Gastroesophageal Reflux Disease (GERD)
Dietary and Lifestyle Approaches to GERD Management
Up to 50 percent of patients with GERD experience persistent symptoms, despite taking PPIs regularly (Dibley 2010). Diet and lifestyle interventions are therefore an important adjunct to standard drug therapy. Education on managing stress, proper diet, physical activity, and understanding the causes and progression of GERD has been shown to promote significant improvement in patient perception of their illness and well-being (Dibley 2010).
Some diet and lifestyle modifications commonly suggested for GERD patients include:
Avoid foods and beverages associated with GERD symptoms. Several common dietary components have been associated with increases in GERD symptoms, including
- Coffee (Bhatia 2011)
- Chocolate (Bujanda 2007)
- Spicy foods (Song 2011)
- Carbonated beverages (Hamoui 2006)
- Alcohol (Grande 1996; Song 2011)
Additional foods that may cause symptoms include tomatoes (cooked and raw), milk, cheese, citrus foods, cakes and pastries (Dibley 2010).
Quit Smoking. Smoking increases GERD symptoms by reducing 1) the ability of the LES to remain closed against increases in gastric pressure, and 2) the clearance of reflux from the esophagus (Kaltenbach 2006). The incidence of GERD increases with the duration of smoking. Based upon data from a large population study, long term (> 20 years) daily smoking resulted in a 70% increase in the occurrence of reflux episodes compared to those who have smoked for less than one year (Nilsson 2004).
Lose weight. Increased body mass and abdominal adiposity increases pressure on the stomach and lower esophagus. This can stress the lower esophageal valve, hampering its ability to maintain a seal against gastric reflux. Sustained abdominal pressure can also increase the risk of hiatal hernia (Festi 2009). Based upon a survey of seven studies, overweight individuals averaged a 43% increase and obese individuals a 94% increase in GERD symptoms over individuals with a normal body mass (Hampel 2005). Esophageal adenocarcinoma incidence was more frequent in overweight individuals in most of these studies.
Monitor meal size and macronutrient composition. Dietary fat delays gastric emptying, which may increase the probability of reflux in susceptible patients. High-fat meals are also associated with increased risk of esophageal cancer (De Ceglie 2011). Whereas high-calorie, high-fat meals appear to elicit GERD (Colombo 2002; Fox 2007), reducing fat content in meals has had beneficial effects in some studies (Iwakiri 1996; Penagini 1998). Low carbohydrate (< 20 gram) meals reduced some reflux symptoms in a small trial in obese subjects (Austin 2006). Aside from their direct effects on GERD, limitation of fat, carbohydrate, and total calorie intake are effective methods for weight reduction, which itself is an effective anti-reflux strategy. Weight reduction is also an effective way to positively impact many additional aspects of health and potentially enhance longevity. More information is available in the Caloric Restriction protocol and The Nine Pillars of Successful Weight Loss article in Life Extension Magazine.
Avoid eating close to bedtime. GERD patients have long been advised to avoid eating close to bedtime in order to give the stomach adequate time to empty before lying down (DeVault 1999). Clinical studies, however, have had mixed results regarding the minimization of GERD symptoms (Gerson 2009; Orr 1998; Lanzon-Miller 1990).
Elevate the head of the bed while sleeping. Several studies have suggested that raising the head of the bed 8-11 inches, or sleeping on a “wedge”, can reduce the number and duration of reflux episodes (Kaltenbach 2006). This approach uses gravity to help keep stomach contents out of the esophagus. Left lateral recumbency (sleeping on one’s left side) may also reduce GERD symptoms by potentially keeping the LES above the level of the stomach and reducing pressure on the valve (Kaltenbach 2006 ).
Limit aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). Some evidence suggests that NSAID use is associated with GERD (Kotzan 2001). NSAIDs exert their anti-inflammatory activity by inhibiting the activity of pro-inflammatory cyclooxygenase (COX) enzymes. However, the COX-1 enzyme is also important for promoting the formation of the protective mucus lining of the stomach.