If you’ve ever had heartburn, you know the uncomfortable burning sensation in your chest and throat is no fun. Heartburn is a symptom of acid reflux, when acid from your stomach bubbles up into your esophagus, the tube connecting your stomach to your throat. Your esophagus is much more sensitive than your stomach, which is built to handle the corrosive effects of acid.
A little acid reflux once in a while is usually nothing to worry about–it’s likely you just ate or drank too much. “Everyone refluxes a little bit,” says Lawrence Schiller, MD, past president of the American College of Gastroenterology.
If the reflux becomes frequent and severe enough, you may have gastroesophageal reflux disease (GERD). While this needs to be treated to avoid complications (including a higher risk of esophageal cancer), you can often take care of or even prevent occasional acid reflux on your own with lifestyle changes like eating smaller meals and losing excess weight. Here are some of the more frequent causes of the condition.
Certain foods and drinks
Many people complain that they get reflux after eating certain foods. Common culprits include items high in fat, chocolate, spicy foods, citrusy or acidic foods like oranges and tomatoes, mint, garlic, and onions, as well as carbonated drinks.
These foods may be more difficult to digest, producing extra stomach acid that can end up in the esophagus. Fatty foods may also relax the lower esophageal sphincter (LES), which usually acts as a “lid” on the stomach. “The LES prevents the backflow of acid from the stomach up to the esophagus,” explains Elena Ivanina, DO, MPH, a gastroenterologist at Lenox Hill Hospital in New York City. Sometimes, though, the LES doesn’t do its job as well as it should.
Doctors often counsel lifestyle changes–including avoiding these triggering foods–to combat reflux symptoms before trying medications. “That’s something people can do without needing to spend a lot of money on medicine,” says Dr. Schiller, also the program director of the gastroenterology fellowship at Baylor College of Medicine in Dallas.
Obesity is one of the main drivers behind both acid reflux and GERD. It may also increase the risk of GERD complications like Barrett’s esophagus, a condition involving precancerous changes in esophageal cells.
It’s not just extra fat that seems to raise the risk. It’s “central obesity,” which means more fat around your middle, says Dr. Ivanina.
Experts believe extra abdominal fat adds pressure to the stomach, forcing acid up into the esophagus. Hormones could also play a role. People who are obese have more circulating estrogen, which has been linked with GERD symptoms. Postmenopausal women using hormone therapy also have an increased risk of reflux.
Studies have shown that losing weight either through diet and exercise or bariatric surgery can ease symptoms of reflux.
A hiatal hernia is when the top part of your stomach bulges up into your chest cavity, preventing the LES from closing properly.
Many people with hiatal hernias have no symptoms at all. In other cases, the hernia can be caused by GERD, and in still others, GERD is a symptom of the hernia.
Hiatal hernias are more common after the age of 50 and in people who are obese. They sometimes also happen after coughing, vomiting, or a physical injury.
Losing weight along with a healthy diet can help control reflux symptoms due to a hiatal hernia. Some people with reflux due to hiatal hernias may benefit from over-the-counter or prescription heartburn medicines. In extreme cases, surgery may be needed to push the stomach back down and reinforce the barrier between the stomach and the esophagus.