Hiatal hernia and weight gain

Contents

Barrett’s Esophagus

What is Barrett’s Esophagus (BE)?

Barrett’s Esophagus (BE) is a complication of chronic gastroesophageal reflux disease (GERD). The normal valve between the esophagus and stomach is incompetent and stomach fluid causes changes in the type of cells in the esophagus. The normal squamous epithelial cells of the esophagus become metaplastic and look like intestinal cells under the microscope. The appearance of the esophageal lining on upper endoscopy can be suggestive of BE, but the actual diagnosis of BE is made after looking at the esophageal cells under a microscope in the pathology lab.

Treatment of Barrett’s Esophagus requires an interdisciplinary approach that draws on various medical specialties. At BMC, physicians in our Center for Minimally Invasive Esophageal Therapies provide comprehensive, quality care including medical oncology, radiation oncology, thoracic surgery, gastroenterology, pathology, pulmonary medicine and radiology.

Virginia Litle, MD, Director, Barrett’s Esophageal Program
BE is estimated to occur in 2 – 5.6 % of people in the United States. BE is a known risk factor for precancerous dysplasia, which can then progress to esophageal adenocarcinoma (EAC). EAC develops in about 0.5% of people with BE annually. BE increase the risk of esophageal adenocarcinoma by 11-40 times when compared to patients without BE. When patients are diagnosed with BE, they are advised to enter a surveillance program of repeat endoscopies on a regular schedule to look for precancerous dysplastic changes or early esophageal cancer. The survival rate of all patients presenting with EAC is 15% at five years, but when EAC is diagnosed early, then cure is possible.

What are the Symptoms?

Typical symptoms of GERD include heartburn and regurgitation. BE occurs in about 10% of U.S. adults with heartburn. GERD however can be silent that is without heartburn or regurgitation, and BE can result in the absence of symptoms. In addition a loss of typical GERD symptoms like heartburn can be suggestive of the development of BE.

Barrett’s esophagus patients may have symptoms of:

  • Heartburn and regurgitation
  • Unexplained weight loss or loss of appetite

What are the Causes?

Barrett’s esophagus is thought to be caused mainly by gastroesophageal reflux disease (GERD), which is persistent reflux occurring at least twice a week. Patients generally experience a feeling of heartburn or acid indigestion, and they may taste food or fluid in the back of the mouth. The use of over-the-counter or prescription acid-reducing drugs may decrease the risk of Barrett’s esophagus.

How is Barrett’s Esophagus Diagnosed?

Diagnosis is often difficult, because symptoms may be limited. The main diagnostic tool is upper endoscopy:

Endoscopy

You will receive an intravenous sedative and pain medication. Once comfortable, the physician will then examine the area using an endoscope—a lighted tube with a small camera at the end. The physician will be able to view any abnormalities and take a tissue samples (biopsies) if necessary.

How is Barrett’s Esophagus Treated?

Barrett’s esophagus may be treated in a number of ways. These include:

  • Surveillance. Your physician may opt for watchful waiting to see if and how your cells change.
  • Mucosal Ablation

    For this procedure, a physician uses a special probe to apply heat energy to diseased cells to destroy them and encourage healthy cells to replace them.

  • Radiofrequency Ablation with Barx ablation

    Heat energy is applied to any areas of intestinal metaplasia to destroy the cells and allow replacement with normal appearing esophagus cells.

  • Cryoablation

    Cryoablation, sometimes called cryotherapy, is a minimally invasive treatment used to destroy diseased cells in the esophagus caused by esophageal cancer and/or Barrett’s esophagus. For cryoablation, a physician inserts a small tube (endoscope) through your mouth and into your esophagus. Once the endoscope is in place, liquid nitrogen is sprayed through the endoscope into the esophagus. The liquid nitrogen freezes the lining of your esophagus. The frozen cells die and are replaced by healthy cells. Cryoablation is used to treat Barrett’s esophagus with high-grade dysplasia, and some early stage esophageal cancers. It can also be used to improve symptoms of advanced cancers. These symptoms include difficulty swallowing and bleeding.

  • Endoscopic Mucosal Resection

    Endoscopic mucosal resection, or EMR, is one of the newer, more minimally invasive techniques we offer for our esophageal cancer patients who have small tumors that have not spread outside of the esophagus. It may also be beneficial for patients with Barrett’s esophagus. In this simple procedure, we are able to locate, remove, and examine cancerous or precancerous lesions of the esophagus. The mucosa is the innermost lining of the esophagus, and it extends down into your gastrointestinal tract. Cancers in this tract often originate in the mucosa, thus making visualization and access to it essential for diagnosis and treatment.

The following lifestyle changes may be helpful in controlling reflux:

  • Eating smaller, more frequent meals
  • Controlling your weight and avoiding obesity
  • Raising the head of your bed 30 degrees
  • Avoiding lying down 3-4 hours after eating
  • Quitting smoking

Gastroesophageal reflux disease (GERD) is the most common gastrointestinal disorder in the United States occurring monthly, weekly and daily in 45%, 25% and 7% of the population, respectively. Gastroesophageal reflux occurs when the contents of the stomach back up into the esophagus and throat. GERD occurs when individuals with reflux (when stomach contents rise up into the esophagus) develop symptoms or injury to the esophagus.

