouthpiece and close your lips tightly around it.
  4. Inhale quickly, intensely and deeply through your mouth for 2-3 seconds.
  5. Remove the inhaler mouthpiece from your mouth. Hold your breath for another 2-19 seconds.
  6. Exhale slowly and calmly through your nose.

Be careful when cleaning the powder inhaler. Most powder inhalers cannot be washed with water or soap. The mouthpiece can only be cleaned with a dry cloth.

Treatment of concomitant diseases

Be sure to inform your doctor about your other medical conditions (for example, high blood pressure, diabetes, etc.), as this may depend on your treatment.

In the case of cardiovascular diseases, medications are used that are not suitable for asthma patients. Be sure to tell your doctor about all medications you take, including pain relievers.On rare occasions, some patients may be allergic to aspirin. In this case, only paracetomol can be used as a pain reliever.

Important to remember:

  • The goal of asthma treatment is to control it.
  • It is very important to lead a healthy lifestyle – physical activity, weight management, smoking cessation and avoidance of respiratory irritants and known allergens.
  • Medication uses both basic and anti-seizure medication, both of which are taken by inhalation.In the case of basic treatment, the first choice is glucocorticosteroids, to which long-acting bronchodilators are added. In this case, the doctor will usually write a prescription for the inhaler that contains both fixed-dose drugs.
  • In the event of an asthma attack, use a short-acting bronchodilator, but do not exceed the prescribed dose.
  • Watch for symptoms of worsening asthma.
  • Tell your doctor about any other medications you are taking and if you have any side effects when taking them.
  • Monitor the dose of the medication in the inhaler so that there is no situation when the inhaler is empty and you do not have a new prescription. Ask for a prescription for you before the inhaler is empty.
  • Information on all prescriptions issued and purchased by you can be checked in the prescription center of the state portal: www.eesti.ee → Services → For a citizen → Health and healthcare → Prescriptions.

With asthma, it is very important to self-monitor your well-being on a daily basis.One of the methods is the already mentioned asthma control test, as well as PEF-metry. The PEF meter is a device that measures the maximum expiratory flow rate. It can be used to assess the movement of air in the respiratory tract and the strength of the muscles that provide this action. Basically, the meter has a scale of liters / minute (l / min).

PEF is not a substitute for spirographic examinations by a physician. The PEF meter is a small, hand-held device that has the advantage of being fast and easy to interpret.Consult your doctor for information on the correct target values ​​for you.

How to use a PEF meter?

• the test should be performed while standing, while keeping the neck and back straight
• make sure that the device reads zero
• Before starting the test, take a deep breath
• place the mouthpiece of the device in your mouth and close your lips tightly around it
• exhale into the mouthpiece with maximum speed and force.
• write down the obtained reading of the device (liter / per minute)
• repeat the test two more times
• as a result, write down the highest score of the three tests performed
• the highest value means the maximum air speed
• Save test results taken at different times so that you can show them to your doctor if necessary.

Keeping your asthma under control requires adherence to your treatment plan.Main symptoms of asthma not under control :

• You wake up at night due to asthma attacks
• You are using large quantities of bronchodilators
• physical activity decreased

The doctor assesses the state of asthma using a spirographic examination, which is carried out as needed, but in the case of persistent (persistent) asthma of moderate and severe severity at least twice a year.

Ask your doctor for a written treatment plan and discuss with him which treatment regimen is best for you.

Important to remember:

  • Constant monitoring of your well-being is very important. At home, it will be possible to use an asthma control test or a PEF meter. It is recommended that you record the test results and take them with you to your doctor’s appointment.
  • Asthma can only be controlled if you adhere to your treatment plan and doctor’s orders.
  • Learn the symptoms that indicate asthma is no longer under control. The question of the need and frequency of the spirogram is decided by the attending physician.

An asthma attack is a sudden worsening of a condition. The cause of an attack can be several: excessive physical activity, various environmental factors, stress and contact with allergens. During an asthma attack, the airways become inflamed, narrowed, and mucus production increases.All of these can cause breathing problems, wheezing, coughing, shortness of breath, and a feeling of heaviness in the chest. The manifestation of symptoms can provoke feelings of fear, uncertainty, helplessness.

