When acid reflux strikes - Response to reader

 Dear Ms Brown,

Can you provide a healthy weight-loss diet, that is, servings of protein, vegetables, starches, etc per day. Also, I have been diagnosed with acid reflux and wanted to know which acidic foods to avoid.

- Normadelle

Dear Normadelle,

This condition is also referred to as heartburn or gastroesophageal disease (GERD). This is a condition where the acid liquid contents of the stomach back up into the oesophagus (the tube leading from the throat to the stomach).

This acid may cause inflammation of the lining of this tube, causing ephagitis, recurring heartburn, nausea, or regurgitation of stomach contents. Unfortunately, more serious complications occur, such as ulcers, strictures of the oesophagus (scars) and Barrett's oesophagus, signified by changes in the cells of the lining of the oesophagus to pre-cancerous cells which can lead to cancer in some patients. Complications also include infection of the lungs and collection of fluids in the middle ear and sinuses.

Muscle defect

Although many people experience reflux of stomach liquids, only some people seem to be prone to GERD, which could be due to the acid levels of the reflux in addition to other factors. A defect in the muscles between the lower oesophagus and the begining of the stomach, called the lower oesophageal sphincter (LES), facilitates this reflux. This muscle should remain relaxed to allow entry to the stomach then close with the stomach contents. A defect causes it to relax and allows the acid content to back up.

You mentioned that you are interested in losing weight and needed guidelines on acidic foods to avoid. Some people who are obese and others with hiatal hernia (a small part of the upper stomach near the oesophagus pushes up through the diaphragm) are prone to acid reflux. Reducing excess body fat could be very important in managing acid reflux.

Guidelines on managing acid reflux

1. Consume small meals to prevent stomach distention which can cause reflux.

2. Your evening meal should be especially small and early to prevent reflux when you retire to bed.

3. Elevate your bed by putting some wooden blocks or other alternatives to ensure that your upper body is elevated. This will raise your oesophagus higher than your stomach, thereby reducing the chance of reflux.

4. Chew gum after meals. Chewing stimulates the production of saliva (which contains bicarbonate) and increases swallowing. The bicarbonate in the saliva neutralises acid in the oesophagus

5. Avoid foods that cause the LES muscle to relax such as chocolate-containing foods, peppermint-containing foods, alcohol and caffeinated beverages such as coffee, tea and carbonated drinks such as sodas.

6. Some people experience reflux with spicy foods and acid-containing foods such as citrus, tomato juice and products. Smoking also relaxes the LES.

7. Apart from lifestyle changes, the doctor will prescribe antacids, histamine antagonist (H2 blocker), proton pump inhibitors (ppI), pro-motility drugs, foam barriers, surgery and endoscopy.

Soy and breast cancer

Dear Ms Brown,

Do soy products cause breast cancer? I read your article with interest as I am a daily consumer of soy milk and occasionally of tofu made from soybeans. However, the answer to my question was really not clear to me.

- Carmen

Dear Carmen,

My recommendation is that fresh soybeans and other products made from soybeans are safe in a regular diet, based on the current evidence. The caution is for us to avoid consuming large amounts of commercially prepared isoflavones and concentrated soy isolates which would have higher levels of isoflavones than natural foods.

Rosalee M. Brown is a registered dietitian/nutritionist who operates Integrated Nutrition and Health Services; email: yourhealth@gleanerjm.com.

Rosalee Brown

DIETITIAN'S DESK