SYMPTOMS

Common symptoms of GERD include heartburn and regurgitation of food into the esophagus and throat. Less common symptoms include upper abdominal pain, chronic cough, hoarseness, chest pain, sensation of a “ball” in the throat, asthma, sore throat, chronic sinus infections, vomiting and difficulty or painful swallowing. Worrisome signs and symptoms include unexplained weight loss, anemia, loss of appetite and bleeding (vomiting blood or tarry stools).

DIAGNOSING

GERD is usually diagnosed based on symptoms and response to treatment. A trial of lifestyle changes and a short course of over-the-counter (OTC) medication is often recommended for individuals with mild symptoms of acid reflux with no evidence of complications. Further testing may be indicated when symptoms fail to improve, if the diagnosis is uncertain or if an individual develops worrisome signs and symptoms.

Endoscopy is commonly used to evaluate patients with GERD symptoms. After sedation is administered, a small flexible tube with a camera known as an endoscope is passed into the mouth, tubular esophagus, stomach and the first part of the small intestine. The image is projected onto a monitor permitting detailed visualization of the gastrointestinal tract’s surface. During the procedure, specimens of the lining of the intestinal tract can be obtained to determine the extent of damage and to establish the diagnosis of certain diseases such as infections or tumors. Specialized instruments passed through the endoscope during the procedure allow diagnostic evaluation and therapeutic intervention. Dedicated endoscopes, such as the endoscopic ultrasound, permit the physician to determine the extent of tumor involvement and, in the case of early detection, perform complete endoscopic removal.

A 48-hour esophageal pH study is the most direct way to confirm the diagnosis of acid reflux. The test involves placement of a small capsule in the esophagus at the time of endoscopy. This capsule contains a pH-sensor which measures esophageal acid exposure during a 48-hour period that can be analyzed to confirm or exclude the diagnosis of acid reflux when the diagnosis of acid reflux is unclear.

Esophageal manometry involves swallowing a small tube that measures esophageal muscle contractions. This procedure can identify abnormal motility patterns of the esophagus and determine if the lower esophageal sphincter, which acts as a barrier to acid reflux, is functioning properly. In a similar manner, esophageal impedance is a procedure that can help determine if non-acid reflux may be responsible for the patient’s symptoms.

Complications of acid reflux include ulcers, strictures, lung disease, throat problems, and the precancerous condition know as Barrett’s esophagus. Barrett’s esophagus is found in 10% of patients with GERD. Periodic endoscopy is performed to monitor patients with Barrett’s esophagus. The most feared complication of GERD is the development of esophageal cancer, often seen in patients with underlying Barrett’s esophagus.

TREATMENTS

Treatment consists of lifestyle modifications such as weight loss, elevating the head of the bed, cessation of smoking, replacing tight clothing, eliminating foods which induce reflux, and also avoiding large, fatty and late meals. Many patients may require over-the-counter antacids such as Maalox, Mylanta and Tums, while others may obtain relief with drugs which decrease acid production known as histamine-2 receptor antagonists such as ranitidine (Zantac), famotidine (Pepcid), nizatidine (Axid) and cimetidine (Tagamet). The more effective acid decreasing medications know as Proton Pump inhibitors (PPI) include omeprazole (Prilosec, Zegerid), lanzoprazole (Prevacid), rabeprazole (Aciphex), pantaprazole (Protonix), esomeprazole (Nexium) and dexlanzoprazole (Dexilant). Some of the PPI formulations are available over-the-counter and are most effective if taken 30-60 minutes before breakfast.

Surgery is reserved for the rare patient who may not be able to take medications or has developed significant regurgitation despite lifestyle modifications. The most commonly performed procedure is the Nissen fundoplication. Although effective in a select group of patients, this procedure is associated with troublesome and often non-reversible post-operative symptoms such as abdominal bloating and gas, early satiety, diarrhea as well as surgical complications. In some studies, up to 65% of patients continue to require further acid reducing therapy despite successful surgery. Newer endoscopic approaches to the management of GERD are being developed for this group of patients.

Stomach Acid Levels and Weight-Loss

A lack of stomach acid production is one of the main reasons why so many people find weight-loss to be such an arduous task. When someone lacks stomach acid, they’re likely to suffer from a sub-optimal metabolism, struggle with blood sugar regulation issues, experience cravings, energy lows and sleep problems, and encounter a variety of other issues. All of these responses make it extremely difficult for someone with a lack of stomach acid to make the lifestyle shifts necessary to lose weight. Furthermore, while poor stomach acid production is a very common problem, it’s often overlooked by many healthcare practitioners. Addressing low levels of stomach acid can make a world of difference when it comes to facilitating weight-loss and cultivating a powerful and healthy body.

1 – What is stomach acid?

The stomach produces stomach acid to help break down and absorb the food we consume. Stomach acid activates important enzymes required for the digestive process and ensures optimal absorption of any nutrients, including proteins, vitamins, minerals and antioxidants. By helping everything get broken down properly, stomach acid also helps fight against the proliferation of bacteria in the stomach and gut – keeping us further balanced. An appropriate level of stomach acid is critical to a properly-functioning physiology and absolutely essential to regulating our body weight and promoting fat-loss.

