While it’s normal to experience some indigestion or heartburn from time to time, experiencing these symptoms chronically could mean something more. As one of the most commonly diagnosed digestive disorders, gastroesophageal reflux disease, or GERD, affects 20% of the U.S. population. Paying attention to how often symptoms come about and managing them with diet and lifestyle changes is essential, since GERD can lead to more severe health issues. In this article, we'll cover the following topics.
What Is GERD?
Gastroesophageal reflux disease (GERD), or chronic acid reflux, is characterized by the stomach continuously leaking acidic gastric contents back into the esophagus. It is chronic and more severe than the occasional heartburn episode because it can cause serious damage to the esophageal lining and other issues. Studies show that GERD impacts mental health and social function and has also been associated with reduced productivity at work.
What Causes GERD?
It is normal for the lower esophageal sphincter (LES) to relax several times daily. For patients with GERD, this relaxation is prolonged or too frequent and leads to gastric contents in the esophagus, causing symptoms. This malfunction is also known as a disruption of the esophagogastric junction barrier.
This disruption has many causes, from increased pressure on the abdomen (like in pregnancy or obesity) and hiatal hernias, to structural defects in the sphincter. Regardless of the cause, it results in the breakdown of the barrier separating the esophagus from the stomach and allows acidic gastric contents to reach the esophagus.
While heartburn and regurgitation, which is when food comes back into the mouth from the esophagus, are the most common symptoms of GERD, there are several other symptoms to pay attention to, such as sore throat, sour or dry mouth, trouble swallowing, nausea, vomiting, dental erosion, chronic cough, laryngitis, asthma, the feeling of food caught in the throat, and even chest pain. Similar symptoms can present in children, but also watch for minor vomiting episodes, respiratory issues, excessive crying, not wanting to eat, bad breath, and difficulty sleeping after eating.
GERD is an uncomfortable condition that often significantly impacts quality of life. Stomach acid is inflammatory to the esophagus, and when exposed to the acid contents often enough, the esophagus's inner lining, or mucosa, starts to get damaged. If left untreated, GERD can cause long-term damage to the esophagus. In some cases, it can lead to health conditions like Barrett’s esophagus (a precancerous condition), esophageal strictures, or erosive esophagitis.
What Are the Complications Associated with GERD?
Stomach acid is potent, and while the stomach was made for this level of acidity, our esophagus, teeth, lungs, and windpipe are not. To put this into perspective, on the pH scale of 0–14, with zero being the most acidic, human stomach acid is a 1 or 2, only slightly less acidic than battery acid. When GERD goes untreated, serious damage can occur to these critical systems, especially in older people. Here are some potential complications of GERD:
- Barrett’s esophagus
- Erosive esophagitis
- Esophageal stricture or narrowing of the esophagus
- Dental disease
- Asthma flare-ups
Can GERD Be Reversed?
If caught early, specific lifestyle changes, diet changes, medications, and other treatment options can be utilized to heal the esophagus and prevent further damage. However, if left untreated for long periods, the damage to the esophagus could be irreversible, and it can become more challenging to treat.
The medications used to treat acid reflux and heartburn are called acid reducers. The most common are antacids such as Tums, histamine-2 blockers such as famotidine, and proton pump inhibitors such as omeprazole. It’s not uncommon for patients to stay on these medications for many years if they are not able to improve their symptoms with nutrition and lifestyle changes. However, as with any medications, there are potential side effects.
Research has found that patients with healed erosive esophagitis experience relapse rates of 81% to 90% within six to 12 months after drug therapy is withdrawn. This is why GERD cannot be managed with medicine alone, and lifestyle and diet changes are an integral part of any treatment plan.
The Best Diet for GERD
While a healthy diet is critical for everyone, when treating gastrointestinal issues like GERD, pay attention to what and how you eat. For example, foods that are highly acidic, spicy, or high in fat may trigger symptoms of GERD. I advise patients to cut out fast foods and ultraprocessed foods high in salt and saturated fats. Simple sugar seems to be another trigger, as well: A recent Vanderbilt study looked at the impact of different types of carbohydrates on GERD and found that subjects who reduced their refined sugar intake alone saw notable improvements in their symptoms.
Adopting a plant-based diet filled with foods rich in fiber and nutrients is vital for many health issues, but I also highly recommend it for GERD. This is because whole plant foods are packed with fiber that is digested further down the intestinal tract, putting less strain on the stomach. This results in a decreased release of gastric enzymes and acid.
Cutting back on alcohol and carbonated beverages is also important, since they are highly acidic and contain caffeine and air bubbles, which can be acid reflux triggers. It is best to avoid them until symptoms are under control, but if an energy boost is necessary to make it through the day, stay hydrated and incorporate less-acidic, lower-caffeine beverages like matcha or green tea. In addition to diet, the way you eat is important too. Here are some eating tips to keep in mind:
- Eat smaller portions: More volume in the stomach can trigger acid reflux, so eating smaller portions throughout the day might be a better option than two or three large meals.
- Eat slowly: It can be helpful to eat slowly. I advise GERD clients to chew well, take their time, and enjoy the meal. This will help the digestive system move food faster and more efficiently through the gut. Since digestion begins with the enzymes in saliva, being present when eating prepares the digestive system to receive and process food.
- Stay upright after meals: Gravity is always at play, and as simple as it sounds, it plays a role in how food moves through the digestive system. Lying down after a meal can strain the lower esophageal sphincter and cause or worsen acid reflux. Waiting at least 3 to 4 hours after eating before reclining or sleeping can improve symptoms. If the gap between eating and sleeping is less, propping the head up on pillows so that it is at a 30- to 45-degree angle to the lower body can decrease the amount of acid reflux.
- Adjust when you drink: Drinking during meals adds volume, so drinking before or after meals could be a better option for GERD patients.
- Avoid carbonation: What you drink matters, too. Most bottled beverages are highly acidic. Avoid them if you suffer from GERD.
- Maintain a healthy weight: GERD is strongly associated with increased weight and obesity, and studies have shown that even individuals with an average BMI can acquire symptoms of GERD after significant weight gain. Likewise, those suffering from GERD with a high BMI have seen a drastic decrease, and in some cases elimination, of symptoms by bringing their BMI down into a more optimal range and maintaining a healthy weight.
- Practice diaphragmatic breathing: Deep breathing helps your body to relax and can reduce the stress often associated with GERD.
Don’t Let GERD Impact Your Quality of Life
Medicine alone should not be depended on for patients suffering from GERD. Patients should avoid harmful behaviors such as smoking, manage stress levels, and identify and avoid personal trigger foods. Measures as simple as going for a walk after eating can not only help stress levels but can also encourage gastric juices to flow correctly. By adjusting diet and lifestyle, patients and doctors can get to the root of the issue (and sometimes reverse it altogether), resulting in better outcomes and quality of life.
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