Shedding a few extra pounds can improve acid reflux symptoms

Weight Loss and Heartburn
Shedding a few extra pounds can
improve acid reflux symptoms
By Linda Carroll
Special to MSN

Go to the doctor to get relief for your heartburn and the first thing she's
likely to say, if you're overweight, is that you need to shed a few pounds.
That's because studies have suggested a strong link between obesity and a
tendency to develop gastroesophageal reflux.

Heartburn symptoms do seem to improve when people cut calories. But no one
really knows why extra pounds can lead to heartburn or why weight loss can
improve symptoms.

Some doctors argue that symptoms of gastroesophageal reflux disease, or
GERD, are the result of a big bulging tummy, that gravity pushes —
especially at night — against the stomach. That extra weight increases the
pressure put on the lower esophageal sphincter, the valve connecting the
esophagus to the stomach. This leads to stomach acid traveling back up into
the esophagus, causing a burning sensation in the upper chest.

There is evidence that people who significantly slim down experience big
improvements in heartburn symptoms. For example, a report published in
February in the journal Obesity Surgery followed 295 patients who were
given gastric banding operations. Four years after the surgery, 79 percent
of patients who initially had heartburn problems said their symptoms
cleared up. Another 11 percent of patients said their heartburn had
improved significantly.

Diet, pregnancy and reflux

Still, there's no consensus among experts as to why weight loss might
improve GERD. It's not clear whether heartburn is extinguished because
pounds have melted away or because people have changed their diets and
eating habits.

The most likely explanation for symptom improvement is the change in eating
habits that accompanies most diets, says Dr. Bennett Roth, a professor of
medicine and chief of clinical gastroenterology at the David Geffen School
of Medicine at UCLA.

"When you lose weight, you eat less," Roth explains. "And when you're
eating less, there's a tendency to not go to bed with a full, overextended
stomach."

Beyond this, dieters often cut back on items that tend to spark heartburn,
such as fatty foods and chocolate, Roth says.

The real answer may be a bit of both, says Dr. Felice Schnoll-Sussman, an
assistant attending physician at the NewYork-Presbyterian Hospital/Weill
Cornell Medical Center and an assistant professor of medicine at Weill
Medical College of Cornell University.

To explain how the extra pounds can lead to GERD, Schnoll-Sussman points to
the problems pregnant women experience.

"It's very common for pregnant women to have reflux even if they've never
had heartburn before," Schnoll-Sussman says. "The reason is that their
expanding uterus presses up on the stomach, which now has a lot less
capacitance. The extra pressure thrusts the contents of the stomach up
against the esophagus."

And, generally, when pregnant women give birth and slim down again, their
heartburn clears up.

You can extrapolate from that example to obesity, Schnoll-Sussman says.

"Here you also have an expanding abdomen," she explains. "And that may put
pressure on the stomach, especially when you're lying down. Now you've got
gravity working against you pushing the belly against your stomach."

A weighty issue

Dr. David C. Metz, a professor of medicine in the division of
gastroenterology at the University of Pennsylvania Health System in
Philadelphia, compares the pressure put on the stomach by extra fat to the
effects of wearing tight clothing and eating a big meal. "That's why we
tell people to loosen their belts after a meal," he says.

Metz suspects that obesity also increases the risk that a person will
develop a hiatal hernia, which, in turn, would make a person more prone to
developing heartburn. It's possible that when you hit a certain weight, the
extra pressure may permanently stretch out the esophagus, leading to the
hiatal hernia, he says. Once the hernia has developed, weight loss won't
help put out the heartburn, Metz says.

Weight loss doesn't help everyone, Schnoll-Sussman allows. People with
other predisposing factors may still experience symptoms even after they
drop the extra pounds.

"But, I've had patients who've lost a lot of weight and they were
completely cured," Schnoll-Sussman says.

The amount of weight loss it takes to improve heartburn may be an
individual thing, experts say.

"My own father had a threshold weight above which he got reflux and below
which he didn't," Metz says. "He could tell me what he weighed based on
that."

-----BEGIN PGP SIGNED MESSAGE-----
Hash: SHA1

On 25 Apr 2004 17:08:14 -0000, Sammi
wrote:

This is off-topic for SSFA.

Thanks

LV



Lady Veteran
- -----------------------------------
"I rode a tank and held a general's rank
when the blitzkrieg raged and the bodies stank..."
- -Rolling Stones, Sympathy for the Devil
- ------------------------------------------------
People who hide behind anonymous remailers and
ridicule fat people are cowardly idiots with no
motive but malice.
- ---------------------------------------------
"To Do Is To Be" Socrates
"To Be Is To Do" Plato
"Do Be Do Be Do" Sinatra
- -------------------------------


-----BEGIN PGP SIGNATURE-----
Version: PGP 8.0 - not licensed for commercial use: www.pgp.com

iQA/AwUBQIv1K+koPZAZfLgsEQKp9gCg1LEs8rKVeLMA5ulEUwD9Em lPfA8An1Gv
YLU1oY89SNpPs437FFIJ8h5Q
=Qj3+
-----END PGP SIGNATURE-----