The GERD Guide

Gastroesophageal reflux disease (GERD) is a chronic digestive disorder is described as the backward flow of stomach acid and/or bile into the esophagus, causing symptoms such as indigestion, food-repeats, and difficulty swallowing. In Western countries, approximately 10-20% of adults are impacted by it making it one of the most common gastrointestinal diseases in the world.

Pathophysiology

The pathophysiology involves lower esophageal sphincter (LES) dysfunction. This is a circular muscle located at the bottom of the esophagus and on top of the stomach. The LES should act as a barrier to prevent partially digested food from escaping back up the esophagus. Often in those with GERD, the LES is weakened or relaxed which allows partially digested food (including stomach acid) to travel back into the esophagus which can cause a lot of inflammation to the esophageal tissue. Common GERD symptoms include bloating, feeling full all the time, belching, flatulence, cramping, heartburn, trouble swallowing, acidic / bitter taste in the mouth, vomiting, coughing, hiccups, chocking sensation, nausea, and abdominal pain.

Obesity, hiatal hernias, pregnancy, smoking, and certain medications can all contribute to GERD.1 It’s also important to consider the strong link between anxiety, stress, and GERD. Stress and anxiety can cause changes in the digestive system, including the esophagus and the stomach that may lead to GERD symptoms or worsen existing symptoms. When you are anxious or stressed, your body releases stress hormones, such as cortisol, which can increase or decrease the production of stomach acid and cause the muscles in the digestive system to contract or relax, including the LES, leading to acid reflux and heartburn. It’s important to note that you don’t want too much or too little stomach acid, and symptoms of both can present similarly. Both stress and anxiety can also affect a person’s eating habits, leading to overeating, eating too quickly, or consuming food that triggers GERD symptoms. In some cases, this can become a viscous cycle where GERD symptoms can cause anxiety, which can worse GERD symptoms, leading to more anxiety. This can be a difficult cycle to break without treatment.

Therapeutic Food Interventions

I encourage you to first consider how you are consuming your food. Your digestive process begins in your mouth and ends with your large intestine, yet only the stomach and small intestines are mentioned most frequently. Each step in the process prepares the food you consume for the next step so it’s critical to consider all parts of the process. Taking time to eat slowly, avoiding eating on the go or in a stressed state, and fully chew your food. Food hygiene can help optimize overall digestion and reduce GERD symptoms.

Now onto the food! An anti-inflammatory diet aims to reduce inflammation in the body, which is theorized to contribute to a range of chronic health conditions, including GERD. The diet emphasizes whole, nutrient-dense foods and limits or avoids foods that are known to promote inflammation, such as processed and fried foods, sugar, and refined carbohydrates. A large population-based study published in the Journal of the Academy of Nutrition and Dietetics found that a diet, which is rich in whole foods, fruits, vegetables, and healthy fats, was associated with a lower risk of GERD symptoms.

Overall, anti-inflammatory diets focus on whole, nutrient-dense foods and limits or avoids foods that are known to promote inflammation, which may help to reduce GERD symptoms and the risk of complications associated with the condition.

Supplementation:

Supplement recommendations will be specific to your signs and symptoms as well as contributing factors to the disease. However, there are a few supplements that may be beneficial for many people with GERD.

Probiotics: Probiotics are live microorganisms that can improve gut health by restoring the balance of bacteria in the gut. Studies suggest that probiotics may help reduce GERD symptoms by promoting gut health and reducing inflammation. A randomized control trial investigated the specific strain of probiotics (Lactobacillus reuteri DSM 17938) for treatment in children with GERD. Results showed that children who received the probiotic supplement had a greater reduction in GERD symptoms compared to the placebo group. This study used a daily dose of 10^8 colony-forming units (CFU) of the bacteria strain for 12 weeks, administered as an oil droplet formulation.

Digestive enzymes: Digestive enzymes are naturally occurring proteins that help the body break down food. Some people with GERD may benefit from taking digestive enzyme supplements to improve digestion and reduce symptoms. A randomized control trial looked at the effectiveness of a digestive enzyme that contained papain, bromelain, and pancreatin for treating patients with GERD. Findings revealed that patients who received digestive enzyme support had a greater reduction in heartburn, regurgitation, and bloating compared to the placebo group.

Self-Management

Lifestyle modifications such as avoiding trigger foods, eliminating smoking, weight loss, and not eating close to bedtime or laying down after eating can help. Additionally, you may want to consider sleeping with your head elevated (ex: using 2 pillows instead of 1), wearing lose clothing or comfortable bras for women, and practicing stress reduction techniques such as yoga or meditation. You may also find it beneficial to keep track of symptoms to help identify specific triggers.

In conclusion, GERD is a chronic digestive disorder that affects many worldwide. The condition is characterized by the backward flow of stomach acid and/or bile into the esophagus, causing symptoms such as heartburn, indigestion, and difficulty swallowing. Obesity, hiatal hernias, pregnancy, smoking, and certain medications can all contribute to GERD. Additionally, stress and anxiety can also play a significant role in worsening GERD symptoms. Along with appropriate medication and lifestyle modifications, dietary interventions can help reduce inflammation and improve gut health, thereby potentially alleviating GERD symptoms.