Recently some of my patients have found lifestyle changes helpful for their reflux symptoms. Reflux is very common however not many link it to their day to day habits which maybe causing the problem.
What is reflux?
Acid reflux or heartburn is a burning discomfort in the centre of the chest or back of the throat which happens as a result of food content of the stomach coming into the food pipe or throat. Where the food pipe connects to the stomach, there is muscular valve called lower oesophageal sphincter (LES) which prevents the stomach content coming back into the food pipe. Reflux can happen if this LES is too relaxed or due to increased abdominal pressure when coughing, straining or wearing tight clothing around the waist. It can also happen if there is a delay in clearing the stomach contents when digestion may not be happening normally.
The statistics show that reflux affects anywhere between 10-30% of the adults in developed countries (1). I wonder if it is a higher number as it is a common presentation in primary care, especially after the holiday season when people have indulged in treats over Christmas and New Year.
The main symptoms include sour taste in the mouth, burning at the back of the throat or centre of chest. Occasionally reflux can present as an irritating cough, dental problems, bad breath or upper tummy pain (2). If your symptoms are recurrent and not improving in four to six weeks it is important to discuss this with your doctor.
What can make the symptoms of reflux worse?
I always like to ask my patients about their day, what they eat, sleeping times as well as stress levels as they all can have an impact on reflux. Getting to the root cause of the problem helps guide what lifestyle changes can actually make a difference.
Some of the common risk factors for reflux include obesity, high stress levels, lack of regular meal times, poor dietary choices along with reduced hours of sleep. Diet does have major role in reflux as certain food items like caffeine, chocolate, fatty or spicy food can lower the tone of the LES. It is important to know that certain medications can also cause heartburn. Most commonly used painkillers like aspirin, ibuprofen or anti-inflammatory medication are known culprits. I would urge you not to stop or change any medication without speaking with your health professional as this is general advice.
I am sure you will agree that most of the above mentioned risk factors are related to lifestyle choices.
Lifestyle tips to improve reflux (3), (4), (7)
- Maintain healthy weight.
- Avoid smoking, vaping and alcohol.
- Have regular meals and avoid eating late. Ideally it is recommended to have the last meal of the day at least three hours before bed. Eating mindfully without distractions and to make sure that food is chewed well (which many of my patients find surprising!). If you are eating on the go or while working it is very likely that food is not being chewed well enough. Avoid eating big meals, especially at the end of the day.
- Avoiding tight clothing around the waist or ribcage can help reduce the abdominal pressure instantly and relieve symptoms of reflux.
- Managing stress levels with relaxing activities and making sure you are getting sound sleep of 6-8 hours every night.
- Elevating the head side of the bed by few inches can be a very effective way to reducing the reflux symptoms which are worse at night. Evidence also shows that lying on the left side helps too (5).
- Avoid drinking water during meals as it dilutes the acid in the stomach which can aggravate the symptoms of reflux. One would think that reflux is due to high amount of acid however due to the recent rise in use of reflux medication, symptoms of heartburn are mostly due to lack of acid which affects digestion in many ways, not forgetting the disruption of absorption of vital nutrients.
- Diet has a big role to play when it comes to reflux and a whole food plant predominant diet is once again high on the list! It is rich in fibre, flavonoids and antioxidants, all of which improve gastric emptying as well as promote healthy gut bacteria. I would like to mention that certain food items can be irritating to specific individuals. If you do notice that after eating certain things your symptoms are worse, it is worth making a note and avoiding them. Commonly caffeine, chocolate, fizzy sugar loaded drinks, fried and spicy food have been associated with relaxing the LES which can cause reflux to get worse (6). Citrus fruits, tomatoes, garlic and onions can also aggravate reflux symptoms. Specific food items which I recommend to include in the food plan are fresh ginger, fenugreek seeds, apple cider vinegar and Aloe Vera. Mint is something I am often asked about and sadly it does not help with reflux and may aggravate the symptoms.
Medication like anta-acids and proton pump inhibitors are the main treatment for reflux and can be helpful in the short-term. However, there is growing evidence of the harmful side effects of these drugs when taken long term which is why I am trying to discuss the lifestyle changes which can help improve the symptoms.
This blog is for general advice and please do not change / or stop your medication without discussing with your health professional.
References
- BMJ Best Practice (2022) Gastro-oesophageal reflux disease. BMJ Publishing Group. http://bestpractice.bmj.com
- https://cks.nice.org.uk/topics/dyspepsia-proven-gord/management/dyspepsia-proven-gord/
- Lifestyle intervention in gastroesophageal reflux disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4636482/
- The role of lifestyle changes in gastroesophageal reflux diseases treatment DOI:10.5152/tjg.2017.10
- Albarqouni, L., Moynihan, R., Clark, J., Scott, A. M., Duggan, A., & Del Mar, C. (2021). Head of bed elevation to relieve gastroesophageal reflux symptoms: a systematic review. BMC family practice, 22(1), 24. https://doi.org/10.1186/s12875-021-01369-0
- Heidarzadeh-Esfahani, N., Soleimani, D., Hajiahmadi, S., Moradi, S., Heidarzadeh, N., & Nachvak, S. M. (2021). Dietary Intake in Relation to the Risk of Reflux Disease: A Systematic Review. Preventive nutrition and food science, 26(4), 367–379. https://doi.org/10.3746/pnf.2021.26.4.367
- Gastroesophageal Reflux Disease (GERD): Highlighting Diagnosis, Treatment, and Lifestyle Changes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9517688/#!po=71.0526
