Digestive Health: The Experts Weigh In

Everyday Health: It makes sense that there are connections between digestive health and weight loss because some digestive conditions cause people to unintentionally lose weight. Are there any digestive health conditions that actually make it more difficult to lose weight?

Mark Babyatsky, MD (mssm.edu)

While most gastrointestinal (digestive health) conditions are associated with weight loss, a notable exception includes severe liver disease and liver cirrhosis. In severe liver disease, patients can look very thin but gain weight because the liver normally makes an important protein known as albumin. As liver disease progresses, it can no longer make much albumin. Since albumin keeps water and other liquids in the bloodstream, its loss results in leaking of fluid from the blood to the belly and legs, causing these parts of the body to increase in size, sometimes by a lot. Even though advanced liver patients appear very ill along with thin faces and arms, they actually gain weight due to the fluid in the legs and abdomen. While weight gain is rare, some patients with duodenal ulcers receive relief by eating more to neutralize the acid made by their stomach, although this appetite rarely leads to weight gain.

Kenneth Brown, MD (kennethbrownmd.com)

Most digestive problems tend to cause a loss of weight from poor absorption of food, but there are a few situations in which our intestinal health can contribute to weight gain. One problem that I frequently see is when an individual has acid reflux or even an ulcer, they tend to eat frequently to decrease the pain temporarily. The pain briefly is alleviated as both the saliva and food neutralize the acid temporarily, but once the food is digested there is even more pain from rebound acid production.

Another very intriguing area of research is the role of small bowel bacterial overgrowth (SIBO) possibly contributing to weight gain, due to the production of methane gasses which may slow the motility down and ultimately lead to more absorption of calories. There are studies underway now looking into the role of bacterial manipulation for potential weight loss.

Christine M. Esters (adventureinwellbeing.com)

Weight gain is an accumulation of toxins in certain organs. Toxic colon is the first place to cleanse since our colon is our sewage system. The second organ to cleanse is the liver, which is filtering fat soluble toxins, and the third organ is our kidneys that eliminate water soluble toxins. Disease related to colon, like constipation, candida, parasites, heavy metal or related to liver or related to kidney make losing weight difficult to impossible.

Lisa Ganjhu, DO (wehealnewyork.org)

Losing weight for the most part is really basic math. In order to lose weight you have to burn more calories than you consume. There really aren’t any digestive disorders that make losing weight difficult. Actually since the digestive tract is responsible for getting nutrients from food, disorder in the digestive tract may cause malnutrition and weight loss. There are certain endocrine disorders that make weight loss difficult. The main reason people gain weight is that they eat too much and exercise too little.

Lisa Pichney, MD (stopcoloncancernow.com)

Digestive conditions such as Crohn’s disease or ulcerative colitis are often treated with steroids; steroid use can cause weight gain. Also, patients with GERD (gastroesophageal reflux disease) or PUD (peptic ulcer disease) often feel better when there is food in their stomach to soak up excess acid. This sometimes results in patients feeding their disease and therefore weight gain can result. The added weight can also contribute to worsening of reflux.

Sutha Sachar, MD (susacharmd.com)

A lot of people confuse abdominal distension from bloating as fat. The reality is that there are certain causes of bloating, such as lactose intolerance, celiac sprue, food allergies, irritable bowel syndrome, and small intestinal bacterial overgrowth which make an individual feel as if they can’t lose the weight even though they may be. Seeing a gastroenterologist who specializes in bloating can rule out these causes and optimize body image and comfort.

Albert Snow, ND (holisticgastroenterology.com)

Yes, that can essentially be true about any inflammatory bowel condition — such as IBS or colitis. What all of those conditions have in common is that the sufferer has had antibiotics. This medication destroys the mucosal lining in that gut, which I call the “software” (the “hardware” being the flesh that makes up the GI tract). This software is what identifies which food group you have swallowed and the calories within it. Without the mucosal lining your digestion will not work properly and therefore not process calories properly. This is the most fundamental cause of weight gain: mismanagement of calories. Everything else that we do wrong regarding food and exercise is compounded by the lack of this fundamental principle. That is why so many efforts to manage weight appear to be futile. Conversely, replace the “software,” process calories better, lose weight. This is something that should get everyone’s attention. Having a healthy, well — developed mucosal lining will not only prevent IBD (irritable bowel disease) but will also allow you to eat rich foods and not gain weight. It is nature’s “erasure,” managing our mistakes, including poor diet, by keeping our pH level at a perfect 6.5. My version is the probiotic diet.

AA Starpoli, MD (starpoli.com)

I would consider depression, iatrogenic causes (those effects of certain medications taken by a patient), and hypothyroidism (low thyroid function) as causes of weight gain.

William Chey, MD (med.umich.edu)

I am not aware of any common GI problems that cause patients to gain weight. Ironically, successfully treating a number of common GI problems can be associated with unintended weight gain. For example, patients with gastroesophageal reflux disease (acid reflux) or irritable bowel syndrome (IBS) will often gain weight after food — related symptoms like heartburn, abdominal pain, diarrhea, and constipation are improved with appropriate therapy. In addition, the use of certain medications such as antidepressants can stimulate appetite and lead to weight gain.

Jacqueline Wolf, MD (drjacquelinewolf.com)

Medications used for digestive health conditions can have a major impact on one’s weight. Anyone who is taking corticosteroids (prednisone, prednisolone) will find it hard to lose weight and usually will gain weight. Corticosteroids are given for conditions such as ulcerative colitis, Crohn’s disease, and autoimmune liver disease. The weight gain is both water weight and absolute weight. It causes the face to balloon out and weight gain around the abdomen. Those on this medication usually don’t see the effects reversed until they are on a very low dose of or even off the medication for several months.

Other medications used for digestive conditions may make it more difficult to lose weight or cause someone to gain weight. These include the SSRIs and the tricyclic antidepressant medications (amitriptyline, nortriptyline, desipramine) used in irritable bowel syndrome or hormones used for endometriosis.

Patients who have a low albumin (malabsorption or problems with the lymphatics) or liver disease may get fluid in their legs or abdomen that may be difficult to lose.

Bharat Pothuri, MD, FACG: Gastroenterologist

At least 15 million people in the United States experience daily heartburn, and many of these people have gastroesophageal reflux disease (GERD). This chronic condition can lead to esophageal damage, not to mention the discomfort and unpleasantness of burning sensations around your chest and upper belly.

Anyone can get the symptoms of heartburn due to a large meal or upset tummy, but GERD is chronic. You experience symptoms at least two times a week, and usually more often. 

Being overweight is the biggest factor associated with GERD. If you’re obese, you’re nearly three times more likely than people of a normal weight to develop acid reflux. If you’re overweight, your symptoms may be extra uncomfortable. Here’s why.

Symptoms of GERD

People with GERD have the familiar burning in the chest and digestive tract caused by the upward action of stomach acid. Other symptoms include:

• A bitter taste in your mouth
• Gassiness
• Coughing
• Excessive belching
• Sore throat
• Swallowing difficulties
• Wheezing

Your weight can make these symptoms worse.

Excess pressure

Your weight increases pressure on your abdomen. The extra fat around the belly squeezes your stomach, so more fluid travels upward into your esophagus. This makes it more likely you experience stomach acid leakage and GERD.

The added pressure also causes the sphincter that sits between the stomach and the esophagus to relax, allowing stomach acid into the esophagus. Being overweight also makes your body less efficient at emptying the stomach contents quickly.

If your pants are a little tight, this too can aggravate symptoms of heartburn. Losing weight so your clothes are less snug also helps.

Best way to lose weight to relieve GERD

A heart-healthy diet supports weight loss and reduces heartburn symptoms. Pay attention to portion sizes and calorie density. Fill yourself up until you feel satisfied, but not stuffed.

As long as it’s balanced, contains plenty of fresh fruits and vegetables, whole grains, lean protein, and healthy unsaturated fat, your diet contains the nutrients to support good health. Add at least 30 minutes of physical activity daily (more if you want to lose weight faster) as well.

If simple calorie control and increased physical activity fail to help, consult Dr. Pothuri here at GastroDoxs. He can offer recommendations that may help kick start your weight-loss efforts.

And as long as heartburn symptoms plague you, continue to follow smart habits that keep symptoms at bay. For example, avoid foods that trigger heartburn, including coffee, tomatoes, and spicy or fried foods. Once you’ve lost weight, some of these foods may be tolerable again – but for now, skip them.

Chocolate and alcohol are also common heartburn triggers, plus they don’t help a lot when you’re on a weight-loss plan. Eat small meals to minimize your heartburn symptoms and to help keep your hunger at bay when you’re losing weight. Avoid late-night snacking, too. Not only does it sneak extra calories into your diet, it can also aggravate heartburn if you go to bed soon after your snack.

If you have GERD and need relief, call GastroDoxs or book an appointment using the online tool. We help people in the greater Houston area manage heartburn with weight loss, lifestyle changes, and medications, if necessary. 

9 Digestive Problems That Cause Weight Gain

When everything is flowing smoothly, life is good. And we’re not just talking good hair days or a flawless presentation at work. Your digestive tract counts too. But when it’s out of whack, it could affect — you guessed it — the scale.

“Gastrointestinal and digestive issues can definitely have a large effect on the way we eat and how our bodies absorb and digest foods, causing us to gain or lose weight,” says Kenneth Brown, M. D., a board-certified gastroenterologist. “Most digestive problems tend to cause weight loss from poor absorption of food, but there are a few situations in which our intestinal health can contribute to weight gain.”

If the number on the scale is changing and you really aren’t sure why, one of these common digestive issues could be the culprit.

1. Acid Reflux Disease

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Also known as gastroesophageal reflux disease (GERD), this causes a painful burning sensation, or heartburn, in the lower chest when stomach acid rises back up into your esophagus. And for people who suffer from it, the term “comfort food” takes on a whole new meaning because the act of eating can actually help reduce pain. “Eating provides temporary relief because both the food you’re eating, and the saliva from actually chewing that food, neutralizes acid,” explains Brown. The only problem? Once the food’s been digested, all the symptoms — bloating, nausea, and hiccups that won’t disappear — tend to come back, and they’re usually more aggressive because of rebound acid production. But because people want help, Brown says it’s easy to get sucked into a dangerous cycle of overeating that leads to weight gain.

The fix: While plenty of online sources say home remedies like apple cider vinegar or aloe vera can help, Brown says there’s no scientific evidence to support those notions. Instead, he recommends taking an over-the-counter medication, such as Prilosec or Zantac (your doctor can help you choose which is best for you), which don’t have weight gain as a common side effect. And if you still find yourself overeating, try these fixes to help break the cycle.

2. Ulcers

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These uncomfortable sores — also known as duodenal ulcers — usually develop in the lining of the stomach or small intestine, and it’s usually because of too much acid production. And just like with GERD, eating food can improve the painful symptoms — including bloat and constant nausea — because it temporarily coats the ulcer with a protective lining and neutralizes the stomach acid, explains Su Sachar, M. D., a board-certified gastroenterologist who specializes in bariatrics, wellness, and optimal health. And, to re-state the obvious, if you’re eating more frequently, those excess calories can lead to weight gain.

The fix: To banish ulcers, see your doctor about the best remedy for you, which might involve an acid-blocking medication — aka an anti-acid — like Prilosec or Zantec, says Sachar. And stop taking nonsteroidal anti-inflammatory drugs or NSAID pain relievers like ibuprofen or aspirin, as they could cause internal bleeding and be life-threatening to those with ulcers. Instead, opt for acetaminophen, or Tylenol, when you need help with pain management.

3. Constipation

Kittisak Jirasittichai / EyeEmGetty Images

When you’re stopped up, that weighed-down feeling you get could be weight gain. But there’s good news: your body isn’t actually absorbing more calories, says Brown, so it’s not true weight gain so much as it is extra fecal matter, which is what could be adding a few pounds to the scale. Not to mention that constipation itself doesn’t exactly give us the motivation to hit the gym and crush a workout. Rather, it’s way more likely that you’re feeling sluggish and heavy… and the couch is calling your name.

