Acid Reflux: How to Ease the Burn

Unfortunately, our fast-paced lifestyles and grab-and-go eating style has made acid reflux all too common. Since May is Digestive Diseases Awareness Month, I wanted to focus on this very common but painful condition. Let’s explore the causes of acid reflux and gastroesophageal reflux disease (GERD) and how to ease the burn. It’s not just about taking a pill. There are some diet and lifestyle factors that may get you symptom free as well or better than taking medication.

What is Acid Reflux

Acid reflux is that uncomfortable burning sensation many of us have experienced after a heavy meal or late-night snack. But there’s much more to this common condition than meets the eye, and that’s what we’re going to explore in this article.

The Ups and Downs of Digestion

Let’s begin with a brief biology lesson. Normally, when we eat, food travels down the esophagus, a muscular tube that connects the mouth to the stomach. At the end of the esophagus is the lower esophageal sphincter (LES), which is a valve that opens to allow food into the stomach and then closes to keep stomach contents (including acid) from flowing back up into the esophagus. It’s supposed to be a one-way valve.

But sometimes, this valve can relax or weaken, allowing stomach acid to escape back up into the esophagus. That’s acid reflux! It’s also commonly referred to as heartburn. Because that’s what it feels like – a burning in your chest. Think of your lower esophageal sphincter as a security guard. If it doesn’t do its job and allows acid to flow back into the esophagus, you have a security breech and that’s a problem.

Importance of Stomach Acid

Please don’t get the impression that stomach acid is the problem. Your stomach produces hydrochloric acid for a reason. It’s necessary for breaking down food for digestion and absorption. It also provides you with a layer of protection against unwanted intruders like pathogenic bacteria. These food-borne bacteria such as E. coli or salmonella can wreak havoc if your defense is down. In fact, not having enough stomach acid is a problem. It can lead to GI infections, damage to the gastrointestinal system, and nutrient deficiencies. Symptoms of low stomach acid may include gas, bloating, burping, upset stomach, nausea when taking vitamins or supplements, undigested food in stool, anemia, hair loss, weak brittle fingernails, fatigue, and interestingly – heartburn.

Stomach acid is important to help break apart protein and is necessary for proper absorption of vitamin B12 and minerals such as calcium, iron, and magnesium.  Several chronic health conditions have been associated with low levels of stomach acid. These include conditions such as food allergies, asthma, lupus, thyroid issues, psoriasis, eczema, osteoporosis, and pernicious anemia. And we tend to make less stomach acid as we age.

The lining of the stomach is designed to withstand acidic conditions. In a normal healthy stomach, having a low pH (1-2) is not a problem. It’s only a problem when the acid leaves the area it is designed to stay in and irritates other tissues – in this case, the esophagus.

What Causes Acid Reflux?

Normally, the pressure is greater in the esophagus than in the stomach. This pressure differential prevents reflux of gastric contents back into the esophagus. But sometimes things interfere with the body’s ability to balance this pressure. Acid reflux can be caused by several factors.

1. Overeating: When portion sizes are larger, we tend to overindulge which can overwhelm our digestive system causing impaired digestion, increased acid secretion, and delayed gastric emptying.  The increased pressure on our stomach can push open the esophageal sphincter allowing acid to escape.
2. Diet: The type of foods we eat can also cause reflux. Spicy foods, acidic foods (tomatoes, citrus fruits), high fat foods (fried foods), chocolate, caffeine, and alcohol can all irritate the stomach and reduce the lower esophageal sphincter pressure triggering reflux.
3. Position: Lying down too soon after eating or wearing tight clothing around the waist can contribute to reflux.
4. Obesity: Excess weight (especially around the mid-section) can increase pressure causing failure of the sphincter to close effectively.
5. Smoking: Lowers LES pressure increasing reflux.
6. Pregnancy: Hormone changes as well as extra weight in the abdominal area during pregnancy creates pressure increasing reflux.
7. Medical Conditions: Hiatal hernias can put pressure on the LES and cause or worsen reflux.
8. Medications: Some medications can cause reflux. If you are taking medication that seems to make reflux worse, talk to your doctor about other options. Drugs like oral contraceptives, theophylline, benzodiazepines, aspirin, tricyclic antidepressants, nitrites, calcium channel blockers, or non-steroidal anti-inflammatory drugs (NSAIDS) like Advil can all contribute to reflux.

How to Ease the Burn

Now that we understand some causes of acid reflux, let’s talk about what we can do to keep the acid in check. Sometimes, making a few diet and lifestyle changes is all we need to extinguish the burn. Treating GERD requires 1. Improving LES competence, 2. decreasing gastric acidity, 3. improving clearance of contents from the esophagus. Try the following tips.

• Eat Smaller Meals: Large meals (especially high fat meals) can overload your stomach and delay digestion, increasing the risk of reflux. Eating smaller meals throughout the day reduces the risk. Also, try to include protein at meals. Protein helps to stimulate gastrin secretion and LES pressure.
• Watch Your Diet: Avoid trigger foods and drinks such as spicy foods, citrus fruits, tomatoes, chocolate, coffee (regular or decaf), carbonated beverages, too much caffeine or alcohol. Other items you may want to avoid include garlic, onions, black pepper, and peppermint or spearmint oil.
• Stay Upright: After meals, try to remain upright for at least a couple of hours to let your body digest your food and use gravity to help keep things down. Avoid lying down or rigorous activity after meals.
• Elevate Your Bed: Raise the head of your bed by 6-8 inches to help prevent reflux at night. And wait 2-3 hours after eating before going to bed.
• Lose Weight. If excess weight around the midline is present, weight loss can help reduce symptoms of acid reflux.
• Avoid tight-fitting clothing. Especially around the midline.
• Don’t Smoke. Smoking weakens the LES. If you smoke, quitting may alleviate the burn.
• Manage Stress: Stress can exacerbate reflux, so find healthy ways to unwind and relax.
• Medical condition. If you have a condition such as hiatal hernia, getting that repaired may greatly lessen reflux symptoms.
• Medications: If you’re taking medication that worsens reflux, talk to your doctor about alternatives.

