GERD: Do You Feel the Burn?

Overview of GERD

Gastroesophageal Reflux Disease (GERD) is a chronic disorder of the gastrointestinal tract that manifests itself as heartburn and regurgitation of acidic gastric (stomach) content into the esophagus. The estimated prevalence of GERD in the U.S. is 20%, making it one of the most diagnosed chronic digestive disorders in the country. Currently, there is no specific cause to explain the development of GERD, but certain lifestyle risk factors have been associated with its development. Some of the common risk factors include overweight or obesity, smoking, poor dietary intake, high consumption of alcohol or caffeine, or unfavorable dietary habits such as eating large meals. GERD symptoms may include heartburn, acid regurgitation, nausea, vomiting, belching, or dysphagia. However, it may also present in an atypical manner with symptoms of chest pain, chronic cough, bad breath, hoarseness, asthma, dental erosions, or laryngitis.

Mechanisms of GERD

The esophagus is a component of the digestive system that connects the mouth to the stomach, which allows food to pass through to the stomach for digestion to occur. The lower esophageal sphincter (LES) is a smooth muscle region located at the low end of the esophagus and its function is to allow the passage of food from the esophagus into the stomach, but it also protects the esophagus from acid reflux by preventing acidic stomach content from entering back into the esophagus. The most common pathological mechanisms of GERD include impaired contraction of the LES and abnormal tone of the LES.

In a normal state the LES is contracted, but it relaxes after food is swallowed for approximately five seconds to allow for food to enter the stomach, and then the LES returns to its normal contracted state. However, another physiologic relaxation (transient LES relaxation) occurs independent of the swallowing mechanism and is thought to be driven by stomach distention, allowing excess gas to be released. For about an hour after eating, a person can have as much as five transient occurrences of reflux, but the development of GERD symptoms may happen if these occurrences continue. In fact, people with GERD symptoms may have an increased frequency in transient LES relaxations that are not caused by the swallowing mechanism, which results in reflux of stomach content into the esophagus. The exact cause of increased transient LES relaxation remains unknown.

Abnormal or decreased tone of the LES can occur from several medications, certain dietary supplements, smoking, or the consumption of certain food and beverages such as spicy food, fried food, orange juice, tomato juice, tomatoes, chocolate, cow’s milk, alcohol, soda, tea, coffee (or caffeine in general), and more.

Dietary Management of GERD

An effective approach for the management of GERD includes the identification and elimination of trigger foods that contribute to GERD symptoms; however, this may not always be apparent because what triggers one person may not trigger another. Therefore, a personalized approach including trial and error of eliminating potential GERD triggers is a good initial strategy rather than a “one size fits all” approach of mass elimination of all trigger foods. Similar to the foods listed above that can decrease LES tone, trigger foods may include the following:

• Alcohol

• Coffee/Caffeine

• Spicy Foods

• Fried Foods

• Tomatoes/Tomato Sauces

• Citrus Juices

• Garlic

• Onions

• Peppermint/Spearmint

• Chocolate

In terms of a specific dietary plan, the Mediterranean Diet (MD) has been shown to improve GERD symptoms through the consumption of nutrient-dense whole foods such as fruits, vegetables, whole grains, legumes, fiber, and healthy fats, while limiting the intake of saturated fats, greasy or fried foods, and refined carbohydrates. The MD also promotes moderate consumption of wine; however, if wine has been identified as a trigger food, it can simply be avoided. Similarly, if other certain trigger foods have been identified that are typically considered part of a healthy MD (e.g. tomatoes, garlic, citrus fruits, etc.), the MD can be modified to exclude these foods too. The MD may also aid in weight loss, which can be an effective approach in the management of GERD symptoms for those considered overweight or obese.

Other Considerations

Besides dietary changes, exercise, weight loss, smoking cessation, and alcohol abstinence, there are other simple changes in habits that have been shown to be effective in improving GERD symptoms and include eating meals at least three hours before bedtime, avoiding large meals, avoiding large amounts of fluids with meals, wearing loose clothing around the abdomen, and elevating your head when sleeping.

Motivational Tip

You don’t have to feel the burn forever! Since there are different lifestyle factors that can contribute to the development of GERD and what impacts one may not affect another, don’t give up if you don’t immediately identify your trigger(s). While sometimes the cause can be apparent, this isn’t always the case. Work with a qualified nutritionist to help guide you in identifying trigger foods or other lifestyle factors that could be contributing to your GERD symptoms. Finally, don’t forget the saying “If at first you don’t succeed, try, try again.”

References:

1. Antunes C, Aleem A, Curtis SA. Gastroesophageal reflux disease. In: StatPearls. Treasure Island (FL): StatPearls Publishing; January 10, 2021

2. Escott-Stump S. Nutrition & Diagnosis-Related Care. 8th ed. Philadelphia, PA: Wolters Kluwer; 2015.

3. Rosen RD, Winters R. Physiology, Lower esophageal sphincter. In: StatPearls. Treasure Island (FL): StatPearls Publishing; April 24, 2020

4. Rakel D. Integrative Medicine. 4th ed. Philadelphia, PA: Elsevier; 2018

5. Newberry C, Lynch K. The role of diet in the development and management of gastroesophageal reflux disease: why we feel the burn. J Thorac Dis. 2019;11(Suppl 12):S1594-S1601. doi:10.21037/jtd.2019.06.42

6. D'Innocenzo S, Biagi C, Lanari M. Obesity and the Mediterranean diet: a review of evidence of the role and sustainability of the Mediterranean diet. Nutrients. 2019;11(6):1306. Published 2019 Jun 9. doi:10.3390/nu11061306

7. Dossett ML, Cohen EM, Cohen J. Integrative medicine for gastrointestinal disease. Prim Care. 2017;44(2):265-280. doi:10.1016/j.pop.2017.02.002