Whether lowering dietary fat is important for people with GERD is somewhat unclear. Historically, low-fat diets have been recommended to patients with GERD because fatty foods appeared to be associated with increased heartburn and fatty foods had been shown to weaken the LES in both healthy people and people with GERD. A number of recent studies, however, have found no correlation between the fat content of a meal and subsequent symptoms of heartburn and reflux. Another study found that hospitalizations due to GERD were no more likely for people who ate high-fat diets than for those on low-fat diets. One study compared different fast foods for their likelihood to cause reflux symptoms and found that chili and red wine caused more symptoms than higher-fat foods such as hamburgers and French fries.
In a preliminary study of obese people with GERD, eating a very-low-carbohydrate diet (less than 20 grams of carbohydrate per day) for six days resulted in a significant improvement in symptoms of GERD. Additional research is needed to determine whether this type of diet would be safe and effective for long-term use.
Eating foods or drinking beverages flavored with spearmint, peppermint, or other spices with strong aromatic oils causes relaxation of the LES and can contribute to symptoms in people with GERD. Chocolate also relaxes the LES and can cause heartburn. Acidic beverages like juices, coffee, and tea have also been linked to increased heartburn pain, as have carbonated drinks, alcohol, and milk.
Infants who suffer from GERD may have a true allergy to cows’ milk. Some small studies estimate that milk allergy is a cause in about 20% of infants with GERD, but a larger study of 204 infants with GERD diagnosed cows’ milk allergies in 41%. For these infants, reflux symptoms improved with elimination of milk products from the diet. Some researchers advise a trial of cows’ milk-elimination in all infants suffering from GERD. Infants with a condition known as multiple food protein intolerance in infancy (MFPI) have been shown to have a high incidence of GERD and may only improve when amino-acid based formula is used in place of other formulas.
Lifestyle changes that may be helpful:
Smoking weakens the LES and is a strong risk factor for GERD. A study of infants with GERD found that exposure to cigarette smoke in the environment is associated with reflux, leading the authors conclude that secondhand smoke contributes directly to GERD in infants. No similar studies on environmental smoke have been done with adults. Psychological stress and alcohol have also been shown to be associated with the weakening of the LES and symptoms of GERD.
A number of studies have found that obesity increases the risk of GERD, though one study found no association between severe obesity and GERD. Obese people tend to have weaker sphincters, and they more often develop a condition related to GERD called hiatal hernia, in which the upper part of the stomach protrudes above the diaphragm, resulting in a deformed LES. It has been suggested that obesity may contribute to GERD by increasing abdominal pressure, but this mechanism has not been proven. The benefit of weight loss for obese patients with GERD is controversial. Some researchers have found that symptoms of GERD are reduced with weight loss, while others have seen no change with weight loss and even increased symptoms in patients with massive weight loss.
Lying down prevents gravity from keeping the stomach contents well below the opening from the esophagus. For this reason, many authorities recommend that people with GERD avoid lying down sooner than three hours after a meal, and suggest elevating the head of the bed to prevent symptoms during sleep.
GERD occurs more frequently during exercise than at rest, and can be a cause of chest pain or abdominal pain during exertion. One study found that increased intensity of exercise resulted in increased reflux in both trained athletes and untrained people. In another study, running produced more reflux than less jarring activities, such as bicycling, while weight training produced few reflux symptoms. Eating just before exercise has been found to further aggravate GERD. On the other hand, a recent survey found that people who participate in little recreational activity were more likely than active people to be hospitalized for GERD. It makes sense for people with GERD to use exercise as part of a healthy lifestyle, perhaps choosing activities that are less likely to cause reflux symptoms.
Eric R. Braverman, M.D.
Dr. Braverman is a Summa Cum Laude and Phi Beta Kappa graduate of Brandeis University and NYU Medical School, did brain research at Harvard Medical School, and trained at an affiliate of Yale Medical School. He is acknowledged worldwide as an expert in brain-based diagnosis and treatment, and he lectures to and trains doctors in anti-aging medicine.