Symptoms that may appear during an asthma attack:

  • Heavy wheezing during both inspiration and expiration
  • persistent cough
  • rapid breathing
  • feeling of tension and chest pain
  • Contractions of the muscles of the neck and chest
  • speech difficulties
  • the occurrence of a feeling of anxiety or panic
  • pallor, sweating
  • blue lips

Mild asthma attacks occur with high frequency and usually last from several minutes to several hours.

When a severe asthma attack occurs, immediate medical attention is sometimes needed. Therefore, it is important to know which symptoms can be considered mild and which are not – such recognition at the right time will help you keep the situation under control. Ask your doctor for a written list of flare-up symptoms. Also ask him to write down the doses and the number of doses for you. If, despite home treatment of the attack, the situation still worsens, you need to call an ambulance within the next hour.

For advice, you can contact the round-the-clock information service of family doctors on the short telephone number 1220 * or by phone (+372) 6346 630. If you need an ambulance, call the emergency number 112. If your condition worsens, go directly to the hospital emergency department.

If you do not immediately take anti-asthma medication when / during an asthma attack, your breathing will become difficult.If you use a PEF meter during an asthma attack to monitor your maximum expiratory flow rate, it is likely to be the lowest of all your best results. This will also help confirm worsening of the condition.

If you do not receive sufficient treatment to relieve an asthma attack, it may be difficult or impossible for you to speak. The reason for this is a decrease in the level of oxygen in the blood, which causes discoloration of the skin and lips – they become blue.In such a situation, you must find help as soon as possible.

Important to remember:

  • Learn the symptoms that can occur in the event of an asthma attack.
  • Try to avoid triggering factors for asthma attacks.
  • It is important to recognize in time which symptoms are mild and which are not, in order to take medicine at home at the right time, or go to the hospital.
  • Ask your doctor to write down a description of the flare-up symptoms for you.
  • Keep close at hand phone numbers where you can contact around the clock – these are the family doctor’s advice line 1220 and the emergency phone number 112.
  • If worsening, go to the emergency room.
  • Learn the names of medicines used to treat asthma attacks at home and their safe dosages.
  • Try to remain calm at all times, panic makes breathing even more difficult.The person caring for you should be calm and know how to help.

The life of an asthma patient should not be different from the life of people without this disease. You feel your body better than anyone else, so you can do a lot yourself to improve your well-being. It is important to adhere strictly to your treatment plan and avoid factors that trigger an asthma attack. Every person is different, and the same rule applies to symptoms that manifest themselves differently in different people.The most important thing is to observe the environment. Contact with allergens (allergy pathogens), chemicals, or other pathogens can cause asthma.

In addition, strong odors (such as paints or household chemicals) can irritate the respiratory tract. An asthma attack can also cause strong emotional experiences such as laughter, crying or, conversely, stress, some medications. You need to know what medications you have taken before and how they affected you.Watch what you eat. If some foods cause you allergies, then they should be discarded. The course of asthma can be influenced by other comorbidities. For example, backfilling of stomach contents into the esophagus (gastroesophageal reflux disease) can cause heartburn and asthma symptoms, especially at night.

It is recommended to keep a diary for observing your well-being, where you need to note information about everyday activities (for example, about the composition of food, how much you moved, whether there were changes in well-being due to a change in the environment, stressful situations, etc.).in order to track, in response to which factor exacerbates an asthma attack, and what helps keep the asthma attack under control.

Below are the main irritants and allergens to avoid. These irritants can cause a change in how you feel and trigger an asthma attack.

Cold air

In case of contact with very cold air, the airways can become irritated, which in turn can trigger an asthma attack.If you are outdoors in winter, cover your mouth and nose with a scarf.


You should not avoid exercising if you are diagnosed with asthma. Discuss with your doctor and find the exercise plan that works best for you. It is important to warm up a little before training and cool down a little after training. Avoid exercising in cold air or during flowering. Also, avoid exercising if your asthma is out of control.

Infectious diseases

Lung infections – such as bronchitis or pneumonia – can be dangerous for someone with asthma. The increased amount of mucus and inflammation in the airways make breathing difficult.

If you have asthma, you can get yourself vaccinated against the flu – discuss this with your doctor.

Flower pollen

Most of the pollen is the main allergen that causes both allergic reactions and exacerbation of allergic asthma in many people.