The fix: To stay, err, regular, Brown suggests sticking to a balanced diet of whole foods that have at least 25 to 30 grams of fiber per day, staying well-hydrated (try to drink one to two liters of water per day), and exercise regularly. If something doesn’t seem quite right, look at these signs for what it could mean, and consider talking with your physician.

4. Bacteria Overgrowth

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Bear with us — this one isn’t quite as gross as it sounds. Basically, your bowel contains both good and bad bacteria, and research shows that the good kind plays a crucial role in your overall health by reducing inflammation and keeping your weight in check. The problem occurs when the amount of bacteria increases, or when the type of bacteria gets thrown off-balance. (For optimal health, it’s best to think of it like a seesaw — best when the good and bad is totally balanced.) When that happens, what’s known as small intestinal bacterial overgrowth (SIBO) can occur, and it can cause weight gain in two ways, says Brown.

First, the bacteria could produce methane gas, which “slows down the overall function of the small intestine, allowing the intestinal villi — small, finger-like projections in the lining of your intestine — to absorb more calories per bite,” he explains. In other words, the exact opposite of what you want to happen. Second, SIBO can slow down metabolism and affect your insulin and leptin resistance, both of which help regulate hunger and satiety. As a result, you’re likely to crave carbs and probably won’t feel full after eating, even if it’s a fully satisfying meal, says Sachar.

The fix: To avoid SIBO, Brown suggests avoiding antibiotics unless absolutely needed (as the name suggests, these medications kill off bacteria, which you only really want if you’re sick to get the seesaw back in balance). If bacteria overgrowth is already happening, though, your doctor may suggest a digestive herbal supplement like Atrantil to help you get back on track.

5. Irritable Bowel Syndrome (IBS)

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The term IBS gets tossed around a lot these days, as “it’s the most commonly diagnosed GI condition, and it often overlaps with other digestive problems like food sensitivities, a leaky gut, and an imbalance of good and bad bacteria,” says Sachar. And like constipation (a symptom of IBS), it can cause bloat and chronic inflammation, which, once again, could lead to weight gain.

The fix: For people who are diagnosed with IBS, it’s about getting to the root of the problem. Your doctor can work with you to build up the good bacteria you need with probiotics, and add digestive enzymes to help break down food so it’s not just sitting around in your gut causing inflammation, explains Sachar. Brown says it could be helpful to try a gluten-free or low gas-producing diet, like FODMAP, as it can help reduce bloating and help get any unnecessary weight gain under control.

6. Crohn’s Disease

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While a smaller appetite and excessive weight loss are common symptoms of Crohn’s disease — an incurable chronic inflammatory conditions — the exact opposite can happen as soon as someone gets put on a treatment that involves steroids, which is usually the first step in trying to find a medication that works for you, says Sachar.

“Steroids tend to increase your cravings for carbs and cause you to hold on to more water and feel bloated,” says Sachar.

Fortunately, it’s usually not too tough to lose the weight once you’re off steroids. That usually happens as soon as a flare-up — or the reappearance of symptoms like diarrhea, constipation, rectal bleeding, and fever — subside and symptoms are better under control.

The fix: First of all, your overall health is more important than a few pounds on the scale, so following your doctor’s orders is imperative. But some doctors do shy away from steroid use, like Brown, as he knows the side effects can be less than desirable. Every patient responds differently to medication, though, so talk with your own physician to see what works best for you.

7. Gastroparesis

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Often associated with those who have type 1 or type 2 diabetes, gastroparesis — also known as delayed gastric emptying — is a disorder that “slows or stops the movement of food from the stomach to the small intestine,” according to the National Institute of Diabetes and Digestive and Kidney Diseases. Because normal digestion isn’t able to occur, it’s common to feel like you’re gaining weight due to fullness and bloating in the stomach area, but the disorder most commonly leads to weight loss in the end.

The fix: According to the American College of Gastroenterology, diet is one of the most important factors in treating gastroparesis. Because fatty and fiber-filled foods take longer to digest, it’s recommended that anyone with the disorder limits or avoids those foods altogether. But since this is a serious condition, it’s best to speak with your doctor to see what the best treatment options are for you.

8. Food Intolerance

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If you’ve noticed your body is easily irritated by certain foods, there’s a good chance you have a food intolerance. Different from a food allergy, which is an immune system response, food intolerance affects the digestive system, making it hard to digest and break down certain foods (the most common being dairy), says the Cleveland Clinic. Those with a food intolerance often experience gas, cramps, and bloating, making it feel like they’re gaining weight. Depending on how severe the food intolerance is, they might also experience diarrhea.

The fix: While you might feel super bloated and uncomfortable throughout the day because of your diet, you might not actually be gaining weight. The Cleveland Clinic recommends avoiding or reducing the foods you think are giving you issues, and if you do end up eating something that bothers your stomach, take an antacid.

9. Ulcerative Colitis

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Although Crohn’s disease can pop up anywhere between the mouth and the anus, UCLA Health says ulcerative colitis stays in the colon, resulting in a constantly inflamed digestive tract that can initially lead to weight loss. Like Crohn’s, though, the treatment for the inflammatory bowel disease — steroids — could make your body gain weight.

“An oral steroid like Prednisone can also cause your body fat to redistribute itself, so instead of it being in your stomach or glutes, it could move to the face or neck,” says Sachar.

Even though you may notice a difference in your weight during treatment, everything should go back down to normal as soon as you’re able to get off the steroids.

The fix: After speaking to your doctor, find a treatment plan that’s right for you and the severity of your ulcerative colitis — one that may or may not involve steroids. While more moderate to severe forms might be treated with steroids, 5-aminosalicylates and immunosuppressant drugs are also options. Whatever you end up using, know your wellbeing is top priority. If that involves gaining a few pounds to better your health, it’s worth it.

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How Does Hyperacidity Or Acid Reflux Lead To Weight Gain?

Medically reviewed by Shanmukha Priya, M. Phil and Ph.D. in Food Science and Nutrition

Your digestive system is the core of your physiology and so is the abdomen the core of your physical self.

The food you take is broken down into small particles and the nutrients are absorbed to provide energy. The undigested residue is discarded as waste.

Table of contents

What is hyperacidity?

The food you take is processed in your stomach and intestine. To do so, certain juices and acids are produced in the system.

If the acids in your stomach are in excess of requirement, you start suffering from hyperacidity or acid reflux. This is also known as heartburn informally, though it has nothing to do with your heart.

Symptoms:

The symptoms of hyperacidity are many; some of the few common ones include:

• Sour taste in your mouth
• Burping
• Discomfort in the upper abdomen
• Burning sensation in Chest, Stomach or in your Throat.
• Heaviness after having meals.
• Indigestion and nausea.
• The rigidity of the stomach.
• Obesity or abnormal weight gain.
• Arthritis and muscle pain.
• Dehydration.
• Mood swings with irritable and nervous behavior.
• Impaired metabolism and low absorption of nutrients.
• Life of low energy.

General causes of hyperacidity

Many things can cause hyperacidity. Knowing them would help you to check them. The common causes are:

• Consumption of fatty and spicy food.
• Not maintaining regular food routines.
• Missing regular meals and eating junk food to make up.
• Drinking too much alcohol.
• Smoking cigarettes.
• Excessive drinking of tea and coffee
• Stress and anxiety
• Drinking carbonated drinks.
• The absence of physical activity.

Acidity and weight gain:

Can acid reflux cause weight gain?

Hyperacidity is the root cause of throwing your normal body processes off balance. Acidity severely impacts your ability to get rid of toxins from your body. As a result, your health is put at risk by causing an imbalance in your pH level.

Additionally, your excess body weight hampers reduction of acidity by impairing digestion. It is to be understood that the acidity of your body and the quantum of fat in your body is closely interconnected. Fat in the body is the first defense protecting the pH of the blood in your body.

When your body fails to remove sufficient toxins from your body through sweat, urine and bowel movement, more fat cells are produced to store them. This is the most common basis for gaining weight. In a round-about way, acid reflux does cause weight gain.

Usefulness of Fat:

You tend to believe that fat is harmful to the body. On the contrary, some amount of fat in your body is essential to maintain the normal functions of your system.

It helps in sustaining your organs like the nervous system, bone marrow and muscles. It also provides energy to the body.

Blood pH and body weight

Studies have shown that the ideal pH of your body should be between 7.3 and 7.4 which essentially mean that your blood is alkaline. If your pH is anywhere below seven, your blood becomes acidic.

There is a low supply of oxygen to the cells creating an environment in which you are prone to suffer from diseases. The chart below is indicative of the pH measurement and what it means to the sustenance of life.

• 7 to 7.5: Healthy
• 6.8: Metabolic acidosis
• 6.4: Improper digestion and difficult to lose weight.
• 6.0: Oxygen deficiency in cells
• 5.5: Extreme acidosis and degenerative diseases
• 5.0: Extreme oxygen suffocation and a threat to life.

It is thus evident that maintaining the correct pH balance is crucial to a life of good health.

Imbalance of pH and weight gain:

By now, it is amply clear the acidity and weight gain are closely related and without finding a solution to the problem of hyperacidity, it is difficult to lose weight. Obesity also aggravates the symptoms of hyperacidity.

The answer therefore to the question: can acid reflux cause weight gain is yes, it can. It is thus important to lose weight. Some experts lately have emphasized the need to restore pH balance in the blood in order to maintain a body weight that allows you to lead a healthy life.

How to restore pH balance?

The first step toward achieving this goal of reducing the acidity of your body and restoring pH balance is a suitable change in your diet and lifestyle.

It is extremely important to keep in mind that dietary changes are not arbitrary and contain a blend of both alkalizing and acidic foods. Eating healthy natural food and incorporating oxygenating exercises into your daily routine is a great way to begin the procedure.

The trick is to shun all the foods that you relished so far and gorged on and start taking those you particularly detested. You may adopt the following measures:

• Eat fruits and vegetables, especially leafy greens and legumes, as they are alkaline foods.
• Eat Soybeans, tofu, nuts and seeds which are all alkaline promoting foods.
• Citrus foods should be eaten in moderation.
• Dairy, eggs, meat, most grains are acid promoters and can be eaten in moderation.
• Eat lentils and beans.
• Eat a lot of green salads but not with vinegar dressing.
• Processed, packaged, convenience and canned foods should not be eaten.
• Drink a lot of water as it will help rid your body of toxins through urine and sweat.
• Do not indulge in drinking tea and coffee.
• Avoid alcohol.
• Stop smoking.
• Avoid stress factors and meditation is a good mean to counter the causes.
• Avoid sedentary lifestyle and indulge in physical activities daily.  Exercises, cycling, swimming, jogging etc. are all good for your health to burn the excess calories and fat.

Conclusion:

Weight gain and hyperacidity are self-promoting and mutually sustaining. However, by restoring the pH balance you are creating an environment that will enable you to combat obesity and lose weight to your desired level.

With a judicious intake of beneficial foods, appropriate changes in the lifestyle and maintenance of alkaline pH, the necessity of the body to produce protective fat cells will be absent.

This will help maintain a optimal body weight and in the process, eliminate the health hazards that is inherent to these conditions.

The benefits of reducing acidity and maintaining pH balance are extensive. It makes you live a life full of energy with good health and contentment.

Obesity & Heartburn: What is the Link?

by Nancy Kushner, MSN, RN, and Robert Kushner, MD

Winter 2013

To view a PDF version of this article, click here.

New research points to an association between obesity and heartburn. Studies have shown that weight gain and an increase in the size of one’s belly may either cause or worsen this condition.

Heartburn, also called GERD (gastroesophagael reflux disease), occurs when stomach acid flows back into the esophagus, which is the food pipe that connects the throat and stomach. Heartburn symptoms often occur shortly after eating and can last for a few minutes or even hours. People may complain of a burning sensation in the chest or throat, a sour or bitter taste in their mouth or even cough symptoms.

