Introduction
Around 2.5 – 3 million people with frequent Gastroesophageal reflux disease symptoms (GERD or GORD) in Australia and many millions more with occasional heartburn or reflux.
Heartburn is the burning sensation in the chest and reflux is the burning sensation plus all the other symptoms which I will mention in a minute.
Australian health sources also describe reflux (called GORD in Australia) as a very common condition affecting people of all ages.
The prevalence appears to have increased over recent decades, likely related to:
Ø rising obesity rates,
Ø diet changes,
Ø sedentary lifestyles,
Ø ageing population,
Ø and possibly stress and sleep patterns.
Importantly:
· occasional reflux after a big meal is extremely common,
· but chronic or frequent reflux is what doctors usually mean by GERD/GORD. That would be every day or after every meal
What is reflux?
Gastroesophageal reflux disease (“reflux” or GERD or GORD) happens when stomach contents, mostly acid and sometimes bile and digestive enzyme, flow backward from the stomach into the oesophagus (food pipe). The oesophagus is not designed to handle acid, so repeated exposure can cause irritation and symptoms.
Common symptoms include:
Ø Burning chest discomfort (“heartburn”)
Ø Sour or bitter taste in the mouth
Ø Regurgitation after meals
Ø Chronic cough, throat clearing, hoarseness, or feeling a lump in the throat
Ø Symptoms are worse after eating a large meal or lying down after eating
Why people get reflux
Reflux usually involves weakness or inappropriate relaxation of the lower oesophageal sphincter (LES), the ring-like valve between the oesophagus and stomach.
Things that can contribute to this weakness:
Ø Large or fatty meals
Ø Alcohol
Ø Smoking
Ø Obesity or increased abdominal pressure
Ø Pregnancy
Ø Hiatal hernia
Ø Certain medications
Ø Delayed stomach emptying
Ø Eating close to bedtime
Ø Eating disorders like bulimia Nervosa
What is a Hiatal hernia? We know the diaphragm is the large muscle under the lungs that helps with breathing.
Normally the oesophagus travels through a small hole in the diaphragm and that is called the hiatus hole, it then connects to the stomach below the diaphragm.
With a Hiatal hernia: the upper part of the stomach slips up through that opening into the chest area.
Foods that can trigger GERD/GORD
Ø Peppermint
Ø Alcohol
Ø Chocolate
Ø Coffee
Ø Spicy foods
Ø Tomato/citrus
Ø Carbonated drinks
Ø Meats
For me personally, I only get reflux when I eat raw garlic.
Why are these foods triggers?
Some foods like:
Peppermint
Alcohol
Chocolate
Fatty foods
– relax the LES (lower oesophageal sphincter).
Why is it important to address reflux other than it being incredibly uncomfortable?
Oesophageal adenocarcinoma is a type of cancer that develops from gland-like cells in the lower part of the oesophagus, usually near where the oesophagus meets the stomach.
It has become more common in many Western countries over recent decades, partly because of increasing rates of:
· chronic reflux
· obesity
· and Barrett's oesophagus.
How oesophageal adenocarcinoma develops
The usual sequence is thought to be:
Normal oesophagus...
- chronic acid reflux...
- Barrett’s oesophagus...
- dysplasia (precancerous abnormal cells)...
- adenocarcinoma.
However:
Ø most people with reflux never get Barrett’s,
Ø and most people with Barrett’s never get cancer.
So the progression is possible, but not inevitable. I will talk a little bit about Barrett’s and adenocarcinoma in a bit.
Some people are told that reflux can be a genetical thing
Genetics appears to play a moderate role in GORD/GERD, but it is usually very rare that it is the sole cause.
Most researchers think reflux develops from a combination of:
Ø inherited susceptibility,
Ø anatomy,
Ø lifestyle,
Ø body weight,
Ø and environmental factors like lifestyle, pesticides and fertilisers on non organic foods, poor sleep, laying down after eating, not exercising enough, eating too big a meal.
Genes can affect several things related to reflux:
Lower oesophageal sphincter (LES) function.
Some people may inherit differences in muscle tone, nerve control, or connective tissue strength, that make the LES weaker or more prone to relaxing inappropriately.
Risk of Hiatal hernia
There appears to be some inherited tendency toward weaker connective tissue or anatomical structure around the diaphragm and oesophageal opening.
That can increase the likelihood of a Hiatal hernia which is strongly linked to reflux.
Body fat distribution
Genes influence:
· obesity risk,
· abdominal fat patterns,
· metabolism.
Abdominal obesity increases pressure inside the abdomen, which can promote reflux.
Stomach emptying and gut motility
Inherited differences in digestive motility may affect how fast the stomach empties, gas/bloating tendencies and pressure inside the stomach.
Sensitivity to acid
Some people may genetically have a more sensitive oesophagus, stronger pain perception, or different inflammatory responses.
That may explain why some people have severe symptoms with little damage, while others have major oesophageal injury with few symptoms.
Evidence that reflux runs in families
Studies show reflux tends to cluster in families.
Twin studies are especially important:
· identical twins show higher similarity in reflux risk than non-identical twins,
· suggesting a meaningful inherited component.
Researchers estimate genetics may account for roughly:
· 30–40% of susceptibility in some studies, though estimates vary.
But genes are not destiny
Having a genetic predisposition does not mean someone will definitely develop reflux.
Lifestyle and environmental factors still matter greatly, whether it is genetic or not.
The following things play a part in reflux :
large meals, obesity, smoking, alcohol, sleep position, pregnancy, medications, stress and diet, diet patterns.
