Approaches for reducing reflux disease
by David Dunaief
Dec 26, 2018 | 8484 views | 0 0 comments | 597 597 recommendations | email to a friend | print
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
It seems like almost everyone has been diagnosed with gastroesophageal reflux disease (GERD).

I exaggerate, of course, but the pharmaceutical companies do an excellent job of making it appear that way with advertising. Wherever you look there is an advertisement for the treatment of heartburn or indigestion, both of which are related to reflux disease.

GERD affects as much as 40 percent of the U.S. population. It typically results in symptoms of heartburn and regurgitation brought on by stomach contents going backward up the esophagus.

For some reason, the lower esophageal sphincter, the valve between the stomach and esophagus, inappropriately relaxes. No one is quite sure why it happens with some people and not others. Of course there is a portion of reflux that is normal after a meal.

The risk factors for GERD are diverse. They range from lifestyle—obesity, smoking cigarettes and diet— to medications, such as calcium channel blockers and antihistamines.

Other medical conditions, like hiatal hernia, and pregnancy, also contribute. Diet issues include triggers like spicy foods, peppermint, fried foods and chocolate.

Smoking and salt’s role

A study conducted in Norway showed that both smoking and salt consumption added to the risk of GERD significantly. The risk increased 70 percent in people who smoked. Surprisingly, people who used table salt regularly saw the same increased risk as seen with smokers.

Treatments vary, from lifestyle modifications for the mild to medications or surgery for the severe cases. The goal is to relieve symptoms and prevent complications, such as Barrett’s esophagus, which could lead to esophageal adenocarcinoma.

Fortunately, Barrett’s esophagus is not common and adenocarcinoma is even rarer.


The most common and effective medications for the treatment of GERD are H2 receptor blockers like Zantac and Tagamet, which partially block acid production, and proton pump inhibitors (Nexium and Prevacid), which almost completely block acid production.

Both classes of medicines have two levels: over-the-counter and prescription strength. You need to tell your doctor if you have taken these medications, even those that are OTC. There are potential side effects with these drugs, especially proton pump inhibitors.

Lifestyle modifications

A number of modifications can improve GERD, such as raising the head of the bed about six inches, not eating prior to bedtime and obesity treatment, to name a few. In the same study already mentioned with smoking and salt, fiber and exercise both had the opposite effect, reducing the risk of GERD.

The analysis by Journal Watch suggests that the fiber effect may be due to its ability to reduce nitric oxide production, a relaxant for the lower esophageal sphincter.


In a study published in Gatroenterology, obesity exacerbated GERD. What was interesting was that researchers used manometry, which measures pressure, to show that obesity increases the pressure on the lower esophageal sphincter significantly.

Intragastric (within the stomach) pressures were higher in both overweight and obese patients when inhaling and exhaling, compared to those with normal body mass indexes. This is yet another reason to lose weight.

Eating prior to bed, myth or reality?

Though it may be simple, it is one of the most powerful modifications we can make to avoid GERD. One study confirmed a 700 percent increased risk of GERD for those who ate within three hours of bedtime, compared to those who ate four hours or more prior to bedtime.

Of note, this is 10-times the increased risk of the smoking effect. Therefore, it is best to not eat right before bed and to avoid “midnight snacks.”

Although there are a number of ways to treat GERD, the most comprehensive have to do with modifiable risk factors. Drugs have their place in the arsenal of choices, but lifestyle changes are the first and most effective approach in many instances.

For further information, visit or consult your personal physician.
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