5 Surprising Things Triggering Your Acid Reflux
Think getting rid of heartburn is just a matter of changing your diet? Unfortunately, it’s not that simple. While diet plays an important role, there are several other, seemingly unrelated risk factors that can cause acid reflux symptoms to flair up and stick around, and ignoring them is one way people get stuck in the vicious cycle of reliance on dangerous acid-blocking medications. Here are 5 often overlooked factors that may be responsible for your acid reflux.
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Risk Factor #1: Being Overweight
Being overweight is not good for your health by any stretch of the imagination, and there are particular risks associated with carrying weight around the midsection. It’s well known in the medical and scientific community that abdominal obesity contributes to heart disease, inflammation and diabetes and is much more dangerous than weight concentrated in other areas of the body. This is often described as the apple shaped body (heavy in the mid-section and thin in the buttocks, thighs and hips) vs. the pear shaped body (thin in the mid-section but heavy in the buttocks, thighs and hips).
As it relates to acid reflux and GERD, increased abdominal mass contributes to significantly more intra-abdominal pressure. This puts more pressure on that very important muscle structure called the lower esophageal sphincter (LES). The LES is the primary barrier that prevents acid from refluxing out of the stomach up into the esophagus. More pressure on the LES increases the likelihood of acid refluxing into the esophagus and causing acid reflux symptoms. It’s for this reason that many people have a complete resolution of their acid reflux symptoms when they lose a significant amount of weight.
Now, thin people are not immune to symptoms of acid reflux, so clearly this is not the only factor involved, but it can be a contributing factor and needs to be considered if you are very overweight in the midsection.
Since being overweight can contribute to increased intra-abdominal pressure and more stress on the LES resulting in reflux, it makes sense to categorize lifestyle habits associated with weight gain as a risk factor for developing these symptoms. A sedentary lifestyle with little to no activity or exercise certainly contributes to weight gain, as does eating a diet abundant in highly processed and calorie-dense foods, so both of these behaviors can be considered modifiable risk factors for acid reflux.
Risk Factor #2: Smoking
Cigarette smoking is a major contributor to acid reflux and GERD symptoms. Several mechanisms have been proposed and studied in relation to this correlation. A 1990 article published in the journal Gut looked at various studies to better understand the direct correlation between cigarette smoking and acid reflux. The study authors found that smokers had significantly weaker LES muscle tone than non-smokers.
As I mentioned, this important muscle structure is the primary mechanism by which our body keeps acid in the stomach and out of our esophagus, and when it’s compromised, reflux symptoms arise. In addition, it was noted that most reflux events in smokers happened during coughing and during deep inhalation. When you cough or breathe deeply, your abdominal pressure increases and puts more pressure on the LES as it tries to contain stomach contents below the diaphragm. Smokers certainly cough more due to the irritating nature of cigarette smoke and often breathe deeply when inhaling smoke. This, combined with a weaker LES, is a perfect recipe for acid reflux.
Here again is a perfect example of how many instances of acid reflux are not caused by too much acid. They are caused by a breakdown of the natural systems designed by the body to properly manage that acid.
Risk Factor #3: Being Under Stress
Most people are well aware of the age-old connection between stress, stomach ulcers and acid reflux. While stress alone rarely causes reflux symptoms, it can be a significant trigger in susceptible individuals, and when combined with other factors, it can be the straw that breaks the proverbial camel’s back.
Stress Hormones Deliver a Double Whammy for Reflux Sufferers
The adrenal glands release the hormone cortisol in response to stress. People who are under constant high levels of stress release more cortisol than the average person in the course of the day. So what is the connection between cortisol and acid reflux?
Several studies have shown that stress and the hormones associated with it, like cortisol, result in the overproduction of stomach acid. More acid means that the protective mechanisms of the stomach lining are under more stress, which makes it more likely that the acid will come in contact with the delicate tissue of the esophagus.
Cortisol also affects the production of chemical messengers in the body called prostaglandins. One role of these chemical signals is to trigger the production of the mucosal secretions that protect the stomach and esophagus from acid. As stress hormones suppress prostaglandin production, the stomach and esophagus begin to lose their protective coating and acid begins to create damage. So as you can see, cortisol packs a double punch when it comes to acid reflux, and using therapies to reduce stress is often key to reducing symptoms.
