Eating leaves sour taste in mouth

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DEAR DR. ROACH: My wife, age 70, complains frequently of a sour taste in her mouth soon after eating. I thought she had esophageal reflux, but I did not find that sour taste is one of the symptoms. She has no heartburn, but the taste occasionally improves after taking an antacid. – B.P.

ANSWER: Gastroesophageal reflux disease can have no symptoms, or many. Sour taste is, in fact, a common symptom. This is the “reflux” of the condition’s name, since it refers to the backward movement of stomach acid – all the way into the back of the throat or even into the mouth. Heartburn is perhaps the most common symptom, but so is difficulty swallowing. This is more common in people with longstanding symptoms.

Antacids neutralize the acid in the stomach but do not prevent the reflux of stomach contents. Widely prescribed medications, including H2 blockers like Zantac or Pepcid (“H2” is a type of histamine receptor, a stimulus for acid production) and proton pump inhibitors (like Prilosec or Nexium, which directly reduce acid secretion), also act on the acid in the stomach, and do not reduce reflux.

In order to reduce reflux, I recommend eating smaller meals, not reclining for two to three hours after eating, losing weight if appropriate and avoiding products that weaken the lower esophageal sphincter, the valve-like muscle at the bottom of the esophagus. Alcohol and tobacco are the biggest offenders.

Raising the head of the bed (traditionally with a brick, but foam wedges also are good) uses gravity to help the refluxed acid get out of the esophagus. Reducing reflux or acid at night is most important. While the body is in a horizontal position, the acid can stay longer in the esophagus and cause damage.

DEAR DR. ROACH: I am very concerned about my 81-year-old sister. She is 4 feet 10 inches tall and weighs 78 pounds. This is a new low weight for her. She recently had bloodwork done and was told she has an underactive thyroid and should take medication for it. She also has a colon problem and COPD.

I thought that with an underactive thyroid, you gained weight, not lost. Can you explain the difference between underactive and overactive thyroid? – C.K.

ANSWER: The thyroid gland in the neck produces thyroid hormone, which affects every tissue in the body. People with an underactive gland (called hypothyroid) tend to gain weight, may have dry skin, and slow bowel movements, and can be lethargic or sluggish. People with overactive thyroid (hyperthyroid) usually are the opposite: full of energy, thin and intolerant of heat. The diagnosis is confirmed by blood tests of thyroid levels.

However, these common conditions occasionally look very different from the normal. I have seen people with severe hyperthyroidism be lethargic to the point of apathy. Weight gain or loss isn’t inevitable with thyroid disease.

However, with severe COPD, weight loss is almost universal. The COPD may be a bigger contributor to her weight loss. But with a body mass index of 16.3, she is dangerously underweight and needs further evaluation and treatment.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803.

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