By: Jean Johnson for Reflux1Some of us have known trim people like Rebecca Oaks, who at 5’3” and 125 pounds, had a case of reflux so intractable that only the Stretta procedure helped her. Click here to read Rebecca’s story.
However, new research confirms that there is indeed a connection between weight and acid reflux.
Research Findings
Perhaps because both obesity and reflux is on the rise, considerable attention has been focused on the link in the past two years. Another reason for the increased attention is that debate still exists within the field of gastroenterology as to the connection between excess pounds and GERD.
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The National Institute of Diabetes and Digestive and Kidney Diseases suggests the following tips for reducing the stress that often causes people to eat more than they want:
Get plenty of sleep.
Practice deep breathing and relaxing your muscles one at a time.
Take a break and go for a walk.
Take short stretch breaks throughout the day.
Try taking a yoga or tai chi class to energize yourself and reduce stress.
Try a new hobby.
Surround yourself with people whose company you enjoy. |
Heavier people appear to be more prone to acid reflux than their slim peers. A 2005 study agrees with this hypothesis. The work came out of the Michael E. DeBakey Veterans Affairs Medical Center at Houston’s Baylor College of Medicine and was reported in the Annals of Internal Medicine. In the last decade, the Veterans Affairs Medical Center has earned a reputation for following patients over time and making connections between lifestyle and disease that will help improve the health status of the vets they serve. In this particular meta-study led by Howard Hampel, M.D., researchers reviewed nine other studies completed during the 1966-2004 period. Hampel and his team looked for links between reflux and overweight or obesity as measured by the body mass index (BMI).
“The association between BMI and GERD complications was markedly consistent,” Hampel et al wrote. “It is prudent to counsel all overweight patients who present with GERD-related diseases that weight loss may help improve symptoms.”
The second study of note was published in the June 2006 issue of the New England Journal of Medicine. Again the focus was on the body mass index.
“We see an extremely linear trend that shows that the higher up you go on the BMI scale, the higher risk you have,” said Brian Jacobson, M.D., assistant professor of medicine at Boston University School of Medicine.
In addition to looking at correlations between overweight and obese people, Jacobson and his colleagues widened the usual net and considered reflux dynamics associated with people who were a healthy weight previously and had gained as they aged. The team’s conclusion was that higher weights cause more reflux troubles.
“If you have heartburn [a common term for GERD or reflux] and you’re at your ideal body weight, I don’t think anyone would suggest that you go to an unhealthy or low weight,” Jacobson told Health Day. “If you have put on a few pounds over the past few years and notice a few symptoms or your symptoms got worse, you may have the motivation to lose weight.”
Jacobson’s work was based on more than 10,000 questionnaires his team sent to randomly-selected participants in the Nurse’s Health Study. Of the group, 22 percent said they had mild reflux symptoms around one time a week, while 55 percent said their reflux was frequent and moderate to severe.
The team measured each woman’s body mass index and correlated those scores to the descriptions of reflux. What they found was that even slight elevations in BMI scores were associated with greater reflux symptoms.
Specifically, women with a BMI of 22.5 to 24.9 were 38 percent more likely to suffer from reflux than were those with scores of 20 to 22.4.
To put that in context, consider that a woman who is 5’5” and weighs 120 pounds is considered normal weight with a BMI of 20. If she puts on 10 pounds, her BMI rises to 21.6. If she lets her weight go to 140 pounds, her BMI then becomes 23.3. Thus, she can put on 20 pounds without her BMI scores ever getting beyond the overweight range – which starts with a BMI of 25.
“So even if you were of normal weight and experienced a gain,” Anthony A. Starpoli, M.D., gastroenterologist at Lenox Hill Hospital in New York City, told Health Day, “you are more prone to reflux.”
Adding to the findings associated with reflux, Jacobson points out that those who carry too much weight are also at risk for heart disease, cancer and diabetes.
“Those conditions are silent, so people aren’t all that motivated to lose weight,” he said. “With heartburn, there’s this annoying problem that’s in your chest. It sort of redefines how you think of weight.”
Starpoli concurs. “Rip-roaring heartburn and regurgitation affects your quality of life immediately. We need to educate people that there are things they can work on to avoid other problems such as cancer, diabetes and cardiovascular disease.”
The most recent work on the GERD-obesity relationship was conducted by Bonnie B. Dean, PhD, researcher, Outcomes Research, Cerner LifeSciences, Beverly Hills, California. Dean’s motivation was the inconsistent results of past studies relating to the association between acid reflux and overweight and obesity.
She went to the Internet to gather her data. Via a survey conducted by Harris Poll Online, Dean sent questionnaires to 18,000 adults and received more than 2,800 replies. Out of the 2,800 replies, 347 individuals reported two or more bouts of heartburn or acid regurgitation a week. That group was also the one in which Dean found high BMIs.
Further data showed that “obese respondents tended to have the highest proportion of severe GERD symptoms and the lowest proportion of mild symptoms, compared with the normal or overweight individuals,” Dean told the Doctor’s Guide.
Her work was supported by a grant from Wyeth Pharmaceuticals, and she enlisted the assistance of colleagues from several U.S. universities. Results were presented at the American Academy of Family Physicians Annual Scientific Assembly held September 2006.
Suggestions from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
“If you are overweight, you are more likely to develop certain health problems,” the NIDDK states. “You can improve your health by losing as little as 10 to 20 pounds.”
The organization adds that “a balanced eating plan, regular physical activity and stress relief can help you stay healthy for life.”
How to take charge and take it off? The NIDDK recommends starting by eating breakfast every day. “People who eat breakfast are less likely to overeat later in the day.”
Next, make friends with whole grains like whole wheat breads and pastas, oatmeal, brown rice and bulgur. Along with this fare, they suggest including an array of colorful vegetables every day that supply a range of nutrients to keep us in top form.
Finally, the NIDDK says to think outside the sugar box and watch fat intake. Combined with reasonable amounts of physical activity and stress reduction, the equation is one that should lead to the normalization of weight over time.
A Word on Portions – Think Baseball, Ping Pong Ball and Deck of Cards
The NIDDK recommends eating only half your meal at restaurants and taking the rest home. This suggestion is in response to the super-sized portions ubiquitous throughout U.S. eateries.
Using everyday objects as a way to estimate portions is a further trick. A cup of cereal, for example, is about the size of a fist, while a half cup of cooked rice, pasta, or potato is equivalent to half the size of a baseball. The baseball image also helps with fruit, with a half cup serving of fruit equal to a half a baseball.
Leave the baseballs behind when entering the realm of nuts, butters and cheeses. Here, visualize a ping pong ball. Two tablespoons of nut butter is about the size of a ping pong ball, as is an ounce of cheese.
Finally, a deck of cards is useful in estimating three- to four-ounce portions of fish, poultry or meat. As for vegetables, you can never have too many of these low-calorie foods.
Armed with these visuals, those interested in whittling down their weight and minimizing their risk for reflux will be in charge no matter where they eat. And, as their weight and GERD symptoms decrease, so too will their risk for heart disease, cancer and diabetes.
