The holiday season is almost here and with it come the big meals and the holiday parties, but also the heartburn and the indigestion…I believe it’s a good time for a little talk about acid reflux.
Acid reflux occurs when the acidic content of the stomach refluxes up the esophagus. While everybody has some degree of acid reflux that usually does not cause any symptoms, many people suffer from gastroesophageal reflux disease or GERD. GERD can cause a variety of symptoms including heartburn, regurgitation of food, sour taste in the mouth, cough…
There are very effective medications that block the acid production in the stomach and control the acid reflux symptoms, however many people may be able to control their reflux by implementing a few simple lifestyle changes. This helps avoid taking medications every day, which can be a hassle and can end up costing a lot of money. It is also important to remember that any medication can have side effects and if we can achieve the same results with lifestyle changes that would definitely be much better than taking long term medications.
So what are some steps we can take to control the acid reflux?
- Eat smaller meals
Eating a large meal leaves the stomach distended and full for a longer period of time and that makes it more likely that the stomach content, including the acid, can reflux back up into the esophagus and cause the dreaded heartburn sensation that many people feel after over eating. Eating smaller and more frequent meals allows time for the stomach to empty its content into the small bowel in between meals.
- Avoid fatty foods
Fatty foods are difficult to digest and they remain in the stomach longer than other foods. So after eating a fatty meal, you would be walking around with a full stomach for a few hours which puts you at higher risk of having acid reflux.
- Do not eat and lie down
Some people wake up at night chocking with food or fluid refluxing all the way up to their throat. This is the worst kind of reflux and it can be damaging to the esophagus. Many more people probably have reflux at night and they don’t even realize it. It is a really bad idea to eat just before you go to bed. This also applies to taking a nap immediately after eating. You should always stay in an upright position for at least a couple of hours after you eat.
- Elevate the head of the bed
This is simple physics. If your chest is higher than your stomach, it is more difficult for fluid to go up from the stomach toward your mouth. This is very important for people who have symptoms at night and people who have a hiatal hernia (which makes the sphincter at the junction between the stomach and the esophagus loose and less effective). One big mistake a lot of people make is using more than one pillow. This only elevates you head and bends your neck while your chest and therefore your esophagus are not elevated. The right thing to do is to put something like wood blocks underneath the head of the bed to elevate it around 6-8 inches. Another option is to use a foam wedge that you can put under the mattress. This way you would be sleeping at a slight incline and gravity will work for you while you are asleep.
- Stop smoking
Smoking is associated with increased relaxation of the lower esophageal sphincter and therefore with acid reflux. Smoking is also associated with an increased risk of many cancers particularly gastrointestinal cancers as well as lung cancer of course. Smoking cessation is not easy and help is available. If you smoke, please talk to your doctor about available options whether prescription medications or over the counter nicotine supplements or other approaches that may be right for you.
- Lose weight
Obesity is a major risk factor for acid reflux and it is associated with a higher risk of esophageal adenocarcinoma, the type of esophageal cancer caused by acid reflux causing damage to the esophagus. Excess abdominal fat increases the pressure on the stomach and pushes the acid up into the esophagus. Shedding a few pounds can make a big difference.
- Avoid reflux inducing foods
Certain foods increase the relaxation of the lower esophageal sphincter causing more acid reflux. Some people tolerate these foods very well, while others have significant worsening of their symptoms. The most notorious foods causing this are caffeine, alcohol, chocolate and peppermint. Try to limit your consumption of such products and you will most likely see significant improvement in your heartburn.
While we generally think of acid reflux as a very benign condition, in some people, GERD can cause damage to the esophagus called Barrett’s esophagus. Barrett’s esophagus is a premalignant condition that can lead to esophageal cancer.
Mild occasional heartburn that responds to over the counter medications is usually not worrisome. However, if the symptoms occur more than 2-3 times a week, are severe or do not resolve with medication, a medical evaluation is necessary. Alarming symptoms such as chest pain, difficulty swallowing, weight loss or vomiting blood require immediate medical attention.
If you would like an expert evaluation for acid reflux, please call Digestive Care Specialists at 301-288-1319.