Say No to Heartburn

What Is Gerd?

Gastroesophageal reflux disease occurs when the lower esophageal sphincter relaxes involuntarily, allowing stomach acid to travel up into the esophagus. The lower esophageal sphincter is the opening between the bottom of the esophagus and the stomach. During normal digestion, food travels down the esophagus, where the lower esophageal sphincter opens, allowing food and saliva to enter the stomach. In individuals with GERD, this sphincter doesn’t close properly, causing stomach acid and food contents to re-enter the esophagus which can cause pain and inflammation.

The most common symptoms associated with GERD is heartburn. Heartburn occurs as a results of acid reflux, also called acid indigestion, acid regurgitation and gastroesophageal reflux (GER). Acid reflux causes a burning sensation in the chest that can radiate toward the mouth, the chest and often results in a sour taste in the mouth. Occasional acid reflux is normal in most people and not usually cause for concern; however, persistent heartburn resulting from acid reflux is a hallmark sign of GERD.

  • Signs and symptoms include:
  • Belching and bloating
  • Burning sensation in the chest (heartburn)
  • Chest pain
  • Chronic cough
  • Halitosis (bad breath)
  • Hoarseness
  • Nausea
  • Regurgitation of stomach contents
  • Difficulty swallowing
  • Sensation of a lump or pain in the throat

WHAT CAUSES GERD?

Certain factors can influence how the lower esophageal sphincter functions including:

  • Cigarette smoking, second-hand smoke exposure
  • Certain medications
  • Hiatal hernia
  • Obesity
  • Older age
  • Pregnancy

COMPLICATIONS OF GERD

Most people with GERD will not develop serious complications, especially if they get treatment. However, potentially serious complications can sometimes happen in people with severe GERD.

Erosive esophagitis – This is when the esophagus is damaged (eroded) as a result of burning from stomach acid. This can lead to ulcers, which may bleed. Bleeding from ulcers is not always visible, but it can be detected with stool tests.

Esophageal stricture – Damage from acid can cause the esophagus to scar and narrow, causing a blockage (stricture) that can cause food or pills to get stuck in the esophagus. The narrowing is caused by scar tissue that develops as a result of ulcers that repeatedly damage and then heal in the esophagus.

Barrett’s esophagus – Barrett’s esophagus occurs when the normal cells that line the lower esophagus (called squamous cells) are replaced by a different cell type (called intestinal cells). This process usually results from repeated damage to the esophageal lining; longstanding GERD is the most common cause.

The intestinal cells have a small risk of transforming into cancer cells over time. As a result, people with Barrett’s esophagus are advised to have a periodic upper endoscopy to monitor for early warning signs of cancer.

Lung and throat problems – If stomach acid backs up into the throat, this can cause inflammation of the vocal cords, a sore throat, or a hoarse voice. The acid can also be inhaled into the lungs and cause pneumonia or asthma symptoms. Over time, acid in the lungs can lead to permanent lung damage.

Dental problems – Repeated episodes of acid reflux can erode the enamel of the teeth over time.

Lifestyle tips for reducing symptoms of GERD

Certain lifestyle and dietary changes can often help relieve symptoms of GERD. If you have mild symptoms, you can try these approaches before seeking medical attention. If your symptoms are more serious, it’s a good idea to talk to your health care provider before making any changes, so they can advise you on how to incorporate these approaches into your treatment plan.

The following lifestyle changes are often recommended:

  • Losing weight (if you are overweight) – Losing weight may help people who are overweight to reduce acid reflux. In addition, weight loss has a number of other health benefits, including a decreased risk of type 2 diabetes and heart disease
  • Raising the head of your bed six to eight inches – Although most people only have heartburn during the two- to three-hour period after meals, some wake up at night with heartburn. People with nighttime heartburn can elevate the head of their bed, which raises the head and shoulders higher than the stomach, allowing gravity to prevent acid from refluxing.
  • You can raise the head of your bed by putting blocks of wood under the legs or a foam wedge under the mattress. Several companies have developed commercial products for this purpose. However, it is not helpful to use additional pillows; this can cause an unnatural bend in the body that increases pressure on the stomach, which can worsen acid reflux.
  • Avoiding foods that trigger symptoms – Some foods also cause relaxation of the lower esophageal sphincter, which can lead to acid reflux. Excessive caffeine, chocolate, alcohol, carbonated beverages. peppermint, and fatty foods may cause bothersome acid reflux in some people. If you notice that your symptoms are worse after you have certain foods or beverages, it’s reasonable to limit or avoid these things.
  • Quitting smoking – Saliva helps to neutralize refluxed acid, and smoking reduces the amount of saliva in the mouth and throat. Smoking also lowers the pressure in the lower esophageal sphincter and provokes coughing, causing frequent episodes of acid reflux in the esophagus. In addition to having many other health benefits, quitting smoking can reduce or eliminate symptoms of mild reflux.