Risk Factor #4: Eating Trigger Foods
It’s no surprise that foods can have an impact on a condition centrally located in the stomach and esophagus. While some foods will just aggravate an already inflamed situation (think spicy or acidic foods), other foods can contribute to problems with the LES or create immune and inflammatory responses that trigger symptoms. Because everyone is unique, everyone has different triggers for heartburn. Consider keeping a food journal—a list of the foods you ate, including how much and when you ate them, and how you felt afterwards. This will serve as a valuable tool for figuring out what your problem foods are.
Let’s first take a look at some of the foods most commonly associated with acid reflux. This list includes foods that either directly irritate the tissues or decrease LES muscle function.
Food Why It’s a Potential Trigger
|Citrus||Has a high acid content|
|Coffee||Has a high acid content and weakens the LES muscle|
|Spicy Foods||Irritating to damaged tissue|
|Fried Foods||Slows stomach emptying and increases pressure on the LES muscle|
|Garlic and Onions||Contains compounds that can irritate damaged tissue|
|Peppermint||Weakens the LES muscle|
|Tomatoes||Has a high acid content|
|Chocolate||Weakens the LES muscle|
|Alcohol||Irritating to damaged tissue and weakens the LES muscle|
The timing of when you eat can also affect symptoms of acid reflux. Eating a large meal late at night increases the risk of symptoms, because lying down with a large amount of food in your stomach increases the pressure on the LES and increases the chances of food or acid refluxing up. In addition, if that meal was high in fat, the food will sit in your stomach longer, increasing the pressure for a greater period of time. Fat slows the emptying of the stomach into the small intestine, and as a result, increases the amount of time the food stays in your stomach.
Risk Factor #5: H. Pylori Infection
One of the most well recognized causes of stomach problems is the presence of an infection called Heliobacter pylori, or H. pylori. It’s most often associated with the formation of stomach ulcers, but its presence can create enough irritation in the stomach that it can cause reflux symptoms. The idea that this common infection can cause reflux is somewhat controversial, but more and more clinicians and researchers are seeing connections between this diagnosis and reflux symptoms. Some of the controversy revolves around the fact that of the estimated 50% of people in the world who are infected with H. pylori, 85% never experience symptoms.
Using acid-blocking medications can increase the rates of initial H. pylori infection and worsen already established infections. There’s also evidence to suggest that taking an acid-blocking medication can increase the risk of developing a condition called atrophic gastritis in those infected with H. pylori. Atrophic gastritis is a process by which the normal cells of the stomach are replaced with fibrous tissue resulting in the impaired secretion of essential stomach substrates like hydrochloric acid.
Further research is needed to fully understand the implications of H. pylori infection, but having your doctor run a blood antibody test for H. pylori, in addition to a breath test, may be worthwhile. The gold standard is a stomach biopsy, but this is very invasive, so the blood and breath tests are great places to start and can reveal important information.
The standard treatments for H. pylori are strong antibiotic therapies, which I don’t recommend, unless it is clearly established that an infection is present. For those individuals with persistent reflux issues that are resistant to typical approaches involving lifestyle, diet and natural supplements, I will often recommend that we do a trial H. pylori eradication, even if lab tests are negative. In these cases, I use only natural therapies, which we will review in Chapter 7. I reserve antibiotic therapy only for those who have a clearly established infection, and even in those cases, natural therapies are sometimes preferred and more effective due to the fact that this organism is becoming highly resistant to antibiotic therapy.
The common theme behind all of this is that the causes of acid reflux can be complicated, and masking these other conditions with dangerous, acid-blocking medication can only worsen acid reflux symptoms and increase reliance on drugs that come with a host of health complications.
To learn more about the real dangers of acid reflux medications and get the acid reflux-eliminating plan that I’ve successfully used with hundreds of my patients, click here.
Dr. Passero completed four years of post-graduate medical education at the National College of Naturopathic Medicine in Portland, Oregon after receiving a Bachelor’s Degree in Environmental Biology from the University of Colorado. Dr. Passero has trained with some of the nation’s leading doctors in the field of natural medicine. In his practice, Dr. Passero focuses on restoring harmony to both the body and mind using advanced protocols that incorporate herbal therapy, homeopathy, vitamin therapy and nutritional programs. Through education and guidance patients are able to unlock the natural healing power contained within each one of us. For more information, visit his website, Green Healing Wellness, or follow him on Facebook.