This association seems to be stronger in women and in the white population as compared to men and other ethnic groups. The increased risk of GERD is thought to be due to excess belly fat causing pressure on the stomach, the development of a hiatal hernia that causes the backflow of acid or hormonal changes like an increase in estrogen exposure that can occur in individuals who are affected by obesity.

Why is this important?

As acid flows back into the esophagus, it can cause irritation and inflammation. Throughout time, complications can develop. The esophagus can narrow, leading to a stricture and swallowing problems. A sore or ulcer can develop which can bleed, be painful and make swallowing difficult. Additionally, precancerous changes can occur to the esophagus, called Barrett’s esophagus, which is the main risk factor for developing esophageal cancer.

It turns out that obesity is associated with three related esophageal disorders: GERD, Barrett’s esophagus, and esophageal adenocarcinoma. The risk for these disorders seems to progressively increase with increasing weight. The goal of treating GERD is not only to decrease bothersome GERD symptoms but also to decrease one’s risks of developing these other, more serious esophageal conditions.

What can you do?

The most effective lifestyle interventions to reduce GERD symptoms are losing weight and, if symptoms occur during sleep, elevation of the head of the bed. New research shows that weight-loss can improve GERD symptoms. In a recent study published in the journal Obesity in 2012, the majority of individuals who were overweight or affected by obesity who enrolled in a structured weight-loss program including dietary, physical activity and behavioral changes, experienced complete resolution of their GERD symptoms. The relationship between weight-loss and resolution of symptoms was dependent on the amount of weight lost, such that the more weight subjects lost, the greater improvement they saw in symptoms. Whereas women saw improvement in GERD symptoms after losing 5 to 10 percent of their weight, men experienced improvement after losing 10 percent of their weight.

In another study published in the journal Gastroenterology in 2010, weight-loss through restriction of calories and increased physical activity also demonstrated a significant improvement in participants’ symptoms of GERD. Most importantly, follow-up at 6, 12 and 18 months showed decreases in abdominal fatness and symptoms of heartburn and acid reflux. Reduced GERD symptoms means lower acid levels in the esophagus. Thus, another benefit to losing weight is that patients may be able to eliminate or reduce their over-the-counter (OTC) or prescription GERD medications.

Though improved GERD symptoms has also been shown in patients who undergo bariatric surgery, it is difficult to know if improvement is due to the anti-reflux nature of the surgical procedure or to the weight-loss itself.

There have also been studies on the effectiveness of elevating the head of the bed to decrease GERD symptoms. Compared with patients who slept flat, patients who elevated the head of the bed did have less esophageal acid exposure and fewer reflux symptoms. Studies show that this can be an effective strategy for some patients. You can elevate the head of the bed using wood or cement blocks under the legs of your bed or using wedges between your mattress and box spring.

Effectiveness of Other Lifestyle Modification Measures

The list of foods, drinks and other factors thought to worsen GERD symptoms is quite long and includes:

• Tobacco
• Alcohol
• Carbonated beverages
• Caffeine
• Chocolate
• Onions
• Garlic
• Spicy foods
• Cooked tomato sauce
• Mint
• High-fat meals

The data studying these items is conflicting. More research is needed to determine the effectiveness that stopping smoking or eliminating the listed foods and drinks will have on GERD symptoms. It is recommended to pay attention to see if any of the listed items seem to worsen your condition. If so, you can decrease or eliminate them and see if symptoms improve.

Other Helpful Lifestyle Measures:

• Eat smaller meals.
• Wear clothes that are looser around the waist.
• Don’t lie down for at least three hours after eating a meal.

Medication Therapy

OTC and prescription medications are available to treat GERD. Ask your healthcare provider for guidance when seeking a medication treatment plan to control your symptoms. OTC medication options include antacids (Mylanta or Tums) that neutralize stomach acid; h3 blockers (Tagamet or Pepcid) that reduce stomach acid; and proton pump inhibitors (Prevacid or Prilosec) that also block stomach acid and allow the esophagus to heal. Prescription strength h3 blockers and proton pump inhibitors are also available. Combining medications can sometimes increase effectiveness.

Like all medications, GERD medications can have side effects and can interact with other drugs, so it’s important to discuss this with your healthcare provider. Be sure to talk about what and how much medication you are taking, the effects on your GERD symptoms and any side effects you are experiencing. The goal of medication therapy is to relieve GERD symptoms, allow the esophagus to heal and prevent GERD complications.

Conclusion

If you think you are experiencing heartburn (GERD) symptoms, it is important to discuss these symptoms with your primary care provider. Together, you will be able to identify an effective treatment plan.

About the Authors:
Nancy Kushner, MSN, RN, is a nurse practitioner, health writer and co-author of Dr. Kushner’s Personality Type Diet and Counseling Overweight Adults: The Lifestyle Patterns Approach and Toolkit.

Robert Kushner, MD, is Clinical Director of the Northwestern Comprehensive Center on Obesity in Chicago, Professor of Medicine, Northwestern University Feinberg School of Medicine, Past President of The Obesity Society, author of more than 160 scientific articles on obesity and nutrition, author of Dr. Kushner’s Personality Type Diet, Counseling Overweight Adults: The Lifestyle Patterns Approach and Toolkit and Fitness Unleashed: A Dog and Owner’s Guide to Losing Weight and Gaining Health Together.

Weight Loss Can Lead to Resolution of Gastroesophageal Reflux Disease Symptoms: A Prospective Intervention Trial

Introduction

Over the past two decades, the prevalence of gastroesophageal reflux disease (GERD) has increased in the western population with the overall prevalence in the general population ranging from 10 to 20% (1-3). The exact etiology for the rising prevalence of GERD is not clear. Although there are no gender or racial predispositions for GERD development (4,5), various lifestyle factors including increased consumption of dietary fats, smoking, and alcohol and change in BMI are potential risk factors that can lead to GERD (6-10). Several studies have suggested that weight gain and/or obesity can play a major role in the development of GERD (9-17) through mechanical changes in the gastroesophageal junction and/or altered metabolic milieu from visceral fat (lower adiponectin and increase in interleukin-1β, tumor necrosis factor-α) (18).

Over the past few decades, the prevalence of obesity in the United States has more than doubled. Recent results from the 2007-2008 National Health and Nutrition Examination Survey (NHANES), using measured height and body weight, indicated that an estimated 68% of US adults were overweight (BMI > 25 kg/m²) and of those, 34% were obese (19). It seems intuitive that the worsening obesity epidemic and the rising prevalence of GERD symptoms may point to a cause and effect relationship. In addition, there also appears to be a dose–response relationship between increasing BMI and occurrence of GERD and related complications like erosive esophagitis (9,16), Barrett’s esophagus (fourfold) (20) and esophageal adenocarcinoma (16) as compared with normal weight individuals (BMI < 25 kg/m²).

Considering the dose–response relationship between obesity and occurrence of GERD and/or its complications, an inverse relationship between weight loss and GERD symptoms would be expected. Previous data on the impact of weight loss achieved through various lifestyle (dietary changes and physical activity) (21-25) or surgical methods (Roux-en-Y gastric bypass or vertical band gastroplasty) (26-30) on GERD symptoms are scarce and with conflicting results (31). A systematic review evaluating the effects of various life style changes on GERD symptoms suggested that weight loss and head of bed elevation could improve symptoms of GERD (32). However, the impact of a structured weight loss program on GERD symptoms in overweight and obese subjects has not been prospectively evaluated. The aims of the current study were to assess (i) the prevalence of GERD symptoms in overweight and obese subjects and (ii) impact of weight loss on GERD symptoms.

Methods

Study details

Obese and overweight subjects were prospectively enrolled at the University of Kansas Medical Center to test the effectiveness of phone based vs. traditional face-to-face clinic program for weight loss and weight maintenance. After enrollment, participants were randomized to a weight management program, delivered either by a group conference phone call or by a traditional face-to-face clinic group. The initial 6 months of the program were aimed at ≥10% body weight loss from baseline and the subsequent 12 months were targeted at body weight maintenance. The study was approved by the local institutional review board.

The inclusion and exclusion criteria for participating in this structured weight loss program were:

Inclusion criteria

(i) Age 18-65 years, (ii) BMI of 25-39.9 kg/m², and (iii) subjects who were cleared for participation by their primary care physicians.

Exclusion criteria

(i) subjects who had participated in another weight loss research project during the previous 6 months, (ii) weight loss of >5% of body weight within previous 12 months, (iii) women pregnant during the previous 6 months, lactating, or planning pregnancy within 18 months, (iv) serious medical risks such as uncontrolled diabetes or hypertension, recent cardiac event (i. e., heart attack, angioplasty, and arrhythmia) or cancer, (vi) eating disorders such as anorexia nervosa or bulimia, (vii) serious psychiatric disorder, (viii) adherence to specialized diet regimes, e.g., multiple food allergies, vegetarian, macrobiotic, etc., (ix) lack of access to grocery store or inability to prepare a meal (i.e., military and college student), (x) severe arthritis or other reasons for restricted mobility, and (xi) BMI >39.9.

Participant enrollment

Subjects from the general population were recruited through newspaper advertising, email messages, public service messages, media contacts, and word of mouth. Interested individuals had a brief phone screen to determine their eligibility for participation in the study. All subjects enrolled in the study were required to submit a medical clearance certificate from their primary care physicians.

All participants had their demographic information, presence of comorbidities, smoking and alcohol history, use of acid suppressive medications including proton pump inhibitor (PPIs) and histamine receptor 2 antagonist, BMI (kg/m²), and waist circumference recorded at baseline and during follow-up visits. The following definitions for BMI were used; BMI <25 normal weight, BMI 25-29.9 as overweight, BMI ≥30-34.9 as obese and BMI ≥35 as severely obese. For men, a waist circumference of ≥102 cm and for women waist circumference ≥88 cm was considered abnormal.

Weight loss program

The participants were stratified by gender to the weight management program delivered by a group conference phone call or by a traditional face-to-face clinic group with an overall enrollment of ~50% male and 50% female in each group.

Strategies for losing weight

At the beginning of the weight management program, all participants received a comprehensive notebook that included instructions on weight loss and maintenance, various diets, exercise protocol, calendars, and instruction on timelines for class meetings. The target body weight reduction was 10% of baseline weight at 6 months.

Dietary modifications

To achieve target weight loss, participants were instructed to reduce their total calorie intake to 1,200-1,500 cal/day using commercially available prepackaged meals, combined with fruits, vegetables, and beverages. Participants were asked to consume a minimum of three shakes at ~100 kcal each, two entrees between 200 and 270 kcal each, and five fruits or vegetables per day.

Physical activity

Self-directed instructions were provided to all participants to undergo moderately vigorous home-based physical activity of walking/other exercise of 15-60 min/day up to 5 days per week. The exercise progression started at 45 min/week (3 days/week, 15 min/day) and progressed to 300 min/week (5 days/week, 60 min/day) by week 12.

Behavioral strategies

Several behavioral strategies including behavior shaping, goal setting, self-monitoring, feedback and reinforcement, social support, problem solving, and relapse prevention were conducted by in-class discussions and activities and regular out-of-class assignments to help participants modify their lifestyles for achieving targeted weight loss.

Follow-up meetings

Group meetings of 60 min duration were held weekly during the initial 6 months. During these group meetings, the initial 10 min were devoted to weight measurements, calculations on physical activity, and assessment of compliance to dietary protocol including number of fruits and vegetables and prepackaged meals consumed per week. Following this, a 30-min lesson on behavioral modifications including nutrition, physical activity, and lifestyle modifications was presented by a health educator. The remaining 20 min consisted of group discussion, problem solving and/or assignments designed to help the participants practice and develop the behavioral strategies for successful weight loss. Similar instructions for losing weight were delivered as group conference phone calls that were identical to the traditional face-to-face group clinics and were conducted by a health educator. Participants were required to email, fax, or call in their weekly data and self-reported weights the evening before the day of class. The class schedule included check-in questions, data review (use of prepackaged meals, fruits and vegetables, physical activity etc. ), lessons and problem solving, and also the assignments for the upcoming week.