Excess weight

Asthma is most common among overweight people, both adults and children. Children who come into contact with secondhand smoke are at greater risk of developing asthma. Teenagers who smoke also have an increased risk of developing asthma. Adults who have contact with tobacco smoke at work and at home have a 40-60% greater risk of developing asthma than those who do not come into contact with smoke. If you have been diagnosed with asthma, then smoking is contraindicated for you.Also, no one should smoke in the rooms where you are staying. On the street, try to avoid places where smoking is allowed and there may be a smell of tobacco.

Indoor molds

Mold usually occurs in damp rooms. Inhalation of fungal spores can cause allergic reactions. Keep your bathroom, kitchen and basement clean and dry


Cockroaches and their secretions can cause allergic reactions in many people.Cockroaches are attracted to food leftovers, debris, and dry food. Do not keep trash open.

Pet dander

Pet dandruff comes from skin, hair, and feathers. Dandruff is excreted by most pets – dogs, cats, birds and rodents. If you have been diagnosed with asthma, it is not recommended to have pets. If you already have a pet, then it should not be kept in the bedroom. The pet needs to be washed regularly.

Important to remember:

  • Know as much as possible about your illness
  • Discuss with your family doctor the possible causes of the exacerbation of the disease and how to manage it.
  • Make sure you always have your seizure medication at home and always take it with you when you leave your home.
  • Know which pathogens and allergens are bad for your well-being.
  • Keep track of the doses of medication in the inhaler so that there is no situation when the inhaler is empty and you do not have a new prescription. Ask your doctor for a prescription before the inhaler runs out.
  • Keep a well-being diary to find situations and factors that contribute to an exacerbation. Try to avoid these situations and aggravating factors.
  • Try to live a fulfilling life. This is possible with the right treatment.

The Asthma Control Test (ACT) will help you assess how you are controlling your disease. Choose the appropriate answer for each question and write the number (one to five) in the square box to the right.

Add up all the answer values ​​to get the result.

1 question

How often in the past 4 weeks has asthma interfered with your activities at work, school, or at home?

All time Very often Sometimes Rarely Never Points
1 2 3 4 5

Question 2

How often during the last 4 weeks have you experienced a lack of air?

More than once a day Once a day 3 to 6 times a week Once or twice a week Not once Points
1 2 3 4 5

3 question

How often in the past 4 weeks have you woken up at night or earlier than usual due to asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or chest pain)?

4 or more nights per week 2 or 3 nights per week Once a week Once or twice in the last 4 weeks Not once Points
1 2 3 4 5

4 question

How often in the last 4 weeks have you used your inhaler (eg with salbutamol)?

3 times a day or more often 1 or 2 times a day 2 or 3 times a week Once a week or less often Not once Points
1 2 3 4 5

5 question

How would you rate your asthma control over the last 4 weeks?

It was not possible to control at all Rarely managed to control To some extent managed to control Good control over Fully managed to control Points
1 2 3 4 5



Explanation of results

90,043 90,085 less than 20 – Bad result

25 points – Congratulations on an excellent result! 20 to 24 – Satisfactory result
You have completely controlled your asthma in the last 4 weeks. You have not had asthma symptoms
and related restrictions.
If your condition worsens,
consult your doctor or nurse.
It is possible that in the last
4 weeks you are good
controlled asthma, but
not completely. Your doctor or
a nurse can help you achieve complete asthma control.
It is possible that in the last
4 weeks you failed
control asthma.
Your doctor and nurse can advise you on the action plan
must be taken to achieve better asthma control.

Review the test results with your family doctor or nurse.

Braman, S. S. 2006. The global burden of asthma. Chest, 130 , 4s – 12s.

Carson, K. V., Chandratilleke, M. G., Picot, J., Brinn, M. P., Esterman, A. J. & Smith, B. J. 2013. Physical training for asthma. Cochrane Database Syst Rev, 9 , Cd001116

Heikkinen, S.A., Quansah, R., Jaakkola, J. J. & Jaakkola, M. S. 2012. Effects of regular exercise on adult asthma. Eur J Epidemiol, 27 , 397-407.

Jia, CE, Zhang, HP, LV, Y., Liang, R., Jiang, YQ, Powell, H., Fu, JJ, Wang, L., Gibson, PG & Wang, G. 2013. The Asthma Control Test and Asthma Control Questionnaire for assessing asthma control: Systematic review and meta-analy- sis. J Allergy Clin Immunol, 131 , 695-703.

