Environmental Nutrition

The burning sensation of heartburn in your chest, caused by stomach contents flowing back up into your esophagus (food pipe), can be agonizing. If you experience this more than twice a week for a few weeks, you may have GERD (gastroesophageal reflux disease). GERD affects approximately 20 percent of people in the U.S. and is on the rise due to the epidemic of obesity. Although some people rely on antacids to soothe their symptoms, dietary and lifestyle changes can be a big help.

Recognizing reflux

Heartburn is a tell-tale sign of acid reflux, but some people with acid reflux don't experience heartburn. "Throat symptoms such as a chronic cough, hoarseness, frequent throat clearing, throat burning, difficulty swallowing and/or a lump-like sensation in the throat may indicate a more severe form of acid reflux disease," says Jonathan Aviv, M.D., an otolaryngologist, the clinical director of the Voice and Swallowing Center at ENT and Allergy Associates in New York City, and author of "Killing Me Softly from Inside: The Mysteries and Dangers of Acid Reflux." He continues, "Such throat symptoms are better predictors of risk for esophageal cancer than traditional heartburn symptoms."

This cancer risk is a big reason you shouldn't ignore any symptoms of reflux and should be evaluated by your doctor. "A precursor of esophageal cancer that we examine patients for is Barrett's esophagus, which is an abnormal lining of the lower part of the esophagus caused by chronic acid reflux," says Pankaj Vashi, M.D., a gastroenterologist and chair of the department of medicine at Cancer Treatment Centers of America in Zion, Ill.

Medication precautions

Television ads promote many over-the-counter (OTC) drugs for reflux. "The general recommendation is to take OTC acid reflux medication for two weeks, then stop the medication to see if the symptoms come back. If the reflux symptoms return, you need to go to your primary care doctor," Vashi says.

Doctors may prescribe stronger doses of drugs called proton-pump inhibitors (PPIs), such as Prilosec and Nexium, for longer-term use, but they're not risk-free. PPIs can weaken bones over time since they suppress acid production, which impairs calcium absorption, Aviv says. "I prefer to try to get people to change their diet and lifestyle rather than relying on medication."

Diet and reflux

Although any food can potentially trigger reflux if a person is sensitive to it, certain foods more frequently cause problems, Aviv says. He divides common problem foods into two categories: acidic foods and foods that loosen or relax the muscle (the lower esophageal sphincter or LES) that acts as a control valve separating the stomach from the esophagus, thus allowing reflux to occur. The dietary items that relax the LES include caffeine, chocolate, alcoholic beverages, mint, onions and garlic. Fatty, spicy and fried foods also may relax the LES, according to the American Society for Gastrointestinal Endoscopy.

The reason that acidic foods can be problematic in reflux is complex. Aviv explains that when a person has acid reflux, pepsin (an enzyme in the stomach that is activated by acid and digests protein), travels with the stomach contents up the esophagus and can stick like Velcro in the esophagus, throat and mouth. "When a person consumes something that's very acidic, such as tomato juice, the pepsin that's lodged in these places gets activated and can start eating away at your throat and esophagus, causing damage and inflammation," Aviv says. This mechanism is also described in a 2011 scientific paper published in Annals of Otology, Rhinology & Laryngology.

The interaction between acidic food and displaced pepsin means trouble for people trying to self-treat heartburn with apple cider vinegar and lemon juice, based on the incorrect idea that reflux is triggered by insufficient stomach acid. "When we examine patients who drink this highly acidic concoction, it looks like a bomb went off in their throat," Aviv says. "There is no scientific paper that supports this treatment, and it's dangerous."

Lifestyle and reflux

In addition to dietary changes, Vashi emphasizes these strategies to reduce reflux:

--Lose weight, if overweight. Excess weight puts pressure on your stomach and relaxes the LES.

--Wear loose-fitting clothing around the waist.

--Avoid smoking and second-hand smoke.

--Eat smaller meals and avoid eating for three hours before lying down.

--Elevate the head of your bed a bit (up to 30 degrees).

(Environmental Nutrition is the award-winning independent newsletter written by nutrition experts dedicated to providing readers up-to-date, accurate information about health and nutrition in clear, concise English. For more information, visit www.environmentalnutrition.com.)