GERD: The Burning Within

Heartburn, indigestion, acid stomach, reflux… There are many terms for the burning in the esophagus that is common to all, at least occasionally.  From historical records, it appears that gastro-esophageal reflux disease, or GERD, has been a problem for mankind from the beginning.  Many remedies have been used over the centuries, some were even highly toxic.

Currently, medications for GERD are among the most-sold drugs in the world.  The most recent drugs completely block acid in the stomach.  They often work, but at the same time they inhibit the absorption of minerals, such as calcium and magnesium, and have been shown to cause osteoporosis when used on a long-term basis.  They also block the absorption of vitamin B-12, which leads to nervous disorders.

Many don’t want to take drugs forever so they opt for surgery, called a fundoplication.  This can work, but is really successful less than half the time.

Because of these problems, many people ask me if there is anything that can be done without drugs or surgery to treat and relieve GERD.  The following is my list; it is almost always successful in my patients.

1. Don’t eat in the evening.  A good rule is not to eat after 6pm or so. Eating stimulates stomach acid production and very often leads to nighttime GERD.
2. Avoid high-calorie, low-fiber foods.  Pizza is a common problem because it is very high in calories, but has very little fiber.  Meat, cheese, white flour products, white rice, pasta, and anything processed generally have little fiber.  The stomach empties according to the calories you eat so it will take a lot longer to empty a pizza than a salad.
3. The corollary to number 2 is to eat lots of foods with fiber.  Have a salad with your meals.  Have only fruit for dessert.
4. Drink only water between meals, no snacks.  Often, the problem isn’t too much, but rather not enough acid.  Eating frequently causes lower stomach acid which may lead to GERD.  Having the stomach empty between meals “resets” the digestive system, allowing you to prepare for another meal.
5. Don’t drink with a meal.  Those who drink anything with a meal (even water!) eat more, causing the stomach to get too full, and it dilutes the acid, raising the pH and creating indigestion.  When we no longer produce saliva then we should stop eating. But, if we drink we can continue to wash-down the food, causing us to eat too much.
6. Avoid foods that seem to make heartburn worse.  In some cases, people are sensitive to foods, or even have allergies, without knowing it.  In one study, a biopsy done on the intestines showed 1% of “normal” people had celiac disease, an allergy to wheat.  I have found that food allergies are a common cause of chronic GERD.
7. Eat small meals.  Feasts should be occasional, not daily.  The stomach works much better with a small meal.
8. Fast regularly.  Not eating or drinking anything for at least one day per month helps the stomach to function properly.  The stomach is more than just a holding tank; it is a complex endocrine organ that controls much of our digestion and absorption.  I always say that it needs a rest periodically, just like every other part of the body.

With these principles, almost everyone is able to get off of their GERD medications, and avoid surgery.  However, if you have persistent symptoms in spite of these, it’s a good idea to find out why.  There are diseases such as infections and cancer that can produce the symptoms of indigestion.  I read of one case of a cardiologist who was giving lectures away from home who was found dead of a heart attack in his hotel room.  His briefcase had lots of antacids.  Apparently, he was treating the chest pain from his heart as “heartburn.”