Briefly, how do I know if I have acid reflux? Is it the same (or different) from GERD or chronic heartburn?
Acid reflux describes a spectrum of symptoms that involves the entire upper GI tract from the throat to the stomach. Laryngopharyngeal Reflux, or LPR, describes reflux that causes symptoms within the throat, or pharynx, and vocal folds, or larynx. Typical symptoms of LPR include throat clearing, a lump in the throat feeling, chronic cough (especially at night), trouble swallowing, sour taste, and can contribute to hoarseness. GERD is defined by the more classic symptoms of heartburn, indigestion, fullness, abdominal discomfort, and regurgitation. People with LPR do not have to have GERD and vice versa, though some can have both. LPR is diagnosed with a combination of symptom presentation and physical findings that can include swelling of the voice box, high acid levels from acid, or oropharyngeal pH testing, and response to treatment. LPR is caused by a combination of acid in the presence of pepsin, the digestive enzyme from the stomach that can cause damage and inflammation of the throat structures.
How does gut bacteria play a role?
The microbiome represents the diverse colonization of our bodies, in particular, our gut, with trillions of organisms of many different varieties that are increasingly being found to influence our state of health. Dysbiosis, or an imbalance in these bacteria, can lead to many diseases including inflammatory bowel disease, diarrhea, obesity, diabetes, and even cancer. Dysbiosis of the esophageal and stomach microflora, or bacteria, can lead to the onset of reflux disease, ulcerations, Barrett’s esophagus, and even cancer. As more is researched, the microbiome will likely play an increasingly important role in the development and potential treatment of the various stages of reflux disease.
How does BBQ present challenges to someone with acid reflux?
The question is, how it doesn’t present a challenge! Most BBQ’s occur during off times: middle of the day, early afternoon, or later at night. Changing the time one eats can alter digestion and time for food movement in the stomach and intestines. In addition, most BBQs are associated with tons of food and drinks that can exacerbate or trigger symptoms in patients with acid reflux disease: coffee, tea, chocolates, greasy/fried food, fatty food, spicy food, soda, and alcohol. Most of these foods do not cause reflux but can trigger episodes, directly stimulate nerves causing symptoms, or exacerbate underlying mild reflux disease. In addition, nearly all BBQ meals include meat, and lots of it. Meat – chicken, fish, pork, and steak, all have high amounts of amino acids that are readily digested in the stomach leading to more acid secretion as well as pepsin secretion: pepsin is the digestive enzyme that breaks down protein and can cause damage to normal tissue within the throat and voice box leading to LPR.
What should I drink (or not drink) at a BBQ?
Alcohol can and does exacerbate reflux disease. Alcohol itself can directly injure tissue causing further irritation. Soda should also be avoided. Soda, even seltzer water, are all acidic ranging from mild to severe (colas are amongst the most acidic drinks we have). Drinking acid in the form of soda can cause direct irritation of the throat structures, voice box, and esophagus and can directly activate pepsin increasing its activity. The carbonation in soda (and beer) can promote reflux of stomach contents into the esophagus as well as expansion of the stomach that leads to reflexive increase in acid secretion.
Drinking water, and lots of it, is the best beverage. For those with reflux disease, drinking alkaline water with an acid level, or pH > 8.0, can naturally neutralize acid and stop the activity of pepsin.
What condiments are good (or not good) for acid reflux?
The least processed the food, the better it is for reflux. Most condiments have lots of oils, vinegar, and sugars that can directly irritate the throat and esophagus as well as promote/trigger reflux symptoms. Using whole vegetable slices, plant based spreads such as hummus, plant-based mayonnaise, mild salsa and avocado are some less irritating alternatives.
Is spicy food OK?
Spicy food consumption can influence some symptoms in people with reflux. There are chemicals in spicy food that directly stimulate nerves within the mouth (the burning sensation), throat, and esophagus that can trigger reflux symptoms. Not everyone with reflux need avoid all spices. Trial and error is often the best approach for those with mild reflux symptoms.
Does BBQ timing matter? Should I stop eating by a certain time?
See above. It is always best to stop eating at least three hours prior to lying down, especially at night before bed time. Stomachs typically empty all of their contents within three hours and thus have much less material to reflux.
How about portion size?
There is no question that overeating can and will lead to worse reflux. Stomach distension, bloating, and regurgitation are all possible with overeating.
What else would you like to add?
BBQs are fun events to celebrate great weather with friends and family. Increasing the amount of grilled vegetables and fruits in place of meat (all types) can provide a delicious and tasty alternative while still enjoying the outdoors. The market is being flooded with more plant based food alternatives such as burgers – The Impossible Burger for example. Increase the addition of plant based salads and plant based hot dogs and sausages to enjoy your BBQ and prevent reflux. Keeping to a plant based diet can prevent future reflux from occurring even when not at a BBQ.