Your Nutrition Solution to Acid Reflux: A Meal-Based Plan to Help Manage Acid Reflux, Heartburn, and Other Symptoms of GERD
224
Your Nutrition Solution to Acid Reflux: A Meal-Based Plan to Help Manage Acid Reflux, Heartburn, and Other Symptoms of GERD
224Paperback(First Edition)
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Overview
Product Details
| ISBN-13: | 9781601633231 |
|---|---|
| Publisher: | Red Wheel/Weiser |
| Publication date: | 05/19/2014 |
| Series: | Your Nutrition Solution |
| Edition description: | First Edition |
| Pages: | 224 |
| Sales rank: | 420,523 |
| Product dimensions: | 5.20(w) x 8.20(h) x 0.50(d) |
About the Author
Read an Excerpt
CHAPTER 1
your questions about acid reflux — answered
So your doctor has told you that you have acid reflux or maybe even GERD. Now what? What does that mean? Naturally you have loads of important questions swirling around in your head. This chapter provides some common questions and their answers that can help you sort through all of the basic information surrounding acid reflux and GERD. Once you have a better understanding of the hows, whats, and whys of acid reflux, you will be ready to dive into the nutrition and lifestyle changes you need to make you feel better and prevent future damage. This is a perfect starting point!
What Is Acid Reflux?
First of all, if you have been told you have acid reflux, don't feel alone. A good 10 percent of Americans suffer with some degree of heartburn or acid reflux. In fact, it is much more common now than it was in the past. A longterm study found that the number of people who experience acid reflux at least once a week has gone up almost 50 percent in the last 10 years, with women appearing to be a bit more susceptible than men. That may say a little something about our current American diet!
Basically, acid reflux occurs when the liquid content from your stomach, the gastric acid, backs up or "refluxes" into the esophagus. More specifically, at the entrance to your stomach, between the esophagus and the stomach, there is a valve made of muscle called the lower esophageal sphincter or LES. When functioning normally the LES closes immediately following food passing through the esophagus and through the valve, keeping the contents of your stomach where it belongs — in your stomach. If the LES is not functioning normally, either by not closing all the way or opening too often, the liquid, which contains stomach acids among other stomach juices, can squeeze through the LES and move back up into the esophagus. This can cause irritation of the lining of the esophagus, resulting in symptoms of burning and chest pain known as heartburn.
Are Acid Reflux, Heartburn, and GERD All the Same Problem?
No. Although the terms acid reflux, heartburn, and GERD are often used interchangeably, they don't all have the same definition. Acid reflux is the act of acid from the stomach refluxing back up through the LES and into the esophagus. Heartburn is a symptom of acid reflux and is the actual burning and pain that one might feel due to acid reflux. Gastroesophageal Reflux Disease (GERD) occurs when your symptoms of acid reflux, including heartburn, become chronic and flare up at least twice every week.
Your Nutrition Solution Tidbit: The term gastroesophageal means "relating to the stomach and esophagus." The esophagus is the tube that transports food from your mouth into your stomach.
What Is "Silent" Reflux?
Laryngopharyngeal reflux, or LPR, is often referred to as "silent reflux." Similar to GERD, LPR is also caused by acid reflux. However, the symptoms are usually different from those typically found with GERD. This makes LPR difficult to diagnose, and is why it is sometimes termed "silent" reflux. There are two valves or sphincters at both ends of the esophagus. With LPR both sphincters do not function correctly so that acidy stomach contents reflux back up into the esophagus and keep going all the way through the top valve. This causes stomach acid to back up into places a bit higher such as your throat (pharynx), voice box (larynx), and sometimes even your nasal passages. The result is inflammation in areas that are not equipped to protect against gastric acid.
Your Nutrition Solution Tidbit: The term laryngopharyngeal is defined as "pertaining to the larynx (voice box) and the pharynx (throat)."
Silent reflux can be common in infants because (a) the valves of their esophagus are not fully developed, (b) they have a shorter esophagus, and (c) they lie down the majority of the time.
