By Dr. Mercola
Do you eat dinner late at night and go to bed less than three hours later? Do you also suffer from unexplained post-nasal drip, cough, and difficulty swallowing? These could be signs of acid reflux, which, unbeknownst to many, can occur without the telltale signs of heartburn and indigestion.
Further, if you want to nip it in the bud, all you may have to do is change your lifestyle to eat dinner earlier. Eating late at night, especially if you overeat and/or eat heavy foods, and then lying down shortly after, is a recipe for acid reflux.
Increasingly Later Dinners May Be Driving Acid Reflux Cases
In the last 35 years, New York physician Jamie Koufman, who specializes in acid reflux, told the New York Times that long work hours necessitate a late dinner for many.1 Then, many people push it back further by trying to fit in shopping, exercise and other activities beforehand.
Adding to the problem, dinner tends to be the largest meal of the day for most Americans, and it's often made up of heavy processed foods in overly large portions.
Under the best circumstances (in a young, healthy person), your stomach takes a few hours to empty after you eat a meal. As you get older or if you have acid reflux, the process takes longer.
Then, when you lay down to go to sleep, it's much easier for acid to spill out of your full stomach, which is what leads to acid reflux. Even if you don't have heartburn, you could still have acid reflux if you have symptoms like hoarseness, chronic throat clearing, and even asthma.
Plus, acid reflux can lead to esophageal cancer, which has risen five-fold since the 1970s. According to Dr. Koufman, "the single most important intervention is to eliminate late eating." He continued:2
"Typical was the restaurateur who came to see me with symptoms of postnasal drip, sinus disease, hoarseness, heartburn and a chronic cough. He reported that he always left his restaurant at 11 p.m., and after arriving home would eat dinner and then go to bed. There was no medical treatment for this patient, no pills or even surgery to fix his condition.
The drugs we are using to treat reflux don't always work, and even when they do, they can have dangerous side effects. My patient's reflux was a lifestyle problem. I told him he had to eat dinner before 7 p.m., and not eat at all after work. Within six weeks, his reflux was gone."
Why You Don't Want to Treat Acid Reflux with Acid-Blocking Drugs
One of the most commonly prescribed drugs for acid reflux are proton pump inhibitors (PPIs), which are very effective at blocking acid production in your stomach. While that may sound like an appropriate remedy, considering the fact that stomach acid is creeping up your esophagus, in most cases, it's actually the worst approach possible.
There are over 16,000 articles in the medical literature showing that suppressing stomach acid does not address the problem. It only temporarily treats the symptoms. PPIs like Nexium, Prilosec, and Prevacid were originally designed to treat a very limited range of severe problems.
According to Mitchell Katz, director of the San Francisco Department of Public Health, who wrote an editorial on this topic four years ago, PPIs are only warranted for the treatment of:3
- Bleeding ulcers
- Zollinger-Ellison syndrome (a rare condition that causes your stomach to produce excess acid)
- Severe acid reflux, where an endoscopy has confirmed that your esophagus is damaged
According to Katz, "about 60 to 70 percent of people taking these drugs have mild heartburn and shouldn't be on them." Part of the problem with PPIs is that when you suppress the amount of acid in your stomach, you decrease your body's ability to kill the Helicobacter bacteria. So if your heartburn is caused by an H. pylori infection, it actually makes your condition worse and perpetuates the problem.
Besides that, reducing acid in your stomach diminishes your primary defense mechanism for food-borne infections, which will increase your risk of food poisoning. PPI drugs can also cause potentially serious side effects, including pneumonia, bone loss, hip fractures, and infection with Clostridium difficile (a harmful intestinal bacteria).
It's also worth noting that you'll also develop both tolerance and dependence on PPI drugs, so you should not stop taking proton pump inhibitors cold turkey. You need to wean yourself off them gradually or else you might experience a severe rebound of your symptoms. In some cases, the problem may end up being worse than before you started taking the medication.
