For the 20% of people with gastroesophageal reflux disease, the Thanksgiving meal is literally hard to digest. Here are menu items to be thankful for.

Research shows that Americans consume more than 3,000 calories at the Thanksgiving table. As many as one in five of those people may feel those calories twice. 

That’s how much of the U.S. population suffers from gastroesophageal reflux disease, or GERD. This is when the stomach persistently pushes its contents back up into the esophagus, the tube that connects the throat to the stomach. Many people confuse GERD with acid reflux, because they both trigger heartburn, but these events are not the same.

How GLP-1 drugs can aggravate GERD.

In recognition of Annual GERD Awareness Week this November 22 to 28 (coinciding with Thanksgiving), the following explains the differences between GERD and occasional acid reflux, and provides tips for avoiding flareups during the holiday festivities.

How to Tell GERD from Acid Reflux

Acid reflux describes an episode when the muscle (sphincter) between the stomach and esophagus opens when it shouldn’t, enabling the foods and acids in the stomach to flush up and regurgitate. 

Most everyone has experienced reflux occasionally, perhaps after a larger-than-usual meal, eating spicy foods, or lying down immediately after eating. The telltale sign is heartburn – a burning sensation in the chest. This does not necessarily mean you have GERD. 

What distinguishes GERD from run-of-the-mill heartburn is the reflux has become chronic – bringing on symptoms two or more times a week, and potentially bringing serious complications, such as damaging the esophageal tissue. GERD is an ongoing disease, caused by an irregularity that weakens or unnecessarily relaxes the stomach sphincter. 

Some medical researchers believe a hiatal hernia, when part of the upper stomach bulges though a hole into the chest, could cause the sphincter to degrade this way. Also, certain foods, excess weight, and smoking can weaken the stomach sphincter.

Symptoms of GERD, and When It Requires Medical Attention

GERD is not something you should just tolerate, because the fluids forced up from the stomach are toxic to the lining of esophagus. So before reaching for that second holiday cocktail or slice of fried turkey, gauge how severe your GERD might be. Symptoms include:

• Burning and discomfort in your chest, neck, and/or throat
• Persistent burping
• A sour or bitter taste in your mouth 
• Chronic sore throat and/or cough; wheezing and hoarseness
• Trouble swallowing and feeling like food is stuck in your throat
• Nausea and vomiting

Long-term GERD can bring on more severe symptoms, including damaged tooth enamel and gums. Also, due to toxin exposure, the esophagus can become inflamed, develop ulcers, and narrow so swallowing becomes difficult (dysphagia). 

Severe GERD also can develop into a pre-cancerous abnormality called Barrett’s esophagus.

How to Prepare a Thanksgiving Meal for GERD 

To reduce the chances of anyone at your table experiencing the above symptoms this Thanksgiving, plan a meal that will make you grateful for a comfortable, symptom-free evening. Following are five doctor-approved steps for what you should eat, avoid, and practice during Thanksgiving Day festivities. 

Step 1: Know your trigger foods. If you’ve kept a journal of what you eat and drink and how your body reacts, you likely know which foods can bring on GERD symptoms. Generally, these include:

• Fried, processed, and fast foods, which are high in fats, salts, and spices
• High-fat dairy
• Acidic foods (tomatoes and citrus)
• Garlic and onions
• Chocolate
• Alcohol
• Carbonated and caffeinated beverages. 

If you want to enjoy small portions of these foods, do so slowly and earlier in the day so they have time to clear your stomach before you sleep.

Step 2: Find desirable GERD food replacements. Foods that can actually help prevent acid reflux include: 

• Those high in fiber. Think root vegetables, brown rice, and green vegetables including broccoli and green beans. 
• High-alkaline foods that tend to lower acids, including cauliflower, nuts, melons, and bananas.
• High-water foods. For example, lettuce, cucumber, and celery. 

Try out recipes using these ingredients but note that preparation is important. GERD-friendly methods include steaming, baking, broiling, grilling, poaching, and even air frying. Do not fry or sauté in butter or heavy sauces. Some suggestions:

• Green salad with celery, cucumber, nuts, and fennel (an alkaline food) with an apple cider and olive oil vinaigrette.
• Roasted carrots, turnips, and other favorite root vegetables. Instead of seasoning with garlic or onions, try oregano or turmeric. 
• Baked sweet potatoes rather than fatty mashed potatoes (or make mashed potatoes in low-fat or nut-based milks). 
• Brown rice turkey dressing cooked in broth.
• White turkey meat, which is leaner than dark meat.
• One cocktail if you want, or a non-alcoholic drink low in sugar, but sip either slowly.

Step 3: Be able to see your plate. Eat smaller portions to prevent overfilling your stomach, which could keep the sphincter from tightly closing. If possible, use a smaller plate to help limit portions. Should this not be an option, fill just 50% to 75% of your large plate.

Stop 4: Eat slowly. It takes five to eight seconds for a medium-sized mouthful of food to reach the stomach. Take smaller bites, put your fork down, and chew thoughtfully between each bite, so your food can reach your stomach before the next one. This will help you monitor GERD reactions. 

Stop 5: Take a few minutes before taking seconds. The rule of thumb with GERD is to eat until you are 75% full (comfortable and no longer hungry). By stopping before you are full, you can save room for a small slice of pie but skip the whipped cream.

Special Considerations: Before the Meal

When choosing your Thanksgiving outfit, opt for something loose fitting. Avoid belts or tight waists that can restrict your belly and lower esophagus and slow digestion. Slowly sip water, ginger tea, or other healthy beverages about 30 minutes before the meal. 

Special Considerations: After the Meal

Stay upright for at least two hours after your Thanksgiving meal. This will give your stomach time to empty. Take a comfortable walk (nothing strenuous) or simply sit with your back straight. 

When it is time to sleep, start by lying on your left side; it reduces reflux risk. If possible, elevate your body from the waist up by placing blocks beneath your headboard legs, or a wedge under the mattress (simply raising your head with a pillow will not work). 

Learn more about how to prepare for a GERD-free Thanksgiving, before, during, and after a meal.

When to Put Down Your Fork and Seek GERD Treatment

Thankfully, preventing GERD is achievable. Typically, the first line of treatment for GERD involves lifestyle modifications including regular physical activity, deep-breathing exercises (diaphragmatic breathing), and managing your weight. Your doctor might prescribe medications to reduce or block acid production. 

If these practices do not ease your symptoms, it is likely time to see a doctor to determine the severity of your GERD. Medical interventions include surgeries to tighten the lower sphincter, either with existing tissue or a ring of magnetic beads (LINX device).

Remember: You have control of what and how you eat, so you have control of GERD. You might not count your calories on Thanksgiving Day, but you can count on yourself. 

Visit our GERD website to learn more about causes and treatments and to watch a short, instructional video. To request a consultation, fill out an online form here.