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What is GERD?
GastroEsophageal Reflux Disease is a chronic gastrointestinal (GI) disease where stomach contents move up into the esophagus (throat) causing pain and possible vomiting. This can happen both during the day and at night and symptoms can be triggered by certain foods or beverages. GERD can cause damage to the lining of your esophagus leading to possible serious complications. Direct causes of GERD are not clear but risk factors that contribute are both genetic and environmental.
Other possible symptoms:
Nausea
Trouble swallowing
Chest pain
Feeling like there's a lump in your throat or that your throat is tight
Painful swallowing
A sour taste in your mouth
Why is weight considered a risk factor for GERD?
Many studies contribute high BMI or an increase in BMI, even if it’s within the “normal range”, increases your risk for GERD. The idea behind a higher weight contributing to GERD is that more abdominal weight increases the pressure around your stomach. Increased pressure causes stomach contents to be pushed up into the esophagus. Although a lot of research studies claim a higher BMI increases your risk for GERD, many of these studies don’t back that claim up. There are some studies that show a positive association of high or increased BMI with GERD but not causation, meaning there are lots of people who have a higher BMI and have GERD but there’s no direct evidence showing a high BMI causes GERD.
It’s like claiming going outside in cold weather with wet hair will cause a cold. Yes, lots of people will go outside with wet hair in the winter and will subsequently catch a cold but we know that a virus causes the common cold not having wet hair outside. The difference being, no one thing causes GERD. We have some theories and know a lot of the physiology but there is no definite cause. Like with most chronic diseases, it’s about many different risk factors and what ultimately causes GERD is going to be different for different people.
Does your weight really cause or contribute to GERD?
It’s possible. I can’t say that it does or it doesn’t, but for me that’s not the point. What concerns me is that there are so many healthcare providers (registered dietitians included) and researchers that jump to conclusions when it comes to weight or BMI. The issue is not whether living in a larger body or gaining weight causes GERD, or any other chronic disease, but that weight loss seems to be causally doled out like a cure-all despite being extremely hard to achieve and rare to maintain.
Some studies I read claimed weight loss to be a simple, non invasive, and easy first line treatment for GERD. On which I call bull shit (excuse my language). I hate to make assumptions but I’m going to assume the researchers making these claims hold a lot of thin privilege and are likely in relatively good health.
There is nothing simple or easy about intentional weight loss, or it wouldn’t be such a huge subject in internal medicine, nutrition, pharmacology, epidemiology, mental health, public health, and pretty much any form of medicine and general health topic you can think of. And non-invasive, WOW. Even if you’re referring to the medical meaning of non-invasive (no breaking of skin or contact with internal tissue) what about bariatric surgery? And when it comes to intentional weight loss, what part of it isn’t invasive mental or emotionally?
So, if everyone around you is telling you that you have to lose weight if you want to treat your GERD, especially if you don’t want to be on medication for life or the meds aren’t working, should you just give in? Hell no. There are options out there and it’s important to find a team of healthcare providers who will support your decision to stick it to diet culture.
How do we treat GERD without focusing on weight?
Medications
PPI
H2RA
Antacids
I am not a pharmacist so I won’t go into the effectiveness, risk factors, or side effects of these medications. If you are taking medication for GERD make sure you are aware of the long-term risks and have a plan with your healthcare provider if you feel like you need to reduce or discontinue them.
Identifying Trigger Foods and Beverages
Commonly reported trigger foods:
Chocolate
Spicy foods
High fat foods
Tomatoes
Citrus fruit
Onions and garlic
Sour foods
Commonly reported trigger beverages:
Peppermint tea
Orange juice
Coffee
Carbonated beverages
Alcohol
Even though these foods and beverages are commonly reported as refluxogenic (causing reflux symptoms), the evidence in research is contradictory at best. It’s likely people with GERD have foods and beverages that trigger symptoms but they may be individual to each person and there may be no clear explanation as to why those foods are triggering symptoms.
There is no reason to remove any of these foods from your diet unless you find that they cause you symptoms. Just like with everything else in nutrition, it’s important to seek individual nutrition advice, like from a registered dietitian.
