One of the great disservices Western medicine has imparted upon society is the notion that the mind and body are disconnected. The fact of the matter is that whatever goes on in your mind—your thoughts, your emotions—influences how the rest of your body works—or in the case of acid reflux, doesn’t work properly. This chapter discusses some lifestyle changes that very well might help with your acid reflux symptoms, and your overall health in general.
In today’s society, stress is at such a high rate that physicians can’t seem to write prescriptions fast enough for antidepressant and antianxiety drugs, medications that can help mask the pain but do nothing for the underlying stress. Now, while some stress is good, it’s chronic stress, or “dis-stress,” that can lead to a number of illnesses and exacerbate others, including acid reflux.
Prolonged, frequent, or intense stress can weaken the body’s ability to resist infection and increase the likelihood of developing diseases. It can lead to permanent health issues including ulcers, high blood pressure, kidney disease, arthritis, and even allergic reactions.
The hypothalamic-pituitary-adrenal (HPA) axis plays a major role in the health of both your mind and body. This intricate connection between your brain and endocrine system exerts a wide influence over your health, and many researchers suggest that the HPA axis is being overtaxed by our stressful twenty-first-century lifestyles.
It all starts in the brain with the hypothalamus, a specialized glandular area of the brain that some consider the master gland, which acts as a controller of the pituitary gland. During times of stress—physical, emotional, or mental—the hypothalamus releases corticotropin-releasing factor (CRF), which in turn signals the pituitary gland to release adrenocorticotropic hormone, or ACTH. This hormone then travels through the bloodstream to the adrenals, two small, triangle-shaped glands that are located on the top of the kidneys. When ACTH reaches the adrenals, it causes them to release even more hormones that affect how your body and mind deal with stress, in either a positive or negative fashion.
There are a number of studies showing how stress can influence and worsen acid reflux. One of these, published in 2010 in Norway, was a population-based study of over 65,000 men and women examining the relationships between stress and symptoms of acid reflux. The researchers were able to conclude that common, everyday stressors such as “high job demands, low job control, job strain, low job satisfaction, time pressure and self pressure were positively associated with the risk of GERD symptoms.”
While it would be wonderful to have the financial means to live a stress-free life, the vast majority of us simply aren’t ever going to be able to live that life. But don’t worry; there are ways—besides running off to Tahiti!—that can help you reduce the stress in your life and therefore improve your overall health as well as reduce your acid reflux symptoms.
One of the most widely studied and effective ways to reduce the burden of stress is through the study and practice of mindfulness. This stress reduction method is based on learning how to achieve a certain level of consciousness that is best described as a nonjudgmental moment-to-moment awareness of one’s own self both in terms of mind and body.
In terms of acid reflux, mindfulness-based stress reduction techniques as well as more traditional psychotherapy have also proved their worth via multiple studies. In a paper published in 2000 in the journal Gastroenterology, researchers examined 95 patients with functional dyspepsia—a common gastric complaint that can include acid reflux—and looked at how psychotherapy could help. In this randomized, controlled trial, the authors of the paper showed that psychotherapy could decrease the symptoms of dyspepsia. A more recent paper published in 2013 confirmed these results, showing that even brief sessions of psychotherapy can be “a reliable method to improve gastrointestinal symptoms . . . in patients with functional dyspepsia.” In terms of mindfulness-based therapies, a paper published in 2014 performed a meta-analysis on a number of other studies and concluded that “studies suggest that mindfulness based interventions may provide benefit in functional gastrointestinal disorders.”
If you’d like to explore the benefits of mindfulness, a good place to start trying mindfulness in your daily routine can be found at the University of California Los Angeles Mindfulness Research Center website (www.marc.ucla.edu). Here, you’ll find a number of free, guided meditations that will help you start to become more mindful.
The number of former smokers in the United States now outnumbers the number of current smokers, and that’s a statistic we all should be happy about. There’s a plethora of data showing that not only does smoking greatly increase your risk for killers such as heart disease and cancer, but it can also play a significant—and problematic—part in acid reflux.
One of the earliest studies to postulate how smoking is involved in the pathogenesis of acid reflux was published way back in the pre-Internet era in 1990 in the journal Gut. In this study, researchers looked at a group of twenty-six smokers, aged thirty-three to sixty-three, and performed various tests on them, including manometry and esophageal pH monitoring. The researchers found that cigarette smoking directly caused both lowering of the cardiac sphincter pressure and an increase in acid secretion, leading the authors to conclude that “cigarette smoking probably exacerbates reflux disease by directly provoking acid reflux and perhaps by long lasting reduction in lower esophageal sphincter pressure.”
