Fixing your acid reflux

You’ve just eaten a heavy meal and feel that familiar burn in your chest & throat. There’s an unpleasant taste in your mouth as well, and maybe a burp or two. Classic symptoms of acidity, you think, pop an antacid and go about your day. Job done. Right?

Well, perhaps. The occasional acid reflux is common enough, but if you find that you persistently experience these symptoms, you could be suffering from gastro-esophageal reflux disease (GERD/GORD). This is caused by the weakening of the diaphragm – a long, thin muscle that holds the stomach and its contents in place – which leads to a backwash of the stomach acids into the esophagus. This is a condition that could not only greatly affect your quality of life, but have serious consequences if left untreated in the long term. Prolonged exposure to stomach acids could result in inflammation and damage to the cells lining the food tube, a condition known as Barrett’s esophagus, and raises the risk of developing a rare esophageal cancer.

The common indicators of GERD include:

· Heartburn – a burning sensation in the chest or throat, usually after eating

· Trouble swallowing and abnormalities in taste and smell

· Burping, and a feeling of being bloated

· Hoarse voice, cough & sore throat

· Mouth ulcers, bad breath and excess amounts of saliva

· Tooth cavities, erosion of tooth enamel and inflammation in the gums

· Sinusitis and asthma

· Episodes of choking, gagging and vomiting

· Pain in the upper part of the abdomen

· Diarrhea, constipation or both

· Loss of appetite

While frequent heartburn is a telltale sign, some people have acid reflux without heartburn, which is a condition known as silent reflux.

The factors causing GERD are not straightforward, and persistent symptoms need a thorough evaluation to find the underlying cause. That said, scientific consensus is that it’s triggered through a combination of genetic and environmental factors, as well as dietary & lifestyle choices. While genetic predisposition plays a major role, experts are confident that poor diet, smoking, excessive alcohol consumption and a lack of exercise can effectively turn on the genes responsible.

It therefore stands to reason that GERD can be managed and controlled to a large extent by dietary and lifestyle interventions, and a diet comprised primarily of plant- based whole foods, low in fat and rich in fiber has significant potential to prevent and treat acid reflux. On the other hand animal protein, which includes meat, poultry, seafood, eggs, milk and dairy, is highly acidic in nature and increases the stomach’s acid production. Arachidonic acid present in animal protein is pro-inflammatory and therefore better avoided when you have an existing inflammatory condition. Meat and dairy products are also high in saturated fat, and research shows that reflux gets worse in the three hours after eating a high fat meal.

Given the complexity of the disease however, this is one scenario where you might need to go beyond just the adoption of the diet and look at food combinations, or the inclusion or avoidance of certain foods as food sensitivities may trigger the symptoms.

So what, then, are the dietary interventions to manage GERD?

Let’s start with fruits. They contain antioxidants that decrease gastric acid production and natural digestive enzymes that promote effective digestion. Their high water content keeps the body hydrated and neutralizes the acids in the stomach. Load up on melons, which could include watermelons, muskmelons, honeydew and cantaloupes, and on sweet and sub-acidic fruits like bananas, figs, apples, mud apples, pears, papayas, mangoes, grapes and apricots. Considering that we’re trying to reduce the stomach acid levels, initially eliminate tomatoes and citrus fruits like oranges, grape fruits, lemons, pomelos etc. They do have other nutritional benefits, however, and once your symptoms improve you can look at re-incorporating them gradually based on your tolerance levels.

Apply the same pattern for vegetables and greens, and opt for those that have a high water content. Bottle gourd, ash gourd, cucumber, celery, lettuce and zucchini are natural choices, and it’s best to incorporate them as a salad. Cruciferous vegetables like broccoli sprouts, broccoli, cabbage, cauliflower, kale, mustard greens and moringa contain a natural plant compound called sulforaphane that inhibits the growth of H.Pylori bacteria. An increased level of this bacteria is associated with the development of reflux disease, and regular consumption of these foods can naturally increase the resistance of the stomach to acids.

Consider replacing the grains in your diet with pseudo grains like millets, quinoa, teff, amaranth, buckwheat etc. They are superior to cereal grains in several ways; not only are they gluten-free, they also have higher amounts of protein, vitamins and minerals than rice or wheat. Unpolished millets, specifically, confer benefits relevant to GERD. Foxtail millet protects the gastric system, browntop millet eases constipation and relieves the pressure on the lower esophageal sphincter, and proso millet and sorghum are highly alkaline and combat acidity. Whole grain such as oatmeal is a good source of fiber, keeps you feeling full and also absorbs stomach acids. In terms of rice, red rice has ten times more antioxidants than brown rice, but avoid the glutinous varieties. Note that gluten in itself does not cause GERD, but studies suggest that a gluten-free diet can effectively relieve acid reflux symptoms.

