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Acid reflux, the upward streaming of stomach acid in the throat and mouth, is bad enough. Even worse, it can come with severe gas. Here is an explanation of what is going on and what to do about it.

Acid reflux, also known as gastroesophageal reflux disease or GERD, occurs when a ring of muscles at the bottom of the esophagus known as the lower esophageal sphincter isn't strong enough. Weak muscles allow the valve at the top of the stomach to open and acid to travel up. The severity of symptoms depends on the amount of acid. If you eat a lot of food at a single meal, your stomach produces a lot of acid. There is more acid to escape into the throat. If you eat less, your stomach produces less acid, and there is less acid to come up into the throat. The first way to treat GERD is simply to make a habit over never, ever stuffing yourself, and always leaving a little for later.

There is more pressure on the stomach to send acid up when there is a layer of fat on top of the stomach and intestines. Obesity is a risk factor for GERD. There can also be a problem with hiatal hernia, which tends to occur after the age of 40 without any obvious early symptoms. Pregnancy can cause GERD for similar reasons. There are certain medications that aggravate the problem, such as beta-blockers for high blood pressure or tremors, L-dopa for Parkinson's disease, or birth control pills, and it is usually worse after drinking alcohol.

Everyone produces gas, although most gas is odorless. On average, people belch or flatulate 13 to 22 times a day. Gas is a byproduct of fermentation of high-fiber carbohydrates in the colon. Probiotic, "friendly" bacteria feed on fiber as their primary food source. They extract nutrients for themselves, and even produce some nutrients, such as cancer-preventive butyric acid, for their human hosts. When friendly bacteria are fed too much fiber, however, as is the case when someone becomes eats too many low glycemic index foods (it is actually possible to eat too many high-fiber foods), they produce large amounts of gas. Gas can accumulate after drinking large amounts of carbonated beverages or beer.

Some people have an unusual tendency to have both acid reflux and severe gas. Sometimes this is a complication of fundoplication surgery to correct GERD called acid-bloat syndrome. The surgery prevents belching and vomiting in addition to reducing the flow of acid up from the stomach. Because it prevents gas flowing up, more gas has to flow down. However, because it is not a perfect procedure, there can still be acid reflux. Usually these problems resolve as the muscles heal after surgery, in two to four weeks, but sometimes, especially in people who have diabetes, they persist.

What can you do?

  • First of all, simplify your diet so that you eat just a few, that is, two or three different foods at most meals. This will give you an opportunity to notice which foods cause you problems. Sometimes there is some quirk in your digestive chemistry that makes you unusually sensitive to a particular food. Eliminating that food can eliminate problems. As you find which foods are "safe," you can eat a greater variety of foods, but don't let the variety tempt you to overeat. Never stuffing yourself is essential to getting GERD under control.
  • Secondly, use antacids sparingly. Antacids, especially aluminum-based antacids, interfere with your stomach's ability to release calcium from food. Even chewable TUMS with calcium, ironically, reduce your digestive tract's ability to release calcium. If you take antacids with each and every meal, you will eventually become calcium-deficient, which can lead to osteoporosis. Deglycyrrhizinated licorice (DGL), which is safer than regular licorice, can give you the same benefits without quite as much interference with your digestive tract's ability to release calcium from food. DGL has to be chewed and mixed with saliva to release the soothing ingredient. Don't swallow DGL tablets whole.
  • Finally, make fat your friend. Healthy fats in modest amounts have to be emulsified in the contents of your stomach, and it's harder for your stomach to send them up into your throat. Extreme low-fat, high-fiber diets are actually not healthy for people who have severe acid reflux and gas.

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