Lim, S. S., Vos, T., Flaxman, A. D., Danaei, G., Shibuya, K., Adair-Rohani, H., et al. 2012. A comparative risk assessment of burden of disease and injury at- tributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 380 , 2224-60.

Meren, M., Raukas-Kivioja, A., Jannus-Pruljan, L., Loit, H. M., Ronmark, E. & Lundback, B.2005. Low prevalence of asthma in westernizing countries-myth or reality? Prevalence of asthma in Estonia – a report from the “FinEsS” study. J Asthma, 42 , 357–65

McCoy, E. K., Thomas, J. L., Sowell, R. S., George, C., Finch, C. K., Tolley, E. A.
& SELF, T. H. 2010. An evaluation of peak expiratory flow monitoring: a compa- rison of sitting versus standing measurements. J Am Board Fam Med, 23 , 166–70.

Quanjer, P. H.,. Stanojevitc S, Cole TJ, Baur X, Hall GL, Culver BH, et al Multi-ethnic reference values ​​for spirometry for the 3–95-yr age range: the globaal lung function 2012 equations. Eur Respir J. 2012; 40 (6): 1324–43.

Sagedasemate haiglaväliste infektsioonhaiguste laboratoorse diagnostika ja ravi ja diagnostika algoritmid perearstidele 2005

Sistek, D., Wickens, K., Amstrong, R., D’souza, W., Town, I. & Crane, J. 2006. of respiratory symptoms and bronchial hyperresponsiveness to diagnose asthma in New Zealand. Respir Med, 100 , 2107-11.

Tarlo, SM, Balmes, J., Balkissoon, R., Beach, J., Beckett, W., Bernstein, D., Blanc, PD, Brooks, SM, Cowl, CT, Daroowalla, F., Harber, P. , Lemiere, C., Liss, GM, Pacheco, KA, Redlich, CA, Rowe, B. & Heitzer, J. 2008. Diagnosis and management of work-related asthma: American College Of Chest Physicians Consensus Statement. Chest, 134 , 1s – 41s.

Täiskasvanute astma käsitlus esmatasandil RJ_J / 3.1–2014. Eesti ravijuhend.

90,000 how does garlic affect the body

Several changes in your body that you will notice if you eat garlic every day.

Very often, for colds, grandmothers gave us a magic remedy – garlic. Why is this product so useful and what will be if it is used every day?

Good immunity

Garlic contains allicin, which is one of the most effective natural antibiotics.It also contains a lot of phytoncides, which, due to their properties, act as an antiseptic for the body. Therefore, if you eat this product every day in reasonable quantities, you can independently strengthen your immunity and make your body resistant to many diseases.

Healthy heart and blood vessels

For good cardiovascular function, garlic is an excellent remedy. Studies have shown that one clove of food per day reduces blood pressure by about 10 units.The course of admission should be at least a month. Therefore, if you make it part of the daily diet, it will have a positive effect on the condition of the heart and blood vessels and will be an excellent prevention of many diseases.

Lowers blood sugar

One of the important properties of garlic is to lower blood sugar. When consumed regularly, sugar can be reduced by about 25 percent. In order to achieve this result, you need to eat no more than two cloves of garlic per day.The result will be tangible.

Do not forget, if you have contraindications, then before starting treatment with garlic, it is better to consult a specialist.

Cancer Prevention

Garlic has been one of the main traditional medicines against cancer for many centuries. It contains alium sulfur. Compounds of this very sulfur are included in many drugs against oncology. Studies in Israel have shown that 28 out of 37 patients showed a decrease in cancerous tumors.

Doctors recommend eating no more than 1-2 cloves of garlic every day. This way, you can lower your cancer risks.

“Garlic Spirit”

“Garlic spirit” or strong breath is one of the downsides to garlic, even if you eat it irregularly. When crushed, it releases enzymes that give this odor. Therefore, it is better to give up garlic before an important meeting or date.

But for those who cannot live without this product, there is a solution: just chew the coffee beans for a minute or drink it down with milk.This will help to instantly repel the smell.

Heartburn Cause

Garlic is a common cause of heartburn. Some of the ingredients in this product cause an increased production of acid in the stomach. This largely depends on the characteristics of the organism. Therefore, it is not recommended to eat it for people who have an intolerance to this product, or for those who suffer from diseases of the gastrointestinal tract.

