Gastroesophageal reflux disease, or GERD, is a condition in which acid and stomach contents regularly back up into the esophagus, causing symptoms like heartburn, according to the American College of Gastroenterology. It’s believed that as many as 20 percent of Americans have GERD, making it one of the most common gastrointestinal diseases.
For those who are underweight, having GERD can make gaining weight a challenge, because many calorie-dense foods, such as those high in fats, can exacerbate symptoms, says the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). A person may be underweight for a variety of reasons, and some of those factors may also affect your ability to gain weight. A variety of lifestyle and dietary modifications may help when trying to gain weight with reflux, however.
Elimination Diets May Not Be Necessary
To gain weight, you need to increase your overall daily intake of calories; to do so, Mayo Clinic suggests eating nutrient-dense foods that are also high in calories, including foods high in fats. With GERD, certain foods and substances, such as spicy foods, fatty foods, chocolate, alcohol, and caffeine may worsen reflux, according to the NIDDK.
Rather than automatically eliminating all such foods whether they bother you or not, research suggests that personalized diets based on symptoms — only avoiding what triggers reflux for you — and focusing on things like the timing and size of meals and their macronutrient content are more effective than elimination diets.
Eat Smaller, Higher-Calorie Meals
GERD symptoms can be triggered by eating a large amount of food at a single sitting, UT Health Austin notes. Eating five to six smaller meals per day may reduce heartburn and other symptoms.
When trying to gain weight with GERD, choose foods that are high in nutrient quality and high in calories, Mayo Clinic advises. Top off toast with nut butter instead of jam, or add part-skim mozzarella shreds to top a protein pasta made with chickpeas, lentils, or quinoa. Smoothies packed with unsaturated fats like MCT oil and protein powder are convenient and quick meals. Foods that are easy to digest can also help, according to Banner Health. These choices can be made with the guidance of a dietitian. Making sure to drink your fluids between meals will also leave room to consume more calories at mealtime. Avoiding eating or drinking a few hours prior to bedtime may also help minimize reflux symptoms.
Stop Smoking
If you’re a smoker who’s trying to gain weight and you have GERD, kicking the tobacco habit can help with both problems. Quitting can also have many other health benefits, such as allowing you to smell and taste food better, MedlinePlus notes, which can aid in gaining weight. It can also reduce your blood clot, cancer, and heart disease risk.
Research shows that the nicotine in cigarettes reduces appetite, food consumption, and body weight. Smoking also makes it more difficult to gain weight, since it increases the number of calories you burn daily, according to Moffitt Cancer Center in Tampa, Florida. Research finds that underweight smokers tend to have higher levels of weight gain once they quit, versus people who were already at a healthy weight. And the earlier you quit smoking, the more weight you may be able to gain.
Nicotine is known to relax the band of muscle between the esophagus and stomach, leading to acid reflux and heartburn, according to Cary Gastroenterology in the Raleigh-Durham, North Carolina area. It can also relax the muscles of the esophagus itself, making it harder for the structure to push acid back down as it should. Saliva production, which helps initiate digestion and aids in neutralizing stomach acid, is reduced in smokers; this can also increase symptoms. Smoking regularly can also alter the balance of stomach acid compounds, potentially leading to more reflux and symptoms.
Talk to your doctor about the best way to quit smoking, or check out one of the many free resources available through local health initiatives. The Centers for Disease Control and Prevention (CDC) also offers free programs nationwide, including phone, text, and app-based services.
Warnings and Precautions
If you have concerns about your weight or about GERD symptoms, it’s important to discuss them with your healthcare provider. When trying to gain weight, a registered dietitian can assess your current diet and make recommendations for how to gain or maintain weight in a healthy way. They can also give you tips on how to make sure you don’t worsen gastrointestinal symptoms. Registered dietitian services may be covered by insurance, and the American Heart Association notes that many smoking cessation programs are as well.
