Which Alcoholic Beverages Are Best if I Have Heartburn?

Most of us have felt it at some point: that sudden, uncomfortable burning sensation that starts in the middle of the chest and can creep its way up to the throat. Heartburn — that oh-so-common discomfort — can put a damper on a pizza night or yoga class and can keep us from getting a good night’s sleep.

Believe it or not, heartburn isn't a modern phenomenon resulting from our love for spicy tacos or greasy burgers. Our ancestors experienced it, too! Historical texts and records from ancient Greece and Egypt describe symptoms that closely resemble modern-day heartburn. They even had their own remedies: a mixture of herbs, roots, and sometimes, quirky rituals.

It’s also a known fact that alcohol can make the problem worse. Let’s explore the connection between heartburn, drinking alcohol, and what different types of alcohol mean for acid reflux.

Heartburn 101: The Basics

Let’s start by clarifying: in spite of what the name suggests, heartburn has nothing to do with the heart. The term likely comes from the location of the pain. The burning sensation often felt in the center of the chest can mimic the discomfort one might feel with heart issues. However, heartburn is all about the digestive system.

When we eat, our food travels from the mouth to the stomach via the esophagus. At the bottom of the esophagus is a muscular valve called the lower esophageal sphincter (LES). Its main job is to act as a one-way gate, letting food in and keeping stomach acids from coming back up.

However, sometimes, the LES doesn't close properly or opens too often, allowing stomach acid to creep up into the esophagus. This acid, which is great for breaking down food in the stomach, irritates the esophagus lining, leading to that familiar burning sensation.

Certain factors can make acid reflux more likely:

• Spicy dishes, fatty foods, and certain beverages
• Overeating or lying down right after a meal
• Stress and lack of sleep
• Smoking and certain medications

Each case is a little different, and triggers can shift over time. For example, some people find that certain foods that used to cause heartburn no longer do, while new culprits might appear on the scene. It’s good to keep track of the factors that seem to aggravate heartburn — preventing it before it begins is always our best bet.

Heartburn — or Something Else?

It's worth noting that occasional heartburn is common and is not a cause for alarm. However, frequent episodes can be a sign of a more serious condition called gastroesophageal reflux disease (GERD). This chronic condition can lead to complications if not addressed. The combination of alcohol and GERD can worsen symptoms such as heartburn. If heartburn symptoms persist, it's essential to see a healthcare professional. For people already diagnosed with GERD, researching the relationship between GERD and alcohol may be helpful for understanding and mitigating adverse symptoms.

The Alcohol and Acid Connection

If you've ever indulged in a glass of wine, a cold beer, or a cocktail and soon after felt the sting of heartburn, you're not alone. While alcohol might be responsible for many merry moments and relaxed evenings, it can be a prime culprit behind that unwelcome fiery feeling in your chest. Let's demystify why alcohol and heartburn often go hand in hand.

• Relaxed LES. Alcohol relaxes the LES, making it easy for stomach acid to splash back into the esophagus — the primary cause of heartburn.
• Stomach acid production. Alcohol doesn't just stop at making the LES relaxed. It also stimulates the stomach to produce more acid. A higher amount of stomach acid means that there's a greater chance for it to move upwards when the LES isn’t working effectively.
• Stomach emptying slowed down. Under regular circumstances, our stomach pushes food down into the small intestine after digesting it. However, alcohol can slow down this process, providing more opportunity for acid to rise and cause discomfort.
• Mucosal damage. The stomach lining is equipped with a protective layer to shield it from the potent acid it holds. The esophagus, however, isn’t so fortunate. Alcohol can irritate and even damage the esophageal mucosa, making it more susceptible to the burn of acid reflux.

When you have heartburn, drinking alcohol is clearly a gamble. While it's undeniable that alcohol plays a part in inducing heartburn, not all drinks are made equal when it comes to acid reflux. For instance, carbonated alcoholic beverages (like certain beers) increase the risk of heartburn due to their bubbly nature. Meanwhile, high-proof spirits might irritate the esophagus more due to their higher alcohol content. Let’s explore this subject of heartburn from alcohol in more detail as we take a closer look at wine, beer, hard liquor, and mixed drinks, and learn what is the best alcoholic drink for acid reflux!