Reception of “Rennie” during pregnancy

Recurrent heartburn is usually associated with inaccuracies in diet, large meals and a sedentary lifestyle.But in pregnant women it is explained by other reasons1,3:

  • Hormones released during pregnancy relax the muscles, including the esophageal sphincter, so the valve can let the contents of the stomach back through;
  • Hormonal changes reduce the mobility (motility) of the stomach, and it takes longer to get rid of food. Hence the feeling of being overcrowded after eating.

Recurrent heartburn in the 1st or 2nd trimester does not affect the health of a pregnant woman so much, but it can provoke even more nausea and vomiting.In any case, these unpleasant symptoms are worth discussing with your doctor. This is the only way to be sure that they are not associated with gastroenterological diseases. More often, heartburn occurs in pregnant women in the 3rd trimester.


The best way to get rid of heartburn is to prevent it. To do this, doctors recommend revising habits and menus, excluding provoking factors. Moreover, these tips work not only during pregnancy. Try 1.3:

  • Do not lean on salty, spicy and fatty foods, eat less tomatoes, onions, citrus fruits;
  • Avoiding coffee, alcohol, carbonated drinks – all of which increase the risk of heartburn;
  • Eat in small portions, but more often – so the food will not fill the stomach;
  • Wait at least an hour before going to bed after eating;
  • Move, but not too actively – this will help reduce discomfort.

Milk, a popular folk remedy for heartburn, works only partially. Yes, it temporarily neutralizes excess hydrochloric acid, but the fat in milk stimulates the production of gastric juice, which means it again causes heartburn. If you really drink milk for heartburn, then low-fat and in small quantities.


If lifestyle changes do not help get rid of unpleasant symptoms after eating, doctors select medications for expectant mothers with the least side effects.Most often, antacids are prescribed1,3.

Antacids are substances that neutralize excess hydrochloric acid in gastric juice. As a result, even entering the esophagus, gastric juice does not irritate the mucous membrane and does not cause heartburn symptoms. The simplest antacid that used to be very popular is sodium bicarbonate, or baking soda. Unlike modern medicines, soda does not last long: in a reaction with hydrochloric acid, carbon dioxide is formed, which stimulates juice production and, accordingly, a new attack of heartburn.It is not worth “treating” for a long time in this way: sodium retains fluid in the tissues, and edema is undesirable for pregnant women3.

Antacid medicines containing calcium and magnesium, natural and natural elements for the body, help to fight heartburn. Compounds of calcium and magnesium reduce acidity in the stomach and protect its mucous membrane without harming the body. Preparations with these elements in the composition can be taken even by pregnant women3.



Rennie ®️ contains magnesium and calcium carbonates.Due to the high proportion of calcium, the medicine is active within 3 minutes. Combining with gastric juice, the antacid reduces its acidity. As a result, the symptoms of heartburn become less noticeable or disappear altogether, and the sour belching disappears. Rennie’s diverse flavors ®️ – orange, menthol and mint – will make treating heartburn enjoyable, which is important during pregnancy when taste may change.



Of the restrictions, it is important to know that antacids reduce the absorption of iron, so these drugs should be taken at different times – with a break of at least 1-2 hours.Rennie ®️ is used during pregnancy for heartburn, but it should be taken after consulting a doctor and strictly according to the instructions – no more than 11 tablets per day.

1. Juan C Vazquez. Heartburn in pregnancy // BMJ Clin Evid. 2015.

2. Heartburn // Mayo Clinic.

3. Elokhina T.B., Tyutyunnik V.L. Gastroesophageal reflux disease during pregnancy // BC. Mother and Child No. 19 of 28.08.2008 – p. 1243.

Healthy food | KGBUZ “Vladivostok Clinical Hospital No. 4”

Whether you are active or sedentary, whether you want to lose weight or build muscle, or don’t want to change your weight at all, you need to know and follow the basic principles of a healthy diet if possible.

What is it for? Nutrition is the main and almost the only way of delivering energy and substances necessary for normal life to our body. Almost all the elements involved in bioenergetic metabolism and the construction of new cells in the body are supplied or produced from food with food.

“You are what you eat” – you can’t say better.

A healthy balanced diet has a beneficial effect on all body functions. Adhering to such a diet, you will forget about such unpleasant phenomena as heaviness in the stomach, heartburn, indigestion, problems with stool.Nutrition affects the quality of hair, nails, joints, ligaments and other tissues in our body. The quality and quantity of food also affects mood and stress levels. In other words, nutrition, being a necessary process of maintaining life, affects the quality of life of a person as a whole.

