It's past midnight, but Mike Royce isn't sleeping. The 29-year-old software engineer, awakened for the third night in as many weeks by four-alarm heartburn, is rifling through the medicine cabinet, searching for something that will quench the acidic flames in his gut.

Four out of 10 American men know what Royce is feeling -- a burning pain that creeps into your belly or lower chest, just after you've eaten or maybe late at night. It's esophageal reflux disease, also known as heartburn, the agonizing condition that occurs when caustic acids inside your stomach flush upward into your tender esophagus.

If you've ever watched TV for more than 20 minutes, you already know that there are lots of products to combat this common ailment. Which one should you take? If your heartburn is mild and infrequent, just about any of the drugstore remedies will work pretty well.

"Over-the-counter products are fine if you're having an occasional episode of heartburn, maybe once or twice a month," says gastroenterologist Joel Richter, M.D. But, Richter warns, if you have heartburn more than once or twice a week, or if you suffer from symptoms such as food sticking on its way down, pain when you swallow or unexplained weight loss, call your doctor -- you might be suffering from something much more serious.

First steps to relief
Heartburn generally indicates that the complex functions of the digestive process aren't working exactly as they should. Before you start plop-plopping Alka-Seltzer, try these simple steps to get back in gear:

  • Change your diet. Many foods and beverages can cause heartburn flare-ups, including fatty or spicy foods, chocolate, tomato products, alcohol, coffee, tea and orange juice. These foods may cause the sphincter of the hiatus to loosen, allowing gastric acid to flush back into your esophagus. Also, try eating less at every meal, and don't eat within three hours of going to bed.
  • Drink some water. If you suffer occasional heartburn after meals, simply sipping water can wash the acid back down into your stomach.
  • Calm down. Your brain has an intricate relationship with your stomach; while the linkage between stress and heartburn isn't perfectly understood, it can't hurt to cut down on stressful thoughts and conversations around mealtimes. Better yet, practice daily stress-reduction techniques such as meditation, yoga or listening to soft music in a darkened room.
  • Lift your mattress. Many men suffer from acid reflux at night, because the horizontal sleeping position makes it easier for acid to travel up into the esophagus. You may be able to relieve this by using wooden blocks or books to raise the head of your bed four to six inches. (This may seem uncomfortable at first, but you'll get used to it in a few days.)

  • Lose weight. A big belly hanging over your jeans is a likely cause of acid reflux, but even small weight gains can contribute to the problem.
  • Buy new pants. If your stomach's been growing but your pants size has stayed the same, the tightness around your belly could be forcing acid into your esophagus.
  • Monitor your pharmaceuticals. A variety of drugs, including aspirin, ibuprofen and antibiotics, can contribute to heartburn. Ask your doctor to suggest different medications or alternative ways of taking them.
  • Get a bacteria check. If you're one of the millions of men infected by H. pylori bacteria, you're a more likely candidate for heartburn, an ulcer and even stomach cancer. H. pylori can be treated with antibiotics -- ask your doctor for a breath test, the least invasive way of finding out if you're infected.

Note: The full text of this article, including a rundown of heartburn-relief medications, can be found in the July, 1999 issue of Men's Fitness.