If you have ever felt like there was a raging fire burning in your chest, you may have experienced heartburn – it’s NOT a pleasant feeling. For many people this occurs regularly, disrupting their lives and leaving them very uncomfortable.
People who experience chronic and recurrent heartburn and/or reflux have something called gastroesophageal reflux disorder (GERD). So why does this happen? And what can be done to reduce the symptoms of GERD? Today we will be answering all of these questions and providing insight into how you can manage reflux with diet and lifestyle changes.
What is Acid Reflux?
Acid reflux happens when acid from the stomach gets sent up into the esophagus – where it is not meant to be. This commonly results in spitting up acidic contents as well as a burning sensation in the chest, which is quite painful. There are a few reasons why acid can get inappropriately splashed up into the esophagus:
The sphincter between the esophagus and stomach isn’t working properly
Between the tube that carries our food to our stomach (the esophagus) and the stomach itself, there is a group of muscles called the lower esophageal sphincter (LES). The role of these muscles is to close tightly after food passes through and prevent stomach acid from shooting up into the esophagus. This is an involuntary response that happens naturally; however, it is possible for the LES to become weak or not close properly, meaning acid can inappropriately be sent backward from the stomach.
Part of the stomach slides above the diaphragm
The diaphragm is a muscle that separates the chest from the rest of the abdomen in the human body. The esophagus runs through the diaphragm through a small opening and the stomach sits just below the diaphragm. In some individuals, the top part of the stomach can bulge up through the esophageal opening in the diaphragm, creating a hiatal hernia. These hernias can be small or large and symptoms vary depending on the size.
Indicators of GERD
Although reflux and heartburn are the most common symptoms of GERD, there are other symptoms to look out for that may indicate you have this condition.
Symptoms of GERD include:
● Heartburn/ a burning sensation in the chest
● Regurgitation of fluid or acid into the mouth
● Pressure in the chest
● Waking in the night with burning or pressure in the chest
● Chronic coughing or throat clearing
● Difficulty swallowing
● Unintentional weight loss
While GERD often presents with symptoms, some patients do have ‘silent reflux’ – meaning they may not notice significant symptoms of reflux.
Untreated GERD can lead to longer-term complications such as narrowing of the esophagus, food impaction, asthma-like breathing difficulties, bleeding, and increased risk of esophageal cancer.
It is important to discuss these types of symptoms with your family doctor if you have them! Many patients choose not to bring up GERD symptoms because they believe their symptoms are a result of poor lifestyle and diet choices – ie. they think “it’s my own fault, so I know what the doctor is going to say”.
While diet is an important part of managing GERD, it is not the ONLY option for managing reflux – there are many other things to consider as well. The best options for GERD are multifaceted and include a combination of lifestyle, diet, and often medication! Moral of the story – don’t hesitate to talk to your health care team about ALL the options!
Diagnosis of GERD
The majority of the time, symptoms alone can indicate whether someone is experiencing GERD. If a person responds positively to treatment, further investigation is not generally needed, and a diagnosis can be confirmed.
However, your doctor may feel that assessing the esophagus via endoscopy is appropriate as well and may refer you to a gastroenterologist to have this procedure done. By viewing the esophagus and stomach with a camera, the doctor is able to tell where there is inflammation and/or damage. This also allows the doctor to collect tissue samples to examine closer if necessary.
The gold standard diagnostic procedure for GERD is gastric pH monitoring, which is a procedure that monitors the level of acidity in your esophagus for a period of time. To test for this, a small tube or capsule with a pH sensor is inserted into the esophagus and worn for 24-96 hours (depending on the case). However, this procedure isn’t often the first test option for diagnosis and is used more often in difficult cases of GERD and esophageal pain.
Management Options for GERD
Reducing symptoms of GERD requires a multifaceted management strategy. Depending on the individual, some cases require simple dietary changes, while others may require the addition of pharmacological solutions. There is no “right” way to manage reflux – but rather we personalize the approach to each individual.
Many patients do prefer to make dietary shifts prior to trying medication management, as they value the idea of taking fewer medications overall. At Ignite, we also like to take a food first approach. In particular, we work with our patients to reduce their intake of common trigger foods for GERD.
Dietary Strategies for GERD
There are some foods that can worsen symptoms of GERD, as they lead to increased production of acid in the stomach. In turn, this excess acid has a greater potential of spilling backward into the esophagus.