2 – Symptoms potentially indicative of low stomach acid levels

  • Indigestion
  • Gas
  • Bloating
  • Stomach aches and pains
  • Pulmonary/esophageal/nasal/sinus mucous formation
  • Vertical lines on the nails
  • Manifestation of multiple allergies and intolerances

All of these symptoms are good indicators that the body lacks stomach acid. Although many of these symptoms may be considered “normal” because they’re experienced so often by so many people, their prevalence should by no means suggest they’re normal. These responses are messages from your body telling you something is wrong. Specifically, all of these symptoms are a sign of global inflammation. Inflammation equals breakdown. To restore order to the body, we have to stop this process by examining and treating the digestive system.

3 – Why do we need stomach acid, and how does a lack of it limit us? You are what you absorb!

Without proper stomach acid levels, nutrient absorption is hindered. Although some say we are what we eat, we are really only what we manage to break down and absorb. When our daily nutritional regimen lacks key nutrients, vitamins and minerals, these deficiencies begin to impact bodily functions, further perpetuating the physiological cycle of stress. Our digestive system further down-regulates, leading to a vicious cycle of less and less nutrient absorption and, in turn, greater and greater deficiencies. If we are looking to optimize our health, restore order to our body and lose weight, we must make it our top priority to regulate our stomach acid production.

4 – What causes low stomach acid levels?

It’s not surprising that most people tested end up scoring very low on their stomach acid evaluation. Psychological, emotional and environmental stressors (i.e.: poor food quality, harmful substances, lack of sleep, etc.) put our body into a state of chronic stress. The body essentially enters a “fight-or-flight” mode, in which we become sympathetic nervous system dominant. While this innate response to stress may be useful in a situation where we have to run from a lion, as a daily response, it contributes to the breakdown of our bodies. In a “fight-or-flight” state, the body does not prioritize digestion. Instead, it promotes the inhibition of stomach and intestinal operations, slowing down or halting the digestive process. Such a state also triggers fewer bowel movements, meaning toxins remain in the body for longer, which in turn results in the over activation of the immune system. All of these negative physiological consequences ultimately lead to continuous global inflammation in the body. This keeps the body in a chronic state of breakdown. The digestive symptoms outlined earlier are just the beginning of this dramatic downward spiral.

5 – Stomach acid and weight-loss

To optimize our metabolism, we must ensure that our body is secreting normal levels of digestive juices. Why? Stomach acid facilitates the breakdown and absorption of key nutrients essential to the elimination and detoxification of stored fat tissue. Any deficiencies will down-regulate the overall functioning of our bodies, decreasing our metabolic rate, triggering cravings and causing energy issues and problems with blood sugar regulation. All of these negative consequences impair weight-loss efforts. Luckily, stomach acid levels can be tested and assessed. By diagnosing low stomach acid, the healing process can be initiated to rebalance your body and restore physiological and biochemical order.

6 – How to fix low stomach acid levels

Fixing stomach acid levels is a multifaceted process. While stress is the primary and most important cause of poor stomach acid production, the existence of stress is itself a result of numerous lifestyle factors.

Stress is anything that burdens the body at a cellular level. For example, stress can include:

  • Psychological and emotional stress, brought on by your relationships, career, pursuit of success, etc.
  • Environmental stress (water, air etc.)
  • Poor quality food and beverages
  • Strenuous physical activities

To start the healing process, we have to reduce the stressors inflicting harm on us. Some practical ways to do this include:

  1. Eating a healthy and well-balanced diet
  2. Consuming lots of water to hydrate and detoxify the body
  3. Rotating our food sources for a variety of nutrients, vitamins, minerals and antioxidants
  4. Relaxing our bodies before bed by turning off electronics (computers, televisions, cellphone) 30-60 minutes before sleeping and engaging in a relaxation routine (hot bath, reading, meditation, etc.)
  5. Finding time for ourselves in general to relax and unwind
  6. Taking action to deal with the stressors of our lives head-on (changing careers and following our passions, addressing stressful relationships, etc.)
  7. Implementing supplement protocols to reduce inflammation in the body and promote the healing and functioning of the digestive system (for example, good quality, absorbable probiotics, glutamine supplementation, etc.)

* Always consult with a qualified healthcare practitioner before engaging in any type of supplement protocol

Conclusion

The body is made up of many interconnected systems. We cannot look at any one symptom in isolation — we have to look at the body as a whole. Just like the abdominal region is the physical core of the body, bridging the upper and lower body, the digestive system is the core of our physiology. It’s the bridge between the food we consume and the nutrients we absorb for daily functioning. Any deficiency in this physiological core will result in deficiencies in the rest of our bodies. By addressing digestive problems, you’ll sleep better, have more energy, experience less cravings, improve focus, boost your metabolic rate and expedite weight-loss. Stomach acid is truly the weakest link in the chain of health for many people. If you’ve never had your stomach acid levels tested, booking an evaluation could be the first step towards restoring balance to your body and getting those weight-loss results you’ve always wanted. For more information, please contact us.

Obesity & Heartburn: What is the Link?

by Nancy Kushner, MSN, RN, and Robert Kushner, MD

Winter 2013

To view a PDF version of this article, click here.

