Gastroesophageal reflux disease (GERD) and Diet

Gastroesophageal reflux disease (GERD) is a common functional disorder of the digestive system, in which gastric fluids return from the stomach to the oesophagus. This return causes symptoms such as heartburn (burning pain behind the sternum), retching and indigestion. Although such symptoms may occur occasionally in a large part of the population, when they occur frequently and affect daily life, the condition is considered pathological.

The most typical symptoms include burning in the chest (behind the sternum), a burning sensation in the throat or an acidic taste, pain in the stomach or chest and difficulty in swallowing. In addition, extra-oesophageal manifestations such as chronic cough and hoarseness may occur. It is important to recognise symptoms early to prevent long-term complications such as oesophagitis, bleeding, oesophageal stricture, Barrett's oesophagus and in rarer cases, adenocarcinoma.

What is ultimately responsible for GERD?

The main cause of GERD is a deficiency of the lower oesophageal sphincter (LES), which under normal circumstances prevents the reflux of gastric fluids. When this mechanism is impaired, conditions are created that favour the rise of acidic contents towards the oesophagus. However, in addition to the dysfunction of the CSF, there are many factors that predispose or exacerbate reflux. Obesity, consumption of fatty foods or very large meals, impaired oesophageal emptying, diaphragmatic hernia, delayed gastric emptying and increased intra-abdominal pressure are important contributors. In addition, reflux may involve not only acid but also other components of gastric fluid such as pepsin and bile salts, which cause additional irritation.

What is the influence of nutrition on GERD?

As has been observed, some foods worsen symptoms, while others may relieve or help manage them. In general, high-fat meals seem to favour reflux, mainly because they delay gastric emptying. Coffee, alcoholic drinks (especially red wine and beer), carbonated soft drinks and chocolate (which contains theobromine, a substance that relaxes the CSF) have been linked to worsening symptoms. The same is true for the consumption of tomatoes, citrus fruits, mint, onion and garlic, which are often cited by patients as causing discomfort.

On the other hand, diet can be an essential tool in the treatment of GERD. Although the scientific evidence is not always strong, there is evidence that certain foods are considered safer or even beneficial. Oats, green leafy vegetables, bananas, probiotic yoghurt and lean meats can reduce gastric acid production and protect the oesophageal lining. In addition, adequate intake of fibre and probiotics improves bowel motility, thus enhancing digestion. Natural ingredients such as chamomile, ginger and turmeric exhibit anti-inflammatory activity and enhance overall digestive health.

What else would be good to watch out for?

Apart from the type of food, the behaviour around food is equally important. Eating small and frequent meals is recommended to avoid excessive stomach distension. It is also important to avoid lying down for 2-3 hours after a meal. Also, avoiding tight clothing that presses on the abdomen and raising the head of the bed by 20-30 cm can reduce nocturnal regurgitation. Weight loss in people with obesity offers significant benefits in reducing symptoms.

With regard to water consumption, it does not appear to dilute gastric acid to the extent that it affects digestion or reflux, as the stomach quickly restores its pH. The critical point is how and when it is consumed. It is best to avoid taking large amounts of water at the same time, especially during meals. Although small amounts of water with a meal do not cause a problem, drinking water between meals is generally preferable. It is also advisable to avoid fizzy water if it is found to worsen symptoms.

In summary, Gastroesophageal reflux disease is a multifaceted disorder that requires holistic and individualized treatment. Nutrition is not only a supportive factor, but can also act as a key therapeutic tool, especially for individuals who wish to reduce medication. However, each organism reacts differently to different foods, so understanding individual sensitivities is very important and can help to optimise the nutritional strategy.

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