What are the lifestyle treatments for Gastroesophageal Reflux Disease (GERD)?

From the Guidelines

Lifestyle modifications, including elevation of the head of the bed, weight loss, and avoidance of trigger foods, are essential for managing gastroesophageal reflux disease (GERD) and should be recommended to all patients. According to the most recent study 1, lifestyle modification measures, such as avoidance of refluxogenic foods, food avoidance for at least 2–3 hours before recumbency, positional changes during the sleep period, and weight loss, have been proposed for management of GERD.

Some key lifestyle modifications that can help manage GERD include:

• Elevating the head of the bed by 6-8 inches using blocks or a wedge pillow to prevent stomach acid from flowing back into the esophagus while sleeping
• Maintaining a healthy weight, as excess weight puts pressure on the abdomen and can push stomach contents upward
• Avoiding eating large meals and instead eating smaller portions more frequently throughout the day
• Waiting at least 3 hours after eating before lying down
• Eliminating trigger foods from the diet, particularly acidic foods, spicy foods, fatty or fried items, chocolate, mint, garlic, onions, and carbonated beverages
• Reducing or eliminating alcohol consumption and stopping smoking, as both can worsen GERD symptoms by relaxing the lower esophageal sphincter

These lifestyle changes work by reducing pressure on the stomach, minimizing the amount of acid produced, and strengthening the lower esophageal sphincter function, which collectively decrease the frequency and severity of acid reflux episodes, as supported by the American Gastroenterological Association medical position statement 1. However, the most recent study 1 suggests that avoidance of trigger foods on a patient-by-patient basis is a more reasonable practice, as the data regarding avoidance of presumably refluxogenic foods in extraesophageal reflux is limited.

From the Research

Lifestyle Treatment of GERD

• Lifestyle modifications are considered first-line therapy for patients with gastroesophageal reflux disease (GERD) 2.
• Effective lifestyle interventions for GERD include weight loss and head of bed elevation, which have been shown to improve pH profiles and symptoms 2.
• Other lifestyle measures, such as avoiding trigger foods and beverages, may also be beneficial, although the evidence is largely based on individual experience rather than scientific studies 3, 4.
• Breathing exercises, such as those that induce a change from thoracic to abdominal breathing, may also be helpful in reducing GERD symptoms 3.
• Factors that may exacerbate GERD symptoms include:
  • Obesity or excess weight 2, 3, 4
  • Smoking 2, 4
  • Certain foods and beverages, such as:
    • Chocolates 2, 4
    • Fat-rich foods 2, 4
    • Aerated beverages 4
    • Salty foods 4
  • Lying down after eating or at night 4
• Lifestyle modifications should be tailored to the individual patient's needs and preferences, and may be used in conjunction with medical therapy, such as proton pump inhibitors (PPIs) 5, 4.