How to Treat Acid Reflux: Lifestyle Changes and Medication
If you’ve been diagnosed with acid reflux, which is formally known as gastroesophageal reflux disease (GERD), you may be struggling with ways to treat it and control your symptoms. These symptoms can make it difficult to do simple things like eat a meal and sleep.
GERD is a medical condition that happens due to acidic stomach contents leaking out of the stomach and into the esophagus (the passage between the mouth and the stomach).
This leakage, or reflux, of stomach contents causes a lot of inflammation and irritation to the esophagus, and this inflammation can cause many unpleasant symptoms like:¹
Indigestion
Nausea
Bloating
Sore throat
The feeling of a lump in your throat
Upper abdominal pain
The goal of treating GERD is to decrease the amount of stomach acid that is leaking into the esophagus, as this is what causes the uncomfortable symptoms of GERD. There are certain types of acid reflux and inflammatory conditions of the stomach that require medication, which we’ll discuss later on.
But in most cases, lifestyle changes like weight loss, dietary changes, and sleeping habits may help improve or completely treat your reflux. And if they don’t help enough, there are medications that can be used along with lifestyle changes to improve your acid reflux and the unpleasant symptoms that come with it.
Lifestyle Modifications for the Treatment of Acid Reflux
The first thing that is often recommended, and can typically work well, are lifestyle changes. Lifestyle changes that have been found to improve GERD include weight loss, dietary changes, and changing the position you sleep in.
Weight Loss Improves Symptoms of Acid Reflux
Being overweight or obese can worsen or even cause GERD, and weight loss has been proven to help. One study of 332 adults with obesity found that 81% of them who lost an average of 17 pounds had an improvement in their symptoms. Additionally, 65% of them had their symptoms go away completely. And the more weight that was lost, the greater the improvement in symptoms was.²
The impact of weight loss and GERD symptoms was seen again in a larger study that looked at 15,000 people. It found that people that lost weight to reduce their BMI by 2 points noticed a significant improvement in GERD symptoms.³
If you want to see how much weight you’d have to lose to improve your GERD symptoms, you can use this BMI calculator:
Dietary Changes To Improve Acid Reflux
Certain dietary changes have been believed to improve the symptoms of GERD. You’ve probably been told that decreasing your intake of foods and drinks such as coffee, alcohol, chocolate, and tomato sauce can improve your GERD. But what if I told you that this may not be true?
There have been many studies that have attempted to find a relationship between GERD symptoms and certain foods, and research hasn’t been able to find such a relationship.⁴
However, studies have suggested that eating foods high in simple sugars may worsen GERD symptoms. So balancing your meals with fats, proteins, and complex carbohydrates (whole grains) can reduce GERD symptoms.
The size and timing of meals also shows to be of importance when it comes to managing your GERD symptoms. On average, it can take up to four hours for 90% of a solid meal to be digested and moved out of the stomach. Because of this, eating smaller meals and eating at least four hours before sleep has been shown to decrease the symptoms of GERD.
Additionally, drinking alkaline water has been shown to improve the symptoms of GERD. A study just published in 2023 showed that drinking 1.5 L of alkaline water daily improved the symptoms of GERD and decreased how often rescue medications were needed.⁵
Changing Your Sleeping Position Decreases Symptoms of Acid Reflux
Because of the anatomy of the esophagus and stomach, it’s been found that lying on the left side and raising the head of the bed decreases GERD symptoms at night. You can easily do this by sleeping on more pillows and adjusting the position that you sleep in.⁶
Medications for the Treatment of Acid Reflux
If lifestyle changes don’t improve symptoms, then the next thing that can be tried is medication. The medications used to treat GERD work by either decreasing the acidity of stomach contents or lowering the amount of acid that’s released into the stomach.
1. Antacids
In general, it’s recommended to start with antacids like Tums or Maalox. They’re typically used as needed for symptoms of GERD. They contain things like calcium, aluminum, and magnesium which help to balance out acid levels in the stomach. This can result in a temporary improvement in symptoms.