While evidence is limited, other changes also sometimes seem to help, such as:

  • Avoiding late meals – Lying down with a full stomach may increase the risk of acid reflux. By planning meals for at least two to three hours before bedtime, symptoms may be reduced.
  • Avoid post-meal exercise – Exercising shortly after eating can induce gastric reflux. Vigorous exercise may slow gastric emptying, meaning acid and food remain in the stomach for extended periods, increasing risk of gastric reflux.  On the other hand, postprandial (post-meal) walking can reduce esophageal acid exposure. It’s best to wait one to three hours after a meal before engaging in any vigorous exercise if you experience recurrent heartburn.
  • Eat smaller meals – Consuming smaller meals may help fend off symptoms of GERD. Large meals can contribute to increased gastric distension and may relax the lower esophageal sphincter, leading to heartburn.
  • Wearing loose, comfortable clothing – At minimum, tight-fitting clothing can increase discomfort, but it may also increase pressure in the abdomen, forcing stomach contents into the esophagus.

Curious about how to manage your heartburn?
Have more questions about your symptom picture? Or your risk factors?
Need clarity on how to ensure you’re actually eating right for you?
Unsure about what supplements or medications you should be taking?

As Naturopathic Doctors, we commonly see patients who experience discomfort related to heartburn or have been diagnosed with GERD. We’re here to guide you in all your options and give you all the tools needed to be safe, comfortable and living life to the fullest.

Dr. Jess Hobson, ND

References:

Adamko, D. J. (2018). CTC 2019: compendium of therapeutic choices. Ottawa, ON: Canadian Pharmacists association

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Fass R. Therapeutic options for refractory gastroesophageal reflux disease. J Gastroenterol Hepatol. 2012 Apr;27 Suppl 3:3-7. doi: 10.1111/j.1440-1746.2012.07064.x. PMID:22486864.

Katz, Philip O MD1; Gerson, Lauren B MD, MSc2; Vela, Marcelo F MD, MSCR3 Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease, American Journal of Gastroenterology: March 2013 – Volume 108 – Issue 3 – p 308-328 doi: 10.1038/ajg.2012.444

Maret-Ouda J, Markar SR, Lagergren J. Gastroesophageal Reflux Disease: A Review. JAMA. 2020;324(24):2536–2547. doi:10.1001/jama.2020.21360

Mehta RS, Song M, Staller K, Chan AT. Association Between Beverage Intake and Incidence of Gastroesophageal Reflux Symptoms. Clin Gastroenterol Hepatol. 2020 Sep;18(10):2226-2233.e4. doi: 10.1016/j.cgh.2019.11.040. Epub 2019 Nov 28. PMID: 31786327.

Mehta RS, Nguyen LH, Ma W, Staller K, Song M, Chan AT. Association of Diet and Lifestyle With the Risk of Gastroesophageal Reflux Disease Symptoms in US. JAMA Intern Med. 2021;181(4):552–554. doi:10.1001/jamainternmed.2020.7238

Ness-Jensen E, Hveem K, El-Serag H, Lagergren J. Lifestyle Intervention in Gastroesophageal Reflux Disease. Clin Gastroenterol Hepatol. 2016 Feb;14(2):175-82.e1-3. doi: 10.1016/j.cgh.2015.04.176. Epub 2015 May 6. PMID: 25956834; PMCID: PMC4636482.

Ness-Jensen E, Lindam A, Lagergren J, Hveem K. Tobacco smoking cessation and improved gastroesophageal reflux: a prospective population-based cohort study: the HUNT study. Am J Gastroenterol. 2014 Feb;109(2):171-7. doi: 10.1038/ajg.2013.414. Epub 2013 Dec 10. PMID: 24322837.

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