The thing about the men in gray flannel suits, who came home
from World War II and got married and bought a house in Great Neck with its
very own fallout shelter, who lunched on Dagwoods and napped all weekend, who
feared only the boss and the communists: They all had ulcers.
Ah, the great American ulcer-“the little man living in my
stomach,” said Edward G. Robinson as the cigar-chomping insurance investigator
in Billy Wilder’s1944film, Double
Indemnity . Ulcers were all the rage among the high-powered neurotic set not
so long ago-the Marx Brothers made a cartoon promotional film for The Saturday Evening Post (premier
magazine of the ulcer sufferer) called Showdown
at Ulcer Gulch ; James Gleason played a stressed-out newspaper editor with a
hole in his stomach in Meet John Doe ;
Woody Allen’s character had an ulcer in Sleeper .
Then, in 1983, Barry Marshall made an amazing discovery. Contrary to medical
opinion of the time, ulcers are caused not by stress, not by hoagies, not even
by the Russians; they’re caused by bacteria called Helicobacter pylori . Suddenly, they were curable with simple
antibiotics. Just as suddenly, they became passé. Who gets ulcers anymore? In a
recent article in the Annals of Internal
Medicine , Dr. Martin Blaser, chairman of the department of medicine at New
York University, writes: “The discovery of H.
pylori and its relationship with peptic ulcer disease has led to a new
era.” The ulcer went the way of afternoon highballs, newsreels, Sputnik and
But now, the children of the ulcer age are claiming a
digestive grievance of their own. Acid reflux, an ailment caused by the back-up
of stomach acids in the throat, is becoming the ulcer of the New Age. And just
as the mere mention of ulcers conjures images from the mid–20th century,
someday acid reflux will do the same for the early 21st: The stressed-out
dot-commer, the harassed defender of the Clinton family, the edgy day
trader-all of them reaching for brand-name capsules to relieve the sour, verklempt feeling in the throat.
Heartburn and acid reflux are the digestive epidemics of the early 21st century. Heartburn affects one in five Americans.
Twenty-one million Americans get acid reflux, a heartburn-related disorder that
wasn’t part of the lay person’s lexicon even a decade ago. Americans spend
billions a year on treatment-$4.2 billion on the brand-name drug Prilosec,
which treats acid reflux. Sales of Prilosec are up 34 percent from two years
ago. Now the makers of Prilosec are “developing data for use of Prilosec in
kids,” according to Jim Coyne, a spokesman for AstraZeneca, makers of Prilosec.
And AstraZeneca just got F.D.A. approval for a new drug called Nexium, an
isomer of Prilosec that it hopes will do even better.
In a way, this frenzy is nothing new. Urbane observers of
the human condition generally are always in the throes of some gastric malady
or other. The fin-de-siècle
existentialists-Dostoyevsky, Kierkegaard, Nietzsche-started calling that
not-so-fresh feeling you get when you stare into the void and realize all
existence is absurd “nausea.” Sartre later named a novel after it. Nausea is full of pithy little episodes
like the following: A waitress in a café asks the narrator, “‘What will you
have, Monsieur Antoine?’
“Then the Nausea seized me, I dropped to a seat, I no longer
knew where I was … I wanted to vomit.”
You think that’s bad, nausea boy? Try watching your stock
options turn into toilet paper. You can feel the acid creeping up your throat,
making it tighter and tighter until you think you’ve swallowed a golf ball.
Your well-modulated baritone suddenly bears a distinct resemblance to Jack
Kemp’s scratchy rasp.
Yes, this latest fin
de siècle has its own special nausea: “I think a lot of what was termed
‘ulcer disease’ in the past really is now recognized to be reflux,” said Dr.
David Peura, a physician on the board of the National Heartburn Alliance. “It’s
definitely going up.”
Acid reflux begins when
the valve that lets food into your stomach and keeps acid from washing back
into your throat-the lower esophageal sphincter, or L.E.S.-relaxes too much.
Food and acid refluxes, scalding the esophageal lining. Over time, this causes
a condition called Barrett’s esophagus, an abnormal lining in the throat.
Anything that involves swallowing air, reclining too much or
putting too much pressure on the chest contributes to L.E.S. dysfunction-eating
too much, eating too fast, eating too late at night, not exercising, working
sweatshop hours, wearing tight clothes, being overweight or pregnant. And foods
that contain acid, or take a lot of acid to digest, can be brutal: chocolate,
garlic, orange juice, hot peppers, coffee, beer, aspirin. “Reflux makes more
sense than ulcer disease,” Dr. Peura said. “Since ulcers are caused by the
bacteria, not just by stress, the habits we have when we’re stressed promote
reflux more than ulcers. For instance, people who smoke increase their acid
production. Plus they swallow air. And fatty foods-it’s a double whammy. They
relax the sphincter muscle, but also delay the emptying of the stomach.”
In laymen’s terms, what the doctors are saying is that if
you are a hard-working urban professional in New York in 2001, just about
everything you do is liable to give you acid reflux. Dr. Bruce Yaffe, a
gastroenterologist based on the Upper East Side, calls it “the great New York
City digestive-tract conspiracy.” Dr. Yaffe was talking about his conspiracy
theory over breakfast in a restaurant near Gramercy Park. His meal included
orange juice and coffee, beverages with enough acid to take the paint off cars.
Isn’t that, like, poison? “Moderation is the key,” the doctor said with a grin.
More easily said than done, at least in this city. Take
portly porn king and general man-about-town Al Goldstein, publisher of Screw magazine. Mr. Goldstein rates
every restaurant in the city by the number of Tums it takes him to digest the
food. (Tums is an old-school way to relieve traditional heartburn. Acid-reflux
sufferers generally rely on prescription drugs.) “Katz’s is a three-Tum
heartburn,” he said. “And Il Mulino, that’s a great place. They got a spicy
pasta that is death-defying. One time I complained that they didn’t make it
spicy enough. They put so much pepper on it, I was destroyed for hours.” Talk
of acid reflux makes Mr. Goldstein philosophical: “I deserve heartburn,” he
said. “I’m an overeating fat pig. It’s God’s way of telling me I’m going to
The Sopranos Angle
Mr. Goldstein is not alone in his suffering. At the premiere
party for The Sopranos in late
February, a gaggle of boldface names admitted to being acid-reflux
victims. “Oh, yeah, I get it,” said
Aida Turturro, who plays Janice Soprano in the show. “When I eat too late at
night, it feels terrible.” Benicio Del Toro, who spent practically all of Traffic scowling the scowl of a man with
acid in his throat, averred, “I get it occasionally. But not so much now that I
have some money. I can eat a lot of shrimp now.” James Gandolfini, who as Tony
Soprano spent last season’s finale battling some serious indigestion, has some
real-life gastric difficulties, too. Not that he wants to talk about it. “Yeah.
I get it,” he said. “So?”
Well, perhaps Mr. Gandolfini should consider spending a
minute or two in quiet reflection. City Council Speaker Peter Vallone, a
Mayoral hopeful (and thus a candidate for the mother of all acid reflux), was
asked about his health during a tribute to Julia Roberts sponsored by the
American Museum of the Moving Image on March 4. “I wake up every morning and
pray,” he said. “That’s the secret.” He paused for a moment. “But at night ….”
He declined to elaborate. Later on, George Clooney told The Observer , “I heard Bob Balaban gets it really bad.” Mr.
Balaban-an actor and the director of the ill-fated NBC drama, Deadline -confirmed Mr. Clooney’s
diagnosis. (Hey, those years playing a doctor on TV really paid off!) “I used
to suffer terribly,” Mr. Balaban said. “But it’s not work. Work never makes me
Even fitness fanatic Regis Philbin occasionally refluxes. On
one occasion, he was dining at Babbo on what chef-owner Mario Batali described
as “the spicy lamb sausage ragout.
“The next day,” Mr. Batali said, “on national TV, he was
pounding his chest. ‘Oh, spicy,’ he said.” Mr. Philbin didn’t return a call
through his publicist.
Mr. Batali offered his own explanation for the rise in
reflux. “I think probably what gives a rise to heartburn is the change in the
administration [in Washington],” he said.
For his own part, he said, “You know what gives me heartburn? No taxis.”
For the discriminating acid-reflux sufferer, Mr. Batali suggested a remedy:
“What works for me is bitters and soda. I don’t know what it is, but whatever’s
in them gives immediate relief.” It sounds like a remedy better suited to the
highball, double-feature generation, but hey, if it works, why not?
