Obesity and Acid Reflux

Obesity increases heartburn and GERD

/ Author:  / Reviewed by: Joseph V. Madia, MD

Acid reflux is on the rise as our waistlines expand. What's going on in our stomachs, and is there anything we can do about it?

Over the past few years, studies have pointed out the connection between the increasing number of people suffering from acid reflux symptoms and the spreading obesity epidemic.

Experts suspect that the pressure of extra weight around the middle, combined with a diet high in fat, increase your likelihood of developing gastroesophageal reflux disease – GERD – the medical term for acid reflux.

Heartburn is one of the most common symptoms of acid reflux. It's the burning pain in the pit of your stomach, and the taste of acid traveling up your throat and into your mouth.

Heartburn is not just uncomfortable. For some patients, it could be a precursor to cancer. So if you're suffering from acid reflux, what can you do about it?

What Causes Acid Reflux?

Today, 45 million Americans have GERD. According to one study, incidence has risen by five percent every year between 1992 and 2005.

That's a rise that researchers correlate with the rise of obesity, defined by a body mass index over 30.

Typically, acid reflux happens because of a malfunctioning piece of your digestive anatomy.

The lower esophageal sphincter is at the boundary between your stomach and your esophagus and it is responsible for holding your food in your stomach as it's digested. For people with GERD, that sphincter opens when it shouldn't and allows food to travel up the esophagus.

If you're thin and you have acid reflux, it might mean that you were born with a hiatal hernia. Hiatal hernia is a condition where the stomach sits higher up in the chest than normal, causing your lower esophageal sphincter to be loose.

That loose “valve” in your stomach can't do its job properly, and the pressure from stomach or gastric acid can push it open and push back into your esophagus, causing heartburn.

A similar effect may occur if you are carrying extra weight around your stomach. The weight puts more pressure on your stomach, forcing that lower esophageal sphincter open and pushing acid into your esophagus.

Another interpretation is that the fat cells in our bodies cause inflammation, which loosens up the valve and makes it harder to do its job.

What's more, the high fat diet that contributes to becoming overweight also contributes to acid reflux. It takes longer for the stomach to digest meals that are high in fat, giving heartburn more time to occur.

If you've eaten a bigger meal, the stomach might be dealing with more than it can handle. It struggles to send your food onto its next step, the small intestine, and your food, along with stomach acid, rises back up.

It's an uncomfortable position to be in. The esophagus isn't equipped to deal with stomach acid, which exists comfortably in its native habitat because of a protective stomach lining. Over time, exposure to acid can damage the esophagus and cause Barrett's esophagus, a more serious condition.

Barrett's esophagus can lead to esophageal cancer.

How to Treat It

dailyRx spoke with Dr. Joel Richter, director of the Division of Digestive Diseases and Nutrition at the University of South Florida. Dr. Richter studies and treats esophageal diseases, and has examined the connection between GERD and obesity.

He said that most patients can see the relationship between their own symptoms and their weight.

“Many of [my patients] can relate to the fact that maybe they've been heavy for a while. But they may be able to say, 'I had a little heartburn, then I got pregnant, and after the second pregnancy, I haven't been able to lose 30 pounds,'” Dr. Richter said.

“That's when I say to the patient, 'We don't need you to get down to perfect weight, but if you lose just 10, 15, 25 pounds that may be enough to really ease your symptoms quite a bit.'”

In other words, you may not have to take medication to solve your heartburn problem. If you recognize that you are carrying extra weight, changing your lifestyle and your diet may be enough.

Dr. Richter added that the superfluous pounds contribute to other health problems.

“[Patients] can begin to have a dialogue with their doctor. They can ask, 'What factors in my weight are contributing to illness that I have?' Diabetes is made worse, osteoarthritis is made worse, and acid reflux is worse by being overweight,” he said.

He said that for some patients, surgery is an option to help lose weight. But the popular Lap-Band surgery may not be the best choice for people with reflux.

“The Lap-Band surgery is fine for people who have mild obesity, but it does tend to give people more reflux,” Dr. Richter said. He recommended gastric bypass surgery as an alternative to discuss with your doctor.

The pharmacological approach to heartburn is to take a proton pump inhibitor (PPI), a type of drug that suppresses stomach acid. But recent studies have shown that being on PPIs for an extended period of time has long-term side effects.

Making the changes to your lifestyle that help you lose weight will ease your acid reflux symptoms and improve your overall health.

In the short term, eat a healthier diet that's low in fatty foods, and get active after eating. A walk will help aid digestion, while sitting or lying down encourages food to come up.

Review Date: 
June 15, 2012