There are plenty more studies that back up the idea that smoking and acid reflux are associated. One in 2001 demonstrated that smoking increases the incidence of acid reflux via increasing acid in the esophagus, while another cross-sectional study of 2,680 Japanese men and women, published in 201l, reported that cigarette smoking was “significantly associated with overlaps among GERD, FD [functional dyspepsia], and IBS [irritable bowel syndrome] in Japanese adults.”
While the studies linking cigarette use to acid reflux should be clear to even the most closed-minded cynic, there are even more reasons not to smoke. Besides being linked to acid reflux, smoking is also a causative factor in both Barrett’s esophagus and esophageal carcinoma. A 2012 article examined data from five studies on cigarette smoking, Barrett’s esophagus, and esophageal carcinoma. After analyzing all the data, the authors of the study confidently concluded that “cigarette smoking is a risk factor for BE [Barrett’s esophagus].” In a prospective cohort study on 411 patients with Barrett’s esophagus published in 2013, researchers showed that the risk of developing esophageal carcinoma was significantly increased by smoking cigarettes. From an even more recent study, published in 2014, researchers analyzed data from 24,068 men and women followed over a four-year period and again showed that smoking was associated with the development of both Barrett’s esophagus and esophageal cancer.
First off, there are a number of ways to replace the nicotine that is the major addictive component of tobacco. A number of NRTs (nicotine replacement therapies), originally only available with a doctor’s prescription, can now be bought over the counter without a prescription and include nicotine gum, patches, and lozenges. While all are roughly equally effective, some people prefer the ease of using a patch once a day, while others, especially those smokers who enjoy the hand-to-mouth movement that smoking provides, will do better with the gum or lozenges (as having to put the gum or lozenges in your mouth multiple times a day crudely mimicks the hand movements of smoking a cigarette). There’s also a nicotine nasal inhaler to curb that cigarette craving, but you’ll need a doctor’s prescription for that. The bottom line for all these products is that they can help reduce the actual chemical addiction (of nicotine) that cigarette smoking causes and thus make it easier to quit smoking. None of them will, however, be a magic bullet, and unless you’re ready to give up the smokes, don’t make the erroneous conclusion that you can smoke and use NRTs at the same time—this is a sure-fire way to give yourself nicotine poisoning which can cause very unpleasant symptoms including a rapid heart rate, anxiety, and vomiting.
While it may sound funny to nonsmokers, one of the hardest aspects of quitting smoking for some cigarette users is what to do with their hands. After 20, 30, even 40 years of putting a cigarette into your mouth multiple times a day, it’s a habit that needs to be fed if people are to quit the smoking habit. And so, feed it—with carrots, celery sticks, or apple slices. It’ll take the place of putting a cigarette in your mouth and be healthy for you to boot!
Besides NRTs, there are also non-NRT medications that are prescription only. Bupropion is a medication that was first developed to treat depression, but through a number of studies it was found that it also was effective in helping people quit smoking. It does this through raising the levels of a chemical called dopamine in the brain, something that nicotine also does. It’s thought that because of this, the urge for smokers to light up to raise dopamine levels is blunted, and hence, no urge to smoke.
The newest smoking cessation prescription medication, varenicline, goes one step further than bupropion in actually acting as a nicotine mimic and partially blocking the effects of nicotine in the brain. Both these medications seem to be effective in helping smokers give up the habit, but as in the case of NRTs, bupropion and varenicline are not magic bullets—if you’re not ready to quit smoking, none of these smoking cessation aids will probably do you much good.
Finally, it’s worth asking the following question—even if you do quit smoking, will it actually help relieve your acid reflux? Fortunately, the answer to that question is probably yes, an answer borne out by studies like the one published in 2013 in the American Journal of Gastroenterology. In this paper, researchers examined data from a study out of Norway that included 29,610 men and women. Examination of the data revealed that those smokers who quit, when compared to those who didn’t, had significant relief from their acid reflux symptoms. This is just one more reason to give up cigarettes once and for all.
