Heartburn and reflux can be an unpleasant way to finish a meal and often has us reaching for antacids. But there are diet and lifestyle changes that can also bring relief. Dietitian Katrina Pace explains.
When acid spills back up from our stomach into our oesophagus, it’s called indigestion or heartburn.
A lot of people experience heartburn at some point in their life. Often, it’s because of eating too hot or spicy food, eating too quickly or bending over or lying down too soon after a meal.
However, heartburn doesn’t become a problem until it’s happening at least twice a week. This is when it can be diagnosed as gastro-oesophageal reflux disease (GORD) or just reflux. Over time, reflux can cause the lining of the oesophagus to become inflamed and damaged.
Your oesophagus is a long tube joining your mouth and stomach. Food and drink move down the oesophagus using gravity and muscle waves (peristalsis). Pressure on the lower oesophageal sphincter (LOS) that guards the entrance to your stomach, caused by the peristaltic wave, is the trigger for your LOS to open. If the LOS is open for longer than it needs to be, or if passage of food through the LOS is slow, then acid can move from the stomach up the oesophagus.
You may experience reflux if you are:
- a smoker
- a heavy drinker
- between 35-64 years old or if you are an IBS sufferer
Is it really reflux?
Diagnosis of reflux is usually based on your symptoms.
Starting a short course of medications to relieve symptoms can be used to diagnose reflux.
Following this, an endoscopy may be recommended to check the diagnosis. Other conditions your doctor may check for are Barrett’s oesophagus, oesophageal stricture, cancer, hypochlorhydria or eosinophilic oesophagitis.
Medications to treat reflux
Over-the-counter medications can be useful if you experience the symptoms of heartburn occasionally. Antacids, such as Mylanta, Eno, Quick-Eze and Gaviscon, neutralise the acid in your stomach, reducing the pain of reflux.
Prescription medication can be used for more frequent reflux. H2 blockers, including Zantac, Axid and Tagamet, give longerlasting relief and are suitable for moderate reflux. H2 blockers are medicines that block the action of histamines on a histamine receptor called H2. The proton pump inhibitor (PPI), omeprazole, is usually prescribed for severe reflux and gives relief by blocking the release of acid in the stomach.
A study published in 2000 found 30 per cent of a group of nearly 900 adults living in Greater Wellington complained of reflux. Sixty-nine per cent used over-the-counter medicine to help relieve symptoms, but only 17 per cent had seen a doctor about the issue. In a more recent study, it was reported that PPI prescriptions increased by 20 per cent between 2003 and 2015 in New Zealand.
Symptoms of reflux:
- pain in stomach area (upper abdomen) and chest
- feeling sick
- tasting acid in your mouth
- burning pain when eating hot foods or drinks
- persistent cough, especially at night
- cough and wheeze (that’s not asthma)
- bad breath, sore throat, gum disease, hoarse voice
- chest pain that may feel like heart attack.
Diet and lifestyle factors that can help control reflux focus on preventing the LOS from opening without food or drink, helping food pass through the LOS faster, and avoiding foods that may cause irritation. The only lifestyle factors supported by research are weight loss if overweight and raising the head of the bed. However, in practice, other lifestyle changes may help manage your symptoms, including:
- Watching your posture
Sitting upright and not slouching can help reduce reflux by preventing acid flowing up the oesophagus because of gravity or compression on the stomach. Sit upright when you eat or drink and try not to bend over for up to an hour afterwards. Crouch down if you need to pick up anything from the floor. Raising the head of the bed or sleeping propped up on pillows or a wedge can also help reduce reflux symptoms at night.
- Avoiding eating and drinking at same time
This may overfill your stomach, causing pressure on the LOS. If the sphincter relaxes easily, then the pressure of being overfull can cause reflux.
- Stopping eating two to three hours before bed
This allows food to pass through the stomach before you lie flat during the night.
- Chewing well
Chewing your food well is one way to help food pass more quickly through the LOS. Not chewing properly means solid food remains in larger lumps or chunks. The oesophagus and stomach have to work harder to break the food down, meaning there’s more risk of food staying in the oesophagus and stomach longer. Take time to focus on your food when you eat, chewing each mouthful well and moving it around your mouth as you chew. You’ll also find your awareness of the flavours in the meal increase.
- Watching your weight
Carrying too much weight, especially around the stomach area, puts extra pressure on your internal organs, including your oesophagus and stomach. This makes acid more likely to flow up through the LOS and cause reflux. Losing weight reduces this pressure and can help control reflux.
- Limiting alcohol, caffeine, chocolate and curry
These are well-known irritant foods and can cause the LOS to open more easily. In addition, coffee can prompt acid secretion in the stomach, and both coffee and chocolate contain a compound called methylxanthine, which is a muscle relaxant.
- Avoiding trigger foods if necessary
There are common foods that seem to trigger reflux, see right, but not everyone has problems with these foods. Some people don’t notice any change with common trigger foods but find changing posture has the most effect on their symptoms. It’s important to spend some time investigating whether your symptoms are triggered by food or not. Keeping a simple food and symptom diary and looking for triggering foods is a good place to start. Or talk to a dietitian for tailored advice.
Foods that may aggravate reflux:
- spicy foods
- fried/fatty foods
- acidic foods
- lemon water
Article sources and references
- Boeckxstaens G et al. 2015. Republished: Symptomatic reflux disease: The present, the past and the future. Postgraduate Medical Journal 91:46-54https://pmj.bmj.com/content/91/1071/46.info
- GI Society, Canadian Society of Intestinal Research. What is Gastroesophageal Reflux Disease? badgut.org Accessed October 2018https://www.badgut.org/information-centre/a-z-digestive-topics/gerd/
- Haque M et al. 2000. Prevalence, severity and associated features of gastro-oesophageal reflux and dyspepsia: A population-based study. New Zealand Medical Journal 113:178https://www.ncbi.nlm.nih.gov/pubmed/10917077
- Health Navigator New Zealand. 2018. Gastro-oesophageal reflux, healthnavigator.org.nz Accessed October 2018https://www.healthnavigator.org.nz/health-a-z/g/gastro-oesophageal-reflux/
- Kahrilas P et al. 2017. Emerging dilemmas in the diagnosis and management of gastroesophageal reflux disease. F1000 Research 6:1748https://www.ncbi.nlm.nih.gov/pubmed/29034088
- Kaltenbach T et al. 2006. Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidencebased approach. Archives of Internal Medicine 166:965-71https://www.ncbi.nlm.nih.gov/pubmed/16682569
- Nishtala PS & Soo L 2015. Proton pump inhibitors utilisation in older people in New Zealand from 2005 to 2013. Internal Medicine Journal 45:624-9https://www.ncbi.nlm.nih.gov/pubmed/25828419
- Tibbling L et al. 2011. Factors influencing lower esophageal sphincter relaxation after deglutition. World Journal of Gastroenterology 17:2844https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3120944/
- Vakil N et al. 2006. The Montreal definition and classification of gastroesophageal reflux disease: A global evidence-based consensus. American Journal of Gastroenterology 101:1900-20https://www.ncbi.nlm.nih.gov/pubmed/16928254