GERD, or Heartburn, and How to Fight It

Although you might not now know it from its scientific name—GERD—almost everybody, whether they have diabetes or not, has had at least one episode of heartburn. Most of us have experienced it at one time or another and it is an everyday battle for many women in the latter part of pregnancy. There’s no direct link to diabetes, but it’s often one of the many ailments that people with type 2 diabetes put up with.

GERD stands for gastroesophageal reflux disease and often manifests its presence through feeling of heartburn, a sour taste in the mouth and belching. It can, however, be completely asymptomatic or instead of heartburn cause a chronic dry cough.

Occasional heartburn after eating a particularly heavy, fatty meal is usually nothing to worry about and can be easily treated with an over-the-counter antacid. GERD involves persistent reflux of the acid contents of the stomach back up into the lining of the esophagus.

GERD develops when the sphincter muscle that separates entry to the stomach from the esophagus becomes damaged or incompetent. Normally, this sphincter remains in the closed position. When you eat food, the sphincter opens to allow its passage into the stomach. But, when you have GERD the sphincter doesn’t shut completely after eating, allowing acid to slosh backward into the esophagus.

The lining of the esophagus is not well-suited to handle the low pH. of the stomach contents, producing the symptomatic burning. Prolonged exposure of acid to the lining of the esophagus causes erosions and can change the morphology of the cells so that they no longer resemble esophageal cells, but instead take on the appearance of stomach cells. This condition is known as Barrett’s esophagus. People with Barrett’s esophagus are at higher risk of developing esophageal cancer.

Certain conditions, such as obesity and smoking, predispose to GERD because they reduce the downward pressure on the esophageal sphincter. There are a variety of medications; including antacids, Mylanta®, Tums®, Maylox®; histamine-2 blockers, such as Zantac® and Pepcid® and proton pump inhibitors (PPIs), brand names Prilosec®, Nexium®, Aciphex®, and Dexilant®. that you can take to reduce the amount of acid in your stomach. A short course of PPIs may be all that is needed to heal any esophageal erosion for some people; others may require long-term management with prescription medication. For recalcitrant cases, surgery may be prescribed.

However, even with the use of medication, controlling GERD, like controlling diabetes, is a lifestyle issue. Losing weight and avoiding large, fatty, heavy meals can go a long way to alleviating the symptoms. Some of the dietary advice for GERD dovetails with what is recommended for diabetes. People with GERD should plan small meals that are high in protein and reduced in fat.

Certain foods decrease lower esophageal pressure and should be limited or avoided. These include:

  • Caffeine
  • Chocolate
  • Fatty foods.
  • Mint
  • Alcohol

The response to other foods varies by individual, but these foods have been found to cause problems in many people with GERD:

  • Citrus fruits
  • Tomato products
  • Spicy foods

There are areas where the dietary advice for diabetes and GERD conflict, however. People with diabetes who take certain insulin regimens or who have a history of low blood glucose levels upon waking, may be instructed to eat snacks before bed. However, this recommendation can aggravate GERD. One suggestion is to discuss with your health care provider the possibility of reducing the amount of insulin you are taking or changing the time you take it. If snacking can’t be avoided, those foods very low in fat and otherwise not found to stimulate reflux can be tried.

Those with reflux should avoid eating within three hours of lying down and keep the head of their bed elevated between 4 and 8 inches through use of blocks under the bed legs or specially designed pillows. Although exercise is recommended, those exercises such as sit ups or weight lifting, that put pressure on the abdominal cavity, should be avoided, especially soon after meals.

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