Modi Ronak webOne of the best things about the holidays is gathering with your family for a huge feast. Grandma’s turkey, stuffing, and mashed potatoes bathed in gravy, your favorite aunt’s pumpkin pie — not to mention weeks of holiday cookies. And while that all feels great going into your mouth, it may send you on a trip to the emergency room (ER). 

Not surprisingly, the number of patients who come into the emergency department with indigestion symptoms increases during the holiday season, says Adam Colombo, DO, Network Vice Chairman of Emergency Medicine, St. Luke’s University Health Network. This is particularly true following Thanksgiving and Christmas dinners.

The discomfort and pain caused by overeating can sometimes lead patients to think they are having a heart attack. Often, however, what they’re really experiencing is a severe case of heartburn, Dr. Colombo says. However, that is not always the case, so if in doubt, he strongly suggests that you call your doctor or go to the emergency department.
“Based on symptoms alone, it’s not always easy to distinguish whether someone is having a heart attack or heartburn,” Dr. Colombo says. “I wouldn’t recommend for anyone to decide that alone.” In making a diagnosis, physicians consider the type of symptoms, how long the patient has had them, the constancy of the pain, and if it gets worse with exertion or stress.
“Conversely, there’s a lot of ways that a heart attack will masquerade as something else, and you think it’s just heartburn when it’s not,” he says. Certain conditions, such as diabetes, can affect one’s ability to sense a heart attack. Also, women may have atypical symptoms, such as shortness of breath, nausea, vomiting, and back or jaw pain.
“Believe it or not, eating a big meal can be stressful in its own way and can actually cause people to have heart attacks,” Dr. Colombo says. “Add the travel, seeing family — which for some people can be very stressful — with some alcohol. When you combine all of it together, people can have legitimate cardiac issues as well.”
To add to the confusion, patients can have heartburn, heart attack, and angina, at the same time, says Ronak Modi, MD of St. Luke’s Gastroenterology Specialists. “We actually see an increase in these symptoms closer to the holiday and a lot of it has to do with not only overeating but also what you’re eating,” he says. “People tend to eat saltier foods and less healthy options that increase blood pressure, making chronic conditions worse. This can lead to a heart attack or worsen other chronic medical conditions.” Angina is a type of intense chest pain caused by reduced blood flow to the heart. It can be caused by muscle pain, or by a breathing issue related to the heart or the gastrointestinal track.
Dr. Modi agrees that if you suspect you are having a heart attack, call 911. Also, he suggests that you take a baby aspirin. A person experiencing a heart attack as a cause for chest pain will often have more generalized symptoms, such as dizziness, chest tightness, shortness of breath, and lightheadedness. Also, the chest pain often becomes worse with exertion, he says. Sometimes, patients experience a squeezing sensation that goes to the left arm.
“Heartburn is actually a misnomer in that it has nothing to do with heart, but rather with the gastrointestinal tract,” Dr. Modi says, “Patients who have heartburn usually present with pain that’s burning in nature and have a sour taste in the mouth.” Women often show different heartburn symptoms, such as a chronic feeling of something stuck in their throat.
Heartburn occurs when stomach acid backs up into the esophagus. This is called “reflux.” Another term for heartburn is GERD, which stands for “gastroesophageal reflux disease,” and is the chronic, more severe, form of acid reflux. Heartburn usually occurs right after eating, and the pain responds well to antacids and a separate class of medications called H2 blockers and PPI therapy.
“If I had to recommend one thing that would help the most to reduce GERD, it would be weight loss,” Dr. Modi says. “Bringing your body mass index closer to the normal range would be helpful. Even a loss of 10 to 15 pounds will greatly help you reduce reflux symptoms.”
Also, don’t overeat. When you eat too much, you are more likely to reflux. You only have so much room in your stomac, so overeating can force acid to back up into your esophagus, he says. Avoid spicy and acidic foods, such as tomatoes and tomato-based sauces, mints, chocolate, anything with caffeine and alcohol — especially red wine. Finally, after eating, don’t lie down for at least two hours. Instead, take a walk, which will speed up your metabolism to help with digestion. Exercise reduces the risk of reflux.
Dr. Colombo agrees. “Going for a walk afterward is very cathartic. It’s the way animals manage their food intake, and it’s very good for the human digestive system as well.”
While bouts of heartburn will go away on their own, people who have heartburn that lasts a long time, or have frequent bouts of heartburn, should contact their primary care physician, Dr. Modi says. Treatment for GERD depends on the severity of the symptoms and often involves dietary and lifestyle changes. When the patient has infrequent or very mild symptoms, Dr. Modi suggests keeping track of what food triggered the heartburn and avoid that food in the future. To relieve the discomfort, he recommends over-the-counter medications. For more frequent or severe GERD, physicians typically prescribe stronger antacids or acid suppressive medications. However, patients who have trouble swallowing, or have experienced weight loss or chest discomfort, require further evaluation.
To reduce your risk during the holidays, Dr. Modi suggests having a plan. For example, if you know you’re going to have a big dinner, have a small breakfast and lunch. Also, opt for healthier dishes, eat them first, and make sure your servings are no bigger than what you can fit in the palm of your hand.
“What commonly happens during the holidays is we tend to overeat, and it takes us weeks to get back to our original weight,” he says. “So, we just have to be very conscientious and stick to our game plan.” Eat plenty of fruits and vegetables, and exercise. If you go to a party, scope out your options first, and if there’s something you really love, have a small portion.
And as for that special dessert that your mother made just for you: “It’s alright to take a small portion once a year, but no seconds. After all, you wouldn’t want to offend her.”

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