For people who have gastroesophageal reflux disease (GERD), more commonly 1 known as heartburn, doctors have usually advised giving up alcohol, coffee, tea and smoking. However, a recent study confirms only the correlation between smoking and an increased risk of GERD.

The Study

The study surveyed more than 3,000 people who had severe heartburn and compared them with more than 40,000 people who did not have heartburn in the Norwegian county of Nord-Trondelag.

The researchers compared the lifestyles, including dietary intake, smoking history and exercise habits of people who had no symptoms with those who had severe symptoms.


Smoking was found to be a major risk factor for severe heartburn. There was a 70% greater chance that smokers would have acid reflux than nonsmokers. "Our large, population-based study provides firm evidence in support of our hypothesis that tobacco smoking causes symptomatic (GERD)," says Dr. Roshini Rajapaksa, a gastroenterologist at New York University Medical Center.

Further, the researchers found that people who often used table salt were 70% more likely to have heartburn than people who did not use it.

Rajapaksa says the findings on salt were especially surprising because salt has not been implicated in GERD before. However, she says it is possible that people who are adding a lot of salt to their food may also be eating greasier, less healthy foods, which may increase their risk of heartburn.

Although coffee, tea and alcohol are thought to be major triggers for acid reflux, and most people are advised to avoid these beverages, this study did not find an association between them and acid reflux. "If these findings are confirmed in additional studies, the results are very different from what we've been telling patients," says Rajapaksa.

Lifestyle Changes

The study did find that some lifestyle factors could have a protective effect. Eating high-fiber bread instead of white bread and exercising for 30 minutes at least once a week decreased the chance of getting heartburn.

To avoid heartburn, Rajapaksa recommends eating smaller meals, not eating close to bedtime and avoiding foods that you know give you heartburn. If those measures don't work, however, you may need medication to control your symptoms, she says.

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