Another Reason to Avoid Late-Night Eating: Intermittent Fasting
Our ancestors did not have access to grocery stores or food around the clock. They would cycle through periods of feast and famine, and modern research shows this cycling produces a number of biochemical benefits. Today, simply by altering what and when you eat, you can rather dramatically alter how your body operates for the better.
One of the simplest ways to do this is via intermittent fasting. There are many methods for doing this, but the one I recommend and personally use is to simply restrict your daily eating to a specific window of time, such as an eight-hour window from 11 a.m. to 7 p.m.
This gives you a 16-hour fasting "window" without much sacrifice on your part. It also ties in nicely with eating dinner at a reasonable hour (any time prior to 7 p.m.), while giving you several hours for your food to digest before you lay down for the night.
What Are the Benefits of Intermittent Fasting?
In this case, the earlier dinner will not only benefit any acid reflux that's present, but, when combined with a delayed breakfast at 11 a.m., will give your body the benefits of remaining in a carefully timed "famine mode." Benefits include the following:
- Normalizing your insulin and leptin sensitivity, and boosting mitochondrial energy efficiency: One of the primary mechanisms that makes intermittent fasting so beneficial for health is related to its impact on your insulin sensitivity.
While sugar is a source of energy for your body, it also promotes insulin resistance when consumed in the amounts found in our modern processed junk food diets. Insulin resistance, in turn, is a primary driver of chronic disease—from heart disease to cancer.
Intermittent fasting helps reset your body to use fat as its primary fuel, and mounting evidence confirms that when your body becomes adapted to burning FAT instead of sugar as its primary fuel, you dramatically reduce your risk of chronic disease.
- Normalizing ghrelin levels, also known as "the hunger hormone."
- Promoting human growth hormone (HGH) production: Research has shown fasting can raise HGH by as much as 1,300 percent in women, and 2,000 percent in men,4 which plays an important part in health, fitness, and slowing the aging process. HGH is also a fat-burning hormone, which helps explain why fasting is so effective for weight loss.
- Lowering triglyceride levels and improving other biomarkers of disease.
- Reducing oxidative stress: Fasting decreases the accumulation of oxidative radicals in the cell, and thereby prevents oxidative damage to cellular proteins, lipids, and nucleic acids associated with aging and disease.
Intermittent fasting is the most powerful tool I know to address insulin resistance. However, once the resistance is resolved and you are no longer overweight, have high blood pressure, diabetes, or are taking a statin drug you don't need to do it and would only benefit from doing it occasionally.
Eating Too Late at Night Throws Your Internal Clock Off Kilter
If you're in need of more motivation to move your dinnertime up a few hours, emerging research suggests that the timing of your meals, for instance eating very late at night when you'd normally be sleeping, may throw off your body's internal clock and lead to weight gain. For instance, artificial light, such as a glow from your TV or computer, can serve as a stimulus for keeping you awake and, possibly, eating, when you should really be asleep.
In one study, mice that were exposed to dim light during the night gained 50 percent more weight over an eight-week period than mice kept in complete darkness at night.5 They also had increased levels of glucose intolerance, a marker for pre-diabetes. The weight gain occurred even though the mice were fed the same amount of food and had similar activity levels, and the researchers believe the findings may hold true for humans as well.
When mice were exposed to nighttime light, they ended up eating more of their food when they would normally be sleeping, and this led to significant weight gain. However, in a second experiment when researchers restricted meals to times of day when the mice would normally eat, they did not gain weight, even when exposed to light at night. So when your light and dark signals become disrupted it not only changes the times you may normally eat, it also throws your metabolism off kilter, likely leading to weight gain.