Daily Eating Pattern
Eat smaller more frequent meals
The theory is that eating fewer larger meals over many years may lead to GERD due to stretching of the stomach walls and increased air intake into the stomach causing the LES (lower esophageal sphincter: the barrier between the esophagus and the stomach) to lose its tone.
Increasing Dietary Fibre
Psyllium fibre supplement .
Increase fibre rich foods
Whenever increasing dietary fibre, whether through food or supplements, make sure to increase slowly and increase fluid consumption to avoid unpleasant digestive distress.
Quitting Smoking
Joyful Movement
Movement is known to increase the tone of smooth muscle, like the intestines, and the same is true for the muscles that contribute to the reflux barrier around the LES. One thing to look out for though, is that intense movement can actually worsen GERD symptoms in some people.
Prolonged cycling, running, and intense weightlifting could cause symptoms to be triggered or worsened. Engaging in joyful movement that is light or moderate in intensity more often compared to prolonged and heavy in intensity is probably a better bet, but it depends on your own experience. If you are experiencing symptoms while engaging in movement it might be beneficial to trial a longer period between eating and starting movement as a fuller stomach may lead to symptoms.
Surgery
Again, I am not a gastroenterologist so I am not going to dive into the types of surgery available. I will warn you that you may be denied surgery if your BMI is above a certain number (I’m sorry if that’s happened to you) or you might be recommended a form of bariatric surgery.
Limit Eating in the Evenings
Avoid eating 2- 4 hours before bed
This will depend on the timing of your symptoms. If you experience GERD symptoms during the night then it might be beneficial to try increasing the gap between the last time you eat and going to bed. Eating a smaller snack before bed compared to what you might normally have may also help.
Sleep with head elevated
Use a wedge
Again this depends on if you are experiencing symptoms at night. It is helpful to note that staying in an upright position after you eat during the day can also help with symptoms.
Some of these treatment options may be beneficial to you and some may not. Choosing the treatment options that are likely easier for you to sustain is a good way to start. It’s also important to discuss treatment with your healthcare provider.
Even though research, and likely your healthcare provider, recommends weight loss as a treatment for GERD, there are other ways to treat it. The goal should be to find treatment that improves your quality of life the most while still being sustainable. If your healthcare provider is not willing to consider other treatment options besides weight loss, there is nothing wrong with seeking a second opinion. Regardless of how you do it, it is important to treat GERD as the longer it goes without proper treatment the higher the risk for potential complications due to damage to the esophagus.
P.S.
If you are looking for more information on how to think about overall health without focusing on weight check out these websites:
Sources:
Badillo, R. (2014). Diagnosis and treatment of gastroesophageal reflux disease. World Journal of Gastrointestinal Pharmacology and Therapeutics, 5(3), 105. https://doi.org/10.4292/wjgpt.v5.i3.105
Festi, D., Scaioli, E., Baldi, F., Vestito, A., Pasqui, F., Biase, A. R., & Colecchia, A. (2009). Body weight, lifestyle, dietary habits and gastroesophageal reflux disease. World Journal of Gastroenterology, 15(14), 1690. https://doi.org/10.3748/wjg.15.1690
Jarosz, M., & Taraszewska, A. (2014). Risk factors for gastroesophageal reflux disease – the role of diet. Gastroenterology Review, 5, 297–301. https://doi.org/10.5114/pg.2014.46166
Morozov, S., Isakov, V., & Konovalova, M. (2018). Fiber-enriched diet helps to control symptoms and improves esophageal motility in patients with non-erosive gastroesophageal reflux disease. World Journal of Gastroenterology, 24(21), 2291–2299. https://doi.org/10.3748/wjg.v24.i21.2291
Newberry, C., & Lynch, K. (2019). The role of diet in the development and management of gastroesophageal reflux disease: why we feel the burn. Journal of Thoracic Disease, 11(S12). https://doi.org/10.21037/jtd.2019.06.42
Sethi, S., & Richter, J. E. (2017). Diet and gastroesophageal reflux disease. Current Opinion in Gastroenterology, 33(2), 107–111. https://doi.org/10.1097/mog.0000000000000337
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