New research points to an association between obesity and heartburn. Studies have shown that weight gain and an increase in the size of one’s belly may either cause or worsen this condition.

Heartburn, also called GERD (gastroesophagael reflux disease), occurs when stomach acid flows back into the esophagus, which is the food pipe that connects the throat and stomach. Heartburn symptoms often occur shortly after eating and can last for a few minutes or even hours. People may complain of a burning sensation in the chest or throat, a sour or bitter taste in their mouth or even cough symptoms.

This association seems to be stronger in women and in the white population as compared to men and other ethnic groups. The increased risk of GERD is thought to be due to excess belly fat causing pressure on the stomach, the development of a hiatal hernia that causes the backflow of acid or hormonal changes like an increase in estrogen exposure that can occur in individuals who are affected by obesity.

Why is this important?
As acid flows back into the esophagus, it can cause irritation and inflammation. Throughout time, complications can develop. The esophagus can narrow, leading to a stricture and swallowing problems. A sore or ulcer can develop which can bleed, be painful and make swallowing difficult. Additionally, precancerous changes can occur to the esophagus, called Barrett’s esophagus, which is the main risk factor for developing esophageal cancer.

It turns out that obesity is associated with three related esophageal disorders: GERD, Barrett’s esophagus, and esophageal adenocarcinoma. The risk for these disorders seems to progressively increase with increasing weight. The goal of treating GERD is not only to decrease bothersome GERD symptoms but also to decrease one’s risks of developing these other, more serious esophageal conditions.

What can you do?
The most effective lifestyle interventions to reduce GERD symptoms are losing weight and, if symptoms occur during sleep, elevation of the head of the bed.
New research shows that weight-loss can improve GERD symptoms. In a recent study published in the journal Obesity in 2012, the majority of individuals who were overweight or affected by obesity who enrolled in a structured weight-loss program including dietary, physical activity and behavioral changes, experienced complete resolution of their GERD symptoms. The relationship between weight-loss and resolution of symptoms was dependent on the amount of weight lost, such that the more weight subjects lost, the greater improvement they saw in symptoms. Whereas women saw improvement in GERD symptoms after losing 5 to 10 percent of their weight, men experienced improvement after losing 10 percent of their weight.

In another study published in the journal Gastroenterology in 2010, weight-loss through restriction of calories and increased physical activity also demonstrated a significant improvement in participants’ symptoms of GERD. Most importantly, follow-up at 6, 12 and 18 months showed decreases in abdominal fatness and symptoms of heartburn and acid reflux. Reduced GERD symptoms means lower acid levels in the esophagus. Thus, another benefit to losing weight is that patients may be able to eliminate or reduce their over-the-counter (OTC) or prescription GERD medications.

Though improved GERD symptoms has also been shown in patients who undergo bariatric surgery, it is difficult to know if improvement is due to the anti-reflux nature of the surgical procedure or to the weight-loss itself.

There have also been studies on the effectiveness of elevating the head of the bed to decrease GERD symptoms. Compared with patients who slept flat, patients who elevated the head of the bed did have less esophageal acid exposure and fewer reflux symptoms. Studies show that this can be an effective strategy for some patients. You can elevate the head of the bed using wood or cement blocks under the legs of your bed or using wedges between your mattress and box spring.

Effectiveness of Other Life-style Modification Measures
The list of foods, drinks and other factors thought to worsen GERD symptoms is quite long and includes:

      • Tobacco
      • Alcohol
      • Carbonated beverages
      • Caffeine
      • Chocolate
      • Onions
      • Garlic
      • Spicy foods
      • Cooked tomato sauce
      • Mint
      • High-fat meals

The data studying these items is conflicting. More research is needed to determine the effectiveness that stopping smoking or eliminating the listed foods and drinks will have on GERD symptoms. It is recommended to pay attention to see if any of the listed items seem to worsen your condition. If so, you can decrease or eliminate them and see if symptoms improve.
Other Helpful Lifestyle Measures

      • Eat smaller meals.
      • Wear clothes that are looser around the waist.
      • Don’t lie down for at least three hours after eating a meal.

Medication Therapy
OTC and prescription medications are available to treat GERD. Ask your healthcare provider for guidance when seeking a medication treatment plan to control your symptoms. OTC medication options include antacids (Mylanta or Tums) that neutralize stomach acid; H2 blockers (Tagamet or Pepcid) that reduce stomach acid; and proton pump inhibitors (Prevacid or Prilosec) that also block stomach acid and allow the esophagus to heal. Prescription strength H2 blockers and proton pump inhibitors are also available. Combining medications can sometimes increase effectiveness.

Like all medications, GERD medications can have side effects and can interact with other drugs, so it’s important to discuss this with your healthcare provider. Be sure to talk about what and how much medication you are taking, the effects on your GERD symptoms and any side effects you are experiencing. The goal of medication therapy is to relieve GERD symptoms, allow the esophagus to heal and prevent GERD complications.

Conclusion
If you think you are experiencing heartburn (GERD) symptoms, it is important to discuss these symptoms with your primary care provider. Together, you will be able to identify an effective treatment plan.