Symptoms in infants and children may include:
* Hoarseness
* "Barking" or chronic cough
* Asthma-like symptoms such as wheezing
* Noisy or irregular breathing
* Chronic spitting-up
* Trouble gaining weight
The symptoms in adults can include heartburn, but other signs are less typical than those found in GERD. Often the symptoms are so vague that they are easily confused with other issues, which makes silent reflux tough to identify and diagnose. In addition to possible heartburn, adults with laryngopharyngeal or silent reflux may experience:
* Bitter taste in the mouth after eating
* Burning sensation in back of throat
* Chronic throat clearing
* Persistent cough
* Mild voice hoarseness
* Sore throat
* The feeling of a lump in the throat that does not go away with repeated swallowing
Other less common symptoms include:
* Postnasal drip or excessive mucus in the throat
* Trouble swallowing
* Trouble breathing
Although silent reflux is a bit harder to diagnose through symptoms alone, your doctor can diagnose the problem through a combination of a medical history and a physical exam. If further testing is needed, an upper endoscopy procedure, barium swallow test, and/or pH test, which measures the level of acid in the throat, may be performed. Once diagnosed, as with acid reflux and GERD, silent reflux should be treated with a combination of diet and lifestyle change and possible medications. Without treatment, silent reflux can cause some long-term damage. The irritation of the stomach acid to the throat and larynx can scar the throat and voice box, cause ulcers on the vocal cords, lead to a chronic cough, and increase your risk for cancer in the affected areas. It can also affect the lungs and aggravate pre-existing conditions such as asthma, emphysema, and/or bronchitis. In infants and children, if left untreated, silent reflux can cause contact ulcers, recurrent ear infections, and possible narrowing of the area below the vocal cords due to a buildup of scar tissue. So, although "silent," laryngopharyngeal reflux is nothing to ignore!
What Are the Signs and Symptoms of Acid Reflux and/or GERD?
The symptoms of acid reflux can be extremely individualized. Some people will experience more symptoms than others, and some will experience more severity and more frequency than others. The most classic symptom of acid reflux and GERD is heartburn. However, did you know that there are a variety of other symptoms associated with acid reflux and GERD? That's right! You may be experiencing other symptoms without even realizing that they are associated with acid reflux. These symptoms can include:
* Regurgitation. Regurgitation is the sensation of stomach acid backing up into the back of your throat and sometimes into the mouth. It can cause a bitter taste in the mouth.
* Dysphagia (difficulty swallowing). Some people may experience difficulty or pain when swallowing. It may even feel like you have a lump in your throat.
* Dyspepsia (stomach discomfort). Some people may experience dyspepsia, which is a general term for stomach discomfort. This might include chronic burping, nausea after eating, stomach fullness and/ or bloating, and upper abdominal pain and discomfort after a meal, especially a big one.
* Pain or a feeling of heartburn when lying down. When we are seated upright gravity takes over and stomach acid tends to stay where it belongs. When lying down there is more of a tendency for reflux to take over and for the acid to move into the esophagus. This can cause trouble with sleeping.
Other less common signs and symptoms include chronic sore throat, hoarseness, non-burning chest pain, worsening dental issues, chronic cough, wheezing, and even recurrent lung infections.
Your Nutrition Solution Tidbit: Although chest pain can be a symptom of acid reflux and GERD, it can be difficult to tell what is actually causing the chest pain. If you experience chest pain, especially pain that worsens with physical exertion, seek medical attention immediately.
How Is Acid Reflux Diagnosed?
First let's start with the type of doctor you need to visit if you believe you are experiencing symptoms of acid reflux. A gastroenterologist is the doctor that specializes in the digestive system and its disorders such as acid reflux and GERD. If you experience classic symptoms of heartburn it may be fairly easy for your doctor to diagnose your issue as acid reflux. If your acid reflux doesn't ease with treatment or you have other troubling symptoms your doctor may order testing to pinpoint any further problems and/or complications. If this is the case your doctor may order one or more of the following tests.
Endoscopy
This procedure is the gold standard in testing where acid reflux and GERD are concerned. It is an outpatient exam that can be used to determine the cause of chronic reflux or GERD as well as silent reflux by providing the doctor with a visual of your upper GI system. Although most people with reflux will have an esophagus that looks normal, an endoscopy can detect esophagitis (inflammation of the lining of the esophagus) as well as erosions and/ or ulcers, which can substantiate a diagnosis of GERD. An endoscopy can also identify complications of GERD and/ or other problems that might be causing symptoms similar to GERD, such as ulcers, strictures, Barrett's esophagus, and several types of cancers. Your doctor will provide you with pre-testing guidelines that you will need to follow closely.
