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Yes, GERD (Acid Reflux) is linked to higher BMI
Recently researchers in Boston, supported by the National Institute of Health, sought to confirm what I see every day in my practice: that a higher Body Mass Index (BMI) leads to a higher risk of GERD (N Engl J Med 2006(22);354:2340-8). Previous studies seeking to link GERD and BMI suffered from poor design: they did not include a wide range of BMI or persons with varying degrees of severity of their symptoms.
What Not To Eat: Cereal Edition
I have spent the last twenty-five years or so talking about what you should be eating. Last week I began a discussion of what not to eat. I can't say that I have deliberately avoided talking about what you shouldn't be eating, it's more that I like to remain positive. There's so much great food that's great for you and that has taken me a lot of time to talk about.
Hormone Use and GERD / Acid Reflux
As many as half of all women experience some heartburn during pregnancy. It's not just caused by the growing fetus, but the valve at the top of the stomach, called the lower esophageal sphincter, becomes weaker in pregnancy. Just why this happens is not known, but the theory is that the pregnant woman's higher levels of estrogen and progesterone may contribute to the weakened sphincter, allowing the stomach's contents to reflux back into the esophagus.
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For those who may not be aware, GERD (GastroEsophageal Reflux Disease) is a condition in which the acid inside the stomach goes up into the esophagus (essentially the tube from the mouth to the stomach), causing inflammation of the esophagus (esophagitis) and symptoms ranging from mild heartburn to severe chest pain. (Some people have actually thought they were having a heart attack!) Over time, untreated GERD can lead to damage to the esophagus and the risk of bleeding or even cancer. This damage is known as erosive esophagitis. What you may not know is that people can have GERD but have no symptoms (called asymptomatic ERD) or have NERD (Non-Erosive Reflux Disease), in which the esophagus is not yet damaged.
There are various lifestyle changes that we doctors recommend to those who have GERD, which include frequent small meals, keeping a food diary to determine your personal food triggers (to avoid them), not smoking, and weight loss (if needed). These changes are more a result of trial and error than determined through research, however.
Researchers in Japan, concerned about the increase in the number of Japanese who have been diagnosed with GERD, decided to approach the issue more clinically (Dig Dis Sci 2011;56:2857-2864). They recruited over 2000 men and women who were receiving a health screening from a physician at a Red Cross health clinic to participate in their study.
During the health screening the participants provided a detailed medical history and responded to a questionnaire regarding symptoms of GERD. They also responded to a detailed dietary questionnaire and answered questions about whether they smoked, drank green tea, exercised, etc.. All of the participants then underwent an endoscopy - a procedure that looks at the lining of the esophagus and stomach - to see if they had esophagitis, which is considered a definitive diagnosis for GERD.
The diet and lifestyle factors of those with esophagitis (GERD) were then compared with the diet and lifestyle of those who did not. And the results are very interesting.
Both male and female smokers were more than twice as likely to experience GERD than those who were former smokers or had never smoked.
Both men and women who were overweight were also more likely to experience GERD - but the increase in risk was only 10% at most.
Those who exercised regularly, however, were much less likely to have GERD - over 25% less likely for men and 40% less likely for women. This was completely unrelated to the participant's weight.
Yet another argument for regular exercise. While it's true that exercise can stimulate GERD symptoms for some, it's clear that doing it regularly can help prevent symptoms. The first recommendation is to not exercise too soon after eating. Start easy with something like walking, and keep a diary of your symptoms.
I shouldn't have to tell you to stop smoking. (And if I do, here it is: Stop.)
First posted: May 9, 2012