About the Authors:
Nancy Kushner, MSN, RN, is a nurse practitioner, health writer and co-author of Dr. Kushner’s Personality Type Diet and Counseling Overweight Adults: The Lifestyle Patterns Approach and Toolkit.
Robert Kushner, MD, is Clinical Director of the Northwestern Comprehensive Center on Obesity in Chicago, Professor of Medicine, Northwestern University Feinberg School of Medicine, Past President of The Obesity Society, author of more than 160 scientific articles on obesity and nutrition, author of Dr. Kushner’s Personality Type Diet, Counseling Overweight Adults: The Lifestyle Patterns Approach and Toolkit and Fitness Unleashed: A Dog and Owner’s Guide to Losing Weight and Gaining Health Together.

Got heartburn? Excess weight may be to blame

Are you suffering with serious heartburn? If so, your weight might have something to do with how you’ve been feeling — and how you can feel better.

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Gastroesophageal reflux disease, or GERD, is a common digestive disorder that can affect people of all ages. As recent studies continue to confirm the longstanding link between excess weight and GERD, soaring obesity rates are likely to lead to an increasing number of Americans who are affected by this disease.

The severe, frequent heartburn of GERD occurs when the muscle that acts as a valve between the esophagus and stomach doesn’t work properly, allowing stomach acids to back up into the esophagus, which can damage tissue.

One 2006 analysis of 20 studies, including more than 18,000 patients, showed that in the United States being overweight increased odds of developing GERD by more than 50 percent. Being obese more than doubled the odds.

Among more than 10,000 women analyzed in the Nurses’ Health Study, weight gain of more than about 10 to 20 pounds was linked with almost tripling the development of frequent heartburn symptoms.

The link between being overweight and risk of GERD is not new, but research is beginning to explain why it occurs. One recent study measured pressure within the stomach and found that each increase in body mass index (a measure of weight status) that corresponded to about a 10- to 20-pound weight jump was linked to a 10 percent increase in stomach pressure.

Researchers suggest that excess body fat, particularly around the abdomen, increases pressure in the abdomen, which in turn increases pressure in the stomach. The pressure to the stomach pushes the sphincter muscle between the stomach and esophagus to open. Overeating might also increase that pressure, and so can pregnancy.

Frequent heartburn can be serious
A report in the Journal of the American Dietetic Association on nutrition’s involvement in indigestion and heartburn noted that certain spices and acidic food and drink may cause pain in an esophagus already raw from stomach acid reflux. But these foods may take the blame for episodes that really are due to excessive portions.

Studies have also suggested that fatty foods may increase the tendency for reflux, yet research on fatty foods is unclear. In one small Italian study, for example, the total calories of meals increased the tendency for reflux over the next six hours, while raising fat content didn’t increase reflux if total calories remained the same.

With all the jokes about heartburn, it’s easy to regard it as just an uncomfortable inconvenience. Scientists say, however, that although occasional heartburn is not a worry, frequent heartburn can lead to serious complications if left untreated.

GERD is an established risk factor for esophageal adenocarcinoma, a type of esophageal cancer that has increased approximately 600 percent since 1971. If both obesity and GERD are present, the risk of this kind of cancer increases even more than seen with GERD alone.

There are a wide range of medications available to treat heartburn, some of which can be used together. If heartburn occurs several times a week, see your doctor. If the cause of heartburn is unhealthy eating habits or excess weight, it is probably hurting your health in other ways too.

Instead of trying to make unhealthy eating tolerable, it may be time to develop better eating habits and shape up to a healthy weight to reduce GERD and risk of esophageal cancer.

© 2013 MSNBC Interactive. Reprints

When we respond to most questions we almost always add a recommendation to manage weight “down” to a healthy level. However, for some adults suffering from acid reflux, it is difficult to eat and they struggle to keep their weight up at a safe and healthy level. The reader asking the question below lost 12 pounds, resulting in a BMI score of 20. In our response we offer several suggestions to stop the weight loss and return to an ideal target weight.

Your question:

I was diagnosed with GERD two years ago and I’m still suffering. The biggest concern is my weight; I went from 150 lbs. to 138 lbs. My height is 5’9 my trigger foods are fried fatty foods, dairy, and wheat. I used to eat two times a day, now it’s three times a day. No snacks between meals and I eat four hours before bedtime. Most symptoms develop at night. Sometimes I get nausea and vomit after meals. What can I do to maintain my healthy weight so I won’t lose any more weight?

RefluxMD response:

Thank you for your question. It is common for GERD sufferers to also have dyspepsia, or nausea in the stomach. Although that can lead to vomiting, this symptom is less common. You mentioned that dairy and wheat are foods that trigger symptoms for you, which suggests you may have food allergies. You should consider discussing this with your doctor and determine if you are allergic to any other foods as well. Also ask your doctor about several other potential conditions that can cause nausea, such as gallbladder disease, ulcers and gastroparesis (slow emptying of the stomach). Once these are ruled out, you can begin to focus on how and what to eat to gain weight.