Nuts and seeds are an essential component of a plant-based diet, and there are several that are beneficial to GERD. Almonds are alkaline and high in calcium which helps neutralize stomach acids. The same goes for chestnuts, although they’re not strictly a nut. Pumpkin seeds, milled flax seeds, sesame seeds, milled chia seeds and sunflower seeds are not only highly nourishing but also have acid-reducing properties. While nuts in general contain beneficial fats, they should be consumed in moderation. Other healthy sources of fat could be avocadoes, coconuts and olives in their whole form. Beans, too, are an excellent option to avoid acidity, specifically green beans, navy beans, broad beans and lentils. Nutrient dense, packed with protein and carbohydrate, high in fiber and endowed with resistant starch, they are a valuable addition to your plate. Ensure that they are pre-soaked and boiled before consumption, however.

Hydration is hugely important, both for general wellness and specific to GERD. Studies suggest that staying adequately hydrated confers a host of benefits related to anti-ageing and disease prevention. Opt for tender coconut water which promotes the PH balance within the body, and floral and herbal teas like chamomile, ginger, holy basil, fennel, licorice and slippery elm bark that have anti- inflammatory properties. Sprouted finger millet malt makes a good hot drink. But try not to have a lot of liquids along with your meals as it adds to the volume of your food and increases stomach distention. Coffee including decaf should be avoided, as should chocolate in whole form or as a drink, as it contains caffeine.

Contrary to popular perception, a restorative diet need not be boring and bland. While you should avoid chilli powder, paprika, nutmeg and all forms of pepper (black, cayenne, red and white), you can spice up your meals with basil, cilantro, oregano, rosemary, dried fenugreek leaves, dill and thyme, which add a host of flavor without causing reflux. Carom and cumin seed water have a carminative effect, in that they soothe the digestive tract and promote the expulsion of intestinal gas. Chew on aromatic cardamom pods post meals to activate digestive enzymes and reduce the bitter taste in the mouth which occurs during instances of reflux.

GERD is not only aggravated by spicy, fatty, oily and processed food, but also by overeating, eating too fast, not fully chewing your food or eating just before bedtime. Downsizing your meals is a good idea, as is cooking them in cast iron or steel vessels. Cooking in aluminum vessels or foil can leach trace amounts into the food. While a healthy person would likely excrete the small amounts absorbed, it can have unpleasant effects like hyperacidity and contribute to peptic ulcers, indigestion and flatulence.

Dietary interventions can go a long way, but they form just one half of the coin and lifestyle modifications should not be ignored either. Smokers have a greater risk of Barrett’s esophagus, and this is another good reason to quit smoking. Alcohol, unfortunately, is not great news either. It’s a diuretic and increases the production of urine, causing dehydration which worsens the symptoms of reflux. Weight management is key, given that a high BMI is one of the triggers for GERD. While regular moderate exercise involving activities like walking and light jogging is recommended, high impact or high intensity exercises could aggravate the symptoms. Embrace yoga by all means, it could provide relief and also prevent the burn, but not all asanas are recommended. Inversions, for instance, should be avoided. Consult a qualified yoga therapist to identify the right asanas and kriyas. Our digestive health is sensitive to emotions, so taking time out to relax and meditate could keep you stress free. Exercise, sleep and stress are a triad and variances in any of them will affect the others. Ensure good quality sleep each night by maintaining sleep hygiene. Given that our internal organs are asymmetrical, the side you sleep on matters too. It’s well researched that sleeping on your left side with your head elevated helps ease acid reflux.

While medications such as proton pump inhibitors may be effective, a new study has found that chronic use should be avoided due to negative consequences on long-term health. Given these limitations, it makes sense to turn to dietary and lifestyle modifications for a natural, safe and effective way to treat GERD.

Disclaimer: This article is not meant to constitute medical advice, but to empower you by providing information that you can act on. Given that medical and dietary interventions go hand-in-hand, do consult your medical practitioner if you notice the symptoms of GERD. Dietary & lifestyle interventions are also not a one size fits all approach, so consult a dietary expert to see what works for you.