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Nearly 30 percent of adults in the U.S. cope with frequent heartburn and acid reflux, hallmarks of gastroesophageal reflux disease, better known as GERD. Once thought of as a condition that mostly affects older people, some research suggests that the incidence is increasing among those under 40.
Doctors typically suggest making lifestyle changes to help reduce the frequency and severity of GERD before trying medications that help block or reduce the acid production that leads to symptoms. But up to now, there hasn’t been much hard evidence to back up those recommendations. A new study, published in the journal JAMA Internal Medicine, is the first to quantify the significant relief that diet and lifestyle changes can deliver.
“Doctors have been casual about recommending lifestyle modifications, thinking they may have some benefits, but now we know that changing behaviors can have a dramatic impact,” says Andrew T. Chan, MD, chief of the clinical and translational epidemiology unit at Massachusetts General Hospital and one of the study's authors.
What the Study Found
The researchers analyzed data collected every four years between 2005 and 2017 from the long-running Nurse’s Health Study. That included information from nearly 43,000 women, ages 42 to 62 years, who reported having acid reflux or heartburn at least weekly.
They found that those who adhered to five behaviors, dubbed “antireflux lifestyle factors,” saw a 50 percent reduction in the risk of GERD symptoms, and that adhering to all five could prevent nearly 40 percent of GERD cases in the general population. The five modifications included not smoking; drinking fewer than two cups a day of coffee, tea, or soda; following a healthy diet (one that’s high in whole grains and low in red meat and added sugars); getting at least 30 minutes of moderate to vigorous exercise daily; and not being overweight, defined as maintaining a body mass index (BMI) below 25.
In fact, Chan says, the benefits of these five factors were on a par with the effectiveness of GERD medications such as proton-pump inhibitors (PPIs) like omeprazole (Prilosec) and lansoprazole (Prevacid), and histamine-2 blockers like famotidine (Pepcid) and cimetidine (Tagamet).
“That means that diet and lifestyle changes may replace the need to be on medication for the long term,” Chan says. “We also found that those taking medication and also adhering to one or more of these modifications saw an increased benefit.” That's an important finding because other research suggests that these drugs don't completely eliminate symptoms in all people who take them. For example, in a 2019 study published in the journal Gastroenterology, 54 percent of people taking PPIs still had persistent GERD symptoms. This was more likely to be the case in Latinos and younger people.
While this study analyzed data from a large number of people followed over more than a decade, all the subjects were women and primarily white. The researchers noted that this population does make up a large portion of those suffering from GERD. “But based on our understanding of GERD and its risk factors, we’re very optimistic that these findings would be relevant to men and to people of other backgrounds,” Chan says.
The study also didn’t look at every lifestyle change that could potentially reduce GERD symptoms. Rather, the researchers focused on the five they felt would have the biggest impact. But they acknowledge that others—such as limiting alcohol intake—may have a positive effect, too.
How to Get the Biggest Benefit
“I’ve long recommended these and other lifestyle modifications to my patients,” says Christine Lee, MD, a gastroenterologist at the Cleveland Clinic. “The results of this study help give those recommendations specific parameters and add more weight to their importance.”
The researchers found that adhering to all five lifestyle modifications reduced symptoms the most. Many of these behaviors are linked, so it’s not surprising that the more of them you follow, the better your results. “Staying physically active helps you maintain a healthy body weight, as does eating a healthy diet,” Lee says. “Both of those factors also help you avoid constipation, a condition that worsens reflux symptoms.”
But each lifestyle factor the researchers looked at had its own independent effect on GERD. Of the five, maintaining a healthy BMI provided the greatest benefit. Compared with those who were overweight, those with a BMI of less than 25 experienced 31 percent less GERD. “Obesity and being overweight are important risk factors for reflux,” Chan says. “There are mechanical changes in the body as a result of carrying excess weight, and obesity may also effect how the gastrointestinal tract cycles food through your system.” So if you’re going to pick one change to focus on, make it weight loss.