Reflux is the backward flow of the stomach contents through the sphincter into the oesophagus. This may be accompanied by a rising, burning feeling in the chest; often referred to as heartburn. Signs and symptoms may also include an acidic taste in the mouth, increased burping, a hoarse throat or a dry cough. Reflux, or gastro-oesophageal reflux disease (GORD), is a very common disorder with 20-40% of adults reporting symptoms at least once weekly. Hiatus hernia is a common contributor to reflux. When GORD is untreated and persistent the prolonged acid exposure increases the risk of developing serious inflammation and damage to the oesophagus, with a small risk of malignancy.
Diet and lifestyle
Dietary and lifestyle modifications are often considered the first line of therapy for sufferers of reflux or GORD. These include weight loss and cessation of smoking where applicable; dietary changes and elevation of the head of the bed. Obesity is a causative factor due to increasing pressure from the abdomen. Pregnant women experience a high rate of reflux symptoms for the same reason with symptoms possibly being aggravated due to the hormonal changes of pregnancy.
Diet can affect reflux in a number of ways with an individual’s dietary habits, including specific foods and drinks, playing a role. Dietary components can alter the tone of the sphincter between the oesophagus and the stomach and also affect the amount of acid that is produced in the stomach, thus exacerbating the burning sensation and inflammation of the oesophagus.
The effect of foods
Large, high fat meals are a common cause of reflux as they increase the pressure exerted on the oesophageal sphincter as well as slowing down stomach emptying into the intestines and increasing the acid produced in the stomach. For those suffering from reflux, it is advisable to consume more frequent, smaller and less fatty meals.
Peppermint, spearmint and coffee reduce the tone of the oesophageal sphincter allowing for more backward flow of stomach contents. Caffeine containing foods and beverages stimulate acid secretion and reduce the tone of the oesophageal sphincter whilst beer, wine and other fermented alcoholic beverages increase gastric acidity. Chocolate can also be an aggravating food.
Foods which are acidic; such as citrus fruits and juices, tomatoes and soft drinks may irritate and cause pain when the oesophagus is inflamed, as can highly spiced foods, such as chilli, curry and pepper. Small quantities of spice don’t affect most people with reflux, although some individuals are actually allergic to some spices and this causes their symptoms. Diets low in fruit and vegetables and wholegrain cereals have been implicated in increasing the risk of oesophageal cancer. Another good reason to ensure you are having your daily quota of fruit and vegetables.
Elimination of foods
Whilst avoiding particular foods and particular types of meals can be extremely beneficial to sufferers of GORD it is vitally important that the elimination of foods does not lead to nutritional deficiencies. Individual GORD sufferers may have certain trigger foods that can exacerbate their own individual symptoms, but may not cause problems for other sufferers. It is highly recommended to seek the advice of an accredited practicing dietitian (APD) who can provide individual expert advice on your particular diet if you are considering eliminating major foods or food groups. An APD can also assist in the identification of an individual’s problem food chemicals. APDs can be located through the following web address http://www.daa.asn.au/index.asp?pageID=2145874281.
Medications as a cause
Many common medications prescribed for a wide variety of medical conditions may cause reflux symptoms as an adverse effect. If you suspect that your medication may be a causative or contributing factor discuss this with your pharmacist or doctor as there may be a more appropriate medication for you without the troubling side effects.
Medical treatments
Symptomatic relief and healing of the oesophagus is generally achieved with medications prescribed by your doctor or obtained from your pharmacist. Proton pump inhibitors, H2 antagonists or for mild, infrequent cases antacids, can be extremely beneficial.
Nutritional implications of medical treatments for reflux or GORD
Medications that are used to treat reflux or GORD can have significant effects on the absorption of certain nutrients in the diet. Antacids should ideally be taken at least two hours apart from meals as they bind to minerals such as iron and prevent absorption of these minerals. Long term intake of regular antacids needs caution as apart from often being high in sodium, which may increase blood pressure; antacids may reduce levels of thiamin (vitamin B1) in the body.
Other medications used to treat reflux; specifically H2 antagonists and proton pump inhibitors, reduce the acid production in the stomach for a significant period of time. Affecting the pH of the stomach is known to affect the ability of the body to absorb nutrients. Vitamin B12 requires an acidic environment for it’s absorption and people may become B12 deficient due to taking these medications. The absorption of minerals such as calcium, zinc and iron; as well as folic acid and beta-carotene may also be decreased due to the less acidic state of the stomach with resultant inadequate nutrient levels.
Whilst it is important to follow your health professional’s recommendations for taking these medications; it is considered appropriate to minimise their use and to check the above nutrient levels in the body.
GUIDELINES FOR MINIMISING YOUR SYMPTOMS OF REFLUX