A person may inherit vulnerability but only develop symptoms after:
Ø weight gain,
Ø ageing,
Ø pregnancy,
Ø or years of dietary/lifestyle pressure.
Genetics and Barrett’s oesophagus
Genes may also affect who develops Barrett's oesophagus after chronic reflux.
Most people with reflux never develop Barrett’s, suggesting some individuals are biologically more susceptible to tissue changes from acid exposure.
Researchers are studying genes involved in:
· inflammation,
· tissue repair,
· cell growth,
· and cancer risk.
But there is no single “reflux gene” or “Barrett’s gene.”
I will go into more detail about Barrett’s Oesophegus very soon I promise, but just a little bit about genes and Barret’s and cancer first.
Why Barrett’s matters
Barrett’s is important because it is considered a precancerous condition.
Repeated acid injury causes the normal oesophageal lining to change into a more intestine-like lining. Over time, some of those cells may accumulate DNA damage and become increasingly abnormal.
Doctors watch for:
· low-grade dysplasia
· high-grade dysplasia
These mean the cells are becoming more abnormal and cancer risk rises.
Where the cancer occurs
This cancer almost always develops in the lower oesophagus, close to the stomach junction, the same area most exposed to reflux acid.
Symptoms
Early stages may cause few symptoms.
As it progresses, symptoms can include:
· Difficulty swallowing (especially solids first)
· Food sticking
· Weight loss
· Chest discomfort
· Persistent reflux
· Vomiting
· Anaemia or fatigue
· Bleeding
Difficulty swallowing that progressively worsens is one of the classic warning signs.
Risk factors for Barret's oesophagus
Major risk factors include:
· Long-standing GERD/GORD
· Obesity
· Smoking
· Male sex
· Age over 50
· Possibly family history
It can definitely be treated.
Why reflux management matters
Managing chronic reflux and monitoring Barrett’s can help detect changes early, before cancer develops.
That’s why people with long-standing reflux, plus risk factors, are sometimes advised to have an endoscopy. Not because reflux commonly becomes cancer, but because persistent inflammation over many years can occasionally lead to these cellular changes.
As mentioned, Barrett’s oesophagus is a condition where the normal lining of the lower oesophagus (food pipe) changes because of long-term exposure to stomach acid from chronic reflux.
Barrett’s oesophagus itself is not cancer, and many people never develop cancer. However:
· It slightly increases the risk of oesophageal adenocarcinoma (a type of cancer).
· The risk is still low, but higher than in people without Barrett’s.
Because of this, people diagnosed with Barrett’s are usually monitored with regular endoscopies.
What can we do about reflux
If overweight, losing weight is essential.
Quit eating meat, drinking alcohol, smoking and replace caffeine with decaffeinated
Avoid fatty deep-fried foods
Take a note of what foods repeatedly cause reflux and avoid those until the reflux is gone – you could then introduce small amounts and see if there are any issues.
Drink:
Ø Bancha/kukitcha tea
Ø Chamomile tea
Ø Ginger tea (mild strength)
Ø Marshmallow root tea
Ø Slippery elm tea
Ø Liquorice tea made with DGL
Ø Fennel tea drinks
Drink warm, not very hot the teas, avoid large volumes of food and eat smaller meals. Avoid lying down for two to 3 hours after eating. Lose weight if you are overweight and avoid personal trigger foods, Raise the head of the bed when sleeping.
Foods that are good for reflux are low acidic foods
High-fibre foods
Fibre helps digestion and can reduce pressure in the stomach over time: Oats, brown rice, wholegrain bread, lentils and legumes and vegetables like broccoli, carrots, zucchini.
Lean proteins (lower fat = less LES relaxation)
So a plant based diet lends itself well, if it is low in added fats
Non-acidic fruits
Less irritating to the oesophagus are bananas, melons, apples (especially non-sour varieties), pears, custard apples, mangoes, dates and figs.
Non-acidic vegetables
Leafy greens (spinach, lettuce), cucumber, carrots, green beans, sweet potato, white potato.
Alkaline or low-acid foods (may feel soothing)
Oatmeal, rice, bananas, almonds (small amounts; high fat for some people
Recipe
If you are gluten free then of course oatmeal won’t cut it, so the recipe I share with you today is a millet porridge.
Soak ¼ cup millet overnight
Up to 1 cup soy milk/almond milk
1 banana
Pinch salt
Then rinse out a saucepan with cold water (don’t dry the saucepan). This stops the millet from sticking on the bottom.
Place the millet into the saucepan and add ½ cup water and a pinch of salt. Put the lid on the saucepan. Bring to the boil and then let simmer for 10 to 20 minutes. You may need to add more water or you can start adding the soy or almond milk if the water evaporates too quickly.
Once the millet is cooked, is nice and soft and is resembling porridge, add it to a blender, add in the rest of the milk and the banana and blend. Place back into the saucepan to reheat if needed or straight into your bowl and enjoy, with stewed pears if you like.
FCT (fun cooking tip)
When to put a lid on a saucepan.
To bring anything to the boil
IF you want things to cook quickly
If you don’t want to lose any of the liquid (like for a soup)
When boiling or steaming veggies
When to keep the lid off a saucepan
To reduce the amount of liquid in the pan
If it looks like the food is going to boil over and out of the pan then keep the lid off or put it on with a portion of it off.
When you want beans like chickpeas, mung beans etc. to hold their shape.
Hope you have a fabulous week and please like, share and subscribe, and sign up for my newsletter.
With Love Veet