During this procedure, medication is applied to numb the back of the throat, and a mild sedative is given. The doctor then uses a thin scope with a light and camera at the tip to explore your upper digestive system, which includes the esophagus, stomach, and the upper part of your small intestines, called the duodenum. During the test the doctor may take small tissue samples (biopsy) for further testing of underlying diseases such as esophageal cancer and/or celiac disease. It may sound scary but it only takes 15 to 30 minutes, and before you know it you are back in recovery.
Your Nutrition Solution Tidbit: New technology is emerging regarding endoscopies. Doctors may soon be able to utilize a much easier way of screening the esophagus for conditions such as Barrett's esophagus, esophageal cancer, hiatal hernia, and esophagitis. This new procedure involves simply swallowing a capsule the size of a multivitamin containing optical frequency domain imaging (OFDI), which is tethered to a string-like device. This new procedure will not require patient sedation or specialized equipment. Good news for patients!
Barium Swallow (or Upper GI Series)
This procedure can detect changes to the lining within your esophagus, and may be used to rule out any possible structural problems as well. This test is also outpatient and completely painless. You will be asked to swallow a chalky barium solution that will coat the lining of your digestive tract. A technician will then take X-rays of your esophagus and upper digestive tract. This will allow the doctor, radiologist, and possibly a speech therapist (depending on your individual symptoms) to view the shape and condition of not only your esophagus but your stomach and upper intestine (duodenum) as well. Although this procedure may be used, it is not a gold-standard test for diagnosing GERD. The problem is that very few people with GERD have changes in the lining of the esophagus that would be visible on x-rays, so it could show negative when in fact a patient has GERD. The test can reveal some complications of GERD such as ulcers and strictures, so it is best used along with endoscopy.
Esophageal pH Monitoring
This procedure is used to identify when and for how long stomach acid is found in the esophagus. It has two versions: the more traditional version utilizes an acid-measuring sensor attached to thin, flexible tubing. The tube is threaded through the nose and down into the esophagus so that the sensor ends up in your lower esophagus. The tube is left in place for 24 hours, with the part of the tube that exits your nose wrapped around the ear and trailing down to the waist, where it is connected to a small recording device that is easily worn or carried. During the 24-hour period of testing, you will be asked to record in a diary when you eat and drink. Each time acid reflux occurs into the esophagus, it stimulates the sensor and records the episode. The detailed information that is collected by both you and the sensor will aid the doctor in analyzing and interpreting your test results. Another, newer version of the pH test utilizes a small pH sensor or probe that is affixed to your lower esophagus using suction. The probe is put in place via a tube inserted through the nose or mouth with little to no discomfort. Once the probe is in place the tube is removed. The probe communicates wirelessly with a recording device usually worn on the waist for about 48 hours. Eventually the probe will fall off and will pass through the remainder of the digestive tract. After 48 hours, the information from the recording device is downloaded to a computer so that the doctor can analyze and interpret the information to help diagnose your symptoms.
Both versions of this test yield similar information, but the wireless pH test seems to be much more pleasant and easier to deal with. The pH study is expensive and is not considered a gold standard for testing when it comes to GERD because some people without GERD have abnormal amounts of acid in their esophagus, so a diagnosis of GERD would require further evidence such as typical symptoms, response to treatment, and/or possible complications of GERD. However, the test can determine, in patients who do not respond to medication treatment, why treatment is ineffective. If the test reveals that there are still substantial amounts of acid in the esophagus while a patient is on prescribed medications, the doctor will assume the treatment is ineffective and needs to be changed. If the test reveals that acid suppression is normal and therefore there is minimal reflux, but the patient is still experiencing symptoms, then the diagnosis of GERD is most likely incorrect, and determining the causes of symptoms will require further testing.
Your Nutrition Solution Tidbit: pH, or potential of hydrogen, is a measurement that reveals whether a solution is acid or alkaline. Gastric fluid that is formed in our stomachs contains hydrochloric acid, which is responsible for the acidic pH value. The acid aides in digestion of the foods and beverages we consume.
