Gastroesophageal reflux disease (GERD), a digestive disorder affecting the lower esophageal sphincter, is on the rise in our westernized societies. It is a chronic condition that is characterized by heartburn and regurgitation and is the most common upper GI disease in westernized countries. Although symptoms are only considered significant clinically if they happen over two times a week, an estimated 10–30% of the North American and European population complain of GERD symptoms at least once a week. About 7% of the U.S. population has symptoms daily. Asian countries have a markedly lower prevalence of GERD. Why are they different? Is the rise of GERD in westernized societies due to our obesity epidemic, activity levels, diet, or sleep patterns? Do you have problems with heartburn? Read on to learn about this new disease.
Why is GERD associated with heart burn and regurgitation? In GERD, the lower esophageal sphincter, the ring of muscle between the esophagus and the stomach, is either weaker or relaxes at inappropriate times. As a result, stomach contents will have more opportunity to go back up to the esophagus through the weakened sphincter, with the end result of heart burn or regurgitation. The severity of the condition depends on the lower esophageal sphincter’s dysfunction and the amount and type of stomach fluid that is brought back up to the esophagus. Due to the irritation from stomach contents on the esophagus, GERD is the most common predisposing factor for esophagus adenocarcinoma. Clearly GERD must be effectively treated in order to reduce cancer risks.
Treatment is where the trouble lies. GERD is often treated based on symptoms alone; unfortunately this approach is quite ineffective since the physiology of GERD varies from each individual.There are two groups of GERD cases; cases with a damaged esophageal mucosa (erosive) and cases with no damage (non-erosive)(NERD). NERD affects more than 60% of people with GERD, but doctors continue to primarily treat GERD according to the erosive GERD treatment. Since NERD has different responses to medical therapy, treatment using standard medicine for GERD (proton pump inhibitors) is ineffective for the majority of GERD patients. Furthermore, no symptoms, as a result of successful GERD treatment, doesn't mean esophageal healing. Patients will, in turn, often relapse due to an unhealed esophagus post treatment. There's really a lack of research on this disease, which is causing many patients discomfort that may significantly alter their quality of life.
What are some factors that may contribute to GERD? Obese individuals are 2.5 times more likely to have GERD than those at a normal BMI. Alcohol, presence of a hiatus hernia, fatty meals, smoking, pop, coffee, many drugs (beta-blockers, nitrates, calcium channel blockers, anticholinergics) and hormonal (progesterone) products are also associated with an increased risk.
What might work, on a non-drug scale, for treating GERD? Although no large scale trials of GERD and low-carb diets have been done, many small trials have shown positive effects. In a small trial, individuals on a low carb (20g or lower) diet had self-reported remission of symptoms from one day to two weeks on the diet. Furthermore, they had a re-occurrence when the diet was discontinued. Melatonin, curcumin, and quercetin, which can be bought as natural health products, have been shown in both cell cultures and animal studies (but not in human trials) to be effective for GERD treatment. Iberogast is a homeopathic that has shown to be clinically affective, with minimal side effects.Other treatments that have shown success include acupuncture and weight loss. Clearly, more research needs to be done on the treatment options for GERD.
Okay, so you’re saying: medical treatment options are kind of shabby; what can I do after if treatment doesn't work or as a first line option before drugs? This option should entail a lifestyle change and may include weight loss (if overweight) and the avoidance of alcohol, chocolate, citrus juice, tomato-based products, peppermint, coffee, and onion. Avoiding large meals, reducing fat intake, eliminating smoking if you're a smoker, and maybe considering elevating the head of the bed may also be effective. This may seem a bit much, but the goal here is for esophagus healing, symptom relief, and a prevention of reoccurrence.
When formulating a diet, it would be wise to choose an alkalizing diet (which may help reduce the effects of an acidic stomach). Vitamin D may help prevent esophagus damage and may be a good supplement to consider, especially in the wintertime. Exercise can also help to effectively eliminate GERD symptoms due to better internal functioning. Apple cider vinegar, aloe vera juice, baking soda, licorice (herbal), and glutamine are also popular choices to manage GERD symptoms.
While diet, lifestyle, and obesity have been linked with GERD, there is limited research to determine what the root of the problem is and why it is different from person to person. This is why treatment can vary so much from individual to individual. When formulating a diet to manage GERD, special attention should be kept on what causes symptoms. The process of figuring out which foods work for you requires a lot of patience. A daily journal may be worthwhile. Which foods caused you discomfort? Which ones gave you no symptoms at all? Keeping track of what foods are and aren't okay will allow you to make your own, individualized avoid lists.Hopefully this article has given you good information to take steps toward treatment if you (or someone you know) suffer from GERD.Moraes-filho J. (2012) Refractory gastroesophageal reflux. Arg Gastroenterol. 49(4):296-301.Nwokediuko S. (2012) Current Trends in the Management of Gastroesophageal Reflux Disease: A Review. doi:10.5402/2012/391631.Patrick L. (2012) Gastroesophageal Reflux Disease (GERD):A Review of Conventional and Alternative Treatments. Altern Med Rev.16(2):116-33.See this and other articles on Jennifer Novakovich’s website JennovaFoodBlog.com