Gaining weight while struggling with GERD

Our GERD-friendly food plan and diet program, RefluxMD’s Recipe for Relief, has many elements that can assist you in your mission. Although most adults suffering from acid reflux struggle with excessive weight, the principles to gaining weight are just the opposite of those required to lose weight: increase the number of calories consumed compared to the calories burned in daily activity. This is the simple truth for any weight gain diet. In section III of our book we outline a step-by-step approach to developing the proper caloric targets to manage your weight.

Know your BMI and target BMI.

BMI is body mass index, and your current BMI is 20.3, which is low. Your prior BMI of 22.2 at 150 pounds is healthy, and you should target a healthy BMI for yourself (24 or under for anyone that suffers with GERD) and set that as your goal.

Know how may calories you burn.

Many online calculators can estimate the number of calories burned based upon your age, gender, height, weight and activity level. For example, a 6’2” sixty year old male who is active (30-minutes of moderate activities most days of the week) will, on the average, burn approximately 2,850 calories daily.

Establish a target weight gain per week.

Let’s assume a target total weight gain of 20 pounds to achieve a final weight of 158. We recommend a safe weight gain of 1 to 2 pounds per week. Assuming 1 pound of weight gain per week, it will take 20 weeks (+/- 4 weeks) to achieve your goal, adjusted for outside circumstances.

Develop your calorie consumption plan.

To gain 1 pound per week you will need to add an additional 3,500 calories more each week (500 calories a day) to your current diet. I realize this may seem difficult, but you might try eating more frequent and smaller meals during the day, eating slowly, and drinking liquids in between meals.

With this as your tactical plan, you should track everything you eat, determine the calorie total of each, and compute the total number of calories you consume each day and each week. Only track your weight every 2 or 3 weeks and make adjustments along the way based upon your progress, as well as for any changes in your activity level.

Diet modifications to consider with a weight gain diet

You should make some changes to your diet to begin gaining weight. If you feel uncomfortable doing this, please consider consulting with a dietician to help you develop a more detailed program. We were very impressed with Kimberly Tessmer, RDN, LD who founded Nutrition Focus and who participated with RefluxMD on our book. Try to substitute low calorie foods for calorie-dense foods. Here are some suggestions for you to consider:

  • Eggs
  • Mixed nuts
  • Peanut butter
  • Avocados
  • Salmon
  • Yogurt
  • Oat cereals with almond milk
  • Spinach
  • Dried fruits
  • Broccoli
  • Apples

I also suggest you consider having a smoothie each day (we offer 8 different smoothie recipes in Recipe for Relief), use almond milk (more protein than milk), and consider adding protein powder as well. Also, meats such as chicken and turkey breast offer a good dose of protein. I would also minimize alcohol and sugar in your diet whenever possible.

We also recommend that you learn more about how to develop a GERD-friendly diet by reading our article, the five steps to an acid reflux diet.

Minimize nighttime symptoms

Since your symptoms appear worse at night vs. the daytime, here are few things you might also try

Raise the head of your bed by 7 inches.

This will make gravity your friend as you attempt to keep the contents of your stomach in your stomach.

Drink alkaline water.

Drink alkaline water just prior to going to bed and keep some close by for access during the night. You can buy this type of water at most grocery stores and it will be labeled as having a pH of 9 or greater.

Do not eat nighttime snacks.

You report eating early, so keep that up, and avoid the temptation to snack after dinner.

Avoid YOUR trigger foods.

You may have more than you think (chapter 15 in Recipe for Relief offers a good list), so keep a food log and track your symptoms to identify any other trigger foods (chapter 18)

Try several of the home remedies (chapter 11).

Many of our members report excellent results with these foods and beverages that can typically be found in your pantry at home.

Antacids, H2 blockers, and proton pump inhibitors (PPIs)

Consider adding an antacid or H2 blocker as necessary. Our medical advisors recommend using the lowest strength antireflux medication required for satisfactory symptom relief. We do not encourage the long-term use of PPIs daily, but intermittent use daily for a week or two at a time does not increase your risk of the many potential side affects associated with these drugs. Dr. Tom DeMeester, one of the top global experts on this disease, wrote an important article that you might find interesting, The warning on the label says use for 14 days.

I hope this helps!

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Please note, RefluxMD does not provide medical advice. This content is provided for informational purposes only and should not be used as a replacement for direct medical advice from your health care provider. See our Terms of Use for more detailed information.

A 30-Pound Weight Loss and Portion Control Tamed My Heartburn

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At first I barely noticed I had gastroesophageal reflux disease, a condition in which stomach acid backs up into the esophagus. I had problems with acid reflux only if I ate a really big meal. It was a little weird—it felt like I couldn’t keep food down—but it would go away; when I ate a normal meal, I didn’t have any problems at all. Then it started to get worse. Eventually it got to a point where drinking a glass of water would trigger acid reflux. On a vacation with my then-fiance—now my wife—I was in pain the entire time we walked back to our hotel after dinner. That was the last straw. My fiance told me I had to see a doctor; this was a serious problem.
Heartburn-Easing Foods That Fight GERD

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  • 7 Surprising Heartburn Triggers
  • 7 Daily Habits That Curb Acid Reflux

I had never heard of GERD before my doctor told me I had it, and I didn’t really know anything about acid reflux. The doctor prescribed omeprazole (Prilosec), one of many medications called proton-pump inhibitors that reduce the amount of acid in the stomach. Prilosec works great for some people, but in my case it only reduced the acid reflux, it didn’t stop it completely. I had less pain, but I still had acid reflux—it was still unpleasant.

