Eating chocolate is risky for reader with heart ailment

Question: You really blew it in your response to a person concerned about the health effects of chocolate. You said there's no caffeine in chocolate. My doctor told me to stay away from coffee and chocolate because caffeine could throw my heart out of rhythm.

Last year I developed an abnormal heart rhythm and had to be shocked with electrocardioversion to get back into normal rhythm. I'm avoiding caffeine since I don't want to go through that again.

Answer: We may have overstated the case. As we specified, the primary ingredient in chocolate is theobromine, a compound related to caffeine. One chemical analysis (Biochemist, April/May 1993) showed no detectable caffeine in chocolate. Other sources list a small amount of caffeine in cocoa and chocolate candy, perhaps because of different analytic techniques.

For comparison, a 5-ounce cup of coffee has 80 to 115 mg of caffeine. A 12-ounce can of cola runs around 40 to 50 mg, and so does a cup of tea. A cup of decaf coffee or cocoa has 4 mg, and an ounce of milk chocolate is listed as having about 6 mg of caffeine. An ounce of dark chocolate might vary from 5 mg to 25 mg.

For most people, this amount of caffeine is not a problem. For you, however, the consequences of eating chocolate are probably too serious to risk it.

Question: I used to take Prilosec, but several months ago my doctor switched me to Nexium to combat acid reflux. It gives me a headache, and I worry that it might interfere with the absorption of vitamin B-12. Are there any other ways to combat heartburn?

Answer: Drugs like Aciphex, Prilosec, Prevacid and Protonix are extremely effective at suppressing acid, but long-term regular use might make it harder to take in vitamin B-12. This nutrient requires acid in the stomach for adequate absorption. Vitamin B-12 is essential for proper nerve functioning.

One reader offered the following: "I heard somewhere that when I got acid reflux I should try chewing sugarless gum. It works for me and is a lot cheaper than all the drugs I had been using. The pain goes away almost immediately."

We are sending you our Guide to Digestive Disorders for more information on pharmaceutical and nondrug approaches to fighting heartburn. Anyone who would like a copy, please send $2 in check or money order with a long (No. 10), stamped (60 cents), self-addressed envelope to: Graedons' People's Pharmacy, No. G-3, P.O. Box 52027, Durham, NC 27717-2027.

Persistent heartburn can be a serious symptom. If you have reflux several times a week, be sure to check with a gastroenterologist.