Diagnosis of GERD and recording of symptoms at baseline and follow-up

All participants enrolled in this weight loss program completed a validated GERD questionnaire (reflux disease questionnaire (RDQ)) at baseline and follow-up visits. The RDQ comprises of 12 questions; six each related to reflux symptom frequency and severity and each question was assigned a score of 0-3. This questionnaire pertains to three major components—heartburn, regurgitation, and dyspepsia. Based on the response a cumulative additive score on response to all the 12 questions could range from 0 to 36. For the current study, the score was calculated based on the responses only to heartburn and regurgitation with a score ranging from 0 to 24. Based on previous studies using the RDQ, the presence of GERD was defined as RDQ score of ≥2 with at least weekly heartburn and/or regurgitation symptoms (2). Severity rating of GERD symptoms was also based on the responses in the questionnaire: severity score of 1 was rated as mild, 2 as moderate, and 3 as severe GERD symptoms. The RDQ questionnaire has been previously validated and has scored highly on multiple criteria including internal consistency, item discrimination, test–retest reliability, and regression with specialty physician diagnosis (33). Data suggests that RDQ performs well across different populations and correlates well with treatment responses (33,34).

All participants completed the RDQ at 6-month follow-up regardless of changes in body weight and waist circumference. Changes in RDQ questionnaire score were used to define changes in GERD symptoms. At 6-month follow-up, complete resolution of GERD was defined as a RDQ score of 1 or less, partial improvement in GERD as any decrease in RDQ and worsening GERD if there was any increase in the baseline RDQ score.

Data collection, assessment of outcomes, and statistical analysis

Outcome data, body weight and other physical findings were recorded in the clinic (for both phone and clinic groups) at regular intervals. Participants of both groups also reported by phone or during clinic visit the number of prepackaged meals consumed and estimated physical activity.

Descriptive statistics were calculated at baseline and follow-up. Paired t-test was used to compare changes in GERD symptoms scores, body weight, and waist circumference between baseline and 6-month follow-up. Presence of GERD, heartburn, and regurgitation symptoms with varying degrees of weight loss (<5, 5-10, and >10%), and decrease in waist circumference (≤5, 5-10, and >10 cm) were also compared using χ² test. Pearson’s correlation coefficients (r) were calculated to evaluate the association between changes in overall GERD, heartburn, and regurgitation symptom scores with mean and percent body weight and waist circumference changes. A P value <0.05 was considered significant.

Post hoc power estimates suggested that the proposed analyses were adequately powered in this study. Achieved power was 0.99-1 and 1 for paired t-test and χ² test, respectively. Power of 0.88 was achieved for testing the association between change in GERD symptoms score and percent body weight change. For the other associations, however, power was not satisfactory (0.15-0.59). All statistical analyses were conducted using SAS version 9.2 (SAS Institute, Cary, NC).

Results

Baseline characteristics

A total of 332 subjects were enrolled in the weight loss program and completed the RDQ at baseline and at 6-month follow-up. The mean age was 46 (range 19-66) years, 80% were Caucasians, 15% African-Americans and included 66% women. The mean weight, BMI, and waist circumference were 101 (±18) kg, 35 (±5) kg/m², and 103 (± 13) cm, respectively and the vast majority had a BMI >35 (83%) and a waist circumference >100 cm (58%) (). Eighty nine subjects (27%) had a history of hypertension, 26 (8%) had diabetes mellitus and one with heart disease.

TABLE 1

Clinical characteristics of all subjects enrolled in a weight loss program (baseline and 6 months)

Variable	Baseline (N = 332)	6-month follow-up (N = 332)	P
Weight (kg)	100. 7 ±18.1	87.6 ±16.7	<0.01
BMI (kg/m2)	34.7 ±4.6	30.2 ±5.0	<0.01
Waist circumference (cm)	102.7 ±12.9	92.1 ±13.0	<0.01
Subjects with GERD symptoms	124 (37%)	51 (15%)	<0.01
GERD symptom score	2.1 ±3.7	0.8 ±2.6	<0.01
Heartburn score	0.6 ±1.4	0.3 ±1.1	<0.01
Regurgitation score	0.9 ±1.6	0.3 ±0.9	<0.01
PPIs/h3RAs use	35 (11 %)	26 (8%)	ns

Consecutive subjects were randomized to either the clinic based (167 subjects) or phone based (165 subjects) weight loss program and each group comprised of 41 and 33% subjects with GERD, respectively (P = not significant).

Overall prevalence of GERD in the study population

The baseline prevalence of GERD in this cohort was 37% (124/332). Regurgitation (n = 86; 26%) was reported more frequently than heartburn (n = 61; 18%) with approximately a third of the symptomatic subjects (n = 36; 29%) experiencing moderate to severe GERD symptoms.

GERD symptoms scores during follow-up

The majority of the subjects (97%) lost weight at the 6-month follow-up period with a mean weight loss of 13.1 (±7.7) kg and a mean decrease in waist circumference by 10.6 (±9.1) cm. Compared with baseline, there was a significant decrease in the overall prevalence of GERD symptoms (15 vs. 37%; P < 0.01) with significant improvements in overall symptom, heartburn and regurgitation scores (all P < 0.01). The mean reduction in GERD symptom score was 1.3 (±3.5) ( and ). There was no significant difference in the degree of weight loss and/or GERD symptom scores between the two groups i.e., those enrolled in phone vs. clinic based weight loss programs. Among subjects who had GERD at baseline, 81% had a reduction in GERD scores (65% with complete resolution and 15% with partial resolution), 13% had no change whereas 7% subjects had worsening of their GERD symptoms. There was no significant difference in the use of acid suppressive medications (including PPIs and histamine receptor 2 antagonists) at baseline (11%) and during follow-up (8%), (P = not significant) ().

TABLE 2

Change in overall GERD symptom scores (measured by RDQ) with weight loss

Correlation between degree of weight loss and GERD scores

A positive correlation was observed between the degree of body weight loss (percent change) and change in GERD symptom scores over the 6-month follow-up period. There was a significant improvement in overall GERD symptoms with percent body weight loss (Pearson’s correlation coefficient, r = 0.17, P < 0.05) (). Similarly, a significant association between percent body weight loss and decrease in heartburn scores was noted (r = 0.12, P < 0.05) however, the correlation between degree of body weight loss and regurgitation scores was not significant (r = 0.12, P = not significant). There was no significant correlation between decrease in waist circumference (mean or percent) and overall GERD, heartburn or regurgitation symptom scores; r = 0.05, 0.08, and 0.06, respectively (all P = not significant) ().

Scatter plot diagram showing dose-response relationship between gastroesophageal reflux disease symptom scores and (a) degree of weight loss, r = 0.17, P < 0.05, and (b) reduction in waist circumference, r = 0.05, P = not significant.

GERD symptoms and gender differences

Subjects were then sub-grouped into different body weight reduction categories of <5, 5-10, and ≥10% and decrease in waist circumference to <5, 5-10, and ≥10 cm. There was no significant change in overall GERD symptom scores with <5% weight loss of baseline body weight for all subjects. However, a weight loss of 5-10% lead to a significant reduction in overall GERD scores (P < 0.05) in women. Whereas among men, a significant improvement in GERD symptom scores (P < 0.01) was observed after a weight loss of ≥10% of baseline body weight. Similarly, there was no significant change in overall GERD symptom scores with a <5 cm waist circumference reduction (from baseline waist circumference). However, losing 5-10 cm waist circumference led to a significant reduction in GERD symptoms (P < 0.01), among women. In men, there was a significant reduction in GERD symptoms (P < 0.01) with a waist circumference decrease of ≥10cm ().

TABLE 3

Threshold body weight loss or waist circumference decrease for improvement in overall GERD symptom score and heartburn/regurgitation scores among men and women

Discussion

Over the last few decades there has been steady increase in the prevalence of GERD (1,2,3,9,35) and several recent studies have suggested a significant association between obesity and GERD (9-17). The prevalence of GERD has been shown to increase with increasing BMI (9,16,20) and ranges from 59 to 79% among extremely obese subjects (35-37). As conservative measures for the management of GERD symptoms, although various lifestyle (including weight loss) and dietary modifications have been suggested by a variety of guidelines and consensus conferences, there is no evidence-based prospective data to support the efficacy of these measures (38). The results of our study showed that GERD symptoms were prevalent in 37% of overweight and/or obese individuals enrolled in a weight loss program. Furthermore, results of our prospective study showed that weight loss led to a significant improvement in GERD symptoms, thus establishing weight loss as an important life style modification for the treatment of GERD. In this study cohort, weight loss over a 6-month period, the majority of subjects (81%) experienced a reduction in GERD symptoms and 65% of the study subjects with complete resolution of reflux symptoms.

Contemporary studies evaluating the effect of weight loss in GERD subjects are lacking and ours is the largest prospective trial conducted on this topic. One Swedish study from 1999 evaluated only 34 overweight patients (BMI >23, excluding severely obese) and did show a positive correlation between weight loss and improvement of GERD symptom (21). Another study, as yet in abstract form, was exclusively conducted in obese (BMI 30-39) subjects and also showed a positive correlation between improvement in GERD symptoms with decrease in BMI as well as reductions in waist-hip ratio; odds ratios of 1.10 (95% confidence intervals: 1-1.2) and 1.08 (95% confidence intervals:1-1.1), respectively (35).

However, a few previous studies including severely obese subjects enrolled in a low calorie diet based weight loss protocol failed to show any significant change in GERD symptoms despite a weight loss of up to 10 kg (23,25) or more (24). These varied results of weight loss on GERD symptoms could be because of small sample size, gender differences, wide variation in BMI of subjects (23 vs. 43), and use of different weight loss methods (various lifestyle changes vs. surgical approaches) (21-35). Furthermore, a number of lifestyle intervention treatments have been attempted for GERD—low calorie diet, use of fruits/vegetables, and physical activity; individually each intervention has no direct correlation with GERD improvement as shown in previous population-based studies (13,22,23) and a recent meta-analysis (32). Previous studies have reported no change in GERD with weight loss achieved by low calorie diet alone (25) or in combination with gastric surgery (vertical band gastroplasty) (23) without increase in physical activity. These results suggest that a structured weight loss program (combination of diet, physical activity, and behavioral changes) may be necessary for impact on GERD symptoms.

Studies have shown a dose–response relationship between weight gain (BMI) and occurrence of GERD and complications of erosive esophagitis, Barrett’s esophagus and esophageal adenocarcinoma (9,13,16,20). A questionnaire based large cohort study of middle-aged women nurses, over a period of 25 years, demonstrated a clear dose–dependent increase in the frequency of GERD symptoms with increase in BMI. Overweight and obese women had two to three times higher chance of having GERD symptoms as compared with those with normal weight (13) suggesting a temporal association between weight change and GERD symptoms. We observed a similar association between the degree of weight loss and improvement in GERD symptoms further strengthening the concept of a direct relationship between these two variables. However, some gender differences were noted—a weight loss of 5-10% led to a significant reduction in overall GERD scores (P < 0.05) in women; whereas among men, a significant improvement in GERD symptom scores (P < 0.01) was observed after a weight loss of ≥10% of baseline body weight. Similar to this concept, new onset or worsening of pre-existing GERD may occur only after certain threshold weight change as was reported in previous study by Rey et al. (39) In that study subjects who gained >5 kg showed three times significantly higher frequency of new onset GERD (39). Although a positive and significant correlation between weight loss and GERD scores was noted, it appears that the correlation is not linear and more complex. The change in GERD scores among obese subjects probably occurs secondary to multiple factors such as gender, proportional changes in abdominal vs. peripheral fat weight, hormonal (adiponectin), and genetic factors besides weight loss. In the current study, not all obese subjects with GERD who lost weight had reduction in GERD scores, 13% had no change whereas 7% subjects had worsening of their GERD symptoms. Therefore, weight change is probably one of the factors that affect GERD symptoms.

