Self Help Information About GERD
The main offending foods to avoid in typical American diet are outlined below.
We have also provided a detailed food list for patients who remain symptomatic
in spite of following this outline.
Breakfast - The usual
breakfast of coffee, orange juice, milk, bacon and egg, and banana are the
most offending foods in causing heartburn. Eat toast and jelly with small amount
of butter and a cup of tea. If you are going to have orange juice, have 4 ounces
of sweet fresh squeezed orange juice. Add a small amount of skim milk to your
cereal or have your cereal with your orange juice instead of the milk, try
it, it is good. Boiled egg is better than fried or scrambled.
Lunch - Avoid French fries, potato chips, hot
dogs, and cold cut meats with high fat contents. If you must add relish, catsup,
mustard, barbecue sauce and mayonnaise, add only a touch. In your salad avoid
raw onion, carrot, cucumber, broccoli, cauliflower, and vinaigrette based dressing.
Use regular (non-carbonated) water for beverage.
Dinner - Avoid deep-fried foods like fried chicken,
fried clam, cheese dishes like musaka (ground beef, cheese and eggplant), barbecued
ribs, fatty foods, creamy soups like clam chowder, heavy meals like meatloaf,
and large meals no matter what. Go light on vegetables specially if raw, chocolate
containing deserts, and alcoholic beverages. Stop eating at least three hours
What is O.K. to eat? White meats
like chicken without fat and skin, fish and seafood, and lean red meats either
broiled or grilled. Rice, baked or mashed potato, pasta, steamed or cooked
vegetables, and mild tomato sauce.
RELAX - In patients with heartburn and GERD medications
are primarily used to control symptoms. While on medications you may be able
to eat most foods and beverages without becoming symptomatic. While this is
not recommended most people practice this and get away with it.
Detailed list of foods:
A useful way of thinking about foods which may cause heartburn
dinner foods", that is to say, mints, coffee, tea and fatty foods such
as cake, ice cream, and chocolates. These are definitely foods that cause heartburn.
Avoid foods and beverages that cause heartburn, for example:.
Tea and Coffee (including the decaffeinated
Fruit and vegetable juices such as orange juice,
grapefruit juice, pineapple juice, V8 juice, tomato juice
Carbonated beverage of all types (regular water
is the best drink)
Milk and buttermilk
Beer, wine, and hard liquors
Oatmeal and other fibrous breakfast cereals
Fruits such as kiwis, apples, melons and bananas,
raw peaches, plums, and strawberries
Vegetables such as raw onions, carrots, radishes,
tomatoes, cucumbers, broccoli, pepper, turnip, eggplant
Fatty foods such as bacon, eggs, sausage, hotdog,
cold cuts (i.e. bologna, salami, pepperoni), Italian sandwich, hamburger,
meatloaf, gyro, stews, shepherd's pie, pizza
Deep-fried foods such as french-fries, potato
chips, hash browns, fried clams
Spicy foods like burritos, tacos, curry, homos,
Sauces such as tomato sauce, mayonnaise, ketchup,
mustard, horseradish, gravy, salsa, salad dressings containing lime/lemon
juice and vinegar
Most Mexican, Indian, and Chinese foods served
in restaurants due to their beans, spices, and fat content
Hot & sour soups, thick
soups, bean soups, cream based soups, soups containing beans and legumes
Pickled foods, dehydrated foods such as dates
Elevate the head
of your bed at least six inches by putting a couple of bricks or old
the top legs of your mattress
frame. You can also purchase special foam wedge pillow made for this purpose
from your local pharmacy supply store, or try a more advanced pillow
by contacting www.propuppillow.com.
This will reduce the return of stomach acidity and semi-digested food into
your esophagus, throat, mouth and potentially your lungs when you are sleep.
Avoid exercising at least for one to two hours
after each meal. Do not bend from the waist down for 1-2 hours after each
Avoid eating or drinking except water and medications
for 2-3 hours before going to bed (go to bed with an empty stomach to reduce
the chance of reflux).
Avoid wearing tight belts, pants or corsets.
Stop drinking alcoholic beverages.
Avoid large meals. If necessary eat smaller
amounts more frequently.
Reduce your weight to diminish reflux.
MEDICATIONS THAT ADVERSELY AFFECT GERD
belonging to the following pharmacological classes cause or increase heartburn
by relaxing the
lower esophagal sphinctere: Nitrates, Anticholinergics, Beta-adrenergic
agonists, Alpha-adrenergic antagonists, Aminophyllines, Benzodiazepines,
Calcium channel blockers, Nicotine derivatives, Tricyclic antidepressants,
OVER-THE-COUNTER SELF MEDICATIONS
The best news
for chronic reflux sufferers is Prilosec going over-the-counter. Prilosec(Omeprazole)
has been around for a long time and has an excellent safety record similar
to other PPIs (Omeprazole = Prilosec, Esomeprazole = Nexium, Lansoprazole
= Prevacid, Pantoprazole=Protonix, and Rabeprazole = Aciphex). It is offered
however, for reasons unkown to me, much cheaper than prescription PPIs (typically
$1 vs. $3-4/tablet or capsule of similarly effective PPI) even though it
is as strong, as good and as safe.
Zantac (Ranitidine) 150 mg is over the counter now; last
time I checked the cost of 60 tablet package was $22 at my local pharmacy.
The usual dose is 150 mg twice daily.
Prilosec 20 mg is also over the counter and 14 tablets cost
$11. Therefore, one month supply of either one costs about $22. In patients
who need to take 2 Zantac tablets daily it is more convenient and more effective
to take one Prilosec OTC.
Indeed, in my experience Prilosec 20 mg (omeprazole) is
as effective as Prevacid 30 mg (lansoprazole) and in most patients as effective
as Nexium 40 mg (esomeprazole) and Aciphex 20 mg (rabeprazole) and more effective
than Protonix 40 mg (pantoprazole).
Most of the time patient co-pay is equal or more than the
cost of one month Prilosec OTC. Again based on my experience, Protonix (panntoprazole)
that is the least effective of all PPIs has the lowest co-pay and is preferred
by most HMOs.
Zantaz 150 mg and Prilosec 20 mg, do not require prescription
Histamine Receptor Antagonist (H2-RA) - Over-the-counter histamine
receptor blockers like Tagamet HB, Pepcid AC and Zantac75 reduce gastric acid
formation in response to a meal, therefore they should be taken before each
meal and by the same reason they do not provide immediate relief of heartburn
as antacids do. Based on my clinical experience, Axid (nizatidine) is the least
effective of the H2-blockers. H2-RAs
are relatively safe, but if you need to take them regularly or more than 2
daily you should consult your physician.
Pepcid Complete (over-the-counter) - a
combination of Pepcid AC (Famotidin) and a calcium carbonate antacid. Famotidin
is an H2-blocker which reduces acid secretion within 45 minutes
to an hour of ingestion. The calcium carbonate acts immediately to neutralize
the acid already present in the stomach. This combination provides both short
term and long term relief.
Surpass (an antacid chewing gum) - Recently,
Wrigley Healthcare has released a chewing gum that is coated with 450mg of
calcium carbonate. Calcium carbonate neutralizes the acid and relieves heartburn
immediately. While continuing to chew gum will produce saliva, and since
Saliva's pH is alkaline, the swallowed saliva will continue to neutralize
the remaining acid. Like Tums, Surpass may be used as calcium supplement