Esophageal Motility Testing
This test determines how well the muscles of the esophagus are functioning. For this test, as with some of the others, a thin tube called a catheter is passed through the nose and into the esophagus. The part of the catheter that lies inside the esophagus contains sensors that detect pressure. Pressure within the esophagus is created when the muscles of the esophagus contract. The part of the catheter that comes from the nose is hooked to a monitor that records the pressure. During the test, the contractions of the lower esophageal sphincter are evaluated by having the patient take sips of water. This type of test is used in evaluating symptoms that are not responding to traditional treatment for GERD because abnormal functioning of the esophageal muscle can sometimes mirror the symptoms of GERD. Motility testing can help to identify possible abnormalities and lead to a different diagnosis of esophageal motility disorder.
Gastric Emptying Study
This type of test determines how effectively food is being emptied from the stomach. A small percentage of people with GERD have slow emptying of the stomach that could contribute to the problem of acid reflux. In this test the patient eats a meal with a radioactive substance added. A sensor is placed over the stomach that measures how quickly the radioactive substance in the meal empties from the stomach. This test can be useful for patients with GERD who might not be responding to medication treatment as expected. If the test shows slow gastric emptying the doctor might prescribe additional medication to speed up the emptying of the stomach. In addition, symptoms such as nausea, vomiting, or chronic regurgitation can be the result of either abnormal gastric emptying or GERD. Evaluating gastric emptying therefore can also be useful in identifying patients whose symptoms are due to abnormal emptying of the stomach and not GERD.
What Can Cause Acid Reflux?
People of all ages, from infants whose digestive tracts aren't quite fully developed to the elderly whose digestive systems tend to slow down — and everyone in between — can develop acid reflux. It is difficult to pinpoint exactly what causes acid reflux and GERD, but there are some factors that can make some people more prone to acid reflux:
* Overuse of alcohol
* Obesity
* Smoking (which can substantially reduce the clearance of acid from the esophagus)
* Pregnancy
* Certain medications such as calcium channel blockers, medications for asthma, and some antihistamines, painkillers, and antidepressants
In addition, there are a few medical conditions that can also contribute to problems of acid reflux and GERD. These include hiatal hernias and food allergies/sensitivities.
(Continues…)
Excerpted from "Your Nutrition Solution to Acid Reflux"
by .
Copyright © 2014 Kimberly A. Tessmer, RDN, LD.
Excerpted by permission of Red Wheel/Weiser, LLC.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Introduction 19
Chapter 1 Your Questions About Acid Reflux-Answered 23
What is acid reflux?
Are acid reflux, heartburn, and GERD all the same problem?
What is "silent" reflux?
What are the signs and symptoms of acid reflux and/or GERD?
How is acid reflux diagnosed?
What can cause acid reflux?
Can H. pylori cause acid reflux?
Can too little stomach acid cause acid reflux or GERD?
How can I find out if I have low stomach acid?
How will my acid reflux be treated?
What type of medication is used to treat acid reflux?
Can I treat my acid reflux with natural remedies?
Can I treat my acid reflux with medication alone?
Are there any complications of GERD that I should know about?
Chapter 2 The Nutrition Connection and Beyond 57
Acid Reflux During Pregnancy
Acid Reflux in Infants, Children, and Adolescents
Questioning Medications to Treat GERD Long-term
Alternative Treatments
Chapter 3 Your 5-Step Nutrition and Lifestyle Solution 83
Step 1 Modify Your Eating and Lifestyle Behaviors
Step 2 Eat a Healthier Diet
Step 3 Reach a Healthy Weight
Step 4 Identify YourTrigger Foods
Step 5 Practice Alternative Therapies
Chapter 4 10 Foods to Avoid and 10 Foods to Include 135
10 Common Culprits
10 Potential Helpers
Other At-Home Remedies
Chapter 5 Menu-Planning and Shopping Guide 153
Menu-Planning Tips
Navigating the Supermarket
Using Food Labels to Help Your GERD
Chapter 6 14-Day Menu Guide and Stocking Your Kitchen 179
14-Day Menu Guide
Stocking Your Kitchen
Appendix: Ask the Dietitian 203
Resources 209
Index 217
About the Author 223