Dietary and lifestyle
In most patients reflux occurs because a normal LOS is pushed beyond its ability to prevent reflux. Management options to avoid LOS failure involve behaviour or “lifestyle” and dietary modification.
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Dietary modification
Basic Dietary Changes:
- Fats slow gastric emptying
- Caffeine relaxes the LOS
- Avoid eating late
- Eat smaller meals
Low FODMAP diet
Changes in the normal gut biome especially SIBO can cause reflux type symptoms and when diagnosed a low FODMAP diet may be advised as part of an eradication programme usually in combination with specific anti-biotics, probiotics and sometimes drugs that improve gastro-intestinal motility.
FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. These are short-chain carbohydrates (sugars). Micro-organisms within the gut ferment these molecules often with the production of gas which will cause bloating, cramping pain, wind and sometimes diarrhoea and constipation.
A low FODMAP diet is a three-step elimination diet:
- Removing high FODMAP containing foods usually for two to eight weeks
High FODMAP foods include:
- Dairy-based food and drink
- Wheat-based products, especially bread. People often assume they have “wheat intolerance” if these trigger symptoms
- Beans and lentils
- Some vegetables, especially brassicas such as broccoli, artichokes, asparagus, onions and garlic
- Some fruits, including peaches, apples, cherries, pears
- Slow reintroduction of FODMAPS to identify which cause symptoms
- Subsequent avoidance of specific trigger foods high in FODMAPS
Alkaline diet
Firstly, Pepsin is a powerful enzyme released in the stomach and in addition to acid is thought to be a major contributor to all reflux symptoms but particularly LPR. It has been found in the throat, lungs and even ears of patients! It is biologically active in relatively mild acidic environments but because more so as the pH drops (indicating more acid). Therefore, some patients may find benefit from a low acid diet, avoiding for instance citrus fruit and fizzy drinks. Similarly since alcohol is generally acidic, avoiding drinking may also help. There is also some evidence that the use of alkaline water can help as above a pH of more than 8.5 pepsin becomes deactivated.
Secondly Low residue diet; if gastroparesis is diagnosed a diet low in fibre can help and this should be dietician supervised.
Lifestyle changes
- Weight loss: Increasing pressure in the abdomen puts more pressure on the LOS and losing weight can help. However, many people with GERD are of normal weight
- Getting gravity to help:
- Prop the head of the bed up at night
- Use more pillows