How to Avoid Acid Reflux

Acid reflux is on the rise -- literally and figuratively -- affecting more than 7 million Americans. Researchers say that certain steps can be taken to remedy the discomfort it causes, and to avoid more serious consequences if the symptoms persist.

Gastroesophageal Reflux Disease (GERD) occurs when the lower esophageal sphincter does not close properly, allowing stomach acid to seep into the esophagus. Stomach acid is more potent than battery acid, and is essential to proper digestion. The stomach is equipped to handle it; the esophagus is not.
That seepage of acid upwards into the esophagus inflames the tissue lining, making it tender, then developing erosions that can then lead to bleeding. The sensation, commonly referred to as heartburn in the early stages, a complete misnomer. Occasional heartburn is not cause for concern, as it can be brought on by any number of factors. If heartburn occurs consistently more than twice a week, you should consult a physician or registered dietician. Treatment ranges from behavioral and dietary changes to pharmaceutical remedies. In worst cases, surgery may be required.

In addition to heartburn, acid reflux can cause a bitter taste to come up from the throat, burping, a recurring sore throat or pain when swallowing and a constant need to clear the throat. At night, acid reflux can cause a persistent cough, snoring, breathlessness, choking or gagging and fatigue, the end result of a restless sleep. Even if these symptoms are present, it is important to seek a diagnosis from a doctor or gastroenterologist, because similar symptoms can be caused by a peptic ulcer.

Cedric Bremner, M.D., professor of Clinical Surgery and director of Clinical Research, USC Department of Surgery, is an expert in gastroesophageal reflux and diseases of the esophagus. "This is Western disease," he says. "We're not sure why, but we do believe it is acquired rather than genetic, because it is something that has occurred in the last 30 or so years and exploded in the last 20." He points out that incidences of acid reflux in Japanese study subjects are merely one percent of those in the United States, an indication that dietary factors play an important role.

"We believe it probably involves the diet," says Dr. Bremner, a foregut surgeon. "We know that 60% of Americans are overweight so it may be related to our diet's fat content. Fat causes a long delay of emptying in the stomach. So the stomach is full for longer periods of time. We believe it might be related to distention of the stomach for prolonged periods of time. The lower esophageal sphincter tends to open up with distention of the stomach."

Dr. Bremner adds that America's love affair with sodas may also contribute to acid reflux, because it also distends, or stretches, the stomach.

A December 2006 article in The American Journal of Gastroenterology, links acid reflux to obesity. Since the disease is strongly associated with more serious conditions, such as esophageal ulcers and cancer, weight reduction therapy may be useful in treatment and prevention of these conditions.

"We know that an increase in body weight increases the chance of having heartburn and acid reflux, which can increase the risk of esophageal ulcers and cancer," says Dr. Douglas Corley, author of the study. "While we can't say at this time that weight loss therapy is definitely the solution to this condition, it certainly warrants further research as a treatment."

Five causes are often associated with acid reflux: genetics, excessive weight, smoking, diet and wearing tight clothing while eating.

Three types of remedies are often recommended: natural, behavioral and dietary. In serious cases, medical or surgical actions might be necessary.
Natural approaches include:

- Stress management;
- Identifying food intolerances;
- Ingestion of botanicals, such as chamomile, barberry, bayberry, licorice and Aloe vera;
- Ingestion of antioxidants, found in vitamins A, C and D, berries, peppers, spinach, legumes, whole grains and in beverages like tea and Gatorade;
- Herbs, specifically ginger root;
- Short-term detoxification;
- Increase water intake to normalize the stomach pH.
Behavoral remedies:
- Lose weight.
- Exercise more.
- Eat smaller meals 5-6 times per day.
- Avoid alcohol.
- Avoid smoking.
- Don't wear tight-fitting clothing when you eat;
- Avoid laying down 1-2 hours after you eat -- sit or stand upright;
- Don't eat late at night. Eat 2-3 hours before you go to bed;
- Sleep on an incline. Your head and shoulders should be raised 4-6 inches to reduce the risk of reflux;
- Chew gum occasionally. It increases the output of saliva, which helps wash stomach acid out of the esophagus.
Dietary remedies:
- Restrict yourself to a bland diet, especially during periods of high stress;
- Reduce fat intake. Avoid fried foods and those grilled in fat.
- Avoid carbonated soda.
- Avoid these foods which can cause acid reflux:
- chocolate
- cocoa
- coffee, regular and decaffeinated
- cream sauces
- gravies
- highly acidic foods and juices, such as tomatoes, peppers or orange juice
- candies, chocolate desserts and pastries
- mayonnaise
Limit the following:
- Butter or margarine
- Citrus juices
- dairy products -- milk, cream, cheese
- oils
- salad dressings
- spicy foods
- Use carminitives with care. These are ingredients like peppermint, allspice, cloves, sage, and thyme that soothe the digestive tract. Most of the herbs in the mint and carrot families are carminatives, including anise, basil, cinnamon, garlic, ginger, lemon, and nutmeg. Do not mix these with starches, as it causes increased gas and burping.

If acid reflux persists, your doctor might prescribe acid-suppressing drugs, histamine receptor agonists, proton pump inhibitors or other medications. In severe cases where cancer develops or the esophagus deteriorates, surgery may be recommended.