I am frequently confronted with questions about reflux, heartburn or Gastroesophageal reflux disease (GERD).

Many times this condition is caused by a hiatal hernia, lifestyle problems, or a bacterial infection caused Helicobacter Pylori.

Hiatal Hernias occur when your stomach slides upward above your diaphragm which is a low pressure area.  The junction between the esophagus and stomach has many names; gastroesophageal junction, cardiac sphincter, lower esophageal sphincter.  Some consider it a valve and others do not.  Either way, when the junction between the esophagus and stomach lies above the diaphragm the acid in the stomach tends to spill or propel upward into the esophagus that is not built to withstand the erosive nature of the acids.  This will cause ulcerations, erosions, heartburn pain and can lead to cancerous conditions such as Barrett’s esophagus. 

Lifestyle issues mostly relate to diet and weight.  Weight gain, a waist size over 40 inches for males or 35 inches for females ( I know, no fair ) will increase the pressure pushing the stomach upward through the hernia. 

Helicobacter pylori is a bacteria that lives in the stomach.  It seems amazing that a bacteria can survive in such an acidic environment.  Treating this with medications for acid suppression don’t seem to help much, more acid is thought to help destroy the bacteria.  There are antibiotic regimens that are designed to eradicate the infections and blood testing, endoscopies and breath tests to help diagnose.

Treatment has traditionally been focused on using medications called proton pump inhibitors ( PPI ) to reduce the acid that spills upward.  These can be dangerous medications for some, and they really only treat the symptoms of the acid.  PPI medications can cause diarrhea, prevent acid from killing bacteria that enters the stomach, increase bacterial pneumonia, increase hip fractures, and interact with medications even making plavix less effective in heart attack and stroke prevention.  Once you start them, they are difficult to stop as there is some rebound of symptoms.  This has occurred more lately as insurance companies are being more difficult in providing them as they have become available over the counter.  If you want to stop these medications it takes time.  You’ll have to reduce the dose slowly over months, then transition to an H2 blocker like pepcid, zantac, then stop.  There are lifestyle changes that can help you do this:

Eliminate food triggers: Food allergies, mild allergies or lactose intolerance which would require eliminating lactose.  Eliminate caffeine, alcohol, nicotine as these stimulants reduce the function of the “valve” and increase reflux. 

Eat healthy foods, eliminate processed foods and table salt (sea salt or “Himalayan salt” is an alternative if you do not have high blood pressure).  Substitute with vegetables, organic foods especially locally grown over grocery store, fruits. 

Probiotics, yogurts and other fermented foods can help (such as fermented soy, avoid non-fermented soy).

Avoid greasy, fried foods and fast foods.  For some symptoms are exacerbated by eating mints, spicy foods and some tomato sauces but this can vary.

Avoid simple carbohydrates like potato, white rice, corn, sugar, white breads to aid in weight loss and reduce waist size. 

And finally, healthy exercise daily is a must preferably outdoors with plenty of sunshine yet not so much you burn or damage your skin of course. 

Hope that helps!