We don’t drink directly from streams or pools of water. Pre-technology humans would have had to use their hands to scoop water to their mouths and it’s more efficient when your mouth is closer to the water source since you don’t lose as much on the way up. We also just don’t spend much time bending over anymore which is probably another source of resistance that is missing.

Getting an illustrated children's Bible 22 years ago, I was most surprised by when God told the commander to tell his soldiers to drink from a stream and they were wildly idiosyncratic, some lapping like cats, some cupping the water into their hands etc.

Spoiler alert: commander did multiple tests, each selecting for idiosyncrasies, resulting in a force a fraction of the original size, and won the battle.

GERD is multicausal, which is why there's so many responses already. Personally I went from occasional heartburn to GERD during a period where I was eating spicier food more often, eating more overall, and consuming more alcohol. The latter two are modern problems, spiciness might be as well.

When I was seeing doctors for stomach issues years ago, I remember being told to avoid spicy food among other things. However, population studies don't show a higher rate of GERD/stomach ulcers for groups who report eating spicier food. I think it just irritates damage that is already there that you might not have noticed.

For me, it turned out I was reacting to something in my well water and a bit after switching to bottled water, I could go back to chocolate/coffee/alcohol/spicy food with no problems.

I have recently had a significant improvement in acid reflux symptoms. The key for me was to just eat less.

I am not morbidly obese. I have a pretty small frame and am about 5 ft 6 in tall. My BMI before cutting my portion sizes down was on the upper end of the normal weight range (24.9).

I tend to be a fast eater, and I think that did me no favors.

It makes a lot of sense in retrospect. But when you're not obese, cutting your portion sizes is not the first thing that comes to mind as a method for improving health.

So you weigh about 154.32 pounds?

You got it.

> I tend to be a fast eater, and I think that did me no favors.

Chewing thoroughly until the food almost liquefies helps the stomach digest faster and empty its contents into the intestines.

My wife recently berated my for swallowing part of my food before I'd properly chewed it. I'm trying to pay more attention to it now, and she's right. I take a big bite, chew twice, swallow part of it, and then chew the rest. Another thing I need to unlearn.

I suffered from this in my teens and early 20s. It was pretty terrible, and I'd often vomit. Turns out not eating like shit fixed it.

Yep, I had a terrible diet a few years ago which flared up some moderate acid reflux whenever I had certain sugary drinks. Fanta and Coke were the worst for me. I think the likely culprit was the aspartame. I very rarely drink those types of beverages now and I don't have acid reflux anymore.

Oily greasy food, not exercising, extra weight on the chest, and alcohol that further relaxes the muscle all contribute in my experience.

There is an episode in Andrew Hubermans' podcast which goes into the details of this. Overall if you are keeping your digestive track in "digestion mode" frequently thus not letting it rest will eventually building up constant acid (to digest the food) resulting in reflux. The digestive track goes into "rest mode" about 3-4 hours after your most recent food intake.

Among many others, obesity is a big risk factor.

It's not just weakening that's the problem, but also more pressure from below, and obesity can cause the stomach to be pushed up.

I have a hiatal hernia, where there's a too large opening allowing part of the stomach to slipe through the diaphragm, and that massively increases my acid reflux if I don't take medication.

Weight changes dramatically affects the strength of my symptoms. As I've lost weight the symptoms have largely disappeared again.

We eat a lot of processed foods which are softer compared to chewing tough meat for example. This is known to affect jaw and palate development (which in turn affects teeth alignment, tongue position, and even breathing). [1] Seems like it could also affect the esophagus.

[1] https://news.stanford.edu/2020/07/21/toll-shrinking-jaws-hum...

Fascinating link thanks.

I had a small hunch that it could also be related to how thoroughly we chew. I've noticed over the years that I chewed less and less while eating and started swallowing most pieces whole. Since a few months ago I started to make an effort to really chew on my food until it's properly minced.

According to the link that seems to be part of the problem.

I think sitting all day causes it

This explains a lot. I’ve done nothing but sit for months and I can’t eat anything even remotely acidic anymore.

Sitting all day is just one of many things that likely cause it. Sitting pushed organs around in a different way from standing or laying down.

> LOL

What's funny...?

> Personal experience with this problem lead me to think about it, repeatedly.

It's a comically-understated way to say "I kept having acid reflux, just, so very many times, and it hurt like a motherfucker so I became preoccupied with fixing it".

Some of the most significant progress we made as a species was because some relatively smart and lazy person got really annoyed with some kind of problem.