Therefore, a small percentage of overweight and or obese subjects may not have resolution of GERD with weight loss; future trials defining predictors of GERD improvement in overweight/obese subjects are required. At baseline, a small number (11%) of subjects used PPIs and this decreased to 8% at the 6-month follow-up however, the number of subjects using PPIs was small and therefore no inference can be made on whether obese subjects with GERD symptoms would need less or no medications after losing weight.

There were a few limitations to this study. The impact of weight gain on GERD occurrence could not be evaluated as the majority (97%) of subjects lost weight at 6 months and had improvement in their reflux symptoms. Although this is a prospective longitudinal study, the treatment was not randomized and lacks a control group. Unlike most previous studies that specifically included either over-weight or severely obese populations only, we included both over-weight and obese subjects (BMI 25-39.9) but the majority were healthy and required a clearance letter from their primary care physicians for participating in the study; hence study results may not be generalized to all overweight, obese individuals. In the current study, subjects lost weight by combination of dietary, behavioral, and physical activity changes; therefore the contribution of each modality separately on GERD symptoms could not be evaluated. Finally, although, we used a validated questionnaire (RDQ) for diagnosing and monitoring GERD symptoms, endoscopy and/or pH monitoring was not performed. Despite these limitations, the results of this prospective study are highly suggestive of obesity as a major contributor to GERD and that weight loss can lead to resolution of GERD symptoms in the majority of overweight and/or obese subjects. The large patient population, evaluation of both men and women, use of a structured weight loss program and an objective, validated symptom questionnaire are strengths of our study. These results have significant clinical implications. Using weight loss as an important first line treatment for GERD in overweight, obese individuals could potentially result in significant cost savings on medical treatment, prevent complications of GERD, as well as improve quality of life and overall health status. These categories of over-weight and obese subjects constitutes a major part (68%) of the US population (2008 NHANES consensus) (19) and hence these results could have wide-spread clinical implications for management of GERD. The estimates show that in excess of 10 billion US dollars a year are spent on medical therapy (PPIs) (40) thus presenting a significant economic burden on the health-care system.

In summary, ~40% of adult subjects enrolled in weight loss programs that were overweight and/or obese experienced GERD symptoms. Through a structured weight loss program including dietary, physical activity and behavioral changes, the majority of these subjects achieved complete resolution of their GERD symptoms. There appeared to be a dose–response relationship between the degree of body weight loss and resolution of GERD symptoms and the threshold weight loss for such an improvement was lower in women compared to men (5-10 vs. >10% body weight reduction).

Is There a Link Between Obesity and Acid Reflux?

Obesity is a serious medical condition caused by excess weight that affects many people. In fact, according to the CDC, over one-third of Texans were considered obese in 2019! That’s a lot of people at risk for other medical conditions, including GERD, which is chronic acid reflux.

You may be diagnosed with obesity if your BMI is 30 or greater. Studies have shown that the link between obesity and acid reflux is well-defined. The good news is, however, that the same research shows that losing weight can reduce the frequency of acid reflux.

What Is Acid Reflux?

Acid reflux is a common condition that causes burning pain in the chest and/or throat. Most people call this heartburn and experience it only occasionally. But acid reflux can be more severe when you’re overweight. It can even become chronic, meaning it happens often, and needs to be treated for relief of the burning sensation.

Acid reflux occurs when the lower esophageal sphincter, which is the muscle that connects the esophagus and the stomach, stops functioning properly. When this muscle is working as it should, it opens to allow the food you eat to pass into your stomach. Once food has moved through, the sphincter closes again to prevent the contents of the stomach from flowing backward into your esophagus.

If you have GERD, the lower esophageal sphincter doesn’t close like it should and stomach acid flows, along with some of the food, can flow backwards into the esophagus. This acid is irritating to your esophagus and may cause pain, burning and general irritation. In some cases, vomiting may occur if there is a lot of reflux.

GERD is both uncomfortable and dangerous to your health, ranging in severity from person to person. Some people suffer only mild symptoms and others deal with much more significant problems. Some of the symptoms of GERD include symptoms such as the following a few times a week or more:

• Heartburn that doesn’t go away
• Feeling a lump in your throat
• Regurgitation of sour liquid
• Trouble swallowing
• Chronic cough
• Chest pain and burning in your chest.
• Asthma

Left untreated, the irritation of the acid on the esophagus can eventually lead to cancer in some people.

Obesity and Acid Reflux

Multiple studies have shown a clear link between obesity and acid reflux. For example, a Scandinavian study conducted in 2003 showed that people who are overweight or obese are six times more likely to experience symptoms of GERD than people who are not overweight. This association was found to be most significant among women who have used any form of hormone therapy, as well as those who are premenopausal, indicating that hormones may play a role.

This same study showed that higher levels of obesity were associated with more severe acid reflux symptoms. It was true for both men and women, but it was shown to be worse for morbidly obese women.

Studies have also shown that even smaller amounts of added weight can increase the risk of acid reflux or GERD in both men and women. This means that you are at a higher risk of these issues even if you are just slightly overweight. Specifically, a study published in the New England Journal of Medicine found that there is a direct link between an individual’s BMI and their risk of developing GERD. Even moderate amounts of weight gain can cause GERD to develop or become worse.

How Obesity Causes Acid Reflux

Several different factors related to obesity may bring on acid reflux. For example, carrying extra weight around your abdomen increases the pressure within the abdomen, pushing the stomach, and its contents out of where it should be. This is commonly known as a hiatal hernia, where a portion of your stomach is pushed through the diaphragm and into the chest, allowing for more acid reflux.

People who suffer from obesity may also have higher levels of pancreatic enzymes and bile, which may cause stomach acid to take on a composition that is more irritating to the esophagus.

Can Weight Loss Surgery Reduce GERD Symptoms?

A variety of treatments may be available to help reduce the symptoms of GERD. However, in someone who is overweight or obese, one of the best ways to reduce these symptoms is to lose weight. If you are trying to lose weight to reduce acid reflux or other symptoms of GERD, remember that lifestyle changes are typically the most effective method. For example, you can lose weight by changing your diet and exercising regularly.

If you have tried diet and exercise changes for several months without success, you can look at weight loss surgery. In fact, weight loss surgery can have a great effect on the patient’s health, including reducing acid reflux. In patients with a hiatal hernia, the hiatal hernia can be repaired at the same time as the weight loss surgery to ensure the resolution of reflux and GERD symptoms.

Learn more about the health benefits of weight loss surgery.

If you’re in the greater Houston area, schedule a consultation with Dr. Howard at his office in The Woodlands to find out if you would be a good candidate for bariatric surgery for weight loss. Be sure to let him know if you’re also experiencing acid reflux, or have been diagnosed with GERD.

Categories: Acid Reflux & GERD

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90,000 Medicines for children with gastroesophageal reflux

Review question

Reflux symptoms in most infants gradually resolve by the time they eat solid foods and spend more time upright, and as the esophagus grows longer, but does medication help make this period more comfortable? older people may have heartburn, just like adults. What kind of treatment [of symptoms] works best in these situations?

Relevance

Gastroesophageal (gastroesophageal) reflux occurs when stomach contents are thrown back into the esophagus.This may be a normal variation (“functional reflux”), but in some children and many babies, it [reflux] can occur very frequently, or it can cause symptoms such as pain, weight loss, or other problems (eg, ear infections, cough , and even pauses in breathing). If this occurs, this condition can be regarded as gastroesophageal reflux disease (GERD). Sometimes the esophagus becomes inflamed – a condition known as “esophagitis.”

Existing medications (eg Gaviscon Infant; Gaviscon Infant ^® ) aim to thicken stomach contents, neutralize stomach acid (ranitidine, omeprazole, lansoprazole) or promote faster gastric emptying (domperidone).We looked at all available studies to try to find out if any of the existing medications could help infants and children with reflux, and we wanted to know if these medications make babies and children feel better, or if test results (such as mucosal healing the esophagus, assessed by endoscopy (a small camera that runs down the esophagus) or the decrease in acidity in the esophagus, assessed by a pH probe over 24 hours) when children are taking these medications.

Research characteristics

We included all studies (randomized controlled trials) comparing one type of drug against another or against an inactive drug (placebo). We carefully considered the results of the studies and tried to evaluate those that would be important to doctors, nurses and parents. We found: many differences between studies, and the small number of children included in these studies, short follow-up periods and differing outcomes all made it difficult to combine the data (meta-analysis).

Highlights

Overall, due to the small number of children included in these studies, we cannot be sure that these drugs improve [suppress] symptoms. We found little evidence that drugs work [work] in children under one year of age. especially with functional reflux; mixed evidence has been found as to whether the Gaviscon Infant is helping ^®
, and that in children with reflux disease (changes in pH or endoscopy), medications such as omeprazole and lansoprazole are likely to help.In older children, proton pump inhibitors and histamine antagonists work better for improving symptoms, endoscopic manifestations, and pH measurements, but we were unable to perform a meta-analysis, or assess whether one drug is superior to another.

Quality of evidence

Overall, the available evidence was of moderate to low quality, depending on the drug being studied, and we suggested how future research might be designed to better answer the question of which treatment is best for infants and children with reflux or reflux disease. …

NOT A JOKE, BUT A STOMACH COMPLAINT!

There is hardly a person who would not know what heartburn is. When it “bakes inside”, it is no longer possible to think about something else, and we are looking for quick ways to solve the problem. Every day TV advertising convinces us that it is enough to take a packet of saving powder, and the “fire” will be extinguished. However, doctors are skeptical about such recommendations. Yes, such drugs are able to envelop the walls of the esophagus, protecting against the action of gastric juice.But this approach is acceptable if attacks are very rare. If heartburn occurs at least once a week, symptomatic remedies cannot be dispensed with. And even more so, you should not “wash down” the next attack with a soda solution. How dangerous it is and how modern medicine is able to find out the causes of digestive troubles, said the head of the gastroenterological office of the First Clinical Medical Center Oleg Zaitsev.
– Oleg Vyacheslavovich, is heartburn really so dangerous?
– The body is so arranged that the esophagus and stomach are separated by a special valve – the lower esophageal sphincter, which passes food from top to bottom, allowing it to move in the opposite direction only in extreme situations, such as vomiting.When this checkpoint malfunctions, there may be an “illegal” release of stomach acid. This phenomenon is called gastroesophageal reflux, and the disease itself is gastroesophageal reflux disease (GERD). As a result of such casts, aggressive gastric juice causes a chemical burn of the esophagus – this is what lies behind the familiar to many “harmless” sensation. Gastroscopy of the “burnt” esophagus reveals both erosion and ulcers, and complications of these problems in the form of bleeding or scarring.Alas, the longer the “experience” of heartburn, the higher the risk of malignant tumors. In this case, predictions have to be made with extreme caution, since it is difficult to treat esophageal cancer – this “simple” organ is deeply hidden in the chest and operations on it are technically very difficult. Therefore, it is risky to live with heartburn for years, “washing it down” with soda. Moreover, as soon as it reacts with hydrochloric acid, a violent release of carbon dioxide begins, which puts additional pressure on the lower esophageal sphincter, irritates the gastric mucosa and provokes its glands to secrete gastric secretions again.As a result, a vicious circle is obtained – after taking soda, the heartburn temporarily disappears, but then it intensifies again
_________________________________________________

Breakfast sandwich – heartburn for lunch
The classic morning set – tea with a sandwich – can provoke heartburn. Yeast bread is digested for 4-5 hours, and during this time the stomach produces hydrochloric acid. And the theophylline in tea weakens the sphincter between the esophagus and stomach, creating conditions for reflux to occur._________________________________________________