The Case for Making Dinner Your Biggest Meal of the Day
You've probably heard the advice to make your mid-day meal the biggest of the day and have a lighter meal at dinner, which takes some stress off your body and allows you time to wind down for bedtime (rather than digesting a heavy meal). But this is debatable… and possibly all wrong. Some experts believe that eating your main meal at night may actually be more in-tune with your innate biological clock. Routinely eating at the wrong time may not only disrupt your biological clock and interfere with your sleep, but it may also devastate vital body functions and contribute to disease. According to Ori Hofmekler, author of The Warrior Diet:
"Your body is programmed for nocturnal feeding. All your activities, including your feeding, are controlled by your autonomic nervous system, which operates around the circadian clock. During the day, your sympathetic nervous system (SNS) puts your body in an energy spending active mode, whereas during the night your parasympathetic nervous system (PSNS) puts your body in an energy replenishing relaxed and sleepy mode.
These two parts of your autonomic nervous system complement each other like yin and yang. Your SNS, which is stimulated by fasting and exercise, keeps you alert and active with an increased capacity to resist stress and hunger throughout the day. And your PSNS, which is stimulated by your nightly feeding, makes you relaxed and sleepy, with a better capacity to digest and replenish nutrients throughout the night. This is how your autonomic nervous system operates under normal conditions.
But that system is highly vulnerable to disruption. If you eat at the wrong time such as when having a large meal during the day, you will mess with your autonomic nervous system; you'll inhibit your SNS and instead turn on the PSNS, which will make you sleepy and fatigued rather than alert and active during the working hours of the day. And instead of spending energy and burning fat, you'll store energy and gain fat. This is indeed a lose-lose situation."
That being said, even if you do eat your main meal at night, you'll want to avoid eating it too close to bedtime as doing so may increase your risk of acid reflux symptoms. Ideally, try to give yourself a three- to four-hour window between your last meal of the day and bedtime. Personally, I eat my primary and really only major meal in the mid-afternoon. I snack a bit before and after but this seems to work for me as long as I get enough calories and protein.
If You Have Acid Reflux, It's Time to Overhaul Your Diet
A key to healing acid reflux is to restore your natural gastric balance and function. Eating large amounts of processed foods and sugars is a surefire way to exacerbate acid reflux, as it will upset the bacterial balance in your stomach and intestine.
You simply must eliminate all refined sugars to improve your gut flora. Instead, you'll want to eat a lot of vegetables and other high-quality, ideally organic, unprocessed foods. Also, eliminate food triggers from your diet. Common culprits here include caffeine, alcohol, and nicotine products.
Next, you need to make sure you're getting enough beneficial bacteria from your diet. This will help balance your bowel flora, which can help eliminate H. pylori bacteria (a common cause of heartburn) naturally without resorting to antibiotics. It will also aid in proper digestion and assimilation of your food.
Ideally, you'll want to get your probiotics from fermented foods. If you aren't eating fermented foods, you most likely need to supplement with a probiotic on a regular basis. Try to include a variety of cultured foods and beverages in your diet, as each food will inoculate your gut with a variety of different microorganisms. Fermented foods you can easily make at home include:
- Fermented vegetables
- Cultured dairy, such as yogurt, kefir, and sour cream
In addition, acid reflux is typically a sign of having too little stomach acid. To encourage your body to make sufficient amounts of hydrochloric acid (stomach acid), you'll also want to make sure you're consuming enough of the raw material on a regular basis. High-quality sea salt (unprocessed salt), such as Himalayan salt, will not only provide you with the chloride your body needs to make hydrochloric acid, it also contains over 80 trace minerals your body needs to perform optimally, biochemically.
Sauerkraut or cabbage juice is also a strong—if not the strongest—stimulant for your body to produce stomach acid. Having a few teaspoons of cabbage juice before eating, or better yet, fermented cabbage juice from sauerkraut, will do wonders to improve your digestion.
15 More Natural Strategies for Overcoming Acid Reflux
In addition to those mentioned above, there are a number of other strategies that can also help you get your acid reflux under control, without resorting to medications.