Fact #1: White Wine Causes More Heartburn Than Red

When deciding between red and white wine, you might be surprised to learn that the color does play a role in its potential to cause acid reflux. So if you're choosing between the two, red wine might be the lesser of two evils. But remember: it still has the potential to cause heartburn.

• White wine. That crisp, sharp taste in many white wines? It comes from the higher acid content. So, for those sensitive to acid reflux, sipping on a chardonnay might increase the chances of feeling the burn.
• Red wine. Although generally less acidic than white wines, red wines still contain acid and can contribute to heartburn. However, other factors in red wine, such as tannins, might irritate the esophagus for some people.

Moreover, wine is often enjoyed with a meal. The type of food you pair with your wine can either amplify or mitigate heartburn risks. A spicy or very fatty meal, combined with wine, can be a recipe for increased acid reflux. Pairing wine with milder foods might help balance things out.

Tips for Wine Lovers With Heartburn Concerns

1. Sip slowly. Pace yourself to give your body more time to process the alcohol and acid.
2. Stay upright. Try not to recline or lie down after enjoying your glass. Keeping an upright posture helps keep stomach acid in its place.
3. Moderation is key. Limit the amount you consume in one sitting. A smaller quantity can reduce the chance of triggering heartburn.
4. Stay hydrated. Drinking water alongside your wine can help dilute stomach acid and wash down any that has splashed into the esophagus.

Fact #2: Beer Gives Bubble Troubles

Beer, often referred to as “liquid bread,” has been a part of human life for thousands of years. However, for those prone to acid reflux, that comforting mug of beer might sometimes lead to uncomfortable consequences. Let's take a closer look at beer and its ties to acid reflux.

Beer is a fermented beverage made primarily from water, barley, hops, and yeast. The fermentation process results not just in alcohol — which enough to cause acid reflux by relaxing the LES — but also in certain compounds and gasses that can play a role in digestion:

• Carbonation. The bubbles in your beer might look inviting, but they can be troublemakers! Carbonated beverages can lead to increased stomach gas. This additional pressure can push stomach acid into the esophagus, leading to reflux.
• Acidity. Beer, like other alcoholic drinks, is inherently acidic. Different beers will have varying levels of acidity based on their brewing process and ingredients, but any acid can contribute to reflux when paired with a weakened LES.

The wide world of beer offers a diverse range of flavors and styles, from light lagers to rich stouts. The differences in ingredients and brewing processes can affect their potential to instigate reflux. While individual reactions may vary, it's always a good idea to be mindful and notice if a particular type of beer consistently triggers discomfort.

Guidance for Beer Enthusiasts With Reflux Concerns

• Limit quantity. Opt for a smaller glass if available. By reducing the volume consumed, you can potentially reduce the chance of reflux.
• Ditch the bubbles. If you’re pouring beer into a glass, let it sit for a moment to allow some carbonation to escape.
• Watch the snacks. Beer is often paired with spicy or fried snacks. These can compound the reflux risk, so choose milder, non-acidic accompaniments.
• Mind your posture. After enjoying your beer, try to stay upright for a while. Gravity can be your ally in keeping stomach contents down.

Fact #3: Hard Liquor Leads to High-Proof Blues

Spirits like whiskey, gin, and vodka might seem tempting, but they contain higher alcohol content, which can more readily relax the esophageal sphincter.

When it comes to beverages, hard liquor stands apart with its potent punch and distinct flavors. Whether it's a neat shot of whiskey, a gin on the rocks, or a simple vodka mixer, spirits are often the go-to choice for many. But how do these strong beverages fare when it comes to acid reflux? Let's sift through the facts.

The distinguishing feature of hard liquor over other alcoholic beverages is its higher alcohol content. Here's how that plays into acid reflux:

• The LES factor. As we've discussed with other alcoholic beverages, the LES (remember, that’s the lower esophageal sphincter) can become more relaxed with alcohol consumption. Given the higher concentration of alcohol in spirits, there's a greater potential for the LES to let its guard down, allowing acid to make an unwelcome ascent.
• Stomach lining irritation. Spirits, due to their high alcohol content, can be more irritating to the stomach lining, potentially increasing acid production.
• Quantity vs. concentration. While a typical serving of hard liquor may seem small compared to a glass of beer or wine, the concentration of alcohol is significantly higher. This means even a small amount can have a pronounced effect when it comes to triggering acid reflux.

