Have you ever felt an uncomfortable burning sensation in your throat, chest, or stomach after eating? Ever have that acidic, sour, or bitter taste backing up into your throat or mouth after meals? "Heartburn" otherwise known as acid reflux is a condition in which the stomach contents move up into the esophagus. For most people, this acid reflux is an isolated incident that directly follows an episode of eating or drinking too much. But for an estimated 20% of the population, acid reflux can become a chronic problem known as gastroesophageal reflux disease, or GERD. The symptoms of GERD are essentially the same as acid reflux, though usually more severe and prominent. If left untreated, the ongoing irritation of the esophageal lining can cause permanent tissue damage that can lead to other health problems like esophagitis or Barrett's esophagus. Acid reflux becomes a disease when it causes frequent or severe symptoms or injury. Reflux may damage the esophagus, pharynx or respiratory tract.
Acid reflux can happen a couple of different ways. When we eat, food travels from the mouth down to the stomach through a tube called the esophagus. Where the esophagus meets the stomach, there is a valve called the Lower Esophageal Sphincter (LES). This valve is supposed to stay closed after we eat so that food and stomach acids stay in the stomach. Some foods relax the LES, which allows food and stomach acids to travel back up - reflux. Being overweight can also place pressure on the LES, allowing the valve to open a bit. Another cause of acid reflux is eating foods that contain compounds that are irritating. These compounds can trigger our stomach to produce more acid than normal or are themselves a bit acidic.
It is unfortunately fairly common, but there are things you can do to help ease your symptoms, namly how and what you eat. Let's go over how reflux happens, foods that cause reflux, some foods that can help tame it down, and other ways to calm the burn. You can change your eating habits to help reduce your GERD symptoms:
Reduce your meal size. Large meals cause the stomach to expand, which prevents the sphincter at the top of your stomach from closing completely, resulting in the contents of your stomach washing back up into to your esophagus.
Stop eating when you feel 75% full. This allows your stomach to empty faster, reducing the chance of a GERD event.
Slow down. Put down your eating utensil between bites to allow time for the sensory receptors in your stomach to tell your brain that you are full.
Use smaller plates and bowls. This will help you feel more satisfied eating smaller amounts of food.
Avoid getting too hungry. That way, when you are finally able to eat, you can avoid overeating in one sitting. Eating small portions every 4 to 6 hours is a good eating pattern for people with GERD.
Set a cut off time for eating in the evening. Your metabolism is most active earlier in the day, which is why it’s a good idea to set a cutoff time for yourself in the evening to stop eating. Doerfler recommends 7 pm as a cutoff time so that your stomach has time to empty out its contents before you sleep. It may also be helpful to elevate your head when you sleep so that your gastrointestinal juices can’t wash up into your esophagus.
Keep in mind that what causes acid reflux for you might not cause it for someone else. What triggers GERD is unique to each individual, and it’s important to pay attention to the foods that cause GERD symptoms for you and to eat them in moderation. There are also certain foods that can help your gut work better, protect your esophageal tissues and help promote healthy bowel movements and the proper emptying of your esophagus and stomach. These include more plant-based foods which are rich in soluble fiber, which contain antioxidants and phytonutrients that foster the growth of anti-inflammatory gut bacteria and protect tissue that may be inflamed from GERD irritation. Examples of this include fruits and vegetables, like berries, melons, carrots, sweet potatoes and green vegetables; whole grains, like oats (more on fiber in a bit!) and healthy proteins like beans, peas and lentils. Red meat and processed foods take longer to empty from the stomach, and they also promote gut bacteria that can cause inflammation. Drinking more water also helps rinse the esophagus and aid in digestion. Keeping a food journal can help you identify your triggers. Here are 6 foods that may be causing your symptoms:
All caffeinated foods and drinks, but especially coffee - yes even if it's decaf - can cause LES valve to relax. When the LES valve relaxes, reflux results.
Similarly, chocolate - yeah, sorry - is unfortunately a combination of caffeine, fat, and LES relaxing compounds in cocoa which all add up to reflux.
High-acid fruit like oranges, grapefruit, other citrus, pineapple, tomatoes, and their juices are delicious but unfortunartely naturally high in acid. These acidic foods trigger acid reflux because these foods add to the acid already churning around in your stomach. Whether you have a smoothie, salsa, or pineapple curry, be wary!
Spicy foods can irritate your esophagus, which may already be irritated by acid reflux. In addition, hot peppers found in many spicy foods can keep food in your stomach longer, creating more opportunity for acid reflux to occur. Salsas, sambols, curries, hot sauces, jerk seasoning, hot mustards, anything that makes your mouth tingle can be a trigger.
Fried things (and fatty foods in general) have two different features that make them reflux-licious. Fatty foods stay in the stomach longer and they relax the LES valve. The longer a food is in your stomach, the more chance it has to produce acid that will sneak back up. French fries, potato chips, fried chicken, egg rolls, chimichangas, bacon, and high-fat dairy can all lead to a long night. Not fun!
