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Ramadan is the time of fasting as well as celebrations. After we break the day-long fast, most of us desire our favourite comfort foods, but they frequently come with a slew of digestive adverse effects. Heartburn or acid reflux (gastroesophageal reflux disease, GERD) may definitely detract you from the festive mood. A review study published in the journal Gut reports that the Middle East has approximately 33 per cent of GERD prevalence.

The issue is that you know that a minute of pleasure now will result in hours of suffering later, due to your acid reflux, or GERD. But this does not have to be your life’s problem. You may savour most of your favourite delicacies without the discomfort and suffering, if you prepare ahead of time and make a few sacrifices. Here is everything you must know about GERD risk during the festivals and how to minimise your discomfort.

What is GERD?

Gastroesophageal reflux disease (GERD) is a digestive condition in which the stomach acid spills back into the esophagus, affecting the esophageal lining. Acid reflux and heartburn are signs of GERD. Though acid reflux and heartburn are normal, you may be suffering from GERD if these symptoms persist often or chronically.

The role of overeating

Dr Vito Annese

When we eat in moderation, our bodies operate optimally. With iftars and suhours planned all around the town, overeating is almost unavoidable. “Overeating causes two issues,” says Dr Vito Annese, Consultant Gastroenterology, Fakeeh University Hospital.

“First, having too much food in your stomach raises your chances of belching and acid reflux. Overeating can worsen the symptoms of heartburn and abdominal discomfort in those who already have GERD.”

Second, overeating causes an increase in calories. Excess calories are converted to fat and stored in the body, leading to weight gain and obesity. Excess carbohydrates will also strain the pancreas, an organ that generates insulin to regulate the body's glucose levels. Long-term overeating can result in diabetes, obesity and metabolic disorders such as elevated cholesterol levels.

How can overeating during Ramadan cause or trigger acid reflux?

Dr Mustafa Hakam

“Our stomach has the ability to expand and accept a limited quantity of food and drink,” explains Dr Mustafa Hakam, Consultant Interventional Gastroenterology and Hepatology. “ Eating past fullness (satiety) raises the risk of acid reflux. When a person consumes a meal, the acid generated in the stomach tends to build up on top of the food. The acid pocket is located towards the top of the stomach when a person stands upright. Overeating increases the likelihood of belching, which exposes the lower esophagus (food pipe from the throat to the stomach) to the caustic effects of gastric acid.

“Gastric acid has the potential to induce chemical damage to the upper abdomen or the central lower chest. This burning feeling might be confused with chest discomfort of a heart attack. Acid and food reflux happens not just with large meals or eating too fast, but also when one lies down too soon after eating. In a lot of people, lying down within three hours of eating raises the risk of acid reflux.”

Foods that can trigger acid reflux or heartburn

Several foods can induce or aggravate acid reflux and heartburn, and these may change or be specific for everyone. You should pay special attention to how you feel after consuming specific meals. Foods rich in fat, salt or spice are generally the worst triggers, such as:

● Spicy meals high in citrus, tomato sauces, and vinegar

● Fatty meats such as sausage and bacon and that can persist and raise stomach pressure, allowing acid to enter the esophagus

● Caffeine, chocolate, peppermint, fizzy beverages

● Processed snacks, cheese

● Alcohol, especially red wine

● Fast food

● Fried food

● Black pepper, garlic, raw onions

Foods that help avoid acid reflux or GERD

There are several foods that can help avoid acid reflux. Reshma Devjani, Clinical Dieititian at Fakeeh University Hospital, suggests stocking your pantry with items from the following three categories, along with your iftar/suhour menu items and snacks.

1. Alkaline foods

Foods with a low pH value are acidic and more prone to causing reflux. Those with a higher pH are alkaline and can assist to balance out strong stomach acid. Alkaline high foods include salads, nuts, cauliflower, fennel, melons, bananas, and more.

2. Watery foods

Eating meals high in water might dilute and decrease gastric acid. Include foods like cucumber, celery, watermelons, lettuce, etc.

3. High fibre foods

Fibrous meals help you feel full, which reduces your chances of overeating, which may lead to heartburn. So, fill up on fibre-rich meals like whole grains (oatmeal, whole wheat, quinoa, and brown rice), root vegetables (sweet potato, carrot, turnip, and beetroot), and green vegetables (broccoli, asparagus, cauliflower, leafy greens, cucumbers, and green beans).

Tips to avoid GERD this Ramadan

Here are some ways to lower the chances of developing GERD or reducing its symptoms.

● Control your portion size

Heartburn symptoms are associated not just with what you eat, but also with how much you consume. Excessive eating might cause heartburn. Limiting meal sizes can significantly lower the likelihood of developing heartburn, even for later in life. Break up your meals over time by eating smaller portions so that you do not end up being too full at one go.

● Avoid sleeping immediately after your meal

Heartburn is also caused by eating a large meal just before going to bed. You may avoid this by scheduling two or three hours between your last meal and your bedtime. This will allow your stomach to effectively digest meals.

If you get reflux before going to bed or while sleeping, consider raising your head at night. By adding a couple of additional pillows or a wedge pillow to your bed, you can limit the amount of acid that can move back up your esophagus and avoid reflux.

● Choose the right foods

To avoid heartburn, make wise meal choices. Avoid acidic, high-fat, and spicy foods, as well as any food that may cause heartburn symptoms. Root vegetables, such as potatoes and carrots, are excellent for combating GERD and acid reflux symptoms.

● Minimise your caffeine intake

Caffeine and energy boosting beverages increase acid production and are known to induce heartburn. Instead, try decaffeinated or herbal teas.

● Try to be active

Exercise should be on your Ramadan to-do list since it will get your digestive system working. Get out and walk whenever you can, especially after a large meal. When possible, use the stairs.

Treatment options for GERD

Treatment for GERD should only be started after a thorough diagnosis and consultation with a gastroenterologist.

Surgeries for severe GERD

• Fundoplication

• Transoral incisionless fundoplication (TIF)

• Stretta Procedure

• LINX Surgery

• Bariatric Surgery

Treatment for mild to moderate GERD

• Lifestyle changes

• Over-the-counter medications

• Prescription medicine

Ramadan’s essence is in healing, offering, sharing, enjoyment and happiness. We must recognise that overindulging in food is not the core of Ramadan or Eid celebrations. However, if acidity occurs after a festival excess, home remedies, lifestyle changes, and medicines may help. Consult your doctor if you still have acid reflux/heartburn nearly every other day. They may recommend medicine or other treatments as necessary.

For more information on GERD or gut health, click here