Often, spirits aren't consumed alone. They're mixed with a variety of beverages, from sodas to fruit juices. These mixers can be a double-edged sword:

• Carbonated mixers. Just as with beer, carbonation in mixers can lead to a build-up of gas in the stomach, pushing acid into the esophagus.
• Acidic juices. Citrus mixers, like orange or cranberry juice, add additional acid to the mix, potentially exacerbating reflux symptoms

Tips for Navigating Spirits With Acid Reflux

1. Dilution solution. Consider diluting spirits with non-acidic, non-carbonated mixers. Water or herbal infusions can be good choices.
2. Sip slowly. Given their strength, spirits are best enjoyed slowly. This also gives your body more time to process the alcohol, reducing its impact on the LES.
3. Limit intake. One drink might be enough to cause discomfort for some. Listen to your body and know when to stop.
4. Stay elevated. If you're settling down after a drink, keep your head and upper body elevated to help prevent acid from moving up the esophagus.

Fact #4: You’ll Be Burned by Mixed Drinks

Mixed drinks, with their variety and versatility, often steal the spotlight at gatherings and nights out. But how do these concoctions interact with acid reflux?

When we talk about mixed drinks, we're addressing a fusion of ingredients. Each component can play a role in influencing heartburn:

• Alcohol. As the base, alcohol — regardless of the type — has the potential to relax the LES, setting the stage for acid reflux.
• Acidic ingredients. Cocktails with acidic mixers, such as citrus juices or sodas, can be a double whammy. The alcohol combined with the acidic base can spell trouble for heartburn sufferers. 
• Carbonation. Fizzy mixers, like tonic water or soda, can increase stomach pressure, leading to a greater risk of acid creeping up.
• Sugary syrups. While not directly causing acid reflux, high sugar content can delay stomach emptying, increasing the duration acid stays in the stomach.

Some mixed drinks inherently pose a higher risk for reflux than others due to their ingredient list. A cocktail with multiple acidic components and carbonation might be more problematic than a simpler mix with non-acidic elements.

Guidelines for a Gentler Mixed Drink Experience

For those who have a soft spot for mixed drinks but are wary of acid reflux, a bit of cocktail creativity can go a long way:

1. Know your ingredients. Being informed about what goes into your drink can help you anticipate its potential effects.
2. Communicate with your bartender. If you're at a bar or restaurant, don't hesitate to ask for modifications to make your drink more reflux-friendly.
3. Opt for smaller servings. A smaller drink means a lesser quantity of each potentially problematic ingredient.
4. Substitute wisely. Choose non-acidic mixers when possible. For instance, swap out tonic water for a non-carbonated alternative, or use watermelon juice in place of lemon.
5. Limit layers. The more components in a drink, the harder it is to gauge its potential for causing discomfort. Keep your mixes straightforward.
6. Sip slowly. Sipping slowly can reduce the amount of acid introduced to the stomach at once, and it gives the body a better shot at processing the drink without overburdening the digestive system.
7. Stay active. Engaging in light activity after your drink, like standing or walking, can help combat the effects of reflux.

What Should You Drink If You Have Acid Reflux?

So after diving deep into the world of wine, beer, hard liquor, and mixed drinks, what's the consensus on which are the best options for people dealing with acid reflux? Let's bring it all together.

If you’re struggling with acid reflux, avoid anything that will irritate your digestive tract further. In addition to alcohol, coffee and sometimes green tea can be an irritant, so opt for chamomile or rooibos instead. Smoothies, coconut water, and non-acidic juices are all great options as well. And if you’re set on having an alcoholic drink, choose one that has a lower alcohol content and low acidity, such as a light beer.

Least Troublesome Options

• Diluted hard liquor. When diluted adequately with non-acidic, non-carbonated mixers like herbal infusions or plain water, spirits can be less irritating.
• Simplified mixed drinks. Concoctions with fewer ingredients that are low in acidity and sugar can make for a more stomach-friendly experience.

Proceed With Caution

• Red wine. While still capable of inducing acid reflux, red wine generally has less acidity compared to its white counterpart.
• Light beer. Although not ideal, lighter beers with lower alcohol content are better than heavier, more robust brews when it comes to acid reflux.

