While occasional heartburn—which happens when stomach acid splashes up into the esophagus—is unpleasant, persistent acid reflux can be serious.
"The acid chews away at the protective lining of the esophagus leading to inflammation, ulcer, and destruction of the lining," says Vivek Kaul, MD, associate professor of medicine and acting chief of gastroenterology and hepatology at the University of Rochester Medical Center.
Here are some lifestyle changes that can help.
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Losing weight and maintaining a healthy body size is one of the surest ways to keep acid reflux at bay.
One study of more than 10,000 women found that even a relatively small increase in body mass index could triple the odds of developing gastroesophageal reflux disease (GERD), which is persistent acid reflux.
If the average man or woman loses 10 pounds, he or she will notice an improvement in their reflux, says Robynne Chutkan, MD, assistant professor of gastroenterology at Georgetown University Medical Center in Washington, DC.
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Eating the wrong foods can worsen acid reflux, either by increasing the acidic environment of the stomach or by relaxing the lower esophageal sphincter, a valve that acts as a barrier between the stomach and the esophagus.
Fatty foods top the list of culprits, along with chocolate, citrus fruits, and juices.
But different people can react differently to the same foods. The trick is to figure out which foods bother you the most and avoid them, says Amar Deshpande, MD, assistant professor of medicine at the University of Miami School of Medicine.
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Cut back on alcohol
Boozing is losing when it comes to acid reflux, because alcohol can increase the stomach's acidity.
More acid means it's all the more likely it will spill upwards into the esophagus. Alcohol also contains numerous other chemicals that can be difficult to metabolize and irritate the stomach lining.
It's best to stay away from alcohol if you're prone to acid reflux.
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Typical soda drinks like Pepsi or Coke contain citrus as well as sodium benzoate and other chemicals that can irritate the gastrointestinal tract, says Dr. Chutkan.
They're best to be avoided if you have acid reflux.
Carbonated water, on the other hand, shouldn't cause acid reflux.
"I tell people if you can tolerate San Pellegrino, that's fine," she says. "But if you drink carbonated water and you still have problems, it might be good to cut that out too."
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Smoking can cause reflux not only because it increases acid production in the stomach, but also because it has a relaxing effect on the valve between the esophagus and the stomach.
"That valve normally stays shut and, once it opens up, it inappropriately allows acid and stomach contents to come up," explains Dr. Chutkan.
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Like smoking, caffeine ups acid production in the stomach and opens the lower esophageal sphincter.
That means coffeeeven decaffeinated coffee, which still contains small amounts of caffeineis off the menu for many people with reflux.
Certain medications can raise the risk of acid reflux.
These include bone-strengthening drugs such as bisphosphonates, certain blood pressure drugs, asthma medications containing theophylline, iron and potassium supplements, certain antibiotics (tetracycline is one), as well as aspirin and ibuprofen, and even fish oil supplements.
Taking a sleeping pill such as Ambien (zolpidem) may be a particular problem. One small study found that people taking Ambien were more likely to have nighttime acid reflux and more likely to be wakened by it. If one medication is giving you trouble, talk to your doctor about alternatives, says Dr. Deshpande.
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Take a deep breath
The right kind of breathing, like the right kind of food, may also ease acid reflux symptoms.
In a pilot study in the American Journal of Gastroenterology, researchers randomly assigned 19 patients who had acid reflux to either practice deep abdominal breathing or to a control group.
Those in the deep breathing group had better quality of life and lower stomach acidity four weeks and nine months after starting the practice.
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Exercise the right way
Although exercise is critical for maintaining a healthy body weight, certain types of exercise may worsen acid reflux.
Weight lifting and bench presses, for instance, can create extra pressure in the abdomen, forcing stomach contents up into the esophagus, says Dr. Deshpande.
But timing of exercise may be more important than the type of exercise, says Dr. Chutkan, who recommends that people work out on an empty stomach. "That will take care of symptoms in probably 95% of people," she says.
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Eat smaller portions
Consuming copious amounts of food at one sitting prompts the stomach to release gastrin, a hormone which stimulates the release of stomach acid, says Dr. Deshpande.
Eating smaller amounts at more frequent intervals during the day can be a quick way to cureor at least reduceacid reflux.
Try eating small amounts every four hours or less throughout the day, says Keri M. Gans, RD, a spokeswoman for the American Dietetic Association and author of The Small Change Diet.
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Don't eat before bedtime
Lying flatincluding when you're sleeping or simply lying down to watch TV or read a bookmeans gravity is no longer working in your favor.
And that means stomach acid is more likely to go up into your esophagus rather than stay down in your stomach.
"We advise patients that if they do have significant acid reflux, then they should separate supper time from bedtime by at a least a couple of hours so food has had a chance to move on down," says Dr. Kaul.
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Sleep on a gradient
Sleeping on an incline can make gravity your friend again. But make sure your chestnot just your headis above your abdomen. "The majority of the esophagus is actually in the chest, not the neck," says Dr. Deshpande.
Pillows will only lift your head above your chest. A better idea is to use wedge pillows, or elevate the head of the bed a few inches by using books or a piece of wood under the feet of the bed. One study found that elevating the head of the bed was one of the two most effective lifestyle interventions to reduce reflux. (The other was losing weight.)
The three main classes of drugs for this condition are antacids; proton pump inhibitors (PPIs), such as Prilosec (omeprazole) or Prevacid (lansoprazole); and histamine 2 (H2) blockers such as Pepcid (famotidine) and Zantac (ranitidine).
All three work in different ways to keep acid levels in the stomach under control.
Several different minimally invasive procedures are available including endoscopic surgery and radioablation (burning the esophagus so it produces scar tissue).
One recent study in the Journal of the American Medical Association found that patients undergoing laparascopic anti-reflux surgery, which involves reinforcing the lower esophageal sphincter with part of the stomach muscle, were just as likely to be in remission five years later as those given regular treatment with the proton pump inhibitor Nexium (esomeprazole).