It may be a good idea to resist the comfort of late-night snacks. Recent medical advice from the US says people should not eat for at least 3 hours before going to bed. While not eating before sleep has long been a routine recommendation for those who suffer from reflux disease, healthy Americans who do not have indigestion or reflux are now being given the same advice. This advice is not given in Australia.
Reflux is the regurgitation of stomach acid or stomach contents into the gullet, the tube connecting the mouth with the stomach. It can cause a burning sensation in the chest, which rises into the throat. (For more information see the section ‘Relief from Reflux’ on p. 264.) Eating late at night predisposes a person to having nocturnal reflux.
This applies not only to full meals, but also to light snacks such as milk and biscuits. Studies in the USA have found that even ‘normal healthy subjects’ who eat before going to bed have silent but substantial acid reflux for hours afterwards.
The refluxed acid may be responsible for a range of problems such as hoarseness, sore throat, sore mouth, phlegm in the throat, loss of tooth enamel, coughing, bronchitis and asthma. One study showed that, regardless of sleeping positions, acid remained in the gullet for up to 4 hours after eating. Reflux peaked in the first hour and then decreased progressively.
When men sleep, activity in the gullet slows considerably. This makes it harder to get rid of any acid that may be slopping around at the bottom of the pipe near the junction with the stomach. Also during sleep, men don’t salivate or swallow -activities that help to neutralise the acid and cause the gullet to contract and push the acid back into the stomach.
The way nocturnal reflux adversely affects the upper airway and contributes to conditions such as hoarseness, bronchitis and asthma is not well recognised. In medical circles in the USA, it used to be said that President Clinton’s hoarseness is the result of nocturnal reflux – of acid coming up his gullet pipe and spilling over into his vocal cords.
Although the body has natural defences against acid spilling out in this way, in some it breaks through. Greasy, fatty food is the worst thing to eat late at night because it takes a long time to digest and is likely to lead to reflux.
In Australia, doctors say the general rule is that if it makes you uncomfortable to eat before bed, you shouldn’t do it, but otherwise, it’s fine. However, there is something else about reflux that worries doctors: they are concerned that an increase in reflux disease could be the result of a new treatment for ulcers.
During the past few years, the new standard treatment for most ulcers has been the eradication of a bug in the stomach known as Helicobacter pylori. This bug is the most common bacterial infection in the world and is said to infect between 30 and 40 per cent of Australians. The problem is that, while this bug predisposes people to ulcers, it also may protect them from reflux disease. The bacteria destroy the acid-secreting lining of the stomach: if the bug is killed, the lining can regenerate and flourish. This means more acid may be produced and the likelihood of reflux disease increases.
Studies of people in whom the bug has been eliminated have already begun to demonstrate an increase in acid secretion.
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