Evidence for Lifestyle Adjustments that Benefit GERD Patients
Overview: Results from a recent study found that aerobic activity, limiting or eliminating tobacco use, removing high acidic foods from the diet, and increasing fruit and vegetable consumption may be helpful in managing Gastroesophageal Reflux Disease (GERD).
Key Points: GERD is a common condition that involves reflux where acid leaves the stomach and travels up the esophagus causing burning sensations and pain.1 Other conditions associated with GERD are continuous cough, nausea and asthma. 2 The number of people diagnosed with GERD has been rising for the last two decades and affects between 13- 19% of people worldwide. 1
One of the main therapeutic options for GERD is use of prescription proton pump inhibitors (PPIs), which represent 60% of the medical expenses of GERD treatment. The medical costs associated with treating GERD are upwards of $24 billion annually in the US. 1. A number of studies have recently shown that PPIs can have serious side effects including increased risk of kidney disease, C. Difficile infections, and osteoporotic fractures. 1 Although further research into these side effects is needed, they indicate that high level of PPI use is less than ideal for the long-term treatment of GERD. Therefore addressing GERD and preventing GERD associated complications with other methods such as diet is an important aspect to clinical care.
Studies show that limiting acidic food intake including citrus and tomatoes can help lower reflux symptoms. Other studies have shown that diets high in fruits and vegetables are beneficial for GERD patients and that meat and fatty foods exacerbate symptoms. The Mediterranean diet has improved GERD symptoms in numerous clinical trials as well as diets high in fiber from fruit such as Japanese apricot. Drinking alcohol has been shown to worsen GERD symptoms.1 Carbonated beverages was shown to initially reduce symptoms, however those with night time heart burn had increased symptoms after consuming carbonated beverages. While coffee has been discouraged based on its acidity, two recent studies indicated that coffee itself did not increase symptoms, however GERD patients were seen to more likely drink 2 or more cups of coffee per day. 3
Behavior regarding food has been shown to affect GERD symptoms including getting enough sleep to prevent negative dieting late at night. Eating at least two hours before bed may reduce reflux symptoms as well as elevating the head using a wedge or pillow to prevent acid movement up the esophagus. 1
It is likely no coincidence that GERD has risen as the rate of obesity has also risen. High abdominal fat levels likely increase abdominal pressure on the stomach and disruption of the gastroesophageal Junction and hiatal hernia.1 Research suggests that patients with higher BMI have higher reflux symptoms. Data from the Nurses Study has shown that those with a high BMI who lost weight had a reduction in reflux symptoms and those with a normal BMI who then gained weight had an increase in reflux symptoms.1 Therefore weight loss may impact GERD symptoms. Additionally, increased aerobic exercise may increase the reflux barrier by strengthening the striated muscle in the diaphragmatic crura.1 Regardless of weight, tobacco use has been shown to increase GERD symptoms and may cause esophageal dysmotility and emptying.1
Overall this review emphasizes the importance of diet in GERD management. Modifying diets to eliminate certain foods that cause reflux and focusing on lifestyle changes such as aerobic exercise, timing of food consumption, and reducing tobacco use can improve disease outcomes and prevent additional complications including damage to the esophagus.
Treating GERD clinically using diet and lifestyle modifications remains the first line of therapy. Therefore guiding patients in:
- Limiting or eliminating trigger foods such as citrus and tomatoes and increasing fruit and vegetable consumption
- Having a normal range BMI and participating in aerobic activity
- Eating two hours before bed, elevating the head, and limiting tobacco use.
- Sethi S, Richter JE. Diet and gastroesophageal reflux disease. Current Opinion in Gastroenterology. 2017:1.
- Fox M, Heinrich H. Gastrooesophageal reflux disease and nutrition. In: Lomer M, editor. Advanced nutrition and dietetics in gastroenterology. Hoboken, New Jersey: John Wiley & Sons, Ltd; 2014. pp. 105–110.
- Kubo A, Block G, Quesenberry CP Jr, et†alÆ†Dietary guideline adherence for gastroesophageal reflux disease. BMC Gastroenterol 2014; 14:144.