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This Thanksgiving, Enjoy the Turkey But Hold the GERD

November 22, 2021 – John Farrell has mixed feelings about Thanksgiving.

“It’s great because I love to eat, but at 6-7am I’m like, ‘This isn’t good,’” says the project manager from Virginia Beach, Va. “I feel bloated, it feeds the ebb. I can feel the acid rising in my throat, that burning sensation. There are a lot of regrets for everything I did that day.

For about 5 years, Farrell, 46, has suffered from GERD, which means gastroesophageal reflux disease. With this digestive disorder, your lower esophageal sphincter (LES, a muscular valve between your esophagus and your stomach) does not function properly. It allows food and stomach acids to flow back (up) into your esophagus, which can cause discomfort and a burning sensation.

Most of us have occasional periods of reflux and the heartburn that can result from it, but with GERD it happens twice or more per week. About 60 million Americans suffer from heartburn at least once a month, and up to 15 million suffer from it daily. If GERD is left untreated, it can cause much worse symptoms and even lead to esophageal cancer.

Common triggers of GERD

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.

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

Stefanie Robinson, a medical and dental mail carrier from Pleasant Valley, NY, knows her triggers: acidic foods like tomatoes and stress. She has struggled with GERD on and off for 20 years.

“I take [acid-reducing drug] omeprazole every night, ”she says. “Lately I’ve been feeling stressed out so it doesn’t seem to matter much. I take Tums in between. And the rice pudding or yogurt will help calm 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 going to bed too early.

“The most important things with GERD are the amount of food you eat and the relationship to sleep,” says Yadlapati. “It takes a few hours for the stomach to empty into the small intestines. Once your stomach is emptied, there is really no risk of gastric reflux. But until then, whatever is in the stomach is likely to come up.

Thanksgiving and GERD: a delicate combination

Thanksgiving poses special challenges for people with GERD, for one simple reason: “GERD is all about pressure,” Yadlapati says. “The more pressure we have in our stomach, the more likely it is to start reflux. And what causes the pressure is large amounts of food.

Other vacation-related things, like the stress of travel and family reunions, can make you more vulnerable to attacks, she says.

“Stress increases the excitability of the nerves in the esophagus. If you have small amounts of reflux on another day it might not cause symptoms. But under stressful circumstances, it can cause severe chest pain and burns.

Another common part of holiday celebrations can also cause problems.

“Alcohol is known to relax the lower esophageal sphincter, which facilitates reflux,” says Allon Kahn, MD, assistant professor of medicine at the Mayo Clinic in Scottsdale, AZ. “It is therefore likely, especially with a large meal, to worsen the symptoms.”

While some people with GERD take medications to help them make less stomach acid, others adjust to lifestyle changes, such as identifying and avoiding trigger foods or waiting at least 3 hours after eating. to lie down. But on Thanksgiving, these prudent practices often go out the window. Letting go can lead to a nasty bout of GERD.

“Patients controlled by medication might be less likely to have their symptoms worsened because the acid has been reduced to the point where it may not bother them as much,” says Kahn.

Enjoy the holidays – and what comes after

Whether you know you have GERD or have occasional heartburn, a few tips can help you have a pain-free Thanksgiving:

  • Practice portion control. As hard as it can be to resist a second serving of Aunt Martha’s stuffing, it’s really important to avoid overeating. “By the time you’re feeling full, you’ve already eaten too much,” says Farrell. “Knowing this, I’ll try to stick to one plate. “
  • Be careful with alcohol. In addition to its influence on your LES, drinking alcohol can lower your inhibitions. It makes you more likely to have that second serving of stuffing after all.
  • Choose foods carefully. Fried or very fatty foods are considered refluxogenic, says Yadlapati – they might induce more reflux. And of course, if you’re aware of your own triggers, do your best to avoid them. “I’m going to be very selective in what I eat on Thanksgiving. I will stay away from the salad, as the dressing will contain vinegar. I’m going to stick with the mashed potatoes and the turkey, ”says Robinson. “And maybe I’ll bring my own dessert: rice pudding. “
  • Consider premedication. If you’re managing your GERD with lifestyle changes, you may want to take an over-the-counter medication, like Prilosec, 30 to 60 minutes before you sit down to eat, says Kahn. This can help reduce the amount of acid your stomach produces as you digest.

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

  • Be prepared with antacids afterwards. If you’re not comfortable taking medication ahead of time, Kahn recommends bringing an antacid medication like Tums or Mylanta. “If you act quickly, it can stop the reflux,” he says.
  • Avoid the urge to lie down. Because Thanksgiving meals are much larger than regular dinners, Yadlapati and Kahn both recommend waiting longer than usual before lying down. Aim for 4 hours instead of 3. Or if you need to lie down earlier, use a wedge pillow to elevate your upper body.
  • Try to breathe through your stomach. “It can actually reduce reflux and strengthen your diaphragm,” says Yadlapati. “It also helps relax the nerves in your esophagus. “
  • To move. A little gentle exercise can ease your symptoms. “Going out for a family walk after dinner really helps,” says Farrell.
  • Manage your expectations. People with GERD or regular heartburn often know where their limits are and when they are crossing them. “If you’re planning on spending a late evening and drinking, that’s okay,” Yadlapati says. “Just know that you might wake up in the middle of the night. “
  • Don’t panic, but be careful. “If you really feel chest pain or a feeling of pressure, it makes no sense to assume it’s heartburn,” Kahn says. “Heart attack and heartburn can present themselves the same, and eating a large meal is stressful on the heart. If you’ve never had this symptom before and it’s not mild, see the emergency room.

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