It's common knowledge that certain foods can trigger symptoms of Gastro-oesophageal reflux disease (GORD) — a condition characterized by frequent episodes of acid reflux, also known as ‘gastric reflux'. Researchers and doctors have shown in a number of different studies that excess body weight (even being just slightly overweight) can also trigger the onset of GORD and influence its severity.
The relation between obesity and GORD is clear on all measures of the disease: clinical symptoms, acid esophageal exposure, ulcerative oesophagitis and complications. The pathogenesis of this link may be due to general factors such as visceral adiposity (body fat that is stored within the abdominal cavity), oestrogen levels, or decrease of Helicobacter pylori infection with increased gastric acid secretion. Increased abdominal pressure leads to disturbance of the oesophago-gastric junction and hiatal hernia, and oesophageal motility may be disrupted by obesity. Likewise, there’s also evidence that losing excess body weight and lifestyle modifications can improve or even resolve symptoms of GORD.
So, what is GORD? GORD or GERD (American spelling) is a common and chronic gastrointestinal disorder. Almost 80% of the population will experience symptoms of reflux at some stage in their lives. This occurs when backflow of gastric contents through the lower oesophageal sphincter (LOS) into the distal oesophagus, which is the food pipe that connects the throat and stomach causing the oesophageal mucosa to be attacked by acid and pepsin. Heartburn symptoms often crop up shortly after having food and can last for a few minutes or even hours. People may complain of an acid regurgitation (acid brash), belching and dysphagia, a sour or bitter taste in their mouth or even cough symptoms.
Why is this important?
The continual backwash of acid into the oesophagus can cause irritation and inflammation. Complications can develop due to continuous irritation. This causes narrowing of oesophagus leading to a stricture and swallowing problems. A painful sore or ulcer can develop which can bleed and making them difficult to swallow. In addition, precancerous changes can happen to the oesophagus, called Barrett’s oesophagus, which is the main risk factor for developing oesophageal cancer. Also, GORD presents with respiratory complications in a significant minority of patients such as persistent cough, recurrent or refractory asthma or dysphonia. Other GORD patients present with non-cardiac chest pain owing to oesophageal spasm.
It turns out that overweight/obesity is linked with three related oesophageal disorders: GORD, Barrett’s oesophagus, and oesophageal adenocarcinoma. The risk for these disorders seems to increase progressively with increasing weight.
GORD seriously affects quality of life - proportional to the frequency as well as severity of symptoms but unrelated to the presence or absence of oesophagitis. However, the good news is that quality of life improves rapidly after treatment. The goal of treating GORD is not only to decrease troublesome GORD symptoms but also to decrease one’s risks of developing these other, more serious oesophageal conditions.
Small Weight Gain Linked to GORD
A recent study published in The New England Journal of Medicine (NEJM) shed few insights about GORD and body weight. In this study, researchers wanted to find out whether small changes in body weight even within the limits of normal weight range can have an effect on the severity of acid reflux and related symptoms in women.
The study revealed a clear correlation between the occurrence of GORD symptoms and a woman’s body mass index (BMI). The researchers found that women who were overweight (defined by a BMI of 25-30) were more than twice as likely to develop GORD symptoms as those of normal weight. Women who were obese (with a BMI greater than 30) had almost tripled the risk of GORD symptoms.
Perhaps most surprising, however, was that small differences in body weight in women of normal weight (with a BMI of 21 to 25) also increased the probability of developing GORD. An increase in BMI of more than 3.5 for women who started out with a normal body weight was associated with nearly triple the risk of experiencing frequent GERD symptoms.
The Researchers in this study stressed that there are a number of factors that may determine whether it’s a good idea for you to try to lose weight to help manage your GORD. But if you’ve gained weight and noticed an increase in your symptoms, you may be able to reverse this condition by losing the weight again.
What can you do?
As noted, the most effective lifestyle interventions to reduce GORD symptoms are losing weight and, if symptoms are nocturnal or if during sleep, few tweaks such as elevation of the head of the bed provides good results.
A recent study published in the journal Obesity in 2012 stated that the majority of individuals who were obese or overweight enrolled in a structured weight-loss program including dietary, physical activity and behavioral changes, experienced greater resolution of their GORD symptoms. The relationship between resolution of symptoms and weight-loss was dependent on the amount of weight lost. Men experienced improvement after losing 10 percent of their weight whereas women saw improvement in GERD symptoms after losing 5 to 10 percent of their weight.
Meanwhile, another study published in the journal Gastroenterology revealed that weight-loss through restriction of calories and increased physical activity also demonstrated a considerable improvement in participants’ symptoms of GERD. Above all, follow-up at 6, 12 and 18 months showed decreases in symptoms of heartburn, acid reflux and abdominal fatness. Therefore, another benefit to losing weight is that patients may be able to reduce or eliminate their over-the-counter (OTC) or prescription GERD medications.
Effectiveness of Other Lifestyle Modification Measures
The list of foods, drinks and other factors considered to deteriorate GORD symptoms is quite extensive. The data studying these items is contradictory and more research is needed to determine the effectiveness of stopping or eliminating the listed foods and drinks will have on GORD symptoms.
It is recommended to take notice to see if any of the listed items seem to exacerbate your condition. If so, you can reduce or remove them and see if symptoms improve.
- High-fat meals
- Carbonated beverages
- Spicy foods
- Cooked tomato sauce
Other Helpful Lifestyle Measures
- Wear clothes that are looser around the waist.
- Avoid lying down for at least three hours after eating a meal.
- Eat smaller meals.
If you think you are experiencing GORD symptoms, it is important to discuss these symptoms with your Health care provider. There are OTC and prescription medications available to treat GORD. Consult with your healthcare provider for guidance when seeking a medication treatment plan to manage your symptoms.
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