OP deploying a bit of wit with the comma and the word "repeatedly" at the end. I don't what you'd call it exactly - gallows humor?

Presumably the understatement of it.

Obesity and a sedentary lifestyle will cause mitochondrial dysfunction throughout the body and prevent muscles from working effectively, including the esophageal sphincter. I don't know that causality has ever been directly proven there but it seems likely.

I think tons of anxiety and stress can also weaken the muscle, which can make it more susceptible to been weakened by an external physical trauma.

I have had GERD since 2012 after a surgery and it has been extremely unpleasant to say the least. The author mentions Rantadine which I also took but the problem with that drug was it was found to contain carcinogens and I promptly stopped taking it. I now take pepcid AC 20MG daily and would love to find a way to stop taking it altogether.

In case you are wondering(and I have been to the Dr many, many times about this), triggers for GERD are stress(for me it is the strongest trigger) caffeine, heavy fried foods, spicy foods, cabbage and soy. Methods to avoid acid reflux flare ups are eat slowly(I eat really fast!) eat at least 2-3 hours before bed, and also avoid huge meals. I am truly thankful to OP for this article and will apply its techniques right away, hope the stuff I mentioned helps others as well.

hiatal hernia runs in my family, so it's genetic for me

not sure where you're coming from but LOL for a disease that definitely leads people to die of esophageal cancer on a regular basis not to mention makes living and exercising difficult seems....inappropriate ?

Their "LOL" was in reference to the author's statement of "...personal experience led me to think about this, repeatedly" (which is the author presumably making a joke)

Anecdote: I used to suffer from very bad reflux in my early 20's. I tried all sorts of things. Today I no longer suffer from reflux at all.

The following either didn't work, or only reduced the severity of my reflux:

- Medicines were helpful but not an outright fix.

- Dietary changes did not help at all.

- Sleeping upright helped but only so much. And my sleep quality was terrible.

- A medical device that applies light pressure to your Adam's apple. This actually helped a lot, but was not fun to sleep with.

The two things that I think actually got rid of my reflux for good are:

- Intermittent fasting

- Vomitting cat exercise

Say more about "Vomitting cat exercise"

Step 1: Sit on all fours like a cat/dog.

Step 2: Suck in your gut and arch your back like a cat does when they are startled.

Step 3: Exhale

There is also a variation where you don't arch your back: https://hiitacademy.com/hiit-exercise-how-to-do-cat-vomits/

I basically found myself running out of things to try. My poor sleep quality was especially affecting me and I was desperate to get the reflux under control. And so I spent a lot of time thinking deeply about what could be causing my reflux.

It's difficult to explain why I thought to try this combination (fasting + cat vomitting exercise). It was sort of like I suddenly understood where the weakness was in my esophagus, and that this specific motion/exercise, in combination with giving my esophagus a break for 10 hours/day would relieve the reflux. I fully committed, and in not very long (3-4 weeks if I remember right), my reflux was mostly gone. Only had a few memorable reflux instances in the months that followed and now its been years since I've had any issues at all.

I still practice intermittent fasting 5 days a week but I don't do the cat vomit exercise. Part of me feels strongly that if I hadn't done both those things at the same time, I wouldn't have fixed my reflux, but obviously I have no evidence to prove that.

I also feel its important to mention that reflux has different causes. I felt like what I was experiencing, combined with all the reading I did about reflux, allowed me to settle on this particular regimen.

I am definitely not trying to suggest that this is some secret magical cure that big pharma doesn't want you to know about.

Sounds partly like marjari asana of hatha yoga.

Cat pose or cat cow pose.

Google it.

That does look the same/similar.

Web search says it's an abdominal breathing exercise where you are positioned on the ground on your hands and knees (similar to "cats and camels" for those familiar with that one).

It turns out drinking 4 cups of coffee a day for a few decades isn't great for your esophagus.

coffee doesn't have to be scalding hot, or even hot at all to be enjoyed.

even cold decaf coffee causes reflux.

Now I'm wondering if my excessive tea consumption might be related to my reflux problems. This discussion is giving me a lot to think about.

I thought it was a reference to PH, not temperature?

Anecdotally and subjectively drinking coffee can trigger reflux but yerba mate (another source of caffeine) did improve digestion.

Insulin Resistence. Almost half the people with diabetes also have GERD.

I would posit that chronic inflammation of the stomach mucosa due to the SAD diet could cause neuromuscular problems in the regions that control the LES.