– Doesn’t the use of “acid neutralizers” bought at the pharmacy also solve the problem?
– These are adjuvants that are not included in the standard of treatment for GERD. In addition, they have a short period of action – about half an hour, that is, they do not radically change the situation. If heartburn occurs more often than once a week, you need to use special drugs that reduce the production of hydrochloric acid. But they require careful selection, and often a combined technique.- That is, with heartburn – to the doctor?
– Of course!
– Swallow the notorious pipe?
– Yes, endoscopy of the esophagus is necessary. No less important is such a study as daily pH-metry using the “Gastroscan-24” device. A thin probe with several sensors is installed through the patient’s nose, which take information about the state of acidity (pH) in the esophagus, stomach and duodenum. Why through the nose? Because the procedure is much easier to tolerate, the patient leads a normal life during the study.Information from the probe is recorded by a special device that is attached to the belt. I would like to note that hospitalization in a hospital (unless the patient is, of course, a nonresident) is not required. The next day, the readings from the device are transferred to a computer, processed by a special program and displayed in the form of digital data and graphs.
– What do they show?
– What is the acidity of gastric juice and how often it (or bile from the duodenum) enters the esophagus; how does the acidity change at different times of the day and is there an acid reflux into the esophagus in the supine position, at night; what happens to acidity after eating or taking medication.This allows you to choose the right treatment and evaluate its effectiveness, as well as provides a lot of other important information.
– Why is it important to measure acidity during the day?
– Therefore, acid production in the stomach can change during the day. For example, many interesting events in the body take place at night. Here is a specific example – a patient with an ulcer in the lower third of the esophagus. Once a day, he takes a good medicine that provides a “calm” environment in the esophagus. However, pH-metry revealed that during the night hours in the man’s stomach there is a significant increase in acidity, the so-called “night acid breakthrough”.At this time, the action of the drug stops, and the ulcer remains unprotected. To fix this, it was necessary to prescribe another drug.
-Is it always possible to defeat heartburn?
– Yes, if you take it seriously. The fact is that modern medicines relieve symptoms very quickly. Patients, having calmed down, quit treatment after a week, and then again begin to complain of heartburn. Meanwhile, the main course of treatment for GERD can take up to 3 months, and maintenance therapy lasts up to a year. And, of course, you will need to change your lifestyle, eliminating risk factors._________________________________________________
Miracles of disguise
Not everyone knows that GERD may be the true cause of many non-stomach problems. For example, caries or periodontal disease – the constant throwing of gastric masses into the esophagus leads to a change in the composition of saliva, making it aggressive. Acidic “recoil” can be taken by us for pain in the heart, and also turn into chronic pharyngitis or bronchospasm. So, to determine whether a coughing attack or “angina” coincides with an acid reflux, and pH-metry is called upon._________________________________________________

– What are they?
– The most important thing is excess weight. It increases the pressure in the stomach and disrupts the work of the lower esophageal sphincter, that is, it actually “squeezes” the contents of the stomach into the esophagus, especially at night, when the “plate” of the abdomen literally presses on the latter. Nicotine and alcohol – they have a relaxing effect on the sphincter between the esophagus and the stomach, provoking acid reflux. Theophylline contained in tea has the same effect.By the way, due to the tradition of drinking tea often and a lot, esophageal cancer is widespread in Asian countries. Therefore, the measure is good in everything. Fried, spicy, fatty foods are also in the group of negative factors. In addition, you need to revise the diet – eat often and in small portions, do not eat before bedtime. Do not go to bed or exercise immediately after eating. Do not wear tight clothes, and prefer suspenders to a belt that cuts into the abdomen. And, of course, do not self-medicate! “Fire” in the stomach? Visit a gastroenterologist!

90,000 Weight Loss and GERD: Your First Defense | Healthline

Weight loss and acid reflux

Being overweight is associated with many health problems.These include depression, fatigue, and an increased risk of chronic diseases such as heart disease. Another health problem associated with being overweight is acid reflux or heartburn. Understanding the link between excess pounds and acid reflux can help you take steps to maintain your weight. your heartburn.

Acid reflux Getting acid reflux and GERD

Acid reflux is a common condition. At least 15 million people in the United States experience daily heartburn symptoms.Heartburn can be a symptom of a condition called gastroesophageal reflux disease (GERD). This is commonly referred to as acid reflux, but it is a more chronic condition that requires medical treatment to reduce damage to the esophagus.

Contrary to the name, heartburn has nothing to do with your hearing. Instead, the name comes from a burning sensation around the chest and upper gastrointestinal tract. This burning sensation occurs when stomach acid flows back into the esophagus.This discomfort can last up to two hours at a time.

Heartburn can happen to someone from time to time. However, GERD causes symptoms at least twice a week. Besides the classic burning sensations, GERD can also cause:

• bitter taste in the mouth
• cough
• excessive belching
• flatulence
• sore throat
• difficulty swallowing
• whistling

If you suffer from recurrent or persistent acid reflux, weight may play a role.

Weight and symptoms Effects of your weight on symptoms

Sometimes heartburn can happen to anyone, but being overweight is one of the most common causes of GERD. In fact, the American Society for Gastrointestinal Endoscopy identifies obesity as the leading cause of frequent heartburn. Being overweight increases the pressure in the abdomen, which leads to more acid leakage in the stomach or backflow.

Tight clothing can also worsen heartburn symptoms.Losing weight can help relieve acid reflux, and it can make your clothes looser as another form of treatment.

Risk factors Weight gain and other risk factors

Being overweight is the largest risk factor associated with GERD. Temporary weight gain, such as during pregnancy, can also cause heartburn. In such cases, symptoms usually disappear as soon as you return to your normal weight.

Acid reflux can also aggravate and cause other health conditions such as:

• asthma
• chest pain
• chronic cough
• sore throat
• vocal root tumor

Your diet may also play a role in acid reflux.The following foods are known to worsen GERD:

• alcohol
• carbonated drinks
• Citrus products (including fruit juices)
• coffee
• fatty foods
• garlic

90,059 mint (especially peppermint)

• spicy products
• Tomatoes and related products
• Reducing trigger foods can benefit GERD in two ways: It can help relieve symptoms in the short term, and it can even help you lose weight in the long term.

Tips Weight loss tips

Weight loss is one of the best ways to beat GERD. The first step is to reduce your daily calorie intake. Cutting back on high-fat foods can help reduce calories as well as reduce the risk of heartburn. The same applies to packaged foods and other non-nutritive foods such as sugar.

Exercise is another weight loss technique that is especially helpful for people with heartburn. Walking after a meal helps with calorie burning as well as digestion.This way, you are less likely to lie down after eating and risk further acid leakage in your stomach.

Severe obesity that is not resolved through diet and exercise may require weight loss surgery in some cases. Due to the nature of the procedure, heartburn is a common side effect. You can deal with this in the same way as other life remedies for heartburn:

eat less food

• do not eat less than 2 hours before lying down
• Raise the head of your bed 6-10 inches with foam wedge
• eat slowly
• Avoid trigger foods (e.g. spicy, fatty foods)
• Bottom line Bottom line

There is a strong link between being overweight and acid reflux.Losing weight is one of the best lifestyle changes you can make to help reduce heartburn, as well as your risk of other health complications. If you have GERD, make sure you stick to your treatment plan to avoid damaging your esophagus. Talk to your gastroenterologist if your condition does not improve despite your best weight loss efforts.

Effective Reflux Treatment | Nord Klinik Allianz

Acid reflux can cause sore throat and chest pain, heartburn, and other symptoms.Symptoms can range from mild to severe. If left untreated, chronic acid reflux can damage the esophagus and, in some cases, progress to a precancerous condition known as Barrett’s esophagus.

At the Bremen Mitte Klinikum for Gastroenterology and Internal Medicine, doctors use highly specialized diagnostic tests to detect the presence of GERD. With this information, they can select the most effective course of treatment for each individual patient.Patients are often advised to manage GERD with a combination of medications and lifestyle changes. If symptoms persist or worsen, endoscopic and surgical procedures are performed to provide long-term symptom relief.

Lifestyle changes

Doctors often recommend dietary and other lifestyle changes to reduce reflux and prevent damage to the esophagus. For some people with mild GERD symptoms, lifestyle changes alone can eliminate the discomfort.

Dietary changes

The first step is often limiting the food that caused the reflux. The list of so-called “trigger foods” includes chocolate, coffee, fried foods, mint, spicy foods, and sodas.

May also alleviate illness:

• Avoid lying down for at least two hours after eating or after consuming acidic drinks such as caffeinated drinks.
• Keep your head up while sleeping.Using an extra pillow or two can also help prevent reflux.
• Eat less and more often throughout the day instead of several large meals. It aids digestion and can help prevent heartburn.
• Wear loose clothing to relieve pressure on the stomach.
• Stop smoking. Smoking can increase the production of stomach acid and decrease the function of the lower esophageal sphincter, a muscle that keeps acid and other stomach contents from re-entering the esophagus.Smoking can also reduce the amount of saliva, which neutralizes the acid produced by the body.
• Lose weight.

Drug therapy

Doctors may recommend medications for the treatment of gastroesophageal reflux disease. These drugs can reduce the amount of acid produced by the stomach during digestion, which in turn reduces the amount of acid returned back to the esophagus, which also helps relieve discomfort and prevent GERD from becoming a more serious condition such as esophagitis, chronic inflammation Esophagus or Barrett’s esophagus, precancerous condition.

Antacids

A post-meal antacid can quickly neutralize stomach acid and relieve heartburn symptoms. Antacids can treat mild symptoms of GERD. These medicines are available without a prescription and usually do not cause any significant side effects.

Blockers h3

Histamine H receptor antagonists, also called H2 blockers, block the action of histamine, which is a chemical that causes stomach acid to form.This reduces the amount of acid produced. Although antacids may act faster, h3 blockers may reduce symptoms over a longer period. These medications are also available over the counter, in pill, capsule, liquid or powder form, however, they should be taken strictly as directed by your doctor.

Proton pump inhibitors

Proton pump inhibitors block acid production in the stomach lining. Compared to H2 blockers, they are more effective in reducing the flow of acid reflux into the esophagus.This type of medication may be recommended when GERD symptoms are persistent and severe, when other medications do not work, or when esophagitis or Barrett’s esophagus has been identified. Proton pump inhibitors are available with and without a prescription and should be used as directed by your healthcare professional. These drugs are often used over a long period of time, with few side effects. However, long-term use can inhibit the absorption of certain vitamins and minerals, in particular B12 and calcium.For this reason, regular monitoring by a doctor is important when taking them.

Surgical treatment

If symptoms of GERD, such as heartburn, chest pain, and hoarseness, persist, or if diagnostic tests indicate that GERD is caused by a hernia of the back – a hole in the diaphragm that allows part of the stomach to enter the chest cavity, surgery is recommended.

Our doctors perform a large number of successful GERD surgeries every year, making the Klinikum Bremen Mitte one of the most reliable clinics in Northern Germany.

Because GERD is caused by dysfunction of the lower esophageal sphincter, a ring of muscle that acts as a valve between the stomach and esophagus, gastric surgery is designed to strengthen and strengthen the esophageal sphincter to function properly, ensuring that the valve remains closed and prevents acid and other stomach contents from flowing into esophagus.

The types of operations performed at the Bremen Mitte Klinikum include laparoscopic fundoplication and transoral non-contact fundoplication.

Cost of reflux treatment at Klinikum Bremen Mitte

You can check the price of diagnostics and therapy of reflux disease by filling out the application form on the website or by contacting us in any other way convenient for you.

Back to the clinic

90,000 Articles on oncology – popular and scientific publications for patients

Digestive enzymes – what are they?

The catch phrase “you are what you eat” really carries a certain wisdom.But it would be more accurate to say “you are what you digest.” And in this we are assisted by digestive enzymes, or enzymes, the key to good digestion, a healthy gut and getting all the nutrients we need.

Oddly enough, but until relatively recently, little was known about the mechanism of the digestive system. Today, the number of diseases associated with malabsorption of nutrients due to a lack of digestive enzymes is increasing.