Best To Avoid

• White wine. With higher acidity levels, white wines are generally more likely to trigger acid reflux.
• Complex cocktails. The more ingredients, especially acidic and carbonated ones, the higher the chances of experiencing discomfort.
• Strong beers. Beers with high alcohol content are more likely to relax the LES and irritate the stomach lining.
• Straight-up spirits. Consumed without dilution, hard liquor can be the most problematic due to its high alcohol content.

General Tips for Managing Heartburn

Understanding the roots and mechanics of heartburn can provide not just relief but empowerment. It's always good to know what's happening inside our body and why. 

Thankfully, with modern science and medical advancements, we have a clearer understanding of heartburn's causes and treatments, from over-the-counter antacids to lifestyle changes, making it easier for us to find relief. These are some common treatments:

• Over-the-counter antacids. Products like Tums, Rolaids, and Maalox can neutralize stomach acid and provide quick relief.
• H2 blockers. Medications like famotidine (Pepcid) reduce acid production in the stomach. Potential side effects include headache, diarrhea, constipation, dizziness, and occasionally changes in heart rate and mood. Rarely, they might lead to liver or kidney issues, and interactions with other medications.
• Proton pump inhibitors (PPIs). These drugs, including omeprazole (Prilosec), lansoprazole (Prevacid), and esomeprazole (Nexium), also reduce acid production and are generally more effective than H2 blockers. Potential side effects include headache, diarrhea, nausea, and increased risk of bone fractures, kidney disease, and certain infections. Long-term use may also be associated with vitamin B12 deficiency and stomach problems.
• Prokinetics. Drugs like metoclopramide can help strengthen the LES and speed up stomach emptying, though they're not commonly prescribed due to potential side effects, which include diarrhea, nausea, headache, and in some cases, extrapyramidal symptoms like tremors and involuntary movements. Some may also be associated with increased prolactin levels or cardiovascular effects.
• Lifestyle changes. This includes avoiding trigger foods, not eating before bedtime, elevating the head while sleeping, and maintaining a healthy weight.
• Wearing loose clothing. Tight clothing can put additional pressure on the stomach, exacerbating heartburn.
• Natural remedies. Some people find relief with remedies such as chewing gum (it stimulates saliva production, which can neutralize acid), drinking a baking soda solution, or consuming aloe vera juice.
• Avoiding tobacco and alcohol. Both can relax the LES, so reducing or eliminating them can help.
• Surgery. In severe cases where medications and lifestyle changes don't help, surgical procedures like fundoplication can be used to strengthen the LES.

How To Avoid Heartburn When Drinking

Keep these general tips in mind to avoid alcohol heartburn:

• Keep it small. Moderation is key. A small amount of alcohol might not trigger heartburn as severely as indulging.
• Watch the clock. Drinking earlier in the day and ensuring you don't lie down right after can give your body time to process the alcohol before bedtime.
• Food first. Eating before drinking can help protect the stomach and potentially reduce the risk of acid reflux.
• Diluted drinks. Cutting your alcoholic beverages with water or non-acidic mixers can reduce their strength and lessen their impact on your esophagus.
• Low-alcohol beverages. Opt for drinks with a lower alcohol content. This can be a strategy both for reducing heartburn and for those wanting to cut back on alcohol overall.
• Say no to fizz. Avoid carbonated mixers and opt for still mixers instead.
• Track and learn. Maintain a food and drink diary. Note what you consumed, when heartburn struck, and how severe it was. Over time, you'll be better equipped to identify your personal triggers.
• Mind the gap. Give yourself some time between your last drink and your bedtime, allowing your stomach to settle.
• Stay upright. After enjoying your drink, avoid reclining for a few hours. This helps keep the stomach acid where it belongs: in your stomach!

Summing Up

While cutting back or quitting alcohol is a commendable decision for numerous health reasons, understanding the nuanced relationship between heartburn and your drink choice is crucial. Always listen to your body, and when in doubt, consult with a healthcare professional. After all, a little knowledge (and maybe a splash of water in your drink) can go a long way in keeping that heartburn at bay. Here’s to smarter sipping — whether that means moderation or a refreshing glass of water!