By: Jean Johnson for Reflux1The trio of lifestyle remedies for chronic heartburn touted as “the most effective” out of the long roster that’s generally offered to patients was identified by Stanford University researchers and released in October 2006.
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Lifestyle Tips for Minimizing Acid Reflux from the National Institutes of Health:
Avoid potential trigger foods like: alcohol, caffeine, carbonated beverages, chocolate, citrus fruits and juices, tomatoes and tomato sauce, spicy or fatty foods, full-fat dairy products, and peppermint and spearmint.
Eat smaller meals.
Avoid eating within two to three hours of bedtime.
Avoid bending over or exercising right after eating.
Lose weight if you are overweight.
Stop smoking. “Chemicals in cigarette smoke weaken the lower esophageal sphincter that allows stomach acid to escape back up into the esophagus.”
Sleep with your head raised about six inches.
Avoid tight-fitting belts or clothing around the waist.
Reduce stress. Try yoga, tai chi, or meditation. |
Lauren Gerson, M.D. and her colleagues completed a meta review of 100 sets of published results on how to best relieve chronic heartburn, otherwise known as reflux or GERD (gastroesophageal reflux disease). In tabulating the data, they came up with a concise list of three behaviors to target. 1. Lose Weight
Gerson and her team didn’t say what they found would be easy to address. As Americans are laboring under the heavy burden of an overweight and obesity epidemic, Gerson et al targeted excess weight as number one on their list.
Gerson points to one particular study that showed people who lost on the average of 27 pounds reduced their chronic heartburn by 40 percent. The idea that carrying too much weight – especially around the belly – can exacerbate reflux symptoms is nothing new to gastroenterologists across the nation. Indeed, while current research has not identified precise links between extra pounds and reflux, specialists in the field have speculated over and over again that the pressure of fat on the stomach creates problems and increases the likelihood that acid will back up through the lower esophageal sphincter.
“That’s the thing with science sometimes,” said Ron Jackson of San Francisco. “As far as I’m concerned, science is only half of the discussion. We have to remember that human beings are more than bags of bones and organs. We have hearts and souls, and we need comforting however we can find it.”
Jackson’s mother is a large lady, and a year ago after an emergency visit to the hospital when she thought she was having a heart attack, a physician diagnosed acid reflux. Now she takes a medication and watches the amount she eats.
“My mother has had a hard life in many respects when you think about it – with my father and all. It was love gone sour and things weren’t what they might have been in that respect, that’s for sure. On the other hand, she was a gifted pianist and absolutely gorgeous cook way before Julia Child ever thought of traipsing off to France.
“Also in terms of the eating habits she was raised with – mom’s people were from the Midwest, and you know how those Sunday dinners are back there. She took me back 15 years ago to meet the relatives that we have left, and you should have seen the spreads they put on. Huge baked hams, fried chicken, roast beef, and all the homemade rolls and pickles and potato salads. Everything you could imagine. And that’s not even the dessert table. Talk about high cakes with the frosting picture perfect and the tinted coconut on top. These ladies know how to bake – and how to put on an old-fashioned feed.
“In answer to what you’re probably thinking, our relatives there are hefty. My mother comes from solid farm stock. That’s a fact. And that’s my point really.
“When that’s her history, how is she going to change now? She loves all that stuff, especially the gravy. And I think it brings her comfort because it reminds her of her childhood when times were happier. Besides, there’s something about a meat and potatoes dinner that California cuisine can’t compete with. You feel like you’ve been fed, not only physically but emotionally.”
With his point made, Jackson goes on to explain that he appreciates science and medical advancements. “Oh yes, without it my poor mother would really be having a tough time right now. She relies on her medicine – that and making sure she grazes more and avoids eating too much at once. It’s just that for someone like her – and frankly, I don’t think she’s so different that the thousands of other Americans who are too heavy – it’s not that realistic for her to lose weight. All those habits she’s had over the years are hard to break. That’s what science doesn’t help us with very well – how to address emotional connections like that.
“Look at it this way,” Jackson said. “Nobody wants to be heavy. It’s uncomfortable. Your clothes don’t fit. You don’t look all that great. It’s miserable all the way around. So it’s not that people don’t want to change, it’s that they can’t. They have not found a way out of that problem, and the diets the doctors peddle are a joke. Until they do more than hand patients a sheet of paper and tell them to lose some weight like it was a matter of checking their blood pressure daily, I just don’t see that much can be resolved.”
Jackson’s caveat, of course, is that there are probably some people who can go on a physician-prescribed diet and activity plan and achieve some weight loss that helps relieve their chronic heartburn. “So maybe it’s this handful of patients that will benefit from Stanford’s hue and cry. If they can, all the more power to them, I say. At least it’s a start for society, and who knows, maybe others will follow and things will get better over time. I hope so, because I don’t want to end up like my mother. I’m not heavy now, knock on wood, and I’m going to try and stay that way.”
2. Elevate Your Head
Keeping the head higher than the stomach makes perfect sense since gravity can help keep stomach acids from backing up into the esophagus. This is a straight-forward approach that even Ron Jackson doesn’t take issue with. Gerson’s data show that wedge pillows are helpful in reducing acid reflux episodes.
The trick here is to use a foam wedge, not just extra pillows, according to John R. Saltzman, M.D., a gastroenterologist and director of endoscopy at Brigham and Women’s Hospital in Boston. So make the effort to get a wedge from a medical supply store. Otherwise, says Saltzman, all you will get is “a sore neck without any heartburn relief.”
3. Sleep on Your Left Side
Finally, Gerson’s analysis shows that reflux patients who sleep on their left side have half as many problems as patients who ignored the advice.
Many physicians have recommended this technique to their patients, and the practice has a well developed track record. When people sleep on their right side, the stomach is higher than the esophagus and that allows it to put pressure on the lower esophageal sphincter, in turn increasing the risk for fluid back-up.
As the NIH underscores, while behavioral changes are an excellent way to approach managing chronic heartburn, if these methods do not provide relief, patients are advised to work closely with their physicians to identify medications – both over-the-counter and those available through prescription only – that will help. Additionally, gastroenterologists are versed in a number of interventional techniques that can help resolve severe cases of reflux. For further information on these, including state-of-the-art innovations, see the Reflux1 archive of feature articles.