Why are these enzymes so important? The role of digestive enzymes is primarily to act as catalysts to accelerate specific, vital chemical reactions in the body.

They help break down large molecules into particles that are easier to digest. These particles are used by the body to maintain optimal performance and health.

What are digestive enzymes?

Digestive enzymes are defined as “enzymes that are used in the digestive system.”

All enzymes are catalysts that cause molecules to change their shape. These enzymes help us digest food by breaking down macromolecules into smaller ones so that the intestines can absorb all the nutrients they contain and then distribute them throughout the body.

Types

All major digestive enzymes can be divided into three classes:

1. proteolytic enzymes required for protein metabolism.

90,059 lipases, which are essential for the digestion of fats.

2. amylases required for the breakdown of carbohydrates.

Several types of enzymes are found in the human body, including:

• Amylase. It is found in saliva and pancreatic juice and converts large starch molecules into maltose. Amylase is essential for the metabolism of carbohydrates, starch and sugars, which predominate in plant foods (potatoes, fruits, vegetables, cereals, etc.)etc.).
• Pepsin. It is found in gastric juice. Pepsin helps break down protein into smaller polypeptide units.
• Lipase. It is produced by the pancreas and secreted in the small intestine. When combined with bile, lipase converts fats and triglycerides into fatty acids. It is essential for the proper digestion of foods such as nuts, oils, eggs, meat and dairy products.
• Trypsin and chymotrypsin. These endopeptidases continue to break down polypeptides into even smaller particles.
• Cellulase. It helps digest foods high in fiber, such as broccoli, asparagus, and beans, which can cause gas.
• Exopeptidase, carboxypeptidase and aminopeptidase. They help release individual amino acids.
• Lactase. It converts lactose into glucose and galactose.
• Sugar. Breaks down sucrose into glucose and fructose.
• Maltase. Converts sugar maltose into smaller glucose molecules.
• Other enzymes that aid in the absorption of sugar / carbohydrates include invertase, glucoamylase, and alpha-galactosidase.

How do digestive enzymes work?

Digestion is a complex process that begins with chewing food when enzymes are released into saliva. Most of the work is done by gastrointestinal fluids, which contain digestive enzymes that affect certain nutrients (fats, carbohydrates, and proteins).

By producing specific enzymes, we help the absorption of various types of food. In other words, our body produces enzymes specific to carbohydrates, proteins and fats.

Digestive enzymes are not only beneficial, they are vital. They convert complex foods into easily digestible compounds, including amino acids, fatty acids, cholesterol, simple sugars, and nucleic acids (which help build DNA).

Enzymes are synthesized and secreted in various parts of the digestive tract, including the mouth, stomach, and pancreas.

Below we describe in a little more detail the 6 main stages of the digestion process, which begins with chewing, which triggers the secretion of digestive enzymes in the gastrointestinal tract:

1. Salivary amylase, produced in the mouth, is the first digestive enzyme involved in the absorption of molecules. And this process continues after the food enters the stomach.
2. The parietal cells of the stomach then begin to release acids, pepsin and other enzymes, including pancreatic amylase.The process of splitting partially digested food into chyme (semi-liquid mass of partially digested food) begins.
3. Gastric juice neutralizes the action of salivary amylase, promoting the work of pancreatic amylase.
4. After about an hour, the chyme travels to the duodenum, where the acidity triggers the release of the hormone secretin.
5. This, in turn, causes the pancreas to produce hormones, bicarbonate, bile and various digestive enzymes, of which lipase, trypsin, amylase and nuclease are the most important.
6. Bicarbonate changes the environment of the chyme from acidic to alkaline, which not only allows enzymes to break down food, but also kills bacteria that cannot survive in such conditions.

At this stage, most of the work is done. However, people who are deficient in digestive enzymes need support in the form of nutritional supplements.

There are even on sale digestive enzymes for cats and dogs, because animals can also suffer from this ailment.

Who Needs Enzymes? (Signs of deficiency)

The answer to this question may involve many more people than you might suspect.

Symptoms such as bloating, gas, abdominal pain and fatigue can be associated with an inability to completely digest food. In this case, these people may be helped by taking additional digestive enzymes. Other signs that indicate an enzyme deficiency may include:

• Acid Reflux
• Dyspepsia (pain or discomfort in the upper part of the stomach)
• Food cravings
• Thyroid problems
• Heartburn, indigestion, belching
• Thinning and hair loss
• Dry or dull skin
• Problems with concentration or fog in the head
• Fatigue in the morning
• Sleep problems
• Arthritis or joint pain
• Muscle weakness, pre-workout fatigue
• Mood swings, depression and irritability
• Headaches and migraines
• Worsening PMS symptoms

People with the following health conditions may feel better with supplemental digestive enzymes:

1.Diseases of the digestive system

If you have a gastrointestinal condition such as acid reflux, gas, bloating, leaky gut, irritable bowel syndrome (IBS), Crohn’s disease, ulcerative colitis, diverticulitis, malabsorption, diarrhea or constipation, digestive enzymes can help you.

They can “calm” the digestive organs and reduce abdominal pain and bloating associated with bowel disease.

2. Age-related enzyme deficiency

With age, the environment in the stomach becomes more alkaline, which interferes with the production of enough enzymes by the pancreas.

In addition to comorbidities, the risk of developing digestive problems associated with a lack of gastric juice or digestive enzymes increases with age. This often leads to acid reflux.

3. Hypochlorhydria

Hypochlorhydria (insufficient amount of gastric juice) makes it difficult to absorb minerals, vitamins and other elements from food, resulting in a deficiency of nutrients.

4. Diseases of the liver and other diseases associated with enzymes

Often liver diseases lead to a concomitant deficiency of digestive enzymes. The most common is alpha-1 antitrypsin deficiency, a genetic disorder that affects about 1 in 1,500 people.

Symptoms may include unintentional weight loss, recurrent respiratory infections, fatigue, and heart palpitations.

Diseases, the diagnosis of which may not be associated with a decreased production of digestive enzymes, include:

• Crohn’s disease
• Iron or vitamin B12 deficiency
• Vitamin D deficiency

Enzyme deficiency symptoms can also include:

• Stool changes.Stools may become paler, greasy, or float in water.
• Complaints related to the gastrointestinal tract. Bloating, diarrhea, especially within an hour after a meal, flatulence, and upset stomach can be signs of enzyme deficiency.

5. Insufficiency of the pancreas

Pancreatic insufficiency is the inability of the pancreas to secrete enzymes necessary for digestion. This is a common problem among people with pancreatic cancer.

Taking medications containing pancreatic enzymes (replacement therapy) may be beneficial for patients with pancreatic cancer, chronic pancreatitis, cystic fibrosis, and patients who have had bowel surgery to speed up healing.

Natural sources

Many raw vegetables and fruits contain enzymes that improve digestion.

Raw fruits and vegetables grown in good, nutritious soil are the best natural sources of digestive enzymes.Try to include foods such as:

• pineapple
• papaya
• kiwi
• kefir
• yogurt
• bananas
• mango
• miso, soy sauce and tempeh (fermented soy products)
• sauerkraut
• kimchi
• avocado
• apple cider vinegar
• raw honey
• bee pollen

Digestive enzyme preparations are predominantly produced from the following sources:

• Fruit, mainly pineapple and papaya.Bromelain, an enzyme derived from pineapple, breaks down a wide range of proteins, has anti-inflammatory properties and can withstand a wide range of pH (acid-base). Papain, an enzyme derived from fresh papaya, effectively promotes the breakdown of both small and large proteins.
• Animals. Such drugs include pancreatin, obtained from a bovine or pig.
• Plants. These drugs are derived from probiotics, yeast, and fungi.

Food additives

Since proteins, sugars, starches, and fats require certain types of enzymes, it is best to take drugs that include all of these types.

Many experts believe that the most effective are drugs that contain a full range of enzymes that improve digestion. Look for supplements that include the following enzymes:

• alpha-galactosidase (derived from the black aspergillus fungus and believed to aid in the digestion of carbohydrates).
• amylase (produced by the salivary glands)
• cellulase
• glucoamylase
• invertase
• lactase
• lipase
• malt diastase
• protease (or acidic protease)
• beta-glucanase
• pectinase
• phytase

When choosing enzymes, we recommend following the following guidelines based on symptoms and current health:

• If you have problems with the gallbladder, and you are looking for a natural remedy for its treatment, then pay attention to preparations containing lipase and bile salts.
• Pepsin is certainly present in preparations containing betaine hydrochloride.
• Some products may contain lactase, which until recently was only available as a stand-alone drug. This enzyme helps people with problems with the absorption of sugar from dairy products.
• Protease preparations help assimilate protein. They are especially useful for people with autoimmune and inflammatory diseases.
• Blends with herbs such as peppermint and ginger also support digestion.
• Some people require more pancreatic enzymes than others. For this reason, choose a drug based on your personal needs. Most foods contain some amount of pancreatin, which is a combination of three pancreatic enzymes.

Are there food enzymes for vegetarians?

Some formulations contain only plant-derived enzymes that are suitable for vegetarians and vegans.They usually contain bromelain from pineapple and papain from papaya.

Products designed specifically for vegans usually contain pancreatin derived from the black aspergillus fungus (Aspergillus niger ). The most common source of this enzyme is bile or pig bile.

In addition, some preparations additionally contain herbs and spices. They often include amla extract, which is not an enzyme, but it is used in Ayurvedic medicine as a herbal remedy to improve general well-being.It is believed to work in synergy with other compounds.

When should you take digestive enzymes?

For optimal results, digestive enzymes should be taken 10 minutes before meals or with the first bite. Protease supplements can be taken between meals in combination with other enzymes.

Start with twice a day and adjust the dosage as needed.

Can probiotics and digestive enzymes be taken at the same time?

Yes, enzymes should be taken before meals, and probiotics should be taken after or between meals.

It is beneficial to obtain probiotics from fermented foods. For example, yoghurt, kefir, kimchi or sour cream. Probiotics help normalize the gut microbiome by aiding digestion and reducing symptoms such as gas and bloating.

Health Benefits

How are digestive enzymes useful? Mainly in that they help to digest food.Enzymes should be taken for the following reasons:

• Helps treat leaky gut and other conditions by relieving stress from the gastrointestinal tract.
• Maintains a healthy balance of bacteria in the intestines.
• Help the body break down difficult-to-digest proteins and sugars such as gluten, casein and lactose (milk sugar).
• Significantly reduce symptoms of acid reflux and irritable bowel syndrome.
• Improves absorption of nutrients, preventing the development of deficiencies.
• Naturally blocks the action of enzyme inhibitors found in foods such as nuts, wheat germ, egg whites, seeds, beans and potatoes.

If you do not have enough digestive enzymes, you may experience constipation. In this case, supplementation with enzymes may help. Digestive enzymes are not associated with weight loss and cannot be used for weight loss. However, they can help reduce food cravings and make you feel fuller faster.

Use in Traditional Chinese Medicine and Ayurveda

Conventional medicine uses a holistic approach to treating digestive problems, which means dietary and lifestyle changes rather than medication. Digestive enzymes in drug form became available only 50 years ago. Prior to this, patients were advised to include more raw foods and foods containing probiotics in their diet.

According to the ancient medical system of Ayurveda, digestion is dependent on the amount of Agni, the “digestive fire”.Agni is believed to be increased by treating causes of indigestion (such as eating during stress or shortly before bedtime), adjusting the diet, and strengthening the digestive system with herbs and home remedies.

In Ayurveda, spices play an important role in supporting digestion. Especially healing are considered:

• ginger
• turmeric
• cumin
• coriander
• fennel
• cardamom
• fenugreek
• cinnamon
• rosemary
• sage
• oregano

To increase the amount of digestive fire, it is necessary to drink herbal tea, which promotes the work of enzymes.Such tea can be prepared by pouring boiling water over cumin, coriander and fennel (1/3 teaspoon each). Strain the drink before drinking. Eating papaya can also be beneficial as it contains papain, which helps reduce inflammation.

