You've just enjoyed a great meal, maybe with a few drinks. Suddenly your throat is on fire, there's a bad taste in your mouth, and you've got heartburn. This is known as acid reflux, and is one of the most commonly diagnosed digestive disorders in the U.S.
Everyone experiences acid reflux every now and again, but if it is a regular occurrence it can have a significant effect on daily life, and could be a sign of gastroesophageal reflux disease (GERD).
Roughly 20 percent of people in the U.S. suffer from GERD. So what is it, what triggers it, and how do you stop it?
Newsweek spoke to gastroenterologist Dr. Joseph Salhab, also known as "The Stomach Doc" on social media, about the common and troublesome condition.
What Is Acid Reflux?
"Acid reflux is a condition where stomach acid flows back up into the esophagus, causing a burning sensation or discomfort in the chest area commonly referred to as heartburn," said Dr. Salhab, "Everyone has a gate-keeper between the esophagus and stomach that should prevent backflow of acidic contents. It's a muscle, and it's called the lower esophageal sphincter (LES)."
While the tissue in our stomachs is equipped to deal with high levels of acid, when the acid flows back in to the throat, the esophagus is less well-designed to handle it. The acid thus causes an unpleasant burning sensation.
"Normally, the LES tightly closes after food passes into the stomach, creating a barrier against acid reflux," Dr. Salhab said. "In certain individuals, the LES becomes weakened or relaxes inappropriately, allowing stomach acid to flow back up into the esophagus. On top of that, the esophagus is unable to clear out that excess acid efficiently."
What Are My Triggers for GERD?
Some foods and drinks can cause acid reflux or worsen GERD symptoms. Spicy foods, fatty and fried foods, chocolate, alcohol and coffee can all cause acid reflux.
"Spicy food can contain compounds such as capsaicin, that can irritate the esophagus and relax the LES," said Dr. Salhab. "Fried and fatty foods can delay the stomach from emptying. When this occurs, acidic substances remain in the stomach for a longer period, raising the likelihood of stomach acid and food flowing back up into the esophagus. Acidic foods, like citrus fruits and tomatoes, can increase stomach acid production."
Our morning coffee is a stimulant that gets us ready for the day ahead. However it can also relax the LES, making it easier for acid to reflux in to the esophagus. Alcohol also doesn't help as it not only relaxes the esophagus, "and also stimulates the production of stomach acid," added Dr. Salhab.
In addition to what you eat, how you eat can also have a negative effect on acid reflux and symptoms of GERD. "Dietary habits that can trigger acid reflux include midnight snacking, skipping breakfast, eating too quickly, eating beyond fullness, lying down after eating and eating less than three hours before bedtime," said Dr. Salhab.
It could be that if you regularly take over-the-counter pain medication such as ibuprofen or aspirin, that they are irritating the lining of your esophagus and making GERD symptoms seem more intense.
"Stress has also been shown to trigger the symptoms of heartburn," said Dr Salhab. "It has been shown to increase stomach acid production, and on top of that, stress can affect the perception of pain and can heighten the feeling of discomfort in the chest and esophagus, making GERD symptoms feel more intense."
Can You Cure GERD?
Some people can be more prone to acid reflux if they are born with a weak LES. You can also be born with a genetic predisposition that means certain genes can affect how our bodies are built, how they work, and how they react to things like specific foods or environmental factors.
"Obesity is another risk for GERD, however it is a controllable one," said Dr. Salhab, "Excess weight puts pressure on the stomach, leading to the backflow of stomach acid into the esophagus. For a significant portion of people, losing weight can be curative," he added. Even just a modest weight loss goal of five to 10 percent of body weight has been shown to have a beneficial effect."
Knowing and avoiding your trigger foods is a good way of reducing acid reflux, and increasing your dietary fiber. "Studies have shown that fiber-enriched diets strengthen the LES and can decrease of heartburn frequency," said Dr. Salhab. "A good way to supplement is with psyllium husk."
Increasing physical activity can also have a positive effect on symptoms of acid reflux and GERD. "Going for a walk after dinner can help alleviate symptoms of GERD in several ways," said Dr. Salhab, "Physical activity helps the digestive tract move, helps you maintain a healthy weight, and helps reduce stress levels."
Getting a good nights sleep can help with many minor medical conditions, including GERD. The two go hand in hand as a bad night's sleep can worsen symptoms of GERD, and GERD can interrupt sleep. "To break this cycle, I would avoid eating three to four hours before bedtime, sleep on your side, and avoid lying on your stomach. Additionally, elevating the head off the bed can keep stomach acid down," recommends Dr. Salhab.
For quite a significant amount of the population, GERD can be curable with a combination of both lifestyle changes and with the temporary help of medications however, there will be a subset of people that just can't control their symptoms despite making meaningful lifestyle changes.
Dr. Salhab recommends that these individuals talk to a gastroenterologist who might be able to recommend certain medications such as ones that contain calcium carbonate which can help neutralize excess stomach acid. Medications with sodium alginate can help by forming a gel-like substance to act as a barrier that prevents acid reflux. Medications that block the action of histamine in the stomach can also help, leading to a decrease in the production of stomach acid.
A Final Warning
It's important to note that all GERD medications are not meant for long-term use and are meant to help relieve symptoms when they're happening.
"Maintain a healthy diet with vegetables and fiber, avoid your trigger foods and increase healthy lifestyle habits," concludes Dr. Salhab, "By implementing these changes, you can promote better digestive health and reduce the likelihood of experiencing GERD symptoms."
There might be times when symptoms of GERD may be indicative of a more serious issue.
"If you experience difficulty swallowing, persistent nausea or vomiting, frequent choking on food, unexpected weight loss, or blood in your stool or vomit, it's crucial to seek medical attention as soon as possible," said Dr. Salhab.
"Similarly, severe or worsening chest pain, especially if it's combined with symptoms like jaw or arm pain, could indicate a more serious condition such as a heart issue. In addition, if your acid reflux symptoms persist despite treatment, or require frequent over-the-counter medications, you should schedule an appointment with a gastroenterologist," he finished.
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