DIET AND LIFESTYLE FOR GERD

Dec 28

“All disease begins in the gut.” Hippocrates

Gastroesophageal reflux disease or GERD is one of the most common diseases of the digestive tract in the modern population. GERD is a chronic disease, and as numerous studies have shown, diet and lifestyle are a supporting factor in the course of the disease.

There are many studies on various interventions that have shown the relationship and effectiveness in reducing the symptoms and risks of GERD. Let's look at a few dietary and lifestyle approaches that have a relationship with GERD.

The most common approaches that have been shown to be effective in managing GERD symptoms are:

Decreased BMI;
Reduce portion sizes and avoid late meals. If you typically consume three meals a day, consider reducing your portion sizes and transitioning to four smaller meals throughout the day;
Decreased amount of carbohydrates and especially simple sugars;
Elimination diet with the exclusion of products such as mint, coffee, chocolate, spicy foods and more;
Correction of physical activity;
To give up smoking;
Stress management. Engage in a holistic approach to well-being by incorporating meditation, various breathing practices, and yoga into your routine.

Let's look at some of the approaches:

Eating behavior

The connection between eating behavior and various gastrointestinal dysfunctions has been proven by many studies. The human body consists of those components that come to us with food. For energy production and metabolism, we need dietary elements such as carbohydrates, proteins and fats. Carbohydrates often make up a large part of the diet of a modern person, especially simple carbohydrates, while the amount of protein and unsaturated fats consumed in most cases is reduced.

Studies have shown that there is a link between episodes of reflux and the amount of carbohydrates in the diet. For example, a study (PMID: 27582035) conducted on 144 women also confirmed that a high-fat, low-carbohydrate diet was beneficial for all women in managing GERD symptoms. Whereas a high fiber diet works to reduce reflux symptoms.

The study, which included 36 patients, showed a decrease in the frequency of reflux symptoms and a decrease in pressure on the sphincter, which may also be the cause of GERD symptoms.

As we can see, the analysis and correction of the amount of carbohydrates in the diet should be included in the personalized work with the patient to achieve the maximum effect in GERD (PMID: 29881238), (PMID: 27582035).

Relationship between high BMI and GERD

In addition to the excessive consumption of carbohydrates by modern man, there is also an association of increased BMI (N=18.5 to 24.9) and manifestations of symptoms associated with GERD. Weight gain was associated with an increased risk of gastroesophageal reflux disease symptoms, and weight loss was associated with a reduced risk.

Numerous articles and studies on the relationship between obesity and GERD symptoms have found evidence not only of the relationship between weight loss and reduced risk of GERD, but also of the increased success of antireflux medications in normalizing BMI (PMID: 23358462), (PMID: 16738270).

Given the results of studies linking increased risk of GERD symptoms with elevated BMI in both normal weight and overweight people, people with GERD should be encouraged to work towards normalizing BMI and weight loss, respectively.

Physical activity and GERD

Intense physical activity can also be considered as one of the possible causes of GERD symptoms. However, available research indicates that a positive association between exercise and GERD symptoms is present with vigorous, but not moderate, exercise. Physical activities that may be at risk for GER symptoms include heavy weight lifting and running. The researchers hypothesized that a consequence of frequent abdominal tension associated with strenuous exercise may be a risk for exercise-induced GER symptoms.

Research results also show that intense exercise can cause gastroesophageal reflux in healthy people. Running caused more reflux, and aerobic exercise with less physical arousal (such as cycling) caused less reflux and may serve as an alternative form of exercise for patients with reflux. Resistance training induced GER in some subjects, including healthy subjects (PMID: 2724505).

Also in time, the study found a trend towards higher acid exposure in GERD patients during the day in which exercise was present. These results should not be generalized to regular physical activity, which has been shown to be protective against GER. Moderate, regular physical activity, with dietary adjustments, would be a reasonable approach to prevent symptoms of GERD. (PMID: 15307855)

Elimination Diet

Studies have shown that reducing or eliminating the following foods can reduce or eliminate GERD symptoms:

Chocolate
Coffee
Cow's milk
Spicy food
Carbonated drinks
Tomato juice
Orange juice
Garlic and onion

There may also be individual intolerances to certain foods that will cause reflux. In this case, it is recommended to carry out an elimination diet and the exclusion of foods that are suspected.

In conclusion, although there are many approaches to working with patients with GERD, it should be borne in mind that there are also research projects that have resulted in a lack of association with GERD symptoms and with some interventions. The exclusion of such products as coffee, mint, chocolate, alcohol did not always show a positive result on the effect of GERD symptoms. Just like not all physical activity has an impact on the manifestation of GERD symptoms. While further research is needed, most of the available evidence suggests an association between obesity and elevated BMI, as well as an association of GERD symptoms with excess carbohydrate intake and excessive exercise. Thus, for positive patient outcomes, work must be personalized based on symptoms and on individual responses to food triggers and exercise. Working in a personalized way, exploring the lifestyle, daily routine and eating behavior of the patient can lead to both a reduction in the risks of GERD and a reduction in symptoms.

Reflux can also be caused by Helicobacter Pylori bacteria or Small intestinal bacterial overgrowth (SIBO). Diagnosis and guidance on treatment can be provided by a gastroenterologist.