Foods that commonly trigger reflux include:
- Spicy foods – hot peppers, curry paste, hot sauce
- Citrus – lemons, limes, oranges, grapefruits, juices
- Tomatoes and tomato products – sauces, pastes, ketchup
- Carbonated beverages – soda, carbonated water, kombucha
- High fat foods – fried foods, oily dressings, cream, cheese, nuts, seeds, avocado, butter
- Caffeine – coffee, tea, chocolate, soda
- Peppermint and spearmint – gum, mints, tea
- Simple sugars – high sugar beverages, candy, baked goods, ice cream, white & brown sugar, honey, maple syrup
Keep in mind, every patient with GERD is a bit different and therefore have different tolerance to these foods. A registered dietitian can help to reduce your intake of these common foods in a practical and easy way – providing appropriate alternatives along the way. Our priority is to make sure each individual’s diet is the least restricted possible.
Aside from which foods to choose and avoid, it is also important to know when and how much to be eating to manage GERD. It is best to eat several small volume meals daily rather than consume your daily intake in 3 larger meals. When eating large meals, we are more likely to overfill the stomach, which can lead to more acid being sent upward, causing heartburn.
Additionally, eating late into the evening can lead to complications with GERD. Eating too soon before bed and then laying down can also lead to reflux and heartburn. This often makes sleeping very uncomfortable for patients with GERD. We need to allow enough time for gravity to do its job (ie. for food to travel downward past the stomach). In most cases, we recommend stopping your intake 2-3 hours prior to heading to bed.
Other Lifestyle Changes That Can Improve GERD
In addition to nutrition changes, GERD can be improved by adjusting some key lifestyle factors, including:
- Stopping smoking
- Decreasing or eliminating alcohol
- Elevating the head of the bed
- Avoiding tight fitting clothing (especially in upper abdomen/chest)
- Regular exercise
- Stress management and mindfulness
- Physiotherapy – occasionally, how the diaphragm moves can influence GERD
There are medications that can be prescribed to reduce the amount of acid in your stomach, as well as over-the-counter options to reduce acid reflux. Depending on the patient, your doctor may choose to start a medication right away or suggest you work on diet and lifestyle changes as the first course of action.
Some common medications used to manage GERD include:
- Proton Pump Inhibitors (PPI) – These help to reduce inflammation and the production of stomach acid. Some examples of PPIs include omeprazole, pantoprazole, or rabeprazole. I’m sure you can see the pattern – they all end in -zole!
- Histamine-2 (H2) Blockers – These medications also reduce the production of stomach acid by preventing histamine from triggering the release of stomach acid. Some examples of H2 Blockers include ranitidine and famotidine.
- Antacids – These are a group of non-prescription medications that work to neutralize the acid in the stomach. Some examples of antacids include Bismuth subsalicylate, calcium carbonate, and magnesium hydroxide. Note: these are generic names and products may go by another brand name.
Talk to your doctor about your pharmaceutical options if you have GERD. Not all products will be appropriate for all people, so see your physician to discuss an appropriate choice for you!
For some individuals, diet and lifestyle interventions in combination with medical therapy are unable to provide the relief needed to live comfortably with GERD. In more severe cases, surgery may be required to relieve painful and uncomfortable symptoms and ultimately improve a patient’s quality of life. Poorly managed GERD can lead to other health issues such as scarring, bleeding, and ulcers in the esophagus.
The standard surgical treatment of GERD is called fundoplication surgery. In this procedure, the surgeon wraps the upper part of the stomach around the bottom of the esophagus, which tightens and strengthens the lower esophageal sphincter. This surgery can be performed either as an open surgery or laparoscopically with a few small incisions.
In summary, surgery for GERD is generally a last resort management option but is sometimes medically necessary to avoid long-term complications caused by inflammation in the esophagus.
It is HIGHLY recommended to work with a dietitian when undergoing this procedure, as a specialized diet is required to allow the esophagus and stomach to properly heal and recover.
If you experience heartburn and reflux regularly, it is important to discuss your symptoms with your family doctor.
Our registered dietitians can help you to customize a nutrition plan that actually works for you and can help to ensure you are only avoiding the foods you absolutely need to. If you do require surgery to manage your GERD, it is imperative that you work with a dietitian to follow a soft food diet as the fundoplication heals. Our dietitians can help to optimize your nutrition long term after this surgery – work with one of our dietitians today!