Basics of a healthy diet

What is the correct healthy diet? Everything is very simple. To be healthy, food must meet several simple conditions, namely:

  • Replenish the required amount of proteins, fats, carbohydrates, as well as vitamins and microelements
  • contain the required amount of liquid
  • to replenish the body’s energy consumption for vital functions
  • Promote better digestion and assimilation of food
  • contain only fresh and healthy products

Based on this, 12 basic principles of proper nutrition are formulated.

1. Proper nutrition – varied

The diet should be as varied as possible. This does not mean that you need to eat everything that comes to hand. The point is that during the day the body receives all the necessary substances: proteins, fats, carbohydrates, vitamins, macro and microelements. All these elements must be present in the daily diet of every person. The absence of any of these will lead to health problems, some of which may be irreversible.Carbohydrate-free, fat-free, or protein-free diets are dangerous and unscientific conjectures of internet inventors. Careless adherence to such diets is sure to add health problems. Sometimes there really are indications for reducing the consumption of a particular food component, but they should only be carried out on the recommendation of a qualified specialist and under his supervision.

2. Correct power supply

It is believed that the optimal number of meals per day is not less than five.Indeed, 5-6 meals a day allows you to maintain a feeling of fullness throughout the day and, at the same time, not overeat. Having chosen the number of meals that suits you, you should try to eat at about the same time every day. This will help the body optimize digestion. A constant diet will bring even more benefits in conjunction with the formation and adherence to the regime of the whole day (the same alternation of work and rest every day, a full night’s sleep). It should be mentioned that the last meal should be no later than 2 hours before bedtime (if something is very light, then it can be 1 hour before bedtime).

3. Food should be moderate

Find the best serving size for you. If you feel that you are full, and there is still food left, then you do not need to push it into yourself. The meal should end with a feeling of satiety, but not oversaturation.

4. Products for proper nutrition

Products should be as healthy and fresh as possible. For example, when choosing meat, it is necessary to give preference to poultry or lean beef, but not pork. Any fish will perfectly complement the menu.It is better to buy chilled rather than frozen food, because freezing is an aggressive method of preservation and negatively affects the quality of food.

When choosing any products, you need to carefully look at the composition and shelf life of the products, you can also pay attention to the content of proteins, fats, carbohydrates and calories. It is better to prefer vegetable fats to animal fats. It is not superfluous to mention that in order to maintain a healthy microflora of the gastrointestinal tract, regular use of fermented milk products (for example, low-fat kefir) will be useful.

5. Proper nutrition is healthy and tasty!

Food must be tasty. Yes, in addition to being good, food should be enjoyable. This does not mean that you need to “live to eat”, but tasteless and nondescript food should not be either. The pleasant smell and beautiful appearance of food increases the appetite before the start of the meal and promotes the speedy production of enzymes in the gastrointestinal tract, which are necessary for the digestion of what has been eaten. The good taste of food promotes the secretion of saliva, which is also involved in digestion, and simply lifts the mood.

6. We eat only freshly prepared food and refuse from semi-finished products

The healthiest food is the one that has just been prepared. And its benefits decrease with every hour after cooking, not to mention the dishes of yesterday’s or the day before yesterday’s freshness. They can be not only useless, but even harmful.

The situation is even worse with semi-finished products. If they initially contain a small proportion of useful substances, then in the process of long-term storage and preparation, this little is also lost.In addition, convenience foods often contain large amounts of salt, flavor enhancers, preservatives, and other questionable ingredients. Therefore, you can eat semi-finished products only occasionally, when you absolutely do not have enough time to cook. It happens that someone loves sausage or cannot live without instant noodles. In this case, you can also occasionally “pamper” yourself with these products, but you need to be aware that this food is useless and does not represent any nutritional value.

7.Proper food preparation

Healthy food means properly prepared meals. Many foods must be heat treated before being eaten. In most cases, this is roasting. Frying is any cooking in hot oil. This is where the problem lies. Even if you do not take into account trans fats, which some fast food establishments and margarine manufacturers do not disdain, there are still extra calories obtained by products from oil during frying, as well as the likelihood of the formation of carcinogens when products are heated strongly in oil.Therefore, the preferred cooking methods are boiling, steaming, and baking (eg in an oven). With the proper skill and ingenuity, these methods allow you to get tasty finished products without adding extra fat to them. Frying lovers can use the grill: classic, in the oven, or the grill pan, which allows you to cook food without using oil. Another way to process food without oil is by using the microwave.