Sushi can be a lethal combination of fried, fatty, spicy, and high acidity leading to pain and discomfort. Wasabi root is quite spicy and could provoke symptoms of acid reflux in some. Interestingly, much of the wasabi paste served is made from horseradish.
Just like there are foods that trigger acid reflux, there are some foods that can help tame the fire and keep your system running well!
Ginger as you may already know can be really soothing; it has been used to settle the tummy for hundreds of years – and for good reason. It can work! Ginger can relieve some of the pressure on the LES and speed food out of your stomach, which may help manage your symptoms. Try sipping ginger tea, ending a meal with a piece of low-sugar dried ginger, or add ginger to smoothies, soups, stews, or brown rice.
Most vegetables and low-acid fruits are fiber-filled. Fiber can help reduce the pressure on the LES, which can decrease reflux. Fill half of your plate with colorful non-starchy veggies!
Whether you choose dairy or plant-based yogurt, pick something that is low in fat. Yogurt can coat and soothe your esophagus. As a bonus, it contains probiotics that support digestive health!
Whole grains. Whole grains are a great source of LES-pressure-reducing fiber while also being delicious and great for bowel regulation!
You may think of nuts as only a great source of heart-healthy fats, but they are also rich in fiber! Add a small handful of nuts to your day to benefit from all these tasty tidbits have to offer.
Other Treatments:
Even though there are various stimuli that can trigger heartburn, the underlying mechanism of acid reflux and GERD is typically a functional problem in the esophagus. Like I mentioned earlier, reflux occurs when the lower esophageal either doesn’t close properly or doesn’t close completely after food passes through. This allows an opening for stomach acid and partially digested food to slosh back up the esophagus and cause irritation that can manifest in a variety of different ways. While there are some medical conditions (like achalasia) that can weaken the LES in this way, it can also be caused by excess pressure in the abdominal cavity; this is also why obesity and pregnancy increase the likelihood of acid reflux.
Whether you have an occasional bout of heartburn or a chronic case of GERD, many of the options for treatment are similar. One approach that has been known to ease symptoms over time is a regular exercise habit. However, not all types of exercise or physical activity are necessarily beneficial for acid reflux; in fact, high intensity, high-impact exercises may even worsen acid reflux symptoms. Instead, try low-impact exercises that get you moving without exacerbating the condition. Below are some examples of exercises that can help:
Walking and light jogging are low impact and can be beneficial for acid reflux because it promotes gentle movement.
Swimming laps in a pool is another great exercise that improves cardiovascular health while also not putting strain on joints or the abdominal cavity.
A long, grueling bicycling session can be problematic for acid reflux, but light cycling outdoors or on a stationary bike can be a good cardiovascular exercise without putting excessive strain on the digestive system.
Certain yoga poses and practices may help with promoting calmness and good digestion, especially those that focus on gentle stretching, deep breathing, and relaxation techniques.
Pilates is similar to yoga in terms of low-impact movements, but it places a greater emphasis on building muscles that improve strength, stability, and endurance.
Please note, any movements that put pressure or strain on the abdominal wall for example can actually make acid reflux worse. Examples include gymnastics, crunches, and even some yoga poses. Similarly, high-impact workout routines like weight lifting, sprinting, gymnastics, or vigorous aerobics may promote a flareup of acid reflux. One rule of thumb for beginners is to spend 30 minutes, three times a week doing a low-intensity exercise. You can then adjust based on whether or not the exercise improved the symptoms.
Though there are some specific conditions that include GERD as a symptom, for most people it stems from lifestyle choices that can be changed or modified. There are also risk factors (like simply getting older) that can’t really be changed or modified. This is why treatment for GERD generally involves a variety of methods that may work differently for different people:
Lifestyle tweaks: Diet and exercise are two of the most important lifestyle changes to make in order to improve acid reflux symptoms, but there are other small adjustments that can help as well. Examples include quitting smoking, avoiding tight clothing, or elevating the head of the bed 6-8 inches so that acid is less likely to flow into the esophagus at night (which is when many people experience the worst heartburn).
Meds: Over-the-counter antacids are one of the easiest and least expensive ways to get some quick relief from heartburn. These products generally neutralize stomach acid so that it can’t cause as much irritation when reflux does happen. For more severe cases, an H2 blocker or proton pump inhibitor may be necessary - these medications reduce the amount of stomach acid that is produced.
Surgery: For the severe, chronic cases of GERD that haven’t been improved significantly by other means, surgery is an option. Some endoscopic procedures can potentially strengthen the muscles of the lower esophageal sphincter. Another procedure, known as a fundoplication, involves wrapping part of the stomach around the lower esophagus as a means of strengthening the LES.
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