Reflux (Heartburn)

25% of the population suffer from reflux, informally known as heartburn, at least once a month. Reported incidences of reflux are on the rise and may be due to increased obesity, longevity and the increased use of certain medicines. Reflux is the result of the oesophagus (the tube that connects the throat with the stomach) being exposed to stomach contents and leads to a burning sensation, chest pain, chronic coughing, teeth decay and belching. Antacids help to relieve symptoms but don’t actually get to the root cause of the problem, and long-term use (2 weeks or more) can result in side effects such as diarrhoea, poor calcium metabolism and magnesium build-up.

The severity of reflux varies from the more common non-erosive disease to the more severe erosive disease, which may lead to oesophageal cancer. Poor tone of the lower oesophageal sphincter (a bundle of muscles at the bottom of the oesophagus that contract to prevent stomach contents from travelling back up to the throat) is the most common reason for reflux, and symptoms are often increased when lying down.

Contributing factors

• Obesity (a BMI of 35 or over) is a significant factor related to the rise of reflux incidence, particularly abdominal obesity, which increases the abdominal pressure and causes the oesophageal sphincter to relax, allowing the backflow of stomach contents.

• The increase of reflux is also proportional to age as our muscles weaken and degrade over time.

• Medications that relax the oesophageal sphincter increase the likelihood of oesophageal exposure to stomach acids.

• Stress is reported to worsen symptoms however, the reason for this remains unclear.

• Hypochlorhydria (low stomach acid) is commonly a factor, as low stomach acid is believed to slow down the digestion of food substances which therefore remain in the stomach for a longer period of time and trigger the reflux action.

• Certain foods are reported to increase reflux symptoms and these include; fatty foods, chocolate, coffee, alcohol, spicy foods, large carbohydrate meals (pasta and bread), and acidic foods such as oranges and soft drinks.

Treatment

• Weight loss- if the person's BMI is 35 or more.

• Eliminating trigger foods, as mentioned before.

• Apple cider vinegar may be useful to help increase stomach acidity and speed up the breakdown of food. Start by adding a teaspoon to a glass of water before meals and gradually increase to a tablespoon if needed.

• Protein – adequate protein helps to strengthen the connective tissue of the oesophageal sphincter.

• Fresh fruit and vegetables – adequate vitamins and mineral intake help to reduce reflux.

• Wholegrain carbohydrates – help satiety, and increased fibre may reduce symptoms.

• Quit smoking – smoking increases symptoms.

• Sleep – elevate the foot of the bed by 15-20cm, this may reduce symptoms during the night. Sleeping on your left side also seems to alleviate reflux.

• Evening meal times – eat at least 2-3 hours before going to bed, and do not have a large meal.

• Exercise – regular exercise has been shown to be protective against reflux.

• Hydration – adequate water over the course of the day (2-2.5L for an adult), but avoid large amounts of water at mealtimes as this reduces the stomach acid needed for digestion.

If you are suffering from regular reflux (twice a week or more), then try some of the suggestions above.