Pharmaceutical Treatments

When diet and lifestyle changes alone aren’t enough to control acid reflux, there are several treatment options available. There are natural remedies, over the counter medications, and prescription medications. These supplements or medications work by either buffering the stomach acid, blocking stomach acid, improving motility of the GI tract (prokinetic agents), or protecting the mucosal lining. In severe cases of chronic reflux (GERD), your doctor may recommend combination therapy.

• Natural remedies: Some people find relief with natural options like ginger, licorice root, and aloe vera which help soothe the digestive tract. Always consult with a healthcare provider before trying new supplements as these can interact with other medications and may not be suitable for everyone.
• Over-the-counter medications: Antacids such as Tums, Rolaids, and Gaviscon can provide quick relief by neutralizing stomach acid. H2 (histamine) blockers like famotidine (Pepcid) reduce acid production, and proton pump inhibitors (PPIs) such as omeprazole (Prilosec) and esomeprazole (Nexium) block acid production.
• Prescription medications: In more severe cases, doctors may prescribe stronger or higher dose acid blockers (PPIs or H2 blockers). In some cases where gastric motility is an issue (such as delayed stomach emptying or gastroparesis), prokinetic agents like metoclopramide (Reglan) may be prescribed.

While these treatments can provide relief, it’s essential to address the root cause of acid reflux. Don’t ignore diet and lifestyle factors that may be contributing to the need for medications.

The Risks of Untreated Acid Reflux

If left untreated, chronic acid reflux can lead to gastroesophageal reflux disease (GERD), which can cause complications like esophageal damage and inflammation known as esophagitis. It can lead to ulcers, changes in the esophageal lining known as Barrett’s Esophagus (a precancerous condition), and if left untreated long enough can lead to esophageal cancer. If you experience acid reflux frequently, be sure to talk to your healthcare provider. They can help you find the best treatment plan for your specific needs.

Signs and Symptoms of Acid Reflux

Sometimes people are unaware they have acid reflux. Symptoms may vary and go unnoticed.   If you suspect reflux may be an issue but you haven’t been diagnosed, answer these questions to determine if you might need treatment. Or if you are being treated for reflux, answer these questions to see how well the treatment is working?

• Do you experience a burning sensation in your chest? How often?
• Do you notice food or acid coming back into your throat or mouth?
• Do you notice pain in the center of your upper stomach area?
• Do you experience frequent nausea?
• Do you wake up at night with a burning sensation in your chest or throat?
• Do you feel the need to take antacids or other acid blockers, especially after meals?

Some other possible symptoms of reflux include increased salivation, belching, pain in the chest area, but it can radiate to the arm or jaw, nighttime cough, persistent hoarseness, difficulty swallowing, or recurrent pneumonia.

Caution

There are some concerns with treatment of acid reflux. I wouldn’t be giving you the whole picture unless I informed you of the risks associated with long-term acid blocking medications. While these are very helpful for short-term treatments of reflux or GERD, they are not meant to be taken long-term. In fact, the drug manufacturer’s directions recommend 4-8 weeks of treatment for mild reflux issues and up to 16 weeks for more serious conditions. Unfortunately, many people are prescribed or take these medications for months or years. While it may help control reflux, it can cause other problems with long-term use.

• Suppressing stomach acid can lead to nutrient deficiencies. We mentioned earlier that vitamin B12 as well as minerals such as calcium, iron, and magnesium require acidic conditions for absorption. This lack of nutrient absorption can lead to anemia, loss of bone, and increased risk of cardiovascular disease.
• Lower stomach acid lessens your resistance to intestinal infections from like salmonella and C. diff.
• Long-term acid suppression may also increase the risk of food allergies.
• On the other hand, food allergies or sensitivities may exacerbate reflux. Avoiding foods you react to can result in significant improvement in reflux symptoms. So, if treatment for acid reflux is not working for you, consider getting tested for food allergies or sensitivities. 
• If getting tested for food allergies is not an option for you, some research studies have found avoiding 4 common food allergens resulted in improved symptoms. These foods include cow’s milk, eggs, soy, and wheat. This may be most helpful for those with Eosinophilic esophagitis. A 4-6 week elimination diet might help you discover if allergic reactions are the issue. Just remember, you don’t have to completely remove these foods from your diet forever. You just avoid all of them for the trial period and then reintroduce them one by one to see which one(s) are the problem. It’s best to get help from a registered dietitian when doing an elimination diet.

Conclusion

 If you have a better understanding of the causes, treatments, and risks associated with acid reflux, you can do something about it. As always, if you suspect you have reflux, be sure to talk to your healthcare provider.

References:

• https://www.healthline.com/health/hypochlorhydria#symptoms
• Disease Prevention and Treatment. Life Extension. 5^th edition. GERD. Pg. 649-656.
• Nutrition and Diagnosis-Related Care. AND by Sylvia Escott-Stump. 9^th ed. Esophagitis, GERD, and Hiatal Hernia. Pg. 521-524.
• The Health Professional’s Guide to Gastrointestinal Nutrition. AND. Matarese, L, Mullin, G. and Raymond, J. 2015.