If you struggle with acid reflux, heartburn and indigestion, you may be experiencing gastroesophageal reflux disease, commonly known as GERD.
What is GERD?
GERD is a digestive disorder that typically develops when stomach acids repeatedly flow back up into the esophagus. Your esophagus and stomach are connected by a muscle ring called the lower esophageal sphincter (LES). In normal circumstances, the LES closes after allowing food to pass through the esophagus and into the stomach. This prevents stomach acids from backflowing into your esophagus. An abnormal or weakened LES can lose its ability to effectively close during food transit, allowing stomach acids to leak back into the esophagus. This backwash, known as acid reflux, can irritate the mucosal lining of your esophagus, which may lead to unwanted symptoms and potential complications.
Signs and Symptoms to Look Out For
Common signs and symptoms of GERD include heartburn, chest pain, difficulty and/or painful swallowing, and food regurgitation. You may notice that these symptoms worsen after eating, especially with big meals or right after laying down. Depending on the frequency of your acid reflux, you may also develop a chronic cough. Frequency of these symptoms varies among individuals. Some may experience it daily, weekly, or only a few times per month. If left untreated, GERD can lead to more serious complications. These may include esophagitis (inflammation of the esophagus), esophageal ulcers, narrowing of the esophagus, a precancerous condition called Barrett’s esophagus, and in more rare cases, esophageal cancer.
Risk Factors and How to Prevent Them
While there is a genetic component to developing GERD, there are certain dietary and lifestyle factors that can increase your risk of GERD by weakening the LES overtime. Modifying these dietary and lifestyle habits can help prevent and manage symptoms.
Eating Habits and Patterns
Portion size, timing, and meal spacing matter. Eating large meals can put stress on the stomach and force stomach acids back through the LES and into the esophagus. Eating late at night can also trigger acid reflux by inhibiting gravity from doing its job. If you lay down right after a meal, chances are food will come right back up since it did not have time to properly get digested.
What’s the Solution?
Avoid large meals and opt for small frequent meals spaced out throughout the day. Consuming five to six smaller meals a day and waiting two to four hours between meals will avoid overloading your stomach. This will give it the time it needs to digest the food you eat.
After meals, wait at least two to three hours before laying down. This will help relieve pressure on your stomach. So if you have dinner at 7pm, wait until 10pm before your head hits the pillow.
Speaking of pillows, it is also beneficial to elevate the head of your bed two to six inches with a foam wedge beneath the upper half of your body. This will ease the flow of food transit even when lying down.
The Foods you Eat
Certain foods can trigger acid reflux more than others. These include alcohol, coffee, tea, carbonated beverages, acidic juices, spicy and fatty foods, chocolate, mints and acidic foods such as tomato and citrus.
What’s the Solution?
Limit or avoid foods only if they cause symptoms. Not everyone reacts to the same foods. Therefore, there is no reason to take chocolate out of your diet if it doesn’t trigger your acid reflux. We all love a good chocolate treat and wouldn’t want you to skip it if you don’t have to.
The good news is, some foods can actually aid in reducing GERD symptoms.
High fiber foods
A diet rich in fiber, notably soluble fiber, has shown to reduce the risk of acid reflux.
Fiber-rich food sources include whole grains (oatmeal, couscous, brown rice), root vegetables (sweet potatoes, carrots, beets), and green vegetables (asparagus, broccoli, and green beans). Soluble fiber foods include beans, brussels sprouts, avocado, pears, figs, flax seeds, sunflower seeds, hazelnuts, oats, peas, barely, apples. Psyllium is also a great source of soluble fiber and can be taken in the form of a supplement.
The pH scale is a determinant of acidity and alkalinity levels in an aqueous solution. Turns out, foods have their own pH levels. Low pH foods are more acidic, whereas high pH foods, known as alkaline foods, can help mitigate high levels of stomach acids and reduce acid reflux. Some alkaline foods include most fruits and vegetables (especially green leafy vegetables), soybeans, potatoes, tofu, legumes, seeds and nuts. Foods with high water content can also minimize the effects of heartburn. Some high water content foods include celery, lettuce, cucumber, watermelon, cantaloupe, peaches, broths and soups.
Ginger has shown to alleviate acid reflux symptoms. Its alkaline and anti-inflammatory properties can help reduce irritation. For example, drinking ginger tea is a great way to ease heartburn by soothing the mucosal lining of your esophagus.
Smoking, physical activity, obesity, tight clothing, and even stress can increase the risk of GERD and aggravate its symptoms.
What’s the Solution?
Losing weight if overweight or obese can significantly reduce symptoms of GERD. Avoid exercising right after eating as this can also aggravate symptoms. Tight clothing, especially tight belts or pants, can increase pressure on your stomach. Switch to loose-fitting clothing, especially when eating meals. Find ways to decrease your stress levels through exercising, meditation, journaling, talking to a friend, or whatever it is that helps de-stress your mind and body.
Low Stomach Acid and Acid-blocking Medications
As we’ve learned, acid reflux can increase the risk of GERD. Most of the literature out there suggests GERD is caused by excess stomach acid. However, low stomach acid can also produce the same symptoms of heartburn, indigestion, and acid reflux and may also increase the risk of GERD. You might be thinking, how is this possible?
Whether you have excess or low stomach acid, if the LES is loose or weakened, it allows any amount of acid to backflow into the esophagus. Acid-blocking medications called proton-pump inhibitors (PPIs) are often used to manage reflux. However, if used for prolonged periods, it may actually do more harm than good. Stomach acids have a protective effect against harmful bacteria and aid in the absorption of certain essential nutrients including B12, folic acid, calcium, magnesium, iron and zinc. Low stomach acid puts you at risk for invasion of harmful bacteria and inhibits the absorption of nutrients, which may lead to nutritional deficiencies such as anemia. Stomach acids also help break down protein, fats and carbohydrates for digestion. If low stomach acid occurs, undigested food begins to ferment and putrefy, making it unable to move into the small intestine, which creates a whole other set of issues. The fermentation and putrefaction of undigested foods releases a buildup of gases that can lead to reflux, thus irritating the esophagus and increasing the risk of GERD.
What’s the Solution?
If taking PPIs, make sure to consult with your doctor about the duration of treatment. A standard course of treatment is 14 days. To prevent nutrient deficiencies while on PPIs, your doctor or dietitian may recommend supplementation of nutrients typically affected by low stomach acid. Furthermore, bitters, lemon-infused water, and apple cider vinegar can also help stimulate stomach acid production. While hydration is important, it is best to drink between meals as drinking fluids with meals may dilute stomach acids.
Additional Risk Factors
Research has also shown an association between increased risk of GERD and pregnancy, hiatal hernias, connective tissues disorders, delayed gastric emptying, and other medications, including aspirin and NSAIDS. If you are pregnant or have any conditions that may increase your risk for GERD, talk to your medical team and dietitian about implementing prevention methods to minimize risks.
The Bottom Line
GERD can easily be prevented or managed. It is always important to be followed by your medical team, especially if taking medications such as PPIs. Dietitians also play a key role in providing guidance on how to modify your dietary and lifestyle habits to reduce acid reflux symptoms and minimize risk of GERD.