Gastrointestinal Disorders

Nutritional Pearls: Preventing GERD With Lifestyle Changes

Emily is a 36-year-old woman who was recently diagnosed with Gastroesophageal Reflux Disease (GERD). At a recent appointment, she asks about lifestyle modifications that could help to lessen the frequency of her symptoms.

How do you advise your patient?


(Answer and discussion on next page)

Dr. Gourmet is the definitive health and nutrition web resource for both physicians and patients with evidence-based resources including special diets for coumadin users, patients with GERD/acid reflux, celiac disease, type 2 diabetes, low sodium diets (1500 mg/d), and lactose intolerance.

Timothy S. Harlan, MD, is a board-certified internist and professional chef who translates the Mediterranean diet for the American kitchen with familiar, healthy recipes. He is an assistant dean for clinical services, executive director of The Goldring Center for Culinary Medicine, and associate professor of medicine at Tulane University in New Orleans.

Gastric reflux is a fairly common condition in which stomach acid flows upwards into the esophagus, irritating the lining of the esophagus and causing a burning sensation. Many people experience this on occasion and are able to treat it with over-the-counter medications, but as much as 30% of the adult population in the United States has Gastresophageal Reflux Disease (GERD), a condition in which mild gastric reflux occurs at least twice a week, or moderate to severe reflux occurs at least once per week.

In addition to being uncomfortable or downright painful, GERD can cause chronic coughs, laryngitis, contribute to or worsen asthma, disrupt sleep, and even cause sores in the esophagus.

The most common dietary and lifestyle modifications to help reduce or prevent symptoms include not smoking; maintaining a clinically normal body mass index (BMI); engaging in moderate-to-vigorous exercise for at least 30 minutes per day; consuming no more than 2 cups of coffee, tea, or soda per day; and following a "prudent" diet (with "prudent" defined as having a dietary pattern in the top 40% of the population). Up until now, however, little good evidence other than anecdote has informed these recommendations.

The Research

In a research letter published in JAMA Internal Medicine, Harvard researchers analyzed data gathered from The Nurses' Health Study II, an ongoing prospective study of over 116,000 adult female nurses that began recruitment in 1989. The participants respond to detailed dietary, health, and demographic questionnaires every 4 years.

The authors began their analysis with the surveys returned in 2007, excluding those women who reported having GERD symptoms once per week or more as well as those with cancer or who reported using common prescription GERD medications. Using their survey responses, the authors could identify those women who practiced any or all of 5 lifestyle factors, then correlate those factors with those participants who reported developing GERD between 2007 and 2017, when the analysis ended.

First, the authors assessed the risk of GERD relative to each antireflux lifestyle factors individually, finding that simply not smoking reduced the risk of GERD symptoms by 6% while maintaining a clinically normal BMI alone reduced that risk by 31%.

Those who reported all 5 lifestyle factors were 53% less likely to experience GERD symptoms. The authors estimated that 37% of all GERD symptoms experienced on a weekly basis could be avoided by following all 5 lifestyle factors.

What’s the Take Home?

While this is a prospective study, which means it can't really prove causation, it is a good indication that the 5 lifestyle factors may help prevent GERD.

The drawback, of course, is that the authors defined the 5 lifestyle factors before doing their analysis. What if there are other factors that weren't identified? Nevertheless, if a patient is experiencing symptoms of acid reflux more than once per week, make sure that they work on those lifestyle factors of not smoking; maintaining a clinically normal weight; avoiding more than 2 cups of coffee, tea, or soda per day; getting 30 minutes of moderate exercise each day; and maintaining a healthy diet.

Reference:

Mehta RS, Nhuyen LH, Ma W, et al. Association of diet and lifestyle with the risk of gastroesophageal reflux disease symptoms in US women. JAMA Intern Med. doi:10.1001/jamainternmed.2020.7238