The symptoms of acid reflux usually quickly respond to dietary & lifestyle modifications. These changes in diet & lifestyle are meant to accomplish specific goals. The main guide to apply these measures is understanding the normal aspects of esophageal & stomach functioning in addition to the common causative mechanisms underlying acid reflux disease. The following points will cover, in a process oriented action model, the reasons for most of the practices that should be adopted in the treatment of heartburn.

1- Assisting natural processes which promote acid clearance & stomach emptying

Increasing the production of saliva: saliva is produced by the salivary glands located around the mouth & have a high bicarbonate content & therefore an alkaline reaction. One of the functions of saliva is to neutralize the acid accidentally refluxed into the esophagus. Smoking & salty snacks reduce saliva & contribute to heartburn, they should therefore be avoided. At the same time, chewing gum should be encouraged as a good habit for heartburn sufferers who complain of dryness of the mouth.

Chewing thoroughly: mechanical degradation of food is an important preparatory step prior to digestion as it prepares food for further digestion in the stomach. Eating quickly is a bad habit that results in large food particles which imposes more work activity upon the stomach in the form of increased motility & increased acid production. It thus stays for a longer time in the stomach & delays its emptying. all these factors predispose to acid reflux & the habit of eating quickly should therefore be discouraged.

Small meals: a small meal would be digested easily with small amounts of acid & enzymes produced by the stomach. It is also cleared rapidly & does not increase pressure inside the stomach, consequently favorable circumstances for reflux are minimized. On the other hand a large meal is associated with increased production of acid, increased pressure & distension & delayed emptying of the stomach. all these factors initiate reflux & large meals should be avoided.

Drinking water: water dilutes & washes acid refluxed into the esophagus & promotes its clearance. At the same time it accelerates stomach emptying & prevents reflux. Drinking water should thus be encouraged before & after meals.

Pro-gravity postures: the erect posture favors movement of refluxed acid back into the stomach by the effect of gravity. On the contrary lying down is an anti-gravity posture, this fact should be considered together with our knowledge of the location of the esophagus, mainly within the chest (with negative pressure) & the location of the stomach, inside the abdomen (with positive pressure) these factors favor flow towards the esophagus & hinders esophageal clearance. Another factor related to posture is the increased tone of muscles supporting the lower esophageal sphincter in the upright position, this support is abolished when lying down as these muscles relax. Practically speaking recumbency should be avoided for at least 3 hours after eating, one should not go to bed immediately after meals & in heartburn sufferers the head of the bed should be elevated about 6 inches to stop reflux.

Increasing lower esophageal sphincter pressure: from the functional point of view, high protein diet stimulates gastrin production, a local hormone that increases the sphincteric pressure & prevents reflux. Anatomically, a healthy physical built maintains an optimum tone in the muscles supporting the lower esophageal sphincter. It is well known that obesity weakens body musculature & reduces its contractility. Accordingly, we should maintain a desirable body weight & a low-calorie diet can be used to promote weight-loss if needed. a high protein diet is also recommended.

Promoting stomach emptying: an important function regulating pressure inside the stomach & the amount of acid produced. Whenever emptying is delayed significantly food, acid & enzymes accumulate inside the stomach resulting in increased pressure & distention in addition to increased acid volume. The rate of stomach emptying is proportional to the rate of completion of digestion of a certain amount of food. Accordingly, when the digestive load is increased as following a heavy meal or swallowing large food particles or particularly when the meal is mostly composed of fat, a longer time is needed for digestion & consequently emptying is delayed. Drinking water also promotes stomach emptying. The role of having small meals, chewing thoroughly, low fat diet & drinking water before & after meals should be overstressed.

2- Eliminating factors that initiate reflux into esophagus

Direct irritation of the surface lining the esophageal lumen: avoid citrus,onions, spices & acids from tomatoes

Increased relaxation of the lower esophageal sphincter: avoid eating foods & drinking beverages that reduce sphincter pressure such as:

Beverages: Caffeinated, carbonated or alcoholic beverages Citrus-based juices

Food ingredients: Vinegar, spices, garlic, onion, tomato-based products & peppermint

Vegetables: raw onion & tomatoes

Citrus fruits: orange, lemon, grapefruit

Fatty meals: salad dressing & fried food

Dairy products: sour cream, milk shake, ice cream & cottage cheese

Sweets & desserts: chocolate & potato chips

Medications: avoid medications that lower sphincteric pressure such as: Theophylline, Anticholinergics, Progesterone, Calcium channel blockers, Alpha adrenergic antagonists, Diazepam & Meperidine.

Increased acid production: avoid heavy meals, spices & alcohol.

Increased pressure inside the stomach: avoid practices associated with increasing pressure. These originate either from within the stomach (internal) or from the outside (external). Internal pressures are generated following delayed gastric emptying associated with heavy meals with high fat content or secondary to obstruction of the stomach outlet. External pressures are mostly due to compressive forces associated with practicing exercise following meals especially vigorous exercise with bending movements. Tight clothing also exerts external compression upon the stomach & heartburn sufferers should wear loose-fitting clothing. Obesity is also considered a compressive factor as it increases the bulk of viscera inside the abdomen & weight-loss should be encouraged.

To summarize, the best measures for acid reflux relief are: Understanding normal functions of the esophagus & stomach. Enhancing normal functional mechanisms. Avoiding foods, medications, & lifestyle practices which disturb normal functions & cause acid reflux.

Sheri Dean is a healthcare professional, currently writing informational articles on Acid Reflux Relief. Read more at http://acid-reflux-relief.blogspot.com