Rising awareness of acid reflux has changed the way people
diagnose themselves. “Fewer people are coming in and saying, ‘I have an
ulcer,'” Dr. Peura said. “The perception is, they’re less frequent.” Tamara
Sussman, a fine-art photographic printer from the Upper West Side, agreed. “All
I know is that in high school, you know, I was always kind of a tense person,”
she said. “A schvitzer , you might
say.” Ms. Sussman worried about her worrying. “I thought I was going to give
myself an ulcer. Now, though, I tell [my boyfriend] I have a tummy-ache and he
tells me it’s heartburn.” Stephen Weitz, director of sales at Mediabistro.com,
said: “I used to think I had an ulcer. But I cleaned up my lifestyle, and it
took care of itself.” Likewise, Josh Friedman, who writes and designs the Web
page RPlumms.com, said, “In college I saw a gastroenterologist because my
stomach was always hurting. I thought it might be an ulcer, but they said,
‘No-just chill out.'” Of course, that’s what they told the ulcer sufferers of
old, and it turned out that it was the bacteria, not the stress, that was
As it happens, some scientists equate the rise in acid
reflux to the decline of ulcer-causing H.
Pylori bacteria. In his article, Dr. Blaser examines these trends: “As H. pylori has been disappearing, peptic
ulcer disease … [has] predictably been decreasing. However, maladies such as
gastroesophageal reflux disease … have been dramatically and progressively
increasing ….” This mystery bothered scientists for a long time. Why should
acid reflux-or GERD, as the professionals call it-increase while ulcers
Thanks for Nothing
Finally, Dr. Blaser came up with an answer: H. pylori . “Preliminary studies already
suggest that the presence of H. pylori
may protect against [GERD].” In other words, the same bacteria that caused
ulcers probably prevented acid reflux. It’s something like a vaccine-small
exposure to a pathogen can build up the body’s resistance to certain diseases.
At the dawn of human existence, H. pylori probably colonized every stomach, Dr. Blaser believes.
Like an arranged marriage, humans and bacteria developed common interests over
time. Since the stomach is too acidic for almost any other form of life, the
bacteria got a lot of good real estate to themselves. People, meanwhile, got
insurance against debilitating gastric problems like acid reflux.
But why didn’t the bacteria bore holes in Stone Age
stomachs? Curiously, ulcers didn’t develop until fairly recently. For
centuries, H. pylori and H. sapiens actually lived in peace.
Then, something happened. No one quite knows what, but Dr. Blaser has a theory:
Public health improved. The food and water that once made Nietzsche and his
friends nauseous got cleaned up. People started having smaller families;
conditions weren’t as cramped. The number of discrete strains of H. pylori in the American stomach
decreased from an average of around three to an average of one. “It could be
the change in that ecology has an effect of clinical consequences,” Dr. Blaser
said. As H. pylori decreased around
the beginning of the 20th century, people who did acquire it often got it at a
later age. That’s why the generation that fought in World War II was so
susceptible to ulcers in the postwar years. “It’s like chicken pox,” Dr. Blaser
explained. “When a young child gets it, it’s a mild infection. But if someone
gets chicken pox in their 20’s, it’s much more severe. With H. pylori , an infection could lead to an
ulcer when you’re 30, 40 or 50.”
Baby boomers don’t get ulcers as much-but they are more
susceptible to acid reflux. According to Dr. Yaffe, the fallout’s just
beginning. “What we’re really seeing is that the Baby Boom generation … is in
the 35 to 50 range, when different things are happening in the body,” he said.
The first generation born without much exposure to H. pylori is finally coming into its own dyspepsia. The L.E.S.
stops working as efficiently as it did in young adulthood. The stomach takes
longer to empty than before. “A 45-year-old who eats a hamburger late at night
knows that he’s going to wake up in the middle of the night with reflux,” Dr.
Yaffe said. “Whereas, when he was 25, he could get away with that.”
In the future, Dr. Blaser says, “It may be that doctors will
examine a baby and figure out what its genotype is, and then pull an H. pylori strain from the shelf and say,
‘That’s what we’re going to give you to maximize your chance of health for the
rest of your life.'”
What then? Dr. Peura believes that acid reflux is on its way
out. Public-health trends, like everything else in popular culture, just don’t
have staying power anymore. “With the medications and such, we can take care of
this,” he said. Brand-name drugs and newer treatments are getting the job done.
Could it be, then, that modern medicine will allow us to eat
whatever we want without suffering the consequences? Not a chance. “There is a
waste-basket term we call ‘non-ulcer dyspepsia,'” Dr. Peura said. “Some people
we’re seeing don’t have ulcers, we can’t document they have [acid reflux]-they
probably just have a sensitive stomach. Many of us think it’s sort of a variation
of an irritable bowel or intestine.”
Dr. Blaser, for his part, says, “Something else might come
along and adapt to the stomach. And it may not be as benign as H. pylori .”
Dr. Blaser’s playing it safe. “All I can say is, I haven’t
eaten a hamburger in 25 years,” he said.
-Additional reporting by Deborah Netburn