Three conditions—poor clearance of food or acid from the esophagus, too much acid in the stomach, and delayed stomach emptying—contribute to acid reflux, says Dr. Jacqueline Wolf, a gastroenterologist and associate professor of medicine at Harvard Medical School and author of A Woman's Guide to a Healthy Stomach: Taking Control of Your Digestive Health.
If you've been having repeated episodes of heartburn—or any other symptoms of acid reflux—you might try the following:
1. Eat sparingly and slowly
When the stomach is very full, there can be more reflux into the esophagus. If it fits into your schedule, you may want to try what is sometimes called "grazing"—eating small meals more frequently rather than three large meals daily.
2. Avoid certain foods
People with acid reflux were once instructed to eliminate all but the blandest foods from their diets. But that's no longer the case. "We've evolved from the days when you couldn't eat anything," Dr. Wolf says. But there are still some foods that are more likely than others to trigger reflux, including mint, fatty foods, spicy foods, tomatoes, onions, garlic, coffee, tea, chocolate, and alcohol. If you eat any of these foods regularly, you might try eliminating them to see if doing so controls your reflux, and then try adding them back one by one. The Foodicine Health website at www.foodicinehealth.org
has diet tips for people with acid reflux and GERD as well as for other gastrointestinal disorders.
3. Don't drink carbonated beverages
They make you burp, which sends acid into the esophagus. Drink flat water instead of sparkling water.
4. Stay up after eating
When you're standing, or even sitting, gravity alone helps keeps acid in the stomach, where it belongs. Finish eating three hours before you go to bed. This means no naps after lunch, and no late suppers or midnight snacks.
5. Don't move too fast
Avoid vigorous exercise for a couple of hours after eating. An after-dinner stroll is fine, but a more strenuous workout, especially if it involves bending over, can send acid into your esophagus.
6. Sleep on an incline
Ideally, your head should be 6 to 8 inches higher than your feet. You can achieve this by using "extra-tall" bed risers on the legs supporting the head of your bed. If your sleeping partner objects to this change, try using a foam wedge support for your upper body. Don't try to create a wedge by stacking pillows. They won't provide the uniform support you need.
7. Lose weight if it's advised
Increased weight spreads the muscular structure that supports the lower esophageal sphincter, decreasing the pressure that holds the sphincter closed. This leads to reflux and heartburn.
8. If you smoke, quit
Nicotine may relax the lower esophageal sphincter.
9. Check your medications
Some—including postmenopausal estrogen, tricyclic antidepressants, and anti-inflammatory painkillers—can relax the sphincter, while others—particularly bisphosphonates like alendronate (Fosamax), ibandronate (Boniva), or risedronate (Actonel), which are taken to increase bone density—can irritate the esophagus.
If these steps aren't effective or if you have severe pain or difficulty swallowing, see your doctor to rule out other causes. You may also need medication to control reflux even as you pursue lifestyle changes.