We Indians are becoming inactive and fatter by the day. But, instead of all-round obesity, there is a propensity for the fat to settle around our middles. When we walk, the stomach leads from the front instead of the nose. This is not only aesthetically displeasing, it also causes medical problems.

As we swallow food, it travels down the oesophagus to the stomach. The abdominal muscles hold these two organs in place. A valve prevents regurgitation of food from the stomach. Lax abdominal muscles and fat deposited in the abdomen make it easy for the stomach to expand. The junction between the oesophagus and the stomach becomes loose and displaced. Food and acid regurgitate into it, and sometimes even reach the mouth. If this happens during sleep, the acid enters the larynx and lungs. It results in night-time cough and wheezing.

Acid reflux (actually, gastro-oesophageal reflux disease or GERD) is one of the commonest medical problems today. It presents with myriad symptoms such as severe chest pain (resembling a heart attack), a persistent, irritating, often nocturnal cough, a sour taste in the mouth, burping, hiccups, difficulty swallowing or the feeling of a lump in the throat.

The diagnosis is suspected and made on the basis of the symptoms. Endoscopic studies can confirm the diagnosis.

GERD can occur every day, making life difficult, or the symptoms may appear intermittently. It can cause complications if it is not treated. The constant exposure to acidic stomach contents can produce single or multiple oesophageal ulcers. These ulcers can produce strictures in the oesophagus if and when they heal. Early cancerous changes can also occur.

Popping a pill is an easy solution to this problem. Omeprazole, pantoprazole and other proton pump inhibiting medications and even the earlier group of H2 antagonists (ranitidine) are effective. They are often combined with antacids for rapid relief. These medications are available over the counter. Patients soon stop consulting physicians and self-medicate. Some decide to remain on these drugs long-term as they are considered “safe” and do not appear to have side effects. This is a myth.

The acid in the stomach is present for a reason. Not only does it aid digestion and the absorption of essential nutrients, but it also protects the body from ingested bacteria. Medication to reduce acidity in the stomach causes complications like nutrient deficiencies (especially magnesium), joint pain, weak bones, bone fractures and kidney problems. It can prevent efficient action of other medications (heart medicines) and result in overgrowth of dangerous bacteria in the body.

Medication for GERD should be used for the shortest possible time and reused after the longest possible interval. Ideally, they should not be given for more than two weeks every four months.

Lifestyle modifications are safer and more likely to work in the long run.

• Try and come down to ideal body weight
  
• Do not sleep for at least an hour after eating
  
• Do not eat till you are full
  
• Avoid alcohol
  
• Stop smoking or using tobacco in any form
  
• Avoid foods that cause discomfort. Frequent offenders are raw onions, garlic, citrus juices, coffee and chocolate
  
• Eat 4-6 helpings of fruits and vegetables a day
  
• Eat 4-6 small meals instead of 2-3 large ones
  
• Have small mouthfuls and chew food thoroughly
  
• Avoid tight-fitting clothes
  
• Do 40 minutes of aerobic activity (such as walking, running, swimming or jogging ) and 20 minutes of yoga and relaxation. It will reduce stress and contribute to weight loss. Both of these will improve GERD.