Thanksgiving marks the beginning of the shopping and travel season for many Americans. And if we’re being completely honest, it’s the unofficial start to holiday eating, too. But pace yourself during the Thanksgiving feast. Overindulgence can cause a real pain in the gut, literally – and here’s why.

An estimated 20 percent of the population has gastroesophageal reflux disease or GERD, a disorder that’s diagnosed when heartburn or reflux cause symptoms on a regular basis. Overeating can trigger the common condition, which is likely why the week of Thanksgiving is observed as national GERD Awareness Week.

Dr. Michael Michel, a general surgeon specializing in bariatric and reflux surgery at HCA’s Summerville Medical Center in South Carolina, said everyone at some point in their life is going to experience reflux or heartburn; that doesn’t necessarily mean it’s GERD.

“GERD, heartburn, reflux, acid reflux – most people will interchange those terms,” Dr. Michel said. “The bottom line is that GERD is a disease that manifests when reflux becomes troublesome – the symptoms happen more frequently or when medication is required – is when we make the determination that someone has GERD.”

So, don’t let digestive dysfunction wreak havoc on your holiday. Here’s what you need to know to prevent the burn and, more importantly, enjoy the annual tradition of food, football and fun.

What are the symptoms?

The most common symptom of GERD is heartburn: a burning sensation that people feel underneath their breastbone.  Also, many people experience regurgitation – fluid (that has an acid or sour taste) or food that travels back into the esophagus and into the back of the throat or the mouth. Many people also notice bloating and increased belching and gas.

Dr. Michel explained that the trachea and the esophagus live next to each other as two separate tubes with a common channel at the top –linx-gerd-2_image
the mouth. If acid travels high enough into the esophagus, it can spill over into the trachea and cause asthma, cough and choking. “People will often complain they wake up in the middle of the night choking for no reason,” he said, “And that is likely reflux coming up and causing that discomfort.”

It can also cause hoarseness, laryngitis, ear infections, and dental erosions.

What kinds of food should we stay away from during Thanksgiving to prevent heartburn, acid reflux or GERD-like symptoms?

Tomato-based, spicy, and fatty foods can trigger those symptoms, as well as acidic items like orange juice or any citrusy drinks. Caffeine, chocolate, alcohol and smoking can also increase the acidity in one’s stomach.

Tips to avoid heartburn during the holiday?

“It’s not so much a matter of avoiding it,” Dr. Michel said. “For people who have bad reflux, they may not be able to escape it, but they can minimize the symptoms.”

Here’s how:

    • Avoid the types of foods we discussed previously or take them in small portions.
    • Eat slower and eat a whole lot less than normal, particularly around Thanksgiving. That’s the time when we kind of binge, so to speak, and you want to try to avoid doing that.
    • Avoid lying down three to four hours after eating. A lot of us like to eat and then go to bed or lay back in the recliner while watching a football game, and that’s probably something that will make your heartburn worse.
    • Elevate the head of your bed to try and prevent acid reflux. Rather than lying flat, you can put blocks under the head of your bed and literally raise it a number of degrees. Gravity helps to keep acid down in the stomach where it belongs, as opposed to helping it travel up into the esophagus.
    • Weight loss sometimes helps to decrease symptoms.

What can we do to treat reflux or GERD?

Medications can help treat the amount of acid in the stomach, but none actually treat the underlying cause of reflux, which is the lower esophageal sphincter (LES). LES is a one-way valve separating the esophagus and the stomach, and the real problem with reflux is the one way valve isn’t working. We’ve seen positive patient outcomes in new procedures like LINX, which makes the sphincter stronger with a bracelet of magnet beads, also known as, a magnetic sphincter augmentation device, and the TIF procedure (Transoral Incisionless Fundoplication), a minimally invasive option where a new one-way valve is created from inside the stomach.

“We are the only hospital in the state of South Carolina that performs all of the necessary diagnostic tests as well as all proven therapeutic options, Dr. Michel said. We also perform six different procedures for reflux to include both of these newer procedures.

What are the negative consequences of having reflux for a long period of time without treatment?

It can cause irritation of the esophagus known as esophagitis, which can result in ulcers and/or  scarring of the esophagus. After a few years, people begin to realize certain foods don’t go down quite as easily and it’s because the esophagus is narrowing. You can also develop Barrett’s esophagus, a precursor to esophageal cancer. Esophageal cancer statistically has been increasing faster than any other cancer in this country the past five to 10 years, Dr. Michel said.

Myth-busters: Do these natural remedies really work in managing acid reflux?

Chewing gum: Yes and no. For some people that will work, and for some it won’t. Chewing gum produces saliva in the mouth and, as you swallow, you’re providing a defense mechanism by pushing the acid back down. The down side for some people is when you swallow, you also swallow air. That air then builds in the stomach and can predispose you to acid reflux.

Eating apples: There’s no scientific study to support this claim. But some people think if you eat an apple each day it will help with acid reflux. The idea is that the fermentation of the apple in your stomach will help to promote the emptying of the stomach. So, if you’re stomach empties quicker, you’re less likely to have acid reflux. You know what they say? “An apple a day keeps the doctor away” – at least, in theory.

Sleeping on the left side: This is actually true for some people. If they lay on their left side, they notice that they may have less reflux. If you look at the anatomy of the stomach and think of it as a container, and turn it on the left, it’s going to stay in the dependent portion of the stomach. If they turn to the right, it’s an easy access to the esophagus.

“Many home remedies or old wives’ tales about heartburn or acid reflux have not been proven in medical studies,” Dr. Michel said. “That doesn’t mean they don’t work. There are certainly different things out there that are definitely worth trying.”

Take these extra steps to keep the indigestion in check this Thanksgiving, and throughout the holiday season. It comes down to moderation for most people, Dr. Michel said. And if you practice moderation, you’re probably going to be fine.