What’s scarier than daily pain? No coffee
Even worse was the doctor’s next recommendation—he told me I could have two servings of caffeine a day, at most. That was a shocker: I wanted to say to him, “I already don’t drink, smoke, or do drugs, and now I can’t have my coffee?” I work in public relations, a high-pressure job with long hours—how was I supposed to function without coffee? But somehow I got in the habit of having only two cups of coffee a day, as opposed to five or six servings of caffeine. I gave up Indian food too. Luckily, I didn’t have GERD to the point that I couldn’t sleep at night. And if I had acid reflux at work, as impolite as this sounds, I was able to turn away for a few minutes, swallow, and get myself back under control. Some people are constantly vomiting; I was lucky my GERD wasn’t that bad.

Since the heartburn medication wasn’t completely curing my acid reflux, my doctor performed endoscopies—a procedure in which a lighted scope is used to examine the stomach—a couple of times over the years. Untreated GERD can cause damage to the esophagus, which over time might lead to esophageal cancer. Luckily, he didn’t find much damage.

Because there wasn’t a lot of damage, my doctor said he was hesitant to perform surgery to correct the GERD. In addition, GERD surgery doesn’t always work that well. He said it could be used to tighten the valve that connects the stomach to the esophagus, but said I didn’t really need it.

Next Page: As the extra pounds disappeared, so did GERD

As the extra pounds disappeared, so did GERD
I switched from Prilosec to Nexium when my insurance changed. I tried the over-the-counter Prilosec, but that wasn’t as effective.

I was resigned to the fact that I just had to live with my less painful—but still present—acid reflux. Then I decided to join Jenny Craig in December of 2008.

I cut down from 1,700 calories to 1,500 calories a day, and then to 1,200 calories a day. I lost 30 pounds, dropping from 180 pounds to 150 pounds. I noticed that I was having acid reflux less and less often, and eventually the reflux completely stopped.

There were so many foods I wasn’t supposed to eat, but I realized that they didn’t seem to trigger acid reflux anymore. Now I drink coffee whenever I want, I ate a ton of chocolate at Easter, and I can order spicy food at a Chinese restaurant—none of my old triggers bothers me anymore. As long as I keep the portions under control, I never have any GERD symptoms.

I still take Nexium as a precaution, but I actually forgot to take it this morning and haven’t really noticed. Some days are harder than others to stick to my diet, but it’s worth it to me not to be overweight. And the acid reflux cure—well, that was just a pleasant surprise!

What can I do?

1) Don’t exercise immediately after eating

Make sure you leave around two hours between your last meal and a period of exercise.

2) Avoid high-carbohydrate sports drinks

Because of the acidic nature of these drinks, they can be a causative factor for heartburn symptoms. Drinking water will mean you are much less likely to induce heartburn.

3) Avoid common food triggers

There are certain foods which can trigger heartburn, especially spicy, or rich and fatty foods like curries and acidic based sauces. Most frequent sufferers will know their triggers, so it’s best to avoid these all together, especially before taking exercise.

4) Re-evaluate your heartburn treatment

Many OTC treatments, such as antacids and alginates, only provide short-term relief, meaning heartburn symptoms can come back; frequent sufferers report having to treat an average of more than four times per day to find relief. For some people, re-evaluating their treatment choice can help them achieve longer-term protection against the symptoms. Nexium Control® can provide 24- hour protection from the symptoms of heartburn with just one tablet per day for up to 14 consecutive days.

5) Don’t give up

In the long term, exercise and the resulting weight loss will help decrease your likelihood of experiencing heartburn. Carrying extra weight puts more pressure on the valve between the food pipe and the stomach, which causes acid to leak upwards from the stomach, triggering symptoms.

GERD Weight Loss Tips

This Article is Written and/or Reviewed by RefluxMD Medical Authors Team and Reviewers

Acid reflux is more than uncomfortable. Prolonged bouts can lead to serious health concerns such as an inflamed esophagus and respiratory issues. As we highlight in our article, How excess weight is destroying your LES and driving your GERD symptoms, obesity is not only responsible for GERD symptoms, but it can also be an important factor in disease progression.

Maintaining a healthy BMI (body mass index) is an important part of managing or eliminating GERD symptoms, and medical research has validated this fact. Because weight loss is a difficult process, many people need a GERD weight loss plan to achieve and maintain a healthy BMI of 19 to 24. (calculate your BMI online)

If you are considering a GERD weight loss plan, we have developed some tips to help you get started and to minimize or eliminate acid reflux symptoms.

The more tips you can put into action, the more success you will have with your BMI, and the less you’ll experience the discomfort of acid reflux.

Tip #1 – Eat smaller meals

The stomach is a remarkable organ. It can expand to accommodate as much food as you put in it. But not without consequence. An overstretched stomach can’t easily contract. A full stomach slows digestion and keeps acid levels high for a longer time than normal.

To avoid having the acid regurgitate up into the esophagus, eat small amounts at each meal. The best way to know what “small” means, is to make a fist and try to limit meal portions to that approximate size.

