Gastro-Oesophageal Reflux Disease

In recognition of Gastro-Oesophageal Reflux Disease Awareness week, we asked Katherine Kimber (Dietitian) to explain what it is and what we can do help if we suffer with it. Read what she suggests:

First of all, what is GORD?

GORD stands for gastro-oesophageal reflux disease. It can be shortened to GORD or GERD depending on where you’re based in the world. In this article, I am going to use GORD, but it is the same as GERD. GORD is a condition caused by the stomach acid coming back up into the oesophagus. Depending on how often this happens and the cause, it can be an occasional annoyance or a more severe condition.

GORD is often called reflux, heartburn, and indigestion because that’s what the symptoms include. It mainly occurs due to the ring of muscle at the bottom of the oesophagus (the lower sphincter) weakening and allowing stomach acid to come back up the esophagus.

According to NICE Guidelines, if you suffer from persistent (4 weeks or more) heartburn, acid reflux, vomiting, abdominal pain or discomfort you should book an appointment with your GP as soon as possible. This way, you can have a proper diagnosis and understand the next best steps. Your GP may advise on lifestyle changes similar to those in this article and/or refer you to a gastroenterologist for an endoscopy to diagnose GORD, and to assess for any esophagus damage (1).

GORD is common, affecting 1 in 10 people, but only a small number of people speak to their GP about it, which means it can get worse over time. Fortunately, there are nutrition and lifestyle related changes that can be implemented to help reduce GORD symptoms. All nutrition and lifestyle modifications, including taking any supplements, should be discussed with your GP before beginning any.

Nutrition and lifestyle for GORD

There is a lot of information on the internet about stopping GORD symptoms, but not all are backed by scientific evidence. For some people, it might be that nutrition and lifestyle modifications are all they need to reduce symptoms, but some may also require medications like antacids and proton pump inhibitors (PPIs) from their GP. In this article, I aim to inform you on the latest available research related to nutrition and lifestyle factors for management of GORD. I have split the nutrition and lifestyle modifications into three areas.

The first area is all around timing and regularity of eating. This might sound pretty basic, but a 2014 study (2) finds that people with GORD who eat regularly, rather than eating one large meal in the evening have reduced symptoms. So I have a few specific recommendations:

  1. Eat regular meals: Eating regularly not only can help reduce GORD symptoms, but it’s also key to ensuring you’re feeding your body with the energy and nutrients it needs. Making sure to eat regularly also keeps you from becoming ravenously hungry and ending up overly-full at the next meal, which can also cause GORD symptoms (3).
  2. Avoid eating too close to bedtime: This isn’t a hard and fast rule, because it’s also difficult to fall asleep if you’re too hungry! So it’s about striking a balance between eating with enough time before you go to bed, and making sure you’re not super hungry. A general guide might be to avoid eating around 1 hour before bed – this way when you lie down stomach acid doesn’t move up the oesophagus, resulting in heartburn.

The second area is all about how you eat. Just like timing and regularity, the way in which you eat meals and snacks can have an impact on GORD symptoms. Many people with GORD find that these simple modifications can help reduce heartburn and reflux after eating:

  1. Taking time to slow down to eat: It’s no surprise that GORD symptoms flare up when people are stressed out. It’s usually a time when there’s not a lot of slow, mindful eating – which means air is swallowed and can lead to indigestion and stomach pain.
  2. Tuning into your fullness signals to reduce “overeating”: While it’s completely normal to eat past comfortable fullness every now and again – it can trigger acid reflux. So if you can, try to tune in to how your body feels when you’re starting to become full. It’s different for everyone, but most people find they become less interested in the food they’re eating, becoming more distracting, and feeling a slight distension in the stomach.

Finally, let’s focus on the third area, all about what you eat. This is usually the first thing people try to change when trying to implement changes, but often if people implement the above recommendations, they might not need to change what they eat at all. I think some of the most helpful recommendations include:

  1. Limit caffeine intake, especially tea and coffee: People with heartburn often find too much tea and coffee to be a trigger. The reason for this is because high intake of caffeine over the recommended intake of 400mg per day (around 4 coffees or 6 teas) can cause the muscle into the stomach to relax and open, allowing the stomach acid up into the oesophagus (4).
  2. Specific foods can be triggers: There are a bunch of foods that can trigger symptoms of GORD, and you might already know some of yours. Common trigger foods include spicy, citrus, and high-fat foods, tomatoes, peppermint (including chewing gum), and onions. Depending on the severity of GORD, you might not need to completely cut out your trigger foods. You might be able to figure out what works for you, like not eating them too close to bed, not eating a large portion, or avoiding when your GORD symptoms are already present. Some people find it helpful to keep a food and symptom diary for a while (i.e. 1-2 weeks) to figure out any patterns and experiment with what works.

How supplements can help with GORD

Alongside the recommendations outlined in this article, plus medications if that’s what you and your GP decide is right for you, there are supplements that might help to reduce GORD symptoms. If you are taking medication, or receiving any treatment for GORD speak with your GP and/or gastroenterologist before taking any supplements.

Currently, no supplements are recommended under NICE Guidelines (1) as we do not have enough research on effectiveness, dose, and long-time effects. In this section I will outline the supplements that are often associated with GORD and summarise the current evidence of each.

  1. Ginger: A 2019 review of clinical trials found that standard ginger supplements can reduce nausea after meals in some people (5). However, more extensive and well‐controlled human studies of ginger or its standard extracts are required to demonstrate its effectiveness for management of GORD. Further clinical trials are needed to determine the best dose and preparation of ginger. Further, if you have a bleeding disorder, ginger is not recommended as it is a blood thinner.
  2. Slippery Elm: Slippery Elm has limited scientific research to support it being a supplement for GORD, however it is a popular recommendation in natural health magazines. The supplement is thought to “coat” the digestive tract and reduce stomach acid’s irritation to the oesophagus, however there is currently no scientific evidence this is the case (6). Slippery Elm is recommended unsafe during pregnancy or when breastfeeding, and can interact with medications.
  3. Deglycyrrhizinated licorice (DGL) Licorice: DGL Liquorice has been praised for many years for immediate relief from heartburn and acid reflux. Currently, the only scientific evidence is based on a 2014 case study where two Doctors report that DGL Liquorice supplements helped reduce heartburn in one child they were treating (7). This itself does not warrant a recommendation that DGL Liquorice can help reduce heartburn in everyone, therefore more double-blind, randomised research studies are needed with more participants. Those with heart disease or high blood pressure are not advised to take Licorice supplements due to its effect on potassium levels.
  4. Probiotics: A 2020 review found that supplementing with the probiotic strain Lactobacillus acidophilus may be helpful in reducing heartburn, abdominal gurgling, belching, and indigestion after eating (8). Probiotics are best taken on an empty stomach first thing in the morning, before you eat anything – this way the bacteria isn’t destroyed by your stomach acid that’s produced when you eat.

In summary, we have identified a number of lifestyle interventions that may help reduce GORD symptoms, if you have received a diagnosis from your GP. From timing and regularity of eating, to how you eat, and what you eat. There are some small changes to timing and regularity, and how you eat, that may be beneficial, before needing to change what you eat. It’s difficult to make firm recommendations on supplements for GORD due to a lack of strong scientific evidence from clinical trials. Further, it’s unknown how supplements may interact with GORD medications, and the long-term use of them for GORD.

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This post is meant for educational purposes only and does not constitute medical or nutritional advice or act as a substitute for seeking such advice from a qualified health professional. In order to make the blog series easier to read, I have used a conversational tone in many places with personal pronouns, such as “I” and “you.” This is meant only to make it more pleasant to read, and is not meant to imply that the information constitutes any form of advice, whether personal or general.