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I tried out Sculpt Pilates’s free self-defense class. Here’s what I learned. By Kelsey Lindsey
Image via Shutterstock.

No one wants to imagine themselves landing in a situation that would require them to use self-defense. But rather than crossing your fingers and hoping that never happens, it’s better to be prepared. That was my aim when attending a free self-defense class at Sculpt Pilates in Bethesda, taught by former Marine Lubomyr Murashchik. There is no definitive school of thought on how to respond to attack and how much force you should use, but despite the conflicting schools of thought about self-defense, almost all of them line up with the basic advice Murashchik covers in his workshops.

Here are my four main takeaways from the class.

Be aware.

Murashchik encourages his students to practice being aware at all times. This includes walking and running without earphones, avoiding walking while texting or talking on the phone, and always being conscious of who is walking behind you and coming near you while walking alone. He says one of the worst things someone can do is ignore the uncomfortable gut feeling that may come from someone being too close in public places or saying inappropriate things. If you ever feel threatened, reroute and try to shake them off; if that doesn’t work, head to a public area and confront them in a loud, no-nonsense voice.

Have a plan.

As soon as you start experiencing an uncomfortable interaction, visualize a plan of attack and/or escape. Hopefully you won’t have to use self-defense moves, but it’s better to have them on your mind then be caught unprepared if someone does try to hurt you.

Practice the moves.

Murashchik recommends that his students (very gently) practice self-defense moves on their friends, some of which we practiced during his class. These included eye jabs (aim for the eyebrow when practicing), elbow jabs, kicks to the knees, and stomping on the foot. Partnering up in the class, we each practiced a series of three consecutive moves on our “attacker” so we could get the feel and rhythm of the moves in a safe place.

Use fear to your advantage.

Murashchik encouraged his students to work on offensive rather than defensive behavior when practicing self-defense moves. While most movie scenes depict fights as long, drawn-out ordeals, he says that it usually takes three seconds of confrontation to combat an assailant. This gives you three seconds to either pull out the moves you’ve trained with, or be seized by fear and fail to fight. Visualize situations where you would need to use self-defense moves and what moves you would use in each one. That way, if you ever find yourself in these situations, you hopefully won’t freeze up and know what to do.

Posted at 04:05 PM/ET, 02/25/2015 | Permalink | Comments ()
Registered dietitian Nancy Chapman shares her top tips. Plus—a few recipes to get you started. By Ryan Weisser
Image via Shutterstock.

Now that Valentine’s Day is behind us—and most of the clearance chocolate has been scoured from grocery aisles—it’s time to focus on a healthier celebration for the heart: American Heart Month.

Heart disease is one of the top deadly diseases in the US, according the the Centers for Disease Control and Prevention, and nearly 50 percent of Americans have either high blood pressure or high LDL cholesterol, or they smoke—all of which can lead to heart disease.

But it’s not all doom and gloom. Registered dietitian and longtime American Heart Association advocate Nancy Chapman shares easy tips for cutting back on bad fats and salts to make the switch a little less painful.

Focus on making it simple.

Chapman recommends filling half your plate with fruits and veggies and then adding lean or plant-based proteins. “Starting with fruits and vegetables will lower the saturated fats you add to your plate,” she says.

Using frozen fruits and vegetables is recommended, as they are easily stored, have a long shelf life, and are easy to add to lean-protein dishes, soups, or smoothies.

Be aware of portion size.

“A lot of excess sodium and fat from our diet just comes from eating too much food,” Chapman says. “If we eat more calories than we burn, we gain weight, and that extra weight puts stress on your heart and can raise your blood pressure.”

Also think about balancing your food groups. Fruits and veggies, whole grains, and proteins (especially plant-based proteins) should make up a meal.

Take a look at where you get your oils and fats.

“That which is liquid is better than that which is hard,” Chapman says. Basically: Avoid hard fats, such as the ones you'll find around meat, or the buttery fats in dairy products. Olive, coconut, and peanut oil are all heart-healthier options to cook with.

To quickly get an idea of the amount of fat your food has, Chapman recommends placing your food on a paper towel, which will wick up the excess fats and oils. “If the food is really greasy afterward,” says Chapman, “that’s a good sign that your food is particularly higher in saturated or trans fats.”

Use more herbs and spices.

“Over two weeks, your taste buds can lose the taste for salt,” Chapman says. To get through those two weeks when you're trying to cut down on salt, she recommends reaching for powerful flavors like garlic, cumin, turmeric, cilantro, and chili powder.

Be aware of your bad habits.

“We’re frequently influenced by the people we eat around,” Chapman says. If you know your friends or coworkers are going to persuade you to eat that extra cookie or go for the fries, she suggests doing healthier activities with those social groups to balance out the bad eating habits. “Try seeing if they’ll go for a walk with you after lunch—that way you can socialize and get in some exercise to counteract consuming higher-calorie foods.”

Focus on one meal at a time.

“Folks try to change a total day’s menu, and it makes the switch so much harder,” Chapman says. “Take a look at where you have the most amount of control, and then look at where you have the most difficult time making healthy choices.”

Focus on one meal, like lunch, where you can start brown-bagging a healthy salad or sandwich instead of eating out. Once you feel you have that habit under control, tackle something else, like those 3 PM snack attacks or breakfast on the go.

5 Heart-Healthy Recipes to Get You Started

These recipes all have components of a heart-healthy meal: lean proteins with omega-3 fatty acids, plant-based proteins, vegetables, and antioxidant-rich fruits (and chocolate).

Asparagus and Potato Salad With Lemon-Garlic Dressing and Salmon

No-Bake Cherry-Almond Bites

Whole-Grain Oatmeal Pancakes With Raspberry Sauce

Slow Cooker Moroccan Lentil Soup

Vegetarian Chili

Posted at 10:35 AM/ET, 02/23/2015 | Permalink | Comments ()
All chocolate is not the same. Here are tips on buying great-tasting bonbons that are also relatively good for you. By Torie Foster

On February 14, feel free to indulge in that box of chocolates.

Chocolate is actually pretty good for you. For one, it’s a good source of magnesium: One ounce of dark chocolate supplies about 20 percent of your daily needs, says Nicole Ferring Holovach, an integrative registered dietitian in Frederick.

“Magnesium is one of those minerals that is notoriously hard to get,” Holovach says. “It’s estimated that half of Americans don’t get enough.”

Dark chocolate has also been found to benefit cardiovascular health due to its high levels of flavanols, she says. Several studies have shown that flavanols are associated with significantly lower risks of heart