The entire family is gathered around a fully loaded table, and you've bellied up to a huge and delicious meal. It's a tradition to indulge. But how will you feel after eating?
If you have acid reflux like 45 million other Americans, the answer is “Not great.” Big feasts can easily trigger symptoms of acid reflux, including heartburn, leaving a bitter aftertaste of pain and possibly regret. But there are simple things you can do to make sure that the family gatherings are heartburn-free.
dailyRx spoke with Dr. Robynne Chutkan, spokesperson for the American Society for Gastrointestinal Endoscopy and an assistant professor at Georgetown Hospital in Washington, D.C. and founder of the Digestive Center for Women in Chevy Chase, Maryland. She's an expert on acid reflux, or GERD (Gastroesophageal reflux disease). She told dailyRx that it's better to plan ahead and modify your behavior around food, than to overdose on antacids after a meal.
“I always tell my patients you should eat breakfast like a queen, lunch like a princess, and dinner like pauper,” said Dr. Chutkan. “A lot of people think, 'Oh, it's the holidays, I'm not going to eat anything for breakfast or lunch” and then they gorge themselves on dinner and they're really uncomfortable. Have a big breakfast, really good sized lunch, and eat less for dinner.”
Dr. Chutkan suggests a brunch – or placing the big meal in the early afternoon – rather than having a late dinner. That's because the stomach and intestines are much less active at night, resulting in slower digestion.
The stomach has a big job to do after a large meal. It has to digest more than its usual load, churning and mixing food down into your small intestine.
“The stomach is quite small in terms of what it can hold. So if you eat too much, and the stomach doesn't have time to empty down into the small intestine, acid is going to come back up into the esophagus,” she said.
That's the uncomfortable feeling of heartburn. Heartburn isn't the only symptom of acid reflux – other people with GERD may experience abdominal pain, nausea, coughing, and compulsive throat clearing.
The underlying cause of heartburn is the lower esophageal sphincter, which Dr. Chutkan explains as “the little muscular area between the end of the esophagus and the beginning of the stomach.” In people with GERD, that sphincter opens when it shouldn't, and allows food and acid to travel up the esophagus. Heartburn is the feeling of acid irritating the sensitive lining of the esophagus.
Avoid trigger foods
Certain types of food and drink are more likely to trigger the symptoms of acid reflux. Unfortunately, these are the foods you're most likely to find on the dinner table: High calorie, fatty foods accompanied by alcohol, chocolate, and caffeine.
“The stomach has receptors in it that can sense the content of foods,” Dr. Chutkan explained. “When we eat foods with higher fat content, like meat, cheese, and other richer foods, those take longer for the stomach to digest. They stay in the stomach much longer. And so there's more opportunity for those foods to cause more acid reflux than if you're eating a small bowl of broccoli, for example.”
She added that even if a food is healthy in theory, like greens or sweet potatoes, they're often found on the dinner table swimming in rich sauces, or pumped full of butter and other fats.
Frequently, alcohol, chocolate and caffeine (coffee after dinner, anyone?) come into play during large meals as well. You might have a few beers or glasses of wine or liquor before, after, and during dinner. These are notorious for opening up the lower esophageal sphincter, and causing heartburn and other acid reflux symptoms.
It's best to avoid these foods if possible, but if not, Dr. Chutkan advises to eat fewer calories.
Get active after eating
The post-meal “food coma” is another trouble area for people with acid reflux. After a rich meal, it's common to sit or lay down and relax. But being sedentary can increase your chances of heartburn, Dr. Chutkan told dailyRx.
“Because you're sitting there with a big full stomach, one of the most helpful thing to do is go for a walk after you eat, to keep things active so that the stomach can empty better,” Dr. Chutkan said.
If a walk or other activity is not an option, the second best thing is to stay sitting upright rather than reclining back on the couch. Gravity helps your food move down through the stomach, reducing its opportunity to come back up.
You can always reach for the antacids to settle your acid reflux, if you're not already on daily medications. But Dr. Chutkan recommends making these behavioral modifications before turning to drugs.
She added that unhealthy eating may be at fault for heartburn to begin with. Abdominal weight, or belly fat, presses down on the sphincter in a way that squeezes food up into the esophagus. So if you have an “apple shape” body type, you may want to apply these tips to your diet year-round.
“There's things like breaking up your meal, eating a few appetizers and hors d'oeuvres, then eat a bit of a main course later. Give your stomach a while to digest. Go out for a walk in nature, and then come back and have your meals.”