8. Vegetables and fruits must be present in the diet

Vegetables should be included in every meal.Thanks to the vitamins, organic and mineral substances contained in them, fiber, vegetables have a beneficial effect on the digestion process, stimulate the intestines and supply the body with the necessary nutrients. Vegetables contain almost no fat, and therefore they can be consumed in large quantities and even in the evening, when it is recommended to refrain from other carbohydrate dishes. Green and starch-free vegetables are especially beneficial. Fruits are also rich in vitamins and other nutrients, and they should also be present in the diet.But because of the higher fructose content than vegetables, you should not get carried away with them, especially in the afternoon.

9. Food doesn’t have to be fast

It means that you cannot eat on the run or in a hurry. Even if you are very hungry, you still need to set the table and start your meal without haste. It is very helpful to focus on food as an enjoyable process. While having a leisurely conversation with family or friends over lunch will not hurt, it is better to refrain from watching TV while eating.Chewing food thoroughly is also important. This is especially true for dry food and dry snacks. You can find recommendations to do 20-40 chewing movements before swallowing food for better digestion. How many chews do you make? Count, for the sake of interest.

10. Sweets and flour in the diet

The diet should be absent or minimized sweets and starchy foods. Flour and sweet (the so-called fast carbohydrates) give too much energy to the body, part of which it quickly assimilates, and stores the unclaimed part in reserve in the form of a fat layer.There is a sharp surge of energy, and immediately after that the same sharp decline in strength. The high sugar content of these foods causes a spike in blood insulin levels. If sweets are often abused, diabetes can develop. In addition, with consistently high blood sugar levels, damage to the walls of blood vessels can occur. The sites of such damage become centers for the deposits of cholesterol plaques, which, increasing over time, will interfere with blood flow in the vessels.

But it is not necessary to completely abandon flour and sweets.You can find a useful replacement for them. For example, white bread can be substituted for wholemeal bread. Sweets can be replaced with dried fruits, nuts. If you really want something sweet, then it is permissible to eat a little bitter chocolate or creamy ice cream without additives. Other sweets are allowed, but it is better to eat them in small portions and after the main meal – this will not cause a sharp jump in blood sugar levels.

11. During the day, the required amount of water should be supplied

No one will argue that water is very useful and vital for us.How much water do you need per day? Everything is very simple. You can often find a figure of 2 liters per day or more. This is a general recommendation. Both excess and lack of water in the body are harmful, so you do not need to pour water into yourself against your desire or, conversely, limit your water intake if you are thirsty. It is important to avoid thirst. If you’re thirsty, you’re already dehydrated. Remember to drink small amounts of water throughout the day and avoid excessive thirst.

12. Quitting bad habits

Everyone knows about the dangers of alcohol, tobacco and drugs. The serious damage caused to human health by these substances is a topic for a separate article. It should only be noted here that these substances negatively affect all systems of the body, in particular, the metabolism is disturbed, the gastrointestinal tract suffers, appetite decreases, the central nervous system and the endocrine system are inhibited. Therefore, if you want to be healthy, then you need to get rid of bad habits.

Benefits of proper nutrition

These are twelve basic principles that you follow to improve your diet.It may seem to some that following these principles is difficult, but in reality it is not. Of course, if at the moment your diet does not correspond to any of these principles, then it will be quite difficult to follow all twelve at once. But this is not necessary. You can start gradually – change your gastronomic preferences and adjust the daily routine. Perhaps at first it will take a little more time for cooking and for the meal itself. But gradually it will become a habit. Moreover, very little time will pass and you will feel how your state of health has changed for the better: your appetite has improved, the unpleasant sensations in the stomach after eating have disappeared, in general, all the good things that we talked about at the very beginning have happened.

It should be remembered that these principles of good nutrition are not diet and do not require strict adherence. These are general guidelines for healthy eating and should be followed as much as possible. If you suddenly wrap up in some fast food establishment or eat a donut with jam, then, of course, nothing irreparable will happen. But you will notice how these foods are hard on the stomach compared to healthy and light foods. The severity of unhealthy food overloads the gastrointestinal tract and internal organs.