HEALTH: This Thanksgiving, Enjoy the Turkey But Hold the GERD

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Nov. 22, 2021 — John Farrell has mixed feelings about Thanksgiving.

“It is great because I love to eat, but at 6 o’clock in the morning, I feel bloated and it’s feeding into my reflux. It’s a burning sensation and I can feel the acid in my throat. There’s a lot of regret about everything I did that day.”

For around 5 years, Farrell, 46, has had GERD, which stands for gastroesophageal reflux disease. With this digestive disorder, your lower esophageal sphincter (LES, a muscular valve between your esophagus and your stomach) doesn’t work properly. This allows stomach acids and food to reflux into your esophagus. This can lead to discomfort and a burning sensation.

Most of us have occasional periods of reflux and the heartburn that can result, but with GERD, it happens two or more times a week. Roughly 60 million Americans have heartburn at least once a month, and as many as 15 million experience it daily. If GERD goes untreated, it can cause much worse symptoms and even lead to esophageal cancer.

Common GERD Triggers

While you may have heard that spicy, fatty, or rich foods should be avoided to prevent acid reflux, the reality is more complicated than that.

“Every individual has a different trigger for their GERD,” says Rena Yadlapati, MD, director of the Center for Esophageal Diseases at the University of California-San Diego. I have patients who can eat spicy and spicy foods but get reflux when they eat chocolate. I have others that just cannot drink coffee, but any food is just fine.”

Stefanie Robinson, a medical and dental biller from Pleasant Valley, NY, knows her triggers: acidic foods like tomatoes, and stress. She’s been struggling with GERD on and off for 20 years.

“She takes [acid-reducing drug] omeprazole every evening.” “I feel stressed lately so it doesn’t seem to be doing much. Between meals, I use Tums. And rice pudding or yogurt will help settle my stomach — they seem to coat it.”

In addition to spicy foods and tomato products, Farrell says he has two other key triggers: overeating and lying down too soon. Yadlapati states that the most important factors in GERD are how much food you eat and how close you sleep. It takes several hours for the stomach and small bowels to empty. There is no risk of getting reflux from your stomach once it has empty. But until then, whatever is in the stomach is likely to come back up.”

Thanksgiving and GERD: A Tricky Combination

Thanksgiving poses particular challenges for people with GERD, for one simple reason: “GERD is all about pressure,” Yadlapati says. The more pressure in the stomach, the more reflux will be triggered. And the thing that causes pressure is large amounts of food.”

Other things related to the holiday, like the stress of travel and family gatherings, may make you more prone to an attack, she says.

“Stress increases the excitability of nerves in your esophagus. Reflux symptoms can be mild if it is not severe. But under stressful circumstances, it might cause severe chest pain and burning.”

Another common part of holiday celebrations can also cause trouble.

“Alcohol is known to relax the lower esophageal sphincter, which facilitates reflux,” says Allon Kahn, MD, an assistant professor of medicine at the Mayo Clinic in Scottsdale, AZ. “So it’s likely, especially in the presence of a big meal, to make symptoms worse.”

While some people who have GERD take medication to help them produce less stomach acid, others manage with lifestyle changes like identifying and avoiding trigger foods or waiting at least 3 hours after eating to lie down. These careful habits often get thrown out the window on Thanksgiving. GERD can be severe when you let your guard down.

“Patients who are controlled with medicine might be less likely to have worsening of their symptoms, because the acid has been reduced to the point where it may not bother them as much,” says Kahn.

Enjoy the Holiday — and What Comes After

Whether you know you have GERD or you just get heartburn occasionally, a few tips can help you pull off a pain-free Thanksgiving:

Practice portion control. As hard as it is to resist a second helping of Aunt Martha’s stuffing, it’s really important to avoid overeating. Farrell says, “By the point you feel satisfied, you have eaten too much.” “Knowing that, I’ll try to stick to one plate.”
Be cautious with alcohol. In addition to its influence on your LES, drinking can lower your inhibitions. You are more likely to eat another helping of stuffing.
Choose foods carefully. Fried or very fatty foods are considered refluxogenic, says Yadlapati — they might induce more reflux. You can avoid these triggers if you are aware of them. “I will be very careful about what I eat for Thanksgiving. Salads will be off limits, as the dressing will contain vinegar. Robinson says that he will stick to turkey and mashed potatoes. “And I might bring my own dessert: rice pudding.”
Consider pre-medicating. If you’ve been managing your GERD with lifestyle modifications, you might want to take an over-the-counter medication, like Prilosec, 30 to 60 minutes before you sit down to eat, Kahn says. This can reduce acidity in your stomach as you digest.

Even with the best of intentions, you may still find yourself in pain Thanksgiving night. Here’s what you can do:

Be ready with antacids afterward. If you’re not comfortable taking medication in advance, Kahn recommends bringing along an antacid medication like Tums or Mylanta. He says that if you act quickly, it can stop reflux.
Avoid the urge to lie down. Because Thanksgiving meals are so much larger than regular dinners, Yadlapati and Kahn both recommend waiting longer than usual before lying down. Instead of 3 hours, aim for 4 hours. If you have to lie down faster than usual, a wedge pillow can be used to support your upper body.
Try belly breathing. “It can actually reduce reflux from coming up, and it can strengthen your diaphragm,” says Yadlapati. “It also helps to relax the nerves in your esophagus.”
Get moving. A little gentle exercise may ease your symptoms. Farrell says that going for a walk with the family after dinner is a great way to relieve symptoms.
Manage your expectations. People who have GERD or regular heartburn often know where their limits lie, and when they cross them. Yadlapati says, “If you want to have a late-night drink, it is OK.” “Just know you might wake up in the middle of the night.”
Don’t panic — but pay attention. “If you’re truly experiencing chest pain or a pressure-like sensation, it’s foolish to assume it’s heartburn,” says Kahn. Heartburn and heart attack can be similar symptoms. Eating a large meal can also cause heartburn. If you’ve never had this symptom before and it’s not mild, seek emergency care.”

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