If you reduce your meal portions, you should also consider eating three small meals and 2 or 3 small “healthy” snacks daily. Eating every 2 to 2.5 hours will help you avoid hunger pangs that trigger overeating, and help keep your blood sugars in balance.

Tip #2 – Eat fewer calories

This tip differs from #1 because it’s about the energy contained in the food you eat, not the volume. Eating fewer calories forces your body to draw some energy from reserves (fat cells) to keep you going. Avoid a starvation diet since it works against burning those reserves. Likewise, eating too many calories from carbohydrates will slow the process of burning those reserves.

Reducing your daily intake of calories to a healthy level is key to a successful GERD weight loss plan. The definition of a healthy level varies based on age, gender and activity level. We recommend using the “GOAL” tool in MyBusinessPal, which determines the number of calories to consume daily based on these factors as well as the rate of weight loss desired.

Computing your ideal daily calorie intake is a critical first step in any GERD weight loss plan. Without that information, you might ease some of the discomforts of GERD short-term, but you won’t achieve long-lasting results.

Tip #3 – Give yourself three hours between eating and bedtime

Digestion relies on chemical processes, but it isn’t immune to gravity. When you lie down, the contents of your stomach will level out horizontally. That increases the risk of food and digestive juices slipping back into the esophagus and causing reflux for those with a weak lower esophageal sphincter. To illustrate this, imagine if you have a partially-filled juice jug with a narrow neck. When it’s upright, the contents stay at the bottom. But when you lie it on its side, the juice can also fill the neck, depending on how full the jug is. (Another reason to eat smaller meals!)

The reason for the three-hour delay before bedtime has to do with the average time for food to digest for most adults. Of course, that depends on the foods consumed, but in most cases, that’s how long it takes for approximately half of your meal to move from your stomach into the small intestines, and four to five hours for total emptying. (see gastric transit)

Another idea that may help reduce nighttime symptoms and reduce the chance of disease progression is to sleep on your left side as much as you can. The stomach wraps under the lung on the left side and gravity will help keep the stomach contents in that pocket. If that is difficult for you, we suggest you consider a unique wedge that inclines the upper torso and encourages sleeping on the left side.

Tip #4 – Eat slowly

No matter what’s on your GERD weight loss menu, eat it slowly. There are two benefits to developing this habit.

One benefit is that you’ll chew your food more thoroughly. That will improve the ease of digestion and shorten the digestion cycle. Small pieces of food mean less acidic digestive “juices” are required.

Another benefit of eating slower is that it allows your brain time to register the stomach’s signals of satisfaction. On average, it takes about 20 minutes after the stomach is full before the brain receives that signal. There is a high correlation between eating fast and overeating.

Tip #5 – Stay away from “trigger” foods

All GERD weight loss plans recommend avoiding acidic or acid-producing foods. These are also known as trigger foods.

Foods that commonly cause or aggravate GERD are “hot” (as in spicy) or high in either saturated fats and trans fats. Other trigger foods include coffee (even decaf); tomatoes and tomato products; chocolate; alcohol; carbonated beverages; and excessive refined sugar. Many people also need to limit or eliminate their intake of citrus and mint.

Tip #6 – Eat helpful foods

When planning your GERD weight loss menu, try to incorporate alkaline foods such as avocado, olives, bananas, and eggs. If you can digest dairy products, you can add a limited amount of cheese to that list.

Alkaline foods provide a natural balance to the acid in other foods and well as stomach acids. Also, avocados and olives have monounsaturated and polyunsaturated fats which can provide additional health benefits.

Tip #7 – Walk after eating

This tip helps you follow your GERD weight loss plan in several ways. First, it makes it easier to act on Tip #3 which says to not lie down after eating. Second, knowing that you have to go for a walk after lunch or dinner can prevent you from overeating. And, if you do overeat, it can help ease the discomfort of a distended stomach and acid reflux.

The third way walking can assist you with your weight loss goals is by aiding digestion. There is evidence that walking after a meal accelerates the rate at which your meal leaves your stomach for the small intestine.

Walking can help you stick with your weight loss plan since a 30-minute walk at a 3.5 mph rate will burn approximately 165 calories, and increasing that to a 4.0 mph pace can burn up to 220 calories. It can also increase your metabolism and help you burn extra calories when you are not exercising. Walking also strengthens your cardiovascular and musculoskeletal systems and helps keep blood sugar levels in check, which helps combat those hunger pangs.

If You Need Some Additional Help

Getting your weight and BMI into a healthy range is one of the safest and natural ways to reduce your GERD symptoms. In addition to these seven tips, we encourage you to read 5 steps to an effective acid reflux diet.

The truth is that it’s seldom easy to do. But through our weight management program, our team of health coaches has worked with thousands of people who have succeeded. Yes, calorie reductions, food programs, and exercise are the keys to achieving and maintaining a healthy BMI. However, the “secret sauce” in the process is a talented, knowledgeable, and committed health coach to provide instruction, motivation, and support. We hope you will consider Scale Down for Relief and allow RefluxMD to be your partner.

No matter where you are on your journey to reduce your weight and gain control over GERD, we are here to answer questions and offer support.

Good luck on your journey! It will be worth it!

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