In Traditional Chinese Medicine, Qi, “life energy”, is responsible for digestion. Acupuncture, herbs, movement, and stress relief combined with plant-based enzymes from food can help improve digestion and relieve ailments.

To support digestion, raw fruits and vegetables that have been slightly processed are most often recommended.

Other methods to improve the condition of the gastrointestinal tract include:

• consumption of local / seasonal products
• Consuming non-GMO organic unprocessed foods
• Restriction of consumption of sugar, liquids during meals and cold food
• thorough chewing of food
• refusal to eat 2-3 hours before bedtime
• yoga, tai chi, stretching and other physical exercises to increase appetite

Risks and side effects

Digestive enzymes can be dangerous? If you suffer from chronic diseases, we recommend that you consult a doctor who can select the most suitable enzymes for you.

Depending on the state of health, the specialist will be able to prescribe the safest drugs. If you have suffered or are suffering from liver or gallbladder disease or ulcers, please consult your doctor before taking supplements.

Despite all the benefits, digestive enzymes can cause side effects, including:

• nausea
• diarrhea
• abdominal cramps
• gases
• headache
• edema
• dizziness
• change in blood sugar
• allergic reaction
• modified chair

If you notice these symptoms, stop taking enzymes and talk to your doctor.

Most often, undesirable effects occur when the dosage is too high or when the drug is taken incorrectly. For this reason, it is important to read the instructions before use.

Pancreatic and digestive enzymes

Digestive system enzymes, or stomach enzymes, include pancreatic enzymes as well as plant and fungal enzymes.

Pancreatic enzymes are present in the eight glasses of pancreatic juice that most of us produce every day.This juice contains digestive enzymes to improve digestion and bicarbonate to neutralize stomach acid.

Pancreatic enzymes usually end in –in (trypsin or pepsin), while other enzymes usually end in –ase or –ose (fructose, lactose, sucrose).

Enzymes that deal primarily with fats and amino acids include:

• Lipase – Converts triglycerides to fatty acids and glycerol.
• Amylase – Converts carbohydrates to simple sugars.
• Elastase – breaks down the protein elastin.
• Trypsin – Converts proteins into amino acids.
• Chymotrypsin – Converts proteins to amino acids.
• Nuclease – Converts nucleic acids into nucleotides and nucleosides.
• Phospholipase – Converts phospholipids to fatty acids.

In the human body, enzymes are produced by the salivary glands, stomach, pancreas, liver and small intestine.

The pancreas produces bile salts and acids, which include water, electrolytes, amino acids, cholesterol, fats, and bilirubin. All of these substances come from the liver through the gallbladder.

Cholic and chenodeoxycholic acids combine with the amino acids glycine and taurine to produce bile salts, which are essential for nutrient absorption.

• Digestive enzymes help digest food by breaking down large macromolecules into smaller ones that our intestines can absorb.
• Digestive enzymes are divided into 3 classes: proteolytic enzymes, lipases and amylases. They metabolize various macronutrients.
• Digestive enzyme supplementation may be beneficial for people with inflammatory bowel disease, IBS, low stomach acid (hypochlorhydria), enzyme deficiencies, pancreatic insufficiency, autoimmune diseases, constipation, diarrhea, or bloating.
• Sources of digestive enzymes are fruits (especially pineapple and papaya), animals (bovine and pig), as well as probiotics, yeast and fungus.It is best to use preparations where all the main types of enzymes are present.
• Foods rich in digestive enzymes include pineapple, papaya, kiwi, fermented dairy, mango, miso, sauerkraut, kimchi, avocado, bee pollen, apple cider vinegar, and raw honey.

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drug search, prices and availability of drugs in pharmacies null and Ukraine

About the project – My Pharmacy

My Pharmacy is the fastest and most convenient way to find the necessary medicines in any pharmacy throughout Ukraine.We provide up-to-date information on prices and availability
medicines in pharmacies in Ukraine. Here you can buy medicines at low prices by comparing prices or making an online reservation.

Our database contains data on more than 11,000,000 product offerings of medicines and related products in 3,000 pharmacy outlets in Kiev and other settlements of Ukraine.

Updating the database of the assortment of goods every 20 minutes allows you to always provide the most up-to-date and reliable information about medicines.

In addition, the user can familiarize himself with the work schedule and contacts of each pharmacy point presented on our resource, find the addresses of 24-hour pharmacies and build them
route on the map.

The purpose of this project is to provide an opportunity for each user to search for medicines as simply and efficiently as possible, and ordering pills online is quick and convenient.

Benefits for users

My Pharmacy has a number of advantages that distinguish us favorably from competitors, thanks to which customers choose us.

We offer:

• Ability to quickly search for drugs in pharmacies in Kiev and other cities of Ukraine;
• Inquire about the availability of a medicine in pharmacies in Ukraine;
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• We provide an opportunity to get an additional discount when ordering drugs online;
• Find analogs of expensive drugs by comparing drugs by active ingredient;
• Read the manufacturer’s instructions for use;
• Find out about the availability of drugs in the nearest pharmacies, and independently build a route on the map online;
• On our website you can find out the exact address, contact numbers and working hours of any pharmacy and find the nearest pharmacy point to you.
• Read useful publications about health, learn the latest news from the field of medicine;
• Share your feedback on the quality of service of a particular pharmacy;

Ordering and searching for medicines in pharmacies on the website

On the main page of the site there is a line for quickly finding the necessary medicines. By the full name or its fragment, the resource will offer you a list of found drugs with the current ones.
prices.To purchase a drug at the lowest cost, you just need to compare prices in pharmacies or make a reserve for it for an additional discount.

Using filters by price, distance, work schedule will make your search results more targeted and useful.

The functionality of the service will be useful not only for ordinary users, but also for employees of medical institutions. Selection is available on the advanced search pages
medicines according to specialized indicators:

For each medicinal product, the site contains the original instructions for use from the manufacturer, which indicates everything about the product: active ingredients, purpose, contraindications
and side reactions.Please read this information carefully before purchasing. On the same page, you can quickly find drug analogues by simply clicking the Analogues button. Here you will see everything
options that can replace the drug of interest. And to order pills online, you must click on the green button next to the price.

DEAR USER!

THE “MY PHARMACY” SERVICE ADMINISTRATION WARNS: SELF-TREATMENT CAN BE DANGEROUS FOR YOUR HEALTH! THE INFORMATION ON THIS RESOURCE IS PROVIDED ONLY FOR INFORMATION PURPOSES AND NOT
CAN REPLACE THE DOCTOR’S CONSULTATION.

90,000 11 Tips from Harvard Scientists

Heartburn is a very common and unpleasant condition that occurs when stomach acid enters the esophagus. Anyone who has ever encountered her is familiar with an extremely unpleasant sensation – as if a fire broke out in his chest. How to get rid of heartburn without using medication, and can it be overcome without going to a doctor? In this article, we will present a step-by-step strategy from scientists at Harvard University.

In the majority, acid dyspepsia (this disorder has many names) manifests itself in the form of burning pain in the center of the chest or upper abdomen.Sometimes the pain “radiates” to the neck, jaw or arms, and lasts from several minutes to several hours.

In the place where the esophagus connects to the stomach, there is a muscle in the form of a ring – the lower esophageal sphincter. It works like a gate: it opens when food goes down into the stomach, and immediately closes – so that the food bolt does not return in the opposite direction. Acid reflux, or backflow of gastric contents, occurs when the sphincter opens too often or does not close tightly enough.

The causes of heartburn are not fully understood, so its symptoms can affect anyone. However, there are several categories of people who are at risk of experiencing this disorder more than others:

• Smokers,
• People who are overweight or obese,
• Pregnant,
• People with a hiatal hernia.

You can learn more about the causes of heartburn in this article.

Some habits and certain foods provoke symptoms and only worsen a person’s well-being.What causes heartburn:

• From overeating,
• Due to eating fatty and spicy foods,
• Due to stress,
• When a person lies down after eating.

How to get rid of heartburn without pills?

The symptoms of this disorder cannot be ignored, especially if they bother more than 2 times a week for a long time. But if you’re only concerned about recurrent heartburn, following these guidelines will ease the symptoms. Also, these tips will help reduce the chances of developing serious problems in the future.

Tip # 1: Eat more and little by little

When we overeat, a crowded stomach puts pressure on the lower esophageal sphincter. Subsequently, the muscle is stretched, which allows food particles and gastric juice to enter the esophagus. In addition, the more we eat, the longer the food stays in the stomach and the acid is produced. Instead of the traditional 3 meals, it is better to eat more often, but in small portions.

Tip # 2: Eat Slowly

When we eat very quickly, swallowing large pieces of food, it also puts pressure on the esophageal sphincter.

Tip # 3: Try not to lie down after eating

If we lie down to rest or read after a meal, the pressure on the esophageal sphincter increases. When this happens, acid reflux becomes more likely.

Tip # 4: Do not eat before bed

If we eat 3 hours before bedtime, the likelihood of a backflow of gastric contents into the esophagus is significantly increased.

Tip # 5: Do not exercise immediately after eating

If you have a workout planned, do it a few hours after eating.This will give your stomach time to free itself from food, at least partially.

Tip # 6: Sleep with the torso elevated

Slightly tilting the torso while sleeping will help relieve pressure on the lower esophageal sphincter and relieve nocturnal heartburn. To do this, it is recommended to raise one part of the bed by 15-20 cm, substituting bars under its legs. Not only the head and shoulders should be raised, but the entire upper body. Pillowing is not recommended – in this case, the symptoms may only worsen.

Tip # 7: Stay Away From Carbonated Drinks

Soda causes belching, which promotes acid reflux.

Tip # 8: Avoid foods that aggravate symptoms

Certain foods and drinks increase gastric acid production, delay gastric emptying, and help relax the esophageal sphincter. These products include:

• Fatty foods,
• Spicy foods,
• Garlic,
• Tomatoes,
• Coffee, tea, cola,
• Mint,
• Milk,
• Chocolate,
• Citrus fruits, including juices ,
• Sauces and vinegar,
• Alcohol.

Different foods can cause acid reflux for every person. In order to determine what you are personally reacting to, it is recommended to keep a food diary.

Tip # 9: Chew gum or suck on lollipop after eating

Chewing gum or sucking on lollipop increases salivation. Saliva helps neutralize acid, partially relieves inflammation in the esophagus and “flushes” gastric juice.Avoid mint sweeteners, which can trigger heartburn. Also try to buy sugar-free gum to keep your teeth from decaying.

Tip # 10: Review the medications you are taking

Some medications inflame the esophagus and increase reflux. For example, tricyclic antidepressants relax the esophageal sphincter, and tetracyclines can cause inflammation in the esophagus. If you are currently taking any medications, ask your doctor if they can trigger heartburn.

Advice number 11: Try to get rid of excess weight

Extra pounds put pressure on the stomach, and with it – on the lower esophageal sphincter. Tight belly clothing and a tight belt also contribute to unpleasant symptoms.

What about heartburn pills?

If following the tips listed above does not help, it is better to play it safe and see a doctor. Perhaps, in your case, heartburn attacks have ceased to be episodic and turned into a chronic illness.In this situation, you cannot do without the help of a gastroenterologist. Otherwise, you run the risk of facing some very dangerous complications, including cancer.

Below we will briefly look at what helps with heartburn, namely, what medications doctors prescribe most often.

For the onset of rapid relief, gastroenterologists prescribe antacids. The action of these drugs is based on the neutralization of gastric acid that has entered the esophagus. Another remedy for heartburn is h3 blockers, which block the production of hydrochloric acid.Compared to antacids, they provide a longer lasting effect.

The third and most effective type of heartburn pill is proton pump inhibitors. They reduce the production of hydrochloric acid, although for the onset of the effect, you need to wait about 4 days.

All of these heartburn remedies can only be taken under medical supervision.