Raw, unfiltered apple cider vinegar As mentioned earlier, acid reflux typically results from having too little acid in your stomach. You can easily improve the acid content of your stomach by taking one tablespoon of raw unfiltered apple cider vinegar in a large glass of water. Betaine Another option is to take a betaine hydrochloric supplement, which is available in health food stores without prescription. You'll want to take as many as you need to get the slightest burning sensation and then decrease by one capsule. This will help your body to better digest your food, and will also help kill the H. pylori bacteria. Baking soda One-half to one full teaspoon of baking soda (sodium bicarbonate) in an eight-ounce glass of water may ease the burn of acid reflux as it helps neutralize stomach acid. I would not recommend this is a regular solution but it can sure help in an emergency when you are in excruciating pain. Aloe juice The juice of the aloe plant naturally helps reduce inflammation, which may ease symptoms of acid reflux. Drink about 1/2 cup of aloe vera juice before meals. If you want to avoid its laxative effect, look for a brand that has removed the laxative component. Ginger root or chamomile tea Ginger has been found to have a gastroprotective effect by blocking acid and suppressing Helicobacter pylori.6 According to a 2007 study, it's also far superior to lansoprazole for preventing the formation of ulcers, exhibiting six- to eight-fold greater potency over the drug!7 This is perhaps not all that surprising, considering the fact that ginger root has been traditionally used against gastric disturbances since ancient times.
Add two or three slices of fresh ginger root to two cups of hot water. Let steep for about half an hour. Drink about 20 minutes or so before your meal. Before bed, try a cup of chamomile tea, which can help soothe stomach inflammation and help you sleep.
Vitamin D Vitamin D is important for addressing any infectious component. Once your vitamin D levels are optimized, you're also going to optimize your production of about 200 antimicrobial peptides that will help your body eradicate any infection that shouldn't be there.
As I've discussed in many previous articles, you can increase your vitamin D levels through appropriate amounts of sun exposure, or through the use of a high-quality tanning bed. If neither of those is available, you can take an oral vitamin D3 supplement; just remember to also increase your vitamin K2 and magnesium intake as well.
Astaxanthin This exceptionally potent antioxidant was found to reduce symptoms of acid reflux in patients when compared to a placebo, particularly in those with pronounced Helicobacter pylori infection.8 Best results were obtained at a daily dose of 40 mg. Slippery elm Slippery elm coats and soothes your mouth, throat, stomach, and intestines, and contains antioxidants that can help address inflammatory bowel conditions. It also stimulates nerve endings in your gastrointestinal tract. This helps increase mucus secretion, which protects your gastrointestinal tract against ulcers and excess acidity. The University of Maryland Medical Center makes the following adult dosing recommendations:9
- Tea: Pour 2 cups boiling water over 4 g (roughly 2 tablespoons) of powdered bark, then steep for 3 - 5 minutes. Drink 3 times per day.
- Tincture: 5 mL 3 times per day.
- Capsules: 400 - 500 mg 3 - 4 times daily for 4 - 8 weeks. Take with a full glass of water.
- Lozenges: follow dosing instructions on label.
Chinese herbs for the treatment of "Gu" symptoms caused by chronic inflammatory diseases So-called "Gu" symptoms include digestive issues associated with inflammation and pathogenic infestation. For more information about classical herbs used in Chinese medicine for the treatment of such symptoms, please see an alternative medicine professional. Glutamine Gastrointestinal damage caused by H. pylori can be addressed with the amino acid glutamine,10 found in many foods, including grass-fed beef, free-range chicken, wild-caught fish, organic eggs, raw dairy products, and some fruits and vegetables. L-glutamine, the biologically active isomer of glutamine, is also widely available as a supplement. Folate or folic acid (vitamin B9) and other B vitamins Research suggests B vitamins can reduce your risk for acid reflux.11 Higher folic acid intake was found to reduce acid reflux by approximately 40 percent. Low vitamin B2 and B6 levels were also linked to an increased risk for acid reflux. The best way to raise your folate levels is by eating folate-rich whole foods, such as organic liver, asparagus, spinach, okra, and beans.