Reflux action: eat well, stay well and know your limits
Prolonged reflux can result in inflammation and caustic damage to the oesophagus, so how do we avoid it?
A fatty, rich meal may delay stomach emptying and increase the risk of symptoms. Photograph: Thinkstock
It is common to hear complaints of a burning feeling in the chest or discomfort after eating. Heartburn is a symptom of gastro-oesophageal reflux disease, or Gord, a condition in which stomach acid escapes from the stomach up into the oesophagus.
A certain amount of acid reflux is normal. However, if reflux is prolonged or excessive, it causes inflammation and caustic damage to the oesophagus. Gord is two to three times more common in men than in women.
Many guidelines for the treatment of mild Gord recommend a trial period of lifestyle modification as well as over-the-counter medications such as antacids. Although there is limited evidence to demonstrate the effectiveness of lifestyle adjustments to Gord symptoms, the thinking is that this approach may result in further health benefits in addition to any improvement in Gord.
If there is no improvement, further investigations and treatment may be considered by your doctor.
The following dietary changes are designed to lessen the probability of Gord and to avoid irritation of the inflamed oesophageal tissue.
Lose weight: If you are overweight, lose weight. This is the single biggest factor that you can influence to manage and reduce symptoms of Gord.
This, in turn, reduces the risk of complications arising from poor Gord management over time. Discuss a comfortable weight with your doctor and follow an evidence-based weight-loss approach, not a quick-fix diet.
To lose weight successfully and keep it off, one of the many challenges is to learn to enjoy the foods you love without going overboard. A regime that places all your favourite foods off-limits won’t work in the long run.
If you ban certain foods, it is natural to want those foods more, and then feel frustrated when you give in to temptation. Instead of denying yourself, see if you can eat them less often and in smaller amounts.
There are many ways to lose weight. The key is to find what works for you and to use an approach that doesn’t compromise your health in other ways.
For example, there is no point in being slimmer and managing your Gord symptoms if you are at an increased risk of certain cancers or autoimmune diseases. Don’t focus entirely on your waistline; focus on your overall health.
Take small, regular meals: Eat more slowly and reduce the size of your meals to help you lose weight and manage the stomach contents to avoid symptoms. In general, the large stomach load or volume of food is problematic, even though the food you are eating may be healthy.
Eating on the run increases the risk of reflux. To decrease the risk, slow down and eat consciously. Retrain yourself to be fully present, and to enjoy and savour your food more.
Avoid fatty foods: A fatty, rich meal may delay stomach emptying and increase the risk of symptoms. More importantly, cutting down on fried foods, oily foods, creamy sauces, pastry, cakes, biscuits and so on will help you lose weight and manage symptoms.
Despite the relative dearth of research in this area, when patients with Gord were evaluated, fatty foods were perceived to be most associated with a reflux event.
Combine certain foods: Foods that have a low pH such as tomatoes and citrus fruits may cause reflux in some, but not all, people when eaten on their own on an empty stomach. Many people manage to enjoy small portions when they combine these foods with non-acidic foods such as quinoa or have rice with vegetables. Spicy foods such as jalapeno peppers, garlic and onion can sometimes trigger reflux, but not in everyone.
Use chewing gum: Chewing gum produces saliva which neutralises acid and signals the stomach to move its contents into the small intestine. However, peppermint may trigger Gord by relaxing the lower oesophageal sphincter. In this case, avoid peppermint or mint gums.
Reduce your chocolate intake: Chocolate contains caffeine and a compound called methylxanthin, which relaxes smooth muscle and reduces sphincter pressure. This exposes the oesophagus to more stomach acid after a meal. It’s best to be frugal with your portion size. Try two squares of dark chocolate.
Be watchful and aware, especially when you have symptoms: Note the size of your last meal, and the types and amounts of suspect foods eaten. If you suffer with reflux from certain foods, it’s not always an all-or-nothing situation. It’s usually the dose that maketh the poison.
For example, you can add some spice to foods, but be moderate. Instead of selecting a four-strength chilli choice from the menu, choose a two-strength chilli dish.
Individual symptoms: What causes symptoms in one individual may not cause them
in another. If you make a list of food and drink items that trigger reflux, you can either avoid them or reduce the serving size.
Beware of drinks: Food is not the only Gord trigger; liquids can also contribute. Heartburn risk can be increased by drinking coffee, caffeinated tea, carbonated drinks, and alcohol.
Reduce your intake of spirits, wine and beer. Alcohol can cause the lower oesophageal sphincter to relax and allow acid to enter the oesophagus.
Drinking more than the 11-17 standard drinks per week may also increase your blood pressure and risk of stroke. Reduce to a much more moderate intake.
Reduce your coffee intake. Cut your intake first to one or two cups per day. That’s a maximum of one double-shot of espresso. If symptoms don’t improve, try cutting it out.
Research suggests that not only does the caffeine in coffee increase stomach acid, there is another, as yet unidentified, component of regular and decaffeinated coffee that causes symptoms in healthy volunteers.
Carbonated soft drinks sometimes contain caffeine and are best avoided. However, even without caffeine, carbonated drinks can bloat the stomach which increases the risk of symptoms.
Drinks without any caffeine or carbonation are far less likely to cause reflux. Herbal teas without caffeine, and plain water, are good choices to reduce the risk of Gord.
Watch your timing: The timing of food and drinks can be important too. Ideally avoid hot drinks, alcohol and eating within three
hours of going to bed. Elevate the head of your bed by about eight inches, don’t lie down flat after a meal, and avoid leaning over from the waist.
Have your condition and your medicines reviewed regularly by your GP. Discuss the gradual reintroduction of foods that you noted caused distress once your symptoms decline.
Paula Mee is a dietitian and a member of the Irish Nutrition and Dietetic Institute. See medfit.ie; @paula_mee