What Causes GERD and What Can You Do About It?

gerd hurtsWe’ve had a number of people ask about GERD, short for gastroesophageal reflux disease. Most people think of this condition as “acid reflux.” Knowing how many people are affected by it and how unpleasant the symptoms can be, we thought we’d tell you a little more about it, especially the role that diet and lifestyle plays.

What Causes GERD?

There’s a flap that separates your esophagus from your stomach. For people with acid reflux, this flap weakens, allowing acid to flow backwards from the stomach into the esophagus. Ouch! This irritates the esophagus, leading to acid reflux symptoms. These symptoms may include a sensation of acid in the back of your throat, frequent heartburn, difficulty swallowing and chest discomfort.

Silent GERD – A Sneakier Form of Reflux

Interestingly, there’s another form of acid reflux called “silent” acid reflux or silent GERD, so-named because it doesn’t cause the typical heart burn and acid symptoms. With silent GERD, acid moving backwards irritates the larynx instead of the esophagus. This leads to an entirely different group of symptoms – usually cough, especially at night, post-nasal drainage, hoarseness, excess mucous in your throat or asthma-type symptoms. In some cases, this atypical form of acid reflux is initially diagnosed as asthma or allergies. People with this condition are usually surprised to find the symptoms they’re having are coming from their digestive tract, not their lungs.

Treatment for Acid Reflux

If you see a doctor because you’re having symptoms of GERD, they’ll want to know if you have any so-called “alarm signs,” signs that it could be something more serious. These include weight loss, anemia or problems swallowing. If your symptoms sound classic for reflux, they may try you on a medication that suppresses acid production like a proton-pump inhibitor. If you don’t improve, they’ll probably recommend a procedure called an endoscopy to look at the lining of your esophagus and stomach to make sure there’s not a more serious problem.

These days you can buy medications to treat acid reflux called H2-blockers. They aren’t as powerful at blocking acid as a proton-pump inhibitor but they have fewer side effects. If you have only occasional reflux symptoms, an antacid will temporarily relieve the symptoms, but you shouldn’t use them excessively since they can block the absorption of some drugs and dietary components including some vitamins and minerals and lead to mineral imbalances.

If Possible, It’s Best to Treat GERD Through Lifestyle Changes

Taking a pill that blocks acid sounds like an easy solution to the problem, but medications used to treat GERD have side effects. When you take proton-pump inhibitors long term, it can alter calcium levels and lead to an increased risk for fractures. Both proton-pump inhibitors and over-the-counter acid suppressors like H2 blockers reduce absorption of vitamin B12.

We’ll talk about diet in a minute, but first I want to point out a few things that can make reflux symptoms worse:

  • Wearing tight clothing that pushes in on your tummy
  • Eating within 2 hours of bedtime
  • Lying flat in bed. Some people experience improvement when they elevate the head of their bed five inches. You can use a foam wedge or elevate the top of the bed with blocks.
  • Sleeping on your right side. A study carried out at Stanford showed people who sleep on their left side have fewer reflux symptoms.
  • Smoking
  • Eating big meals or gulping your food. Anything that causes stomach distension like trapped air or a large meal can aggravate GERD. Try eating 5 or 6 small meals rather than 2 or 3 larger ones.
  • Carrying around too much weight. Obesity, especially abdominal obesity, puts pressure on the flap that separates your esophagus and stomach and worsens reflux. Losing as little as ten pounds can improve acid reflux.

How Diet Impacts GERD Symptoms

As we point out in our ebook Eat to Treat Acid Reflux, eating too much, especially a trip to an all-you-can-eat buffet, can make your symptoms worse. Eating too fast can too. The composition of your diet also has an impact.

Foods high in fat are some of the worst offenders. That’s because they slow down stomach emptying. Stay away from high-fat and fried foods. Here’s a list of other common foods that can aggravate reflux:

  • Tomatoes, ketchup, tomato juice and hot sauce
  • Citrus fruits and citrus juices
  • Caffeinated beverages including coffee or tea
  • Chocolate
  • Nuts
  • Soda
  • Alcohol

Other Tips for Treating GERD Symptoms

You may also want to consider taking a probiotic supplement. One study published in Gastroenterology showed certain types of “bad” bacteria may contribute to inflammation in the lower esophagus and increase the risk for reflux symptoms. A probiotic supplement may help to keep these bacteria in check.

Take-Home Tip

Don’t ignore GERD symptoms. If left untreated, it puts you at higher risk for inflammation, strictures and even cancer of the esophagus. If you don’t get better with lifestyle changes or after taking acid-suppressing medications, talk to your doctor.


Gastroenterology. Volume 137, Issue 2, Pages 588-597, August 2009.

Arch Intern Med. 2006;166:965–971.

Gastroenterology. 2006;131:1644–1646.

Kristie Leong M.D.

Dr. Kristie Leong and Dr. Apollo Leong are physicians helping you to lead a healthy lifestyle by sharing nutrition and fitness tips and keeping you abreast of the latest health news.

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