One of the biggest health issues that can contribute to acid reflux is obesity. A study from 2005 in the American Journal of Gastroenterology examined 453 men and women in a cross-sectional study to determine the prevalence and risk factors for acid reflux in employees of the Veterans Administration. The authors definitely concluded that, “overweight and obesity are strong independent risk factors of GERD symptoms and esophageal erosions.” A detailed review article published in 2008 examined the evidence linking reflux to obesity, with the authors coming to the conclusion that “overall, epidemiological data show that maintaining a normal BMI may reduce the likelihood of developing GERD and its potential complications.”
BMI, or body mass index, is a calculation based on weight and height to get a measure of your body fat. This is important because people with higher amounts of body fat tend to have a higher BMI, and this isn’t good for your health. Having excess body fat is known to put you at higher risk for multiple diseases including cancer, diabetes, and stroke.
So if obesity can cause acid reflux, can losing weight decrease or even cure the symptoms? Fortunately, data seems to point to an answer of yes to that question. An early study published in 1999 examined the effects of weight loss on thirty-four obese men and women with reflux over a six-month period. After examining the data, the researchers found a “significant association between weight loss and improvement in symptoms of GORD,” concluding that “patients who are overweight should be encouraged to lose weight as part of the first-line management.” A more recent study, reported in 2013, looked at data from Norway among 29,610 men and women. As in the study from 1999, researchers again showed that obese patients with reflux who lost weight had a significant improvement in their symptoms. Finally, a prospective intervention study, also published in 2013, was even more encouraging regarding weight loss and acid reflux. Among those 332 overweight and obese men and women studied, those who lost the most weight at the end of the six-month study showed the most improvement in their acid reflux symptoms and in fact, the researchers determined that “a structured weight-loss program can lead to a complete resolution of GERD symptoms.”
Of course, when it comes to obesity, weight loss, and acid reflux, the question is “How do I lose weight?” While entire books have been written about this, and knowing that one weight-loss program doesn’t work for everyone, there are some reasonable steps that can be taken by just about everybody who’s committed to losing weight.
Mindfulness, besides being useful in managing stress, has been also shown in multiple studies to potentially help in both losing weight and maintaining weight loss. Authors of a 2013 review paper on mindfulness in the treatment of obesity and eating disorders concluded that “mindfulness approaches can improve or extend long-term health outcomes in persons with eating disorders and is also associated with a reduction in overall food consumption, healthier food choices, and practices that slow the eating process among the obese population.”
Another method of weight loss is food portion control. There have been numerous studies done on food portioning and the burgeoning obesity epidemic, such as one published in 2005 in the Journal of Nutrition. After careful analysis, the authors of the study concluded that, “excessive food portions, particularly of energy-dense foods, contribute to the overconsumption of energy [and calories]. Telling people to simply ‘eat less’ is not likely to be an effective solution, because it is not just large portion sizes that increase energy intake, but rather large portions of energy-dense foods.” Because of this and other studies like this, people looking to lose weight successfully should focus on the importance of not only being mindful of what foods they eat, but also the portions they eat. In addition they should increase their portions of foods that are high in nutritional value/less energy dense, such as fruit and vegetables.
Be it in the gym or in your basement, exercise is another critical component of weight loss. Just about everyone knows that exercise is good for everything from losing weight to defeating health disease to improving your sexual health. But what you might not know is that there are studies showing that an increase in physical activity and exercise can help protect you against acid reflux. A 2004 paper in the journal Gut reported on a case-control study involving 3,153 men and women with acid reflux and compared them to 40,210 people without reflux. The authors of the study showed that just exercising (jogging, cross-country skiing, or swimming) 30 minutes a week decreased the risk of having acid reflux by 50 percent. A more recent study published in 2012 in the World Journal of Gastroenterology reported on a cross-sectional survey done among 4,910 Swedish men and women aged forty to seventy-nine examining physical activity, obesity, and reflux. Like earlier studies, this one showed that “intermediate frequency of physical activity was associated with lower occurrence of GERD among individuals.”
Many people are able to stick to their weight-loss routines at home but falter when it comes to dining out. So what are you supposed to do when you go out to eat? This is a great question. Many people are totally sincere in getting a handle on their obesity, yet feel that they can’t go out with friends and family and not eat, or just order celery sticks and water. As in the case of obesity and weight loss, there are multiple books written on this one subject alone, but some basic tips when it comes to social gatherings and dining out are as follows: