Most of us know the common symptoms of acid reflux, or GERD (gastroesophageal reflux disease); indigestion, burning in the chest (aka heartburn), bringing up foul-tasting fluid into the back of the throat.  But we now know that there are many other symptoms that can also be tied to GERD.  Symptoms like chronic cough (particularly nighttime cough), thick phlegm in the throat that may cause someone to repeatedly try to clear their throat, difficulty swallowing, feeling like there’s a lump in your throat, wheezing, snoring, bad breath, and even sleep apnea (periods of stopping breathing while sleeping).  GERD can interfere with healthy sleep which can then lead to low daytime energy levels, chronic headache, fatigue, and more.  Interestingly, new evidence shows that many people with GERD may not experience the more common heartburn/indigestion, but instead present with cough, or poor sleep. This syndrome has been termed “silent reflux”.  So, what is GERD? How can you tell if you have GERD? And what can be done to fix GERD?  In this episode of reMDdirect’s Weekly Wellness Report, we will look to answer each of these questions regarding this very common condition.

First, let’s explain what GERD is and how it happens.  GERD is the chronic condition of acid reflux.  When we swallow food, it passes through the esophagus and into the stomach by passing through a doorway called the lower esophageal sphincter (LES).  After the food passes through, the LES closes tightly, so that the stomach’s acidic contents can begin breaking down food within the tough chamber of the stomach.  But if the LES does not remain tightly closed, the very acidic stomach acid can spew into the esophagus, and higher into the throat and upper airway (especially common when we are lying down).  This very acidic fluid can cause serious irritation and inflammation in these areas, potentially leading to the symptoms listed above.  And, if left untreated, chronic GERD can lead to chronic inflammation of the esophagus (aka esophagitis) and even cause the cells in the lining of the esophagus to change, something called Barrett’s Esophagus, which increases the risk of esophageal cancer.

So, what causes the LES to not remain tightly closed?  Very common dietary behaviors/options, like overeating, reclining too soon after eating, even eating certain foods (fatty meals, citrus fruits and juices, artificial sweeteners, caffeinated beverages, alcohol, chocolate, garlic, onions, tomato-based foods, mint, and coffee) all can cause relaxation of the LES potentially leading to a flare-up of GERD. Obesity and smoking and even some medications are also risk factors.

Given how common these symptoms are, you or someone you care about has experienced them.  Now let’s talk about what can be done to improve GERD.  First off, as is often the case in our practice, lifestyle modification is key.  In fact, having coached patients through these dietary changes over the last decade, I have seen tremendous results with the following modifications.

These changes can dramatically improve and even cure reflux:

  • Do not lie down for at least 2 hours after eating.

  • Avoid eating within 3 hours of bedtime

  • Avoid foods known to worsen acid reflux

  • Eat foods found to help acid reflux (vegetables, whole grains, nuts…)
  • Lose weight if you are overweight
  • Avoid drinking a lot of water with meals
  • Exercise regularly
  • Quit smoking

In addition to the above lifestyle changes, we may use certain medications to reduce stomach acid.  These medications include antacids (Tums, Rolaids, etc.), H2 antagonists (Pepcid, Zantac, etc.), and proton pump inhibitors (Prilosec, Prevacid, etc.).  As with any medication, we hope to use as low a dose and for as short a period as needed while we emphasize lifestyle modifications for long term improvement.

In my own practice, I have found fantastic results with lifestyle modifications in controlling GERD symptoms.  Often, adhering to a strict GERD diet for 30 days can make a tremendous difference, and can then allow the individual to re-introduce some of the foods they miss most. Want to learn more? Check out some of the links below for some additional reading from trusted resources.  Have questions, or an idea for a future topic for our Weekly Wellness Report? Email me directly at doc@remddirect.com.

And as always, thank you for being a member of reMDdirect, where we are changing healthcare for the better, by reuniting patient and provider.

Additional Reading

https://www.massgeneralbrigham.org/en/about/newsroom/articles/diet-for-gerd

https://www.hopkinsmedicine.org/health/wellness-and-prevention/gerd-diet-foods-that-help-with-acid-reflux-heartburn

https://www.barnesandnoble.com/w/dropping-acid-jamie-koufman-md/1102573677

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About the Author

Dr. Michael Duffy

As a Board Certified Family Physician who has practiced medicine for over 20 years, I have held a variety of leadership roles in hospitals and healthcare technology while always maintaining an active clinical practice. Using those many lessons learned, and in an effort to uphold what is best in primary care, I launched reMDdirect, a new Direct Primary Care practice in Twin Falls, Idaho in October of 2023. My focus is to provide a top notch primary care experience that ensures easy access, transparent pricing, and a great patient experience. I am committed to working with patients and employers to empower the individual to understand and manage their health conditions. In this blog section, I will offer current, evidence-based advice on health issues relevant to you so that you may be better involved in your own care. If there is an issue you would like to see addressed, or if you have any questions on a post, please reach out via the “Contact Us” tab at the top of this website, and please feel free to share this info with others and invite them to connect via this website.  At reMDdirect, we are excited to welcome new patients to the practice. Thank you for being part of the reMDdirect family!