Gastroesophageal reflux disease (GERD) has become a very common condition in the U.S. It’s been reported that 25-40% of Americans experience symptomatic GERD at some point and approximately 7-10% experience symptoms of GERD on a daily basis. I can confirm this in my clinical practice. Many individuals control their symptoms with over the counter (OTC) medications and without consulting a medical professional, so the actual numbers of individuals who have GERD is likely considerably higher.
While my clinical practice is a women’s health practice, it seems that there is no gender preference for GERD. However, esophagitis is 2-3 times higher in men and Barrett’s esophagitis is 10 times higher in men than women with white men being at the most risk for Barrett’s esophagitis. Once we reach 40 the prevalence of GERD increases.
The causative factor in GERD is that there is an excessive retrograde movement of acid-containing gastric secretions or bile and acid-containing secretions from the duodenum and stomach into the esophagus. The functional transient lower esophageal sphincter relaxation or some mechanical under function of this sphincter is the most common cause of this retrograde movement and GERD.
Then the question becomes, what causes this mechanical dysfunction of that lower esophageal sphincter. Certain foods seem to be culprits, including coffee, alcohol, chocolate and fatty meals. Medications such as beta-agonists, calcium channel blockers, anticholinergics and progesterone are also culprits along with nicotine. Delayed gastric emptying, hiatal hernia and obesity may also be contributing factors in some individuals.
When it comes to treating GERD, I find that no one treatment is reliable. I also find that I need to have a broad understanding of the role of lifestyle, natural treatment options such as zinc carnosine, deglycyrrhizinated licorice root, probiotics, melatonin, slipper elm, aloe and yes, artichoke leaf extract, pancreatic and other digestive enzymes and sometimes even hydrochloric acid (although I’m not a fan), as well as over the counter and prescription pharmaceuticals. There can be phases to treatment, multiple treatments at one time, and the tincture of time (yes, Time).
A recent study was published in the JAMA Internal Medicine Journal which highlights the potential role of 5 lifestyle factors in women. Researchers used data from the Nurses’ Health and 43,000 women to determine any associations between dietary and lifestyle factors and the risk for developing GERD. Five anti-reflux lifestyle factors were each independently associated with lower risk for GERD symptoms. These were not smoking; drinking 2 or less cups of coffee, tea or soda daily; a prudent diet of higher intake of fruits, vegetables, legumes, fish, poultry and whole grains; 30 minutes or more of moderate to vigorous daily physical activity and a normal weight of a BMI < 25. Women who adhered to all 5 of these factors had only half the risk for GERD compared to women who adhered to none. Similar results were seen in those who used conventional pharmaceuticals.
Commentary: Often, we forget to start with the basics and the power of the basics. While this study was reporting on these habits and risk for GERD, it should clearly be translated into treatment approaches. There are also foods to be avoided and foods that might be soothing that have come to be listed on a GERD lifestyle plan. Here’s one list:
Lifestyle changes may help reduce the frequency of acid reflux. Try to:
- Maintain a healthy weight. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to reflux into your esophagus.
- Stop smoking. Smoking decreases the lower esophageal sphincter’s ability to function properly.
- Elevate the head of your bed. If you regularly experience heartburn while trying to sleep, place wood or cement blocks under the feet of your bed so that the head end is raised by 6 to 9 inches. If you can’t elevate your bed, you can insert a wedge between your mattress and box spring to elevate your body from the waist up. Raising your head with additional pillows isn’t effective.
- Don’t lie down after a meal. Wait at least three hours after eating before lying down or going to bed.
- Eat food slowly and chew thoroughly. Put down your fork after every bite and pick it up again once you have chewed and swallowed that bite.
- Avoid foods and drinks that trigger reflux. Common triggers include fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine.
- Avoid tight-fitting clothing. Clothes that fit tightly around your waist put pressure on your abdomen and the lower esophageal sphincter.
Reference: Mehta R, et al. Association of diet and lifestyle with the risk of gastroesophageal reflux disease symptoms in US women. JAMA Intern Med 2021 Jan 4 (e pub)
