Be Still, My Heartburn
What's the best way to treat acid reflux?
I double-blind tested 12 drugs—one per day. I set aside one dose of each drug and assigned it a letter, put each dose in an envelope, marked the envelope with the corresponding letter, then placed all the envelopes in a plastic bag. In the spirit of our new partnership, my wife agreed to act as The Administrator (TA). At 11 a.m. each day, TA went into another room, pulled an envelope out of the bag, took the medicine out, wrote the date on the envelope, and placed the envelope in her sock drawer. TA then set the drug on the back of my tongue while I closed my eyes. I ate each day's lunch 60 to 90 minutes after taking the medicine, then monitored symptoms—heartburn, reflux, sourness—until around 8 that evening (when the effectiveness of an H2 would have worn off).
After the trial, I reviewed the notes I had made regarding the intensity of each day's meal. I realize that eating different lunches on different days could have skewed the results—what if, say, a burrito and a slice of blueberry pie induced more volatility than a wedge of lasagna plus Junior Mints?—and yet, for logistical and gustatory reasons, I couldn't possibly have eaten the same lunch for two weeks straight. To compensate for the potential discrepancy, I scored each lunch on an acid-inducing power scale (p), with 10 being extremely acid-inducing and 1 being hardly acid-inducing at all. I also reviewed my notes on the intensity and duration of each day's symptoms, scoring each day on a heartburn symptom scale (H), with 10 representing extremely harsh symptoms and 1 representing no symptoms. I divided the p by the H to come up with a final p/H, with the best possible score being a 10—nasty lunch, no symptoms—and the worst possible score being 0.1—light lunch, nasty symptoms. Finally, I looked at the envelopes and paired each day's results with the corresponding drug.
Note: The price for PPIs and prescription H2s varies according to insurance plan and place of purchase. Drug prices below are taken from Drugstore.com and assume no co-pay discount.
Results (from worst to first):
Aciphex (20 mg) 30 tabs/$114.99
Type: PPI; Rx
Lunch: 1 slice of pepperoni pizza; 1 beer; 1 pack of peanut M&M's
p/H (2/8) = 0.25
Notes: Considering this light lunch, the nagging reflux and heartburn I experienced surprised me, especially with a PPI. TA and I did move heavy furniture all afternoon, so physical stress was high.
Generic Ranitidine (75 mg) 30 tabs/$5.99
Type: H2; OTC
Lunch: Spicy Chinese orange beef with rice; 1 beer; 1 slice of blueberry pie; half a box of Junior Mints
p/H (5/10) = 0.5
Notes: Ranitidine, the active ingredient in Zantac, held out for only one hour before I began to feel a burn around my sternum. For most of the afternoon—despite heavy Tums use—I had a sour sting in my throat.
Placebo (cranberry capsule) n/a
Lunch: 1 grilled steak/black bean burrito with spicy salsa; 1 beer; 1 slice of blueberry pie; 1 coffee
p/H (6/8) = 0.75
Notes: The placebo effect dissipated a mere three hours after lunch, when soreness in my chest and a burn in my lower throat took over. For the rest of the day, I nursed a pack of antacids.
Chip Brantley is the author of The Perfect Fruit, a book about pluots.
Illustration by Mark Alan Stamaty.