2. Histamine-2 Blockers
If you continue to have symptoms with antacids, the next medication that’s often tried is a Histamine-2 Antagonist. These are also known as H-2 blockers. These medications work by blocking a chemical that tells acid-making cells (parietal cells) in the stomach to make acid. Some of the most common H-2 blockers include:⁷
Famotidine (Pepcid)
Cimetidine (Tagamet)
Nizatidine (Axid)
The onset of H-2 blockers is about 60 minutes, which makes them effective at relieving the symptoms of GERD pretty quickly. However, their effects typically wear off within four and ten hours. Due to this, a longer-acting medication may be needed.
3. Proton Pump Inhibitors
If H-2 blockers aren’t lasting long enough or helping enough with your GERD, the next medication that’s tried is called a Proton Pump Inhibitor (PPI). These medications work by blocking the pump in parietal cells that produce stomach acid.⁸
By lowering the amount of acid in the stomach, less acid is available to be able to move into the esophagus and cause inflammation. These medications are either taken once or twice daily. Some of the most common PPIs include:
Pantoprazole (Protonix)
Omeprazole (Prilosec)
Esomeprazole (Nexium)
Compared to H-2 blockers, PPIs take longer to work. On average, PPIs take one to two days to have an effect. So for this reason, you may need to temporarily use H-2 blockers to control your GERD symptoms when first starting a PPI.
Additionally, if you have certain conditions like esophagitis (inflammation of the esophagus) or ulcers, you’ll likely need to be started on a PPI right away. The only conditions that require long-term treatment with a PPI are severe esophagitis, Barrett's esophagus, and peptic strictures. Also, a certain bacterial infection of the stomach caused Helicobacter pylori can cause inflammation and ulcers in the stomach, and the treatment for it involves antibiotics and a PPI.
Typically, it’s recommended that PPIs be used to treat GERD symptoms for up to eight weeks. After this, you should try to only use the medication as needed or use the lowest dose possible to control your symptoms.¹ This is because the long-term use of PPIs can increase the risk of certain medical conditions and vitamin deficiencies – some that can be life-threatening.
What If My Acid Reflux Isn’t Getting Better?
As mentioned before, it’s recommended that PPIs be used for eight weeks for the initial treatment of GERD. But what happens if your symptoms continue after this?
If your symptoms continue even after eight weeks of treatment with a PPI, it’s recommended that you see a gastroenterologist (stomach and intestine doctor) to be evaluated. Typically, the evaluation will include an endoscopy (EGD).
You may need to see a gastroenterologist sooner if you have any of the following symptoms:⁹
Difficulty swallowing
Painful swallowing
Blood in your stool, which can present like bright red stool or dark red/black stool
Weight loss
Getting full quickly
These symptoms can be a sign of serious conditions like cancer and bleeding in the stomach or intestines. If you have blood in your stool of any kind, it’s recommended that you present to the nearest emergency department as soon as possible. The other symptoms listed above, while serious, don’t often require emergent evaluation in a hospital.
Depending on your insurance, you may need a referral from your primary care provider to see a gastroenterologist. And while you’re waiting for your appointment, your primary care provider can help you manage your symptoms with medications.
You can also check out some of my other articles to get more up-to-date, evidence-based information about health and wellness.
Stay informed, stay healthy.
References:
1. GERD: A practical approach – (ccjm.org)
2. Weight loss can lead to resolution of gastroesophageal reflux disease symptoms: a prospective intervention trial – (nih.gov)
4. The role of diet in the development and management of gastroesophageal reflux disease: why we feel the burn – (nih.gov)
5. Heartburn relief with bicarbonate-rich mineral water: results of the randomised, placebo-controlled phase-III trial STOMACH STILL – (nih.gov)
6. The role of lifestyle changes in gastroesophageal reflux diseases treatment – (nih.gov)
7. H2 Blockers – (nih.gov)
8. Proton Pump Inhibitors (PPI) – (nih.gov)
9. Gastroesophageal Reflux Disease (GERD) – (nih.gov)
