Over Easter, millions of South Africans may reach for their chests in discomfort more often than usual and the heartburn culprit, says a local pharmaceutical company, is chocolate.
Research shows that at least 2.5 million South Africans experience heartburn every day. "Very few people are aware that chocolate is one of the top causes of heartburn and that over-indulgence can lead to painful bouts of heartburn," says Mariska Fouche, public affairs manager at Pharma Dynamics, a leading supplier of over-the-counter (OTC) heartburn medication.
She explains that, despite its name, heartburn has nothing to do with your heart. "It's a digestive rather than a cardiac ailment. When the lower oesophageal sphincter (LOS), a tight muscle at the bottom of your oesophagus that acts like a valve, gets irritated or relaxed, heartburn results. The muscle prevents food from your stomach travelling back up your oesophagus by contracting. However, sometimes it relaxes too soon and food, mixed with strong stomach acids, does squirt back up, causing the burning sensation. Heartburn is also known as acid reflux."
Key chemicals in chocolate can trigger muscle relaxation and thus heartburn. "Chocolate contains concentrations of theobromine, a compound that occurs naturally in cocoa, which slackens the LOS. It also contains serotonin - the 'feel-good' chemical that some say accounts for why we enjoy chocolate so much, which has also been shown to affect the function of the LOS. In addition, chocolate is high in fat, another cause of heartburn. So those delicious Easter eggs are full of heartburn-inducing chemicals."
Chocoholics who cannot resist nibbling on a chocolate rabbit or egg this Easter should choose options that contain the least amount of theobromine.
"Dark chocolate with a very high cocoa content has the highest levels. Milk chocolate has less and white chocolate only has trace amounts. Your best choice is a small amount of white chocolate because although it is low in theobromine, it is high in fat and sugar."
To recover from heartburn, follow these steps:
"First, stand up, don't lie down. Gravity will help keep the acid in your stomach. Then drink a glass of water to wash the acid and food back down your oesophagus. If you can, stimulate and swallow extra saliva by chewing gum, or drink an alkaline vegetable juice or eat veggies like cucumbers, radishes, carrots or beetroot. Avoid bending at the waist and wear loose-waisted garments."
You could also reach for popular OTC medicines like antacids and proton pump inhibitors or PPIs. "Antacids typically neutralise the pH levels in the stomach, offering fast relief. However, you run the risk of suffering from heartburn again once the stomach acids return to their previous levels. Antacids are not a long-term solution.
"PPIs - also known as acid secretion reducers - inhibit the proton pumps responsible for transporting gastric acid to the stomach. Less acid is released and the patient gets up to 24 hours' relief.
Chronic sufferer's guide
"Chronic sufferers may have to make other adjustments. Try to eat supper at least two to three hours before going to bed so that acid levels have subsided by the time you lie down. Stick to smaller but more frequent meals to minimize the production of stomach acid.
"If these measures aren't enough, try sleeping on your left side so that your stomach acids pool away from your LOS and raise the head of your bed by about 10 to 15 cm - or sleep slightly propped up, so that gravity helps keep acids in the stomach."
She points out that your physical condition also affects your chances of suffering from heartburn. "If you're overweight, excess body fat can push on the stomach, increasing gastric pressure and forcing food and acid up the oesophagus. Obese patients can also suffer from lower LOS pressure and impaired emptying of the stomach; meaning food and acid are always present.
"Many pregnant women suffer from heartburn because increased levels of hormones can soften the ligaments that usually keep the LOS tightly shut. Smokers generally suffer more heartburn because smoking stimulates stomach acid, weakens the oesophageal muscle and slows the production of saliva, which works to prevent harm to the oesophagus. Drinkers of alcohol also show heightened levels of heartburn because alcohol increases production of stomach acid and relaxes the LOS. If you combine these factors with chocolate consumption, you may suffer from recurring and severe heartburn."
Heartburn diary can track source
"International research shows that up to 94% of heartburn sufferers can link their symptoms to specific foods if they keep a 'heartburn diary' for a few weeks. If you know chocolate is a trigger, rather avoid it this Easter, especially if you are also overweight, pregnant, smoke or drink alcohol.
"Heartburn is also more common at night, which means it may not be immediately obvious that the chocolate you ate during the day is the cause. Keeping a diary that tracks your diet and instances of heartburn should reveal your food triggers quickly."
According to consumer research by confectioners, Africa produces 75% of the world's cocoa and the per capita consumption of chocolate in South Africa is 1.3 kg annually.
"As our diets and lifestyles become more Westernised and sedentary and we eat more chocolate, we can expect to see an increase in the prevalence of heartburn. As always, prevention is always better than treatment. Keep fit, avoid trigger foods, don't smoke and drink moderately or not at all to keep heartburn at bay," concludes Fouche.