Acid reflux - taming the dragon

Symptoms of acid reflux are no fun. In fact, a study showed that reflux makes people more unhappy in their day-to-day life than even cancer or heart failure! The holidays are a time when many people put on 5-10 pounds and indulge in more decadent foods than usual, putting them at risk for symptoms of acid reflux, also known as GERD (gastroesophageal reflux disease). Avoiding acidic foods and foods that relax the “flap” at the bottom of the esophagus are important for reducing acid reflux symptoms. But there are some habits that you can change that will help, too. Here are my tried-and-true tips for reducing acid symptoms and taming the dragon within.

Foods to avoid:

Acidic foods such as citrus, cooked tomatoes (fresh are generally well-tolerated) vinegar, coffee and alcohol.

Foods that relax the flapper (lower esophageal sphincter) – any form of mint (including chewing gum and tea!), fatty meals and large meals.

Behaviors to change:

Stop eating or drinking for 3 hours before lying down because it takes that long for your stomach to empty.

Try to eat your biggest meal in the morning (this helps for weight maintenance, too). Eat breakfast like a king, lunch like a prince, and dinner like a pauper.

Principles of using an acid blocker – By using an acid blocker, we’re giving the cells that line your esophagus a chance to heal themselves and restore the robust, shoulder-to-shoulder acid-proof barrier formation that they used to have. By sparing them the ongoing damage of daily acid splashups for two months, while you also get the above diet and behavior changes going, we can fortify the lining and make it more likely for you to “fly” without an acid-reducing medication.

When you wean off the acid reducer, there will be a couple of days of increased acid. This is called “rebound” and it’s a sign that your body is adjusting to the lack of acid suppression. Essentially, your acid pumps have been “rarin’ to go,” and we’ve been holding them back. Don’t worry – everything will settle down after a couple of days.

Don’t believe what you’ve heard or read about Proton Pump Inhibitors (aka PPIs with names like Prilosec, Nexium, etc) causing heart attack, dementia, stroke or hip fracture. We think PPIs are just guilty by association – when people are carrying extra weight, they often get acid reflux and they have heart attacks, strokes and dementia at a higher rate. We think the hip fracture risk is a statistical phenomenon, because there’s no reduction in calcium absorption, and no change in bone density, meaning that you don’t get osteopenia or osteoporosis because of them.

I don’t love it that PPIs affect the gut microbiome, and I want you off of them as soon as your symptoms allow. But we sometimes need to move in a stepwise fashion, giving you relief for a short period of time and getting some much-needed healing, with the ultimate goal of being both medication-free and symptom-free.