“Being overweight increases pressure around the abdomen, which is more likely to cause reflux,” explains Lauren Gerson, a gastroenterologist at the California Pacific Medical Center in San Francisco. “There may also be hormones, like estrogen, secreted by the fat cells that cause the esophageal sphincter muscle to relax.”
The best evidence that extra pounds increases GERD comes from the Nurses’ Health Study. Women who had gained the most weight over the previous 14 years were more than twice as likely to report heartburn as those whose weight remained stable. And women who had lost the most weight reported a 40 percent drop in symptoms.
“If people have gained 10 pounds in the past year, I might suggest they try to lose that weight, even if they’re in the normal weight range, because that may curb their symptoms,” says Gerson.
When 124 overweight or obese adults with GERD lost an average of 29 pounds by cutting calories and exercising for six months, 65 percent of them said that they no longer had any symptoms and 15 percent reported fewer symptoms.
The study wasn’t perfect—it had no control group, so people may have felt better because they expected to. Even so, many physicians still tell their overweight patients with GERD to lose weight.
“Of all the lifestyle changes to relieve reflux, weight loss has the strongest evidence,” notes Vaezi.
Studies to back up other advice are scant.
“If people have nighttime symptoms, then I recommend that they put a ‘bed wedge’ that’s six to eight inches high under their pillow,” says Gerson. In a small trial on 20 people, that exposed the esophagus to less acid.
Some doctors also advise reflux patients to avoid eating two to three hours before bedtime. But there’s no good evidence that that helps.
For example, when 20 people with reflux ate a 1,000-calorie meal (a hamburger, french fries, and soda) at 9 p.m., they had no more reflux episodes and no longer reflux episodes than when they ate the same meal at 7 p.m. on a different night.
Nor is there evidence that avoiding high-fat meals late at night helps. “But we know that high fat delays gastric emptying, which can lead to GERD,” says Gerson. “So it’s really a common-sense recommendation.”
The jury’s still out on whether quitting smoking eases GERD symptoms. “Obviously, smoking has its own health hazards,” says Gerson.
Sources: N. Engl. J. Med. 354: 2340, 2006; Obesity 21: 284, 2013; J. Gastroenterol. Hepatol. 27: 1078, 2012; Aliment. Pharmacol. Ther. 12: 1033, 1998.
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