Dietary relief from GERD: tame the flames of gastroesophageal reflux disease naturally, with dietary and lifestyle changes.
Recognizing reflux. Heartburn is a tell-tale sign of acid reflux, but some people with acid reflux don't experience heartburn. "Throat symptoms such as a chronic cough, hoarseness, frequent throat clearing, throat burning, difficulty swallowing, and/or a lump-like sensation in the throat may indicate a more severe form of acid reflux disease," says Jonathan Aviv, MD, an otolaryngologist and clinical director of the Voice and Swallowing Center at ENT and Allergy Associates in New York City and author of Killing Me Softly from Inside: The Mysteries and Dangers of Acid Reflux. "Such throat symptoms are better predictors of risk for esophageal cancer than traditional heartburn symptoms."
This cancer risk is a big reason you shouldn't ignore any symptoms of reflux and should be evaluated by your doctor. "A precursor of esophageal cancer that we examine patients for is Barrett's esophagus, which is an abnormal lining of the lower part of the esophagus caused by chronic acid reflux," says Pankaj Vashi, MD, a gastroenterologist and chair of the department of medicine at Cancer Treatment Centers of America in Zion, Illinois.
Medication precautions. Television ads promote many over-the-counter (OTC) drugs for reflux. "The general recommendation is to take OTC acid reflux medication for two weeks, then stop the medication to see if the symptoms come back. If the reflux symptoms return, you need to go to your primary care doctor," Vashi says.
Doctors may prescribe stronger doses of drugs called proton-pump inhibitors (PPIs), such as Prilosec and Nexium, for longer-term use, but they're not risk-free. PPIs can weaken bones over time since they suppress acid production, which impairs calcium absorption, Aviv says. "I prefer to try to get people to change their diet and lifestyle rather than relying on medication."
Diet and reflux. Although any food can potentially trigger reflux if a person is sensitive to it, certain foods more frequently cause problems, Aviv says. He divides common problem foods into two categories: acidic foods (see "Acidic Foods") and foods that loosen or relax the muscle (the lower esophageal sphincter or LES) that acts as a control valve separating the stomach from the esophagus, thus allowing reflux to occur. The dietary items that relax the LES include caffeine, chocolate, alcoholic beverages, mint, onions, and garlic. Fatty, spicy, and fried foods also may relax the LES, according to the American Society for Gastrointestinal Endoscopy.
The reason that acidic foods can be problematic in reflux is complex. Aviv explains that when a person has acid reflux, pepsin (an enzyme in the stomach that is activated by acid and digests protein), travels with the stomach contents up the esophagus and can stick like Velcro in the esophagus, throat, and mouth. "When a person consumes something that's very acidic, such as tomato juice, the pepsin that's lodged in these places gets activated and can start eating away at your throat and esophagus, causing damage and inflammation," Aviv says. This mechanism is also described in a 2011 scientific paper published in Annals of Otology, Rhinology & Laryngology.
The interaction between acidic food and displaced pepsin means trouble for people trying to self-treat heartburn with apple cider vinegar and lemon juice, based on the incorrect idea that reflux is triggered by insufficient stomach acid. "When we examine patients who drink this highly acidic concoction, it looks like a bomb went off in their throat," Aviv says. "There is no scientific paper that supports this treatment, and it's dangerous."
Lifestyle and reflux. In addition to dietary changes, Vashi emphasizes these strategies to reduce reflux:
* Lose weight, if overweight. Excess weight puts pressure on your stomach and relaxes the LES.
* Wear loose-fitting clothing around the waist.
* Avoid smoking and second-hand smoke.
* Eat smaller meals and avoid eating for three hours before lying down.
* Elevate the head of your bed a bit (up to 30 degrees).
--Marsha McCulloch, MS, RD
For people with reflux, Aviv says the most problematic dietary items based on acidity are citrus fruits, tomato products, vinegar, wine, soda, and bottled iced tea. But that's not all. Many canned and bottled foods have become more acidic since the 1970s, when the FDA started requiring certain acidity levels for food safety reasons.
"This is one reason why you'll see ingredients such as citric acid or ascorbic acid in canned foods and beverages," Aviv says. Adding vinegar also increases acidity. For example, cucumbers have a pH around 5.5, whereas dill pickles have a pH around 3.5, so pickles are 100 times more acidic. Choosing fresh or plain frozen foods typically avoids acidic additives.
Caption: Foods that relax the lower esophageal valve can trigger reflux, and acidic foods can contribute to tissue irritation and damage.