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Decreasing Gastro Esophageal Reflux Disease (GERD)

For most Americans, heartburn is just an occasional problem. For those living with RA though, regular use of NSAIDs and medications like Methotrexate or Prednisone, the occasional heartburn becomes more of an everyday trial. This results in chronic acid reflux that causes irritation and inflammation to the lining of your esophagus, a condition known as gastroesophageal reflux disease (GERD).

What are symptoms of GERD?

Symptoms of GERD include heartburn, acid taste in the mouth, increased belching, bloating, hoarseness, dry cough, trouble swallowing, and regurgitation. Any of that sound familiar? A lot of doctors prescribe over the counter or prescription medications like antacids, H2 blockers or Proton Pump Inhibitors, to help control GERD, but sometimes it’s not enough and symptoms persist. Always consider behavior modifications and dietary interventions prior to medications as long-term acid suppression can increase the risk of alteration in the absorption of certain vitamins and minerals. GERD causes discomfort and increases the risk of Barrett’s esophagus and esophageal cancer so it essential to treat GERD and diet and lifestyle are paramount.

10 tips for controlling GERD

1. Avoid dietary irritants: Some foods increase acid secretions while others lower esophageal pressure, the muscle that keeps the acid in our stomach out of our throats. Caffeine-containing, spicy, and acidic foods like citrus, vinegar, tomato, and chili peppers are known offenders, as is alcohol (especially fermented beverages such as beer and wine). Other foods that may worsen symptoms include chocolate, garlic, onions, and spearmint/peppermint. If your esophagus is inflamed, dry or coarse food may be irritating. Everyone is unique and may respond to irritants differently though. Keep a record of your symptoms and food intake for 5 days, including a weekend day. Be sure to record the times you have meals, snacks, and beverages. Then carefully evaluate what triggers your symptoms.

2. Quit smoking: Smoking poses several known health risks and exacerbates GERD. Smoking can decrease the effectiveness of medications like cimetidine (Tagamet) and alters stomach contents, making them more acidic, but it also decreases lower esophageal pressure, making us more susceptible to reflux.

3. Avoid large, high-fat meals: These meals tend to be heavy in the stomach and are slow to digest. This delay prolongs acid secretion, which increases the amount exposed to the esophagus.

4. Eat smaller meals: Consume a healthy, nutritionally complete diet with a balance of nutrients and fiber. Try eating from an appetizer size plate. Plate size has significantly increased in the past couple of decades. By using a smaller plate, visually you’ll feel more satisfied but end up eating less. Learn 10 expert tips on planning a great meal.

5. Avoid tight-fitting clothing, especially after a meal: tight clothing will cause added pressure, which can also exacerbate symptoms.

6. Stay upright and avoid vigorous activity after eating. Plan your exercise timing to occur prior to meals.

7. Avoid lying down for 3-4 hours after a meal. Remaining upright while your food digests will allow gravity to work in your favor while your stomach empties. Make lunch your biggest meal and dinner lighter.

8. Achieve or maintain a healthy weight: Obesity is also a contributing factor to GERD, weight loss may reduce acid contact time in the esophagus, leading to decreased symptoms. Need to lose weight? Learn how to plan for a healthy lifestyle change.

9. Raise the head of the bed: If nocturnal reflux is interfering with your ability to sleep through the night, raise the head of your bed 6 to 8 inches by securing wood blocks under the bedposts. According to the National Digestive Diseases Information Clearing House, just using extra pillows will not help.

10. Try sugar-free chewing gum. Chewing gum has been shown to increase salivary secretions, which helps raise the esophageal pH, creating a less acidic environment. Just avoid cinnamon, spearmint or mint flavored if this is a reflux trigger for you.

Written by: Jonathan Simmons | Last reviewed: September 2013.
References 1. Mahan L. K., Escott-Stump S., & Raymond, J. L. (2012). Krause’s Food & Nutrition Therapy (13th ed.). St. Louis, Missouri: Saunders Elsevier. 2. Miyura, Y., Fukuda, K., Maeda, T., and Kurosaka, M. (2014). Gastroesophageal reflux disease in patients with rheumatoid arthritis. Modern Rheumatology, 24(2):291-5. 3. Nampei, A., Shi K., Ebina, K., Tomita, T., Sugamoto, K., Yoshikawa, H., Hirao, M., and Hashimoto, J. (2013). Prevalence of gastroesophageal reflux disease symptoms and related factors in patients with rheumatoid arthritis. Journal of Clinical Biochemistry Nutrition, 52(2): 179–184. 4. U.S. Department of Health and Human Services. National Institutes of Health. (2007). National Digestive Diseases Information Clearinghouse. Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD). NIH Publication No. 07–0882