The following points will cover, in a process oriented action model, the reasons for most of the practices that should be adopted in the treatment of heartburn.
1- Assisting natural processes which promote acid clearance and stomach emptying
Increasing the production of saliva: saliva is produced by the salivary glands located around the mouth and have a high bicarbonate content and therefore an alkaline reaction. One of the functions of saliva is to neutralize the acid accidentally refluxed into the esophagus. Smoking and salty snacks reduce saliva and contribute to heartburn, they should therefore be avoided. At the same time, chewing gum should be encouraged as a good habit for heartburn sufferers who complain of dryness of the mouth.
Chewing thoroughly: mechanical degradation of food is an important preparatory step prior to digestion as it prepares food for further digestion in the stomach. Eating quickly is a bad habit that results in large food particles which imposes more work activity upon the stomach in the form of increased motility and increased acid production. It thus stays for a longer time in the stomach and delays its emptying. all these factors predispose to acid reflux and the habit of eating quickly should therefore be discouraged.
Small meals: a small meal would be digested easily with small amounts of acid and enzymes produced by the stomach. It is also cleared rapidly and does not increase pressure inside the stomach, consequently favorable circumstances for reflux are minimized. On the other hand a large meal is associated with increased production of acid, increased pressure and distension and delayed emptying of the stomach. all these factors initiate reflux and large meals should be avoided.
Drinking water: water dilutes and washes acid refluxed into the esophagus and promotes its clearance. At the same time it accelerates stomach emptying and prevents reflux. Drinking water should thus be encouraged before and after meals.
Pro-gravity postures: the erect posture favors movement of refluxed acid back into the stomach by the effect of gravity. On the contrary lying down is an anti-gravity posture, this fact should be considered together with our knowledge of the location of the esophagus, mainly within the chest (with negative pressure) and the location of the stomach, inside the abdomen (with positive pressure) these factors favor flow towards the esophagus and hinders esophageal clearance. Another factor related to posture is the increased tone of muscles supporting the lower esophageal sphincter in the upright position, this support is abolished when lying down as these muscles relax. Practically speaking recumbency should be avoided for at least 3 hours after eating, one should not go to bed immediately after meals and in heartburn sufferers the head of the bed should be elevated about 6 inches to prevent reflux.
Increasing lower esophageal sphincter pressure: from the functional point of view, high protein diet stimulates gastrin production, a local hormone that increases the sphincteric pressure and prevents reflux. Anatomically, a healthy physical built maintains an optimum tone in the muscles supporting the lower esophageal sphincter. It's well known that obesity weakens body musculature and reduces its contractility. Accordingly, we should maintain a desirable body weight and a low-calorie diet can be used to promote weight loss if needed. a high protein diet is also recommended.
Promoting stomach emptying: an important function regulating pressure inside the stomach and the amount of acid produced. Whenever emptying is delayed significantly food, acid and enzymes accumulate inside the stomach resulting in increased pressure and distention in addition to increased acid volume. The rate of stomach emptying is proportional to the rate of completion of digestion of a certain amount of food. Accordingly, when the digestive load is increased as following a heavy meal or swallowing large food particles or particularly when the meal is mostly composed of fat, a longer time is needed for digestion and consequently emptying is delayed. Drinking water also promotes stomach emptying. The role of having small meals, chewing thoroughly, low fat diet and drinking water before and after meals should be overstressed.
2- Eliminating factors that initiate reflux into esophagus
Direct irritation of the surface lining the esophageal lumen: avoid citrus,onions, spices and acids from tomatoes
Increased relaxation of the lower esophageal sphincter: avoid eating foods and drinking beverages that reduce sphincter pressure such as:
Caffeinated, carbonated or alcoholic beverages
Vinegar, spices, garlic, onion, tomato-based products and peppermint
Vegetables: raw onion and tomatoes
Citrus fruits: orange, lemon, grapefruit
Fatty meals: salad dressing and fried food
Dairy products: sour cream, milk shake, ice cream and cottage cheese
Sweets and desserts: chocolate and potato chips
Medications: avoid medications that lower sphincteric pressure such as: Theophylline, Anticholinergics, Progesterone, Calcium channel blockers, Alpha adrenergic antagonists, Diazepam and Meperidine.
Increased acid production: avoid heavy meals, spices and alcohol.
Increased pressure inside the stomach: avoid practices associated with increasing pressure. These originate either from within the stomach (internal) or from the outside (external). Internal pressures are generated following delayed gastric emptying associated with heavy meals with high fat content or secondary to obstruction of the stomach outlet.
External pressures are mostly due to compressive forces associated with practicing exercise following meals especially vigorous exercise with bending movements. Tight clothing also exerts external compression upon the stomach and heartburn sufferers should wear loose-fitting clothing. Obesity is also considered a compressive factor as it increases the bulk of viscera inside the abdomen and weight loss should be encouraged.
To summarize, the best measures for acid reflux relief are:
Understanding normal functions of the esophagus and stomach.
Enhancing normal functional mechanisms.
Avoiding foods, medications, and lifestyle practices which disturb normal functions and cause acid reflux.
Sheri Dean is a healthcare professional, currently writing informational articles on Acid Reflux Relief. Read more at http://acid-reflux-relief.blogspot.com