by Brenda Richardson, MA, RDN, LD, CD, FAND 1 HOUR CE CBDM Approved The Role of Nutrition in Preventing and Managing GERD

NUTRITION CONNECTION

NUTRITION IS A VITAL COMPONENT IN THE EFFECTIVE TREATMENT AND MANAGEMENT OF GERD.

It seems like each time I am completing a nutritional what GERD is to support “best practice” prevention and assessment for a resident in post-acute care, there is a positive management. This article will provide general diagnosis of GERD included in their overall listing of information about GERD, along with nutritional factors to diagnoses. This can be expected since gastroesophageal consider for improved outcomes. reflux disease or “GERD” is the most common upper gastrointestinal disorder seen in older adults. Each year, GERD DEFINED more than 20 million people in the United States suffer Gastroesophageal reflux disease (GERD) is defined as from symptoms of GERD daily, while more than 100 a “condition that develops when the reflux of stomach million suffer occasional symptoms. Generally speaking, contents into the esophagus causes troublesome 25 to 40 percent of the U.S. population experiences symptoms and/or complications.” The root cause of the symptomatic GERD. disease is a faulty valve between the esophagus and the stomach, called the lower esophageal sphincter, that Nutrition plays an integral role in effective treatment and relaxes more often than it should. The result is that juice management, and providers need to better understand

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from the stomach—made • Burning pain that is intake, electrolyte up of acid, digestive worse when lying down or imbalances, iron deficiency Brenda Richardson, enzymes, and other bending over and possible decreases MA, RDN, LD, CD, unpleasant substances— • Feeling like food is in iron, vitamin B-12, FAND is a lecturer, sneaks back up into the coming back up into the and calcium absorption author, and owner/ esophagus and damages mouth, maybe with a associated with long-term president of Brenda Richardson, LLC. its lining. The cause(s) bitter taste use of medications that or etiology of GERD is reduce acid production. • Sore throat that won’t go multifactorial, and includes These residents should away both physical and lifestyle be considered at potential factors. • Hoarseness (scratchy- nutritional risk, and sounding voice) nutrition therapy to include FACTORS WHICH • Cough that won’t go away nutrition/lifestyle education MAY CONTRIBUTE • Asthma is an important component TO GERD • Increased salivation of the medical care for this • Increased secretion condition. of hormones (gastrin, • Chest pain Nutrition assessment estrogen, progesterone) • Feeling like there is a lump in the throat should include height, • Presence of other medical weight, weight history, and • Pain when swallowing or conditions such as hiatal appropriate hematological dysphagia hernia or scleroderma information such as • Cigarette smoking • Feeling as though food hemoglobin and hematocrit. • Obesity/overweight sticks in the throat when Other factors to consider going down • Pregnancy include: • Nausea • Use of medications • Chewing/swallowing (dopamine, morphine, • Frequent burping abilities theophylline) • Vomiting • Nausea/vomiting • Specific foods such as If GERD is untreated or is • Constipation or diarrhea spearmint, peppermint, not responsive to treatment, • Heartburn or any other and those high in fat then complications symptoms interfering Each person may not feel may include dysphagia, with the ability to have a GERD in the same way, aspiration, respiratory normal eating pattern and it is important to conditions, ulceration, • Ability to feed self, cook, understand the specific perforation or stricture and prepare meals of the esophagus, and/or symptoms the individual is • Food allergies/ Barrett’s esophagus. experiencing. intolerances or food restrictions COMMON GERD NUTRITION AND SYMPTOMS GERD • Ethnic/cultural or religious influences • Heartburn (often after It is important to note eating) that there are nutritional • Use of medications and biochemical issues • Burning pain behind the • Use of alcohol and to consider in medical chest that may move up vitamin/mineral/herbal or nutritional management toward the neck other supplement types of GERD which include inadequate nutritional Continued on page 18

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• Eating pattern acidity by eliminating chocolate, mint, and • Medical, social, and black and red pepper; foods with a high fat lifestyle history coffee (caffeinated and content in accordance decaffeinated); alcohol with the resident desired • Diagnostic tests in accordance with the goals. • Laboratory tests resident desired goals. • Weight loss as Interviews focusing on the • Substituting smaller, more appropriate. consumption of foods that frequent meals. Large • Smoking cessation. may be exacerbating or meals increase gastric • Improved clearing of triggering symptoms can pressure on the lower materials from the be obtained through a food esophageal sphincter esophagus. history or food recall/food (LES), thereby allowing frequency diary. reflux or aspiration to • Remaining upright after occur. eating (not lying down for Nutrition interventions and three hours after eating). therapy may include the • Trial of food restriction • Avoid eating no later following: to assess effect on lower esophageal sphincter than three hours before • Trial of food restriction(s) pressure by eliminating bedtime. to reduce gastric • Drinking fluids between meals to reduce abdominal distention and discomfort. • Increasing fiber in Join our Team! the diet. • Wearing loose-fitting DRINK FLUIDS • Menu/Dietary Service clothing. • Resident Dietary • Raising the head of BETWEEN Recordkeeping the bed when sleeping MEALS • Dining Enhancement (generally 6-9 inches). • Resident Satisfaction to reduce • Exercise or physical • Inventory Control abdominal activity for at least 30 • Cost Savings minutes per day for most distention and • Price & Product Quality days of the week. Monitoring discomfort. • Electronic Invoicing In general, a trial of limiting or eliminating foods is considered to reduce the TO LEARN MORE symptoms of GERD. The and speak to a personal consultant trial should be conducted call (800) 515-4265 ______in accordance with the resident’s preferences and goals. The trial may include the following foods:

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• Guidelines for the diagnosis and management of gastroesophageal reflux disease. Katz PO, Gerson LB, Vela MF, Am J Gastroenterology. 2013 Mar;108(3):308-28; quiz 329. doi: 10.1038/ajg.2012.444. Epub 2013 Feb 19. • The American Gastroenterological Association Gastroesophageal Reflux Disease (GERD) Guidelines, http://www.gastro.org/guidelines • Academy of Nutrition and Dietetics. Nutrition Care Manual. Gastroesophageal Reflux • Peppermint and spearmint Disease GERD, https://www.nutritioncaremanual.org/topic.cfm?ncm_category_ id=1&lv1=5522&lv2=19379&ncm_toc_id=19379&ncm_heading=&.@ Accessed May 23, 2017. • Chocolate • Alcohol REDUCE INTAKE • Caffeinated beverages (regular tea, coffee, colas, energy drinks, other OF CHOCOLATE caffeinated soft drinks) and caffeinated • Decaffeinated coffee and beverages, such as decaffeinated regular tea, herbal teas except for those with tea, coffee, colas, peppermint or spearmint are energy drinks, etc. allowed • Pepper • High-fat foods including: > Reduced-fat (2 percent) milk, whole milk, cream, high- fat cheeses, high-fat yogurt, chocolate milk, cocoa > Fried meats, bacon, sausage, pepperoni, salami, bologna, NUTRITION & FOODSERVICE frankfurters/hot dogs PROFESSIONAL TRAINING PROGRAM > Other fried foods (doughnuts, French toast, French fries, deep- fried vegetables) > Nuts and nut butters • Enroll anytime, online or by mail > Pastries and other high-fat • Work at your own pace desserts • Online RD preceptor from > More than 8 teaspoons of oil, UND available butter, shortening per day • Excellent ANFP exam pass rates > Any fruits or vegetables that cause symptoms (varies in each Need a refresher? individual) Online Dietary Manager Exam Review The American Gastroenterological Course now available for $100! Association published the following recommendations for the management of GERD specific to Enroll today! nutrition. dietarymanagers.UND.edu • Weight loss is recommended for 1.800.CALL.UND GERD patients who are overweight or have had recent weight gain.

Continued on page 20 Approved Training Program

NUTRITION & FOODSERVICE EDGE | July-August 2017 19 Continued from page 19 CDM • Head of bed elevation Note the emphasis is on the stress management and Medical nutrition and avoidance of meals need for providing a diet physical activity. therapy “best practice” is 2-3 hours before bedtime reflecting the individual recommended to assist should be recommended needs of the resident, and CONCLUSION with control of symptoms for patients with not a global elimination. Nutrition plays an integral and to increase the nocturnal GERD. role in effective treatment overall intended purpose In addition to nutrition, and management of GERD. of pharmacotherapy. • Routine global lifestyle interventions In general, treatment for Utilization of nutritional elimination of food are part of therapy for GERD includes lifestyle risk tools, prompt referrals, that can trigger reflux GERD. Counseling is often modification, use of nutritional assessments, and (including chocolate, provided regarding head of medications and possible individualized intervention caffeine, alcohol, acidic, bed elevation, tobacco and surgery. Eighty percent do improve quality of life for and/or spicy foods) is alcohol cessation, behavior of individuals with GERD those experiencing GERD. E not recommended in the modification to include treatment of GERD. are controlled with medications.

1 HOUR CE Questions CE CBDM Approved

NUTRITION CONNECTION

Reading The Role of Nutrition in Preventing and Managing GERD and successfully completing these questions online has been approved for 1 hour of continuing education for CDM, CFPPs. CE credit is available ONLINE ONLY. To earn 1 CE hour, purchase the online CE quiz in the ANFP Marketplace. Visit www.ANFPonline.org/market, select “Publication,” then select “CE article” at left, then search the title “The Role of Nutrition in Preventing and Managing GERD” and purchase the article.

1. Gastroesophageal reflux disease is referred to as: 5. Symptoms of GERD are: A. GEARD A. The same for everyone B. Upset stomach syndrome B. Unique for every individual C. GERD C. Never the same 2. Gastroesophageal reflux disease is the most common 6. In general, a trial of eliminating particular foods to reduce upper gastrointestinal disorder seen in: the symptoms of GERD should only be conducted: A. Older adults A. In a sterile environment B. Adolescents B. In a research metabolic unit C. Lactating mothers C. In accordance with the resident’s preferences 3. The root cause of GERD is: and goals A. The lack of an enzyme in the esophagus 7. The goal of medical nutrition therapy is to assist with: B. A faulty valve between the esophagus and the A. Control of symptoms, and to increase the overall stomach intended use of pharmacotherapy C. Consumption of too much milk in the diet B. Decreasing the intake of all high-fat foods 4. Factors which may contribute to GERD include: C. Healing the lining of the esophagus A. Dementia B. Pressure injuries C. Both physical and lifestyle factors

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