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As many as 7% of Americans suffer from heartburn every day, and many more suffer it at least weekly. In the "old days", people with heartburn were advised to eat smaller meals, drink less alcohol, smoke less, eat less "spicy foods", avoid chocolate, coffee, acidic (e.g.citrus) drinks, and more; for symptomatic relief, antacids were prescribed. In the case of hiatal hernias, elevation of the head of the bed was the most common recommendation.

Now we have proton pump inhibitors that lower gastric acid secretion, which takes care of the symptoms of a large number of sufferers, not to mention newer drugs affecting lower esophageal pressure, etc. But drugs are not without side effects.

In this age of evidence-based medicine, what lifestyle modifications have been shown to really help gastric acid reflux symptoms or GERD?

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It sounds like you know that some lifestyle modifications have been shown to be beneficial with patients who have mild to moderate GERD and that these interventions are typically preferable to pharmacological intervention. Right on!

The definitive information on management of GERD can be found on the website of the American College of Gastroenterology.

Here is the specific section that you're looking for:

  1. Weight loss is recommended for GERD patients who are overweight or have had recent weight gain. (Conditional recommendation, moderate level of evidence).

  2. Head of bed elevation and avoidance of meals 2–3 h before bedtime should be recommended for patients with nocturnal GERD. (Conditional recommendation, low level of evidence).

  3. Routine global elimination of food that can trigger reflux (including chocolate, caffeine, alcohol, acidic and/or spicy foods) is not recommended in the treatment of GERD. (Conditional recommendation, low level of evidence)

In my personal experience, all three of these are worth trying.

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Effective lifestyle modifications would include:

  • Weight loss - excess weight causes pressure on the stomach, overcoming the lower-oesophageal sphincter and pushing acid into the oesophagus

    • Abstinence from Alcohol - alcohol irritates the gastric lining causing pain.

    • Stopping smoking - nicotine activates receptors in the stomach wall, encouraging the secretion of acid.

Additional recommendations would include stopping non-steroidal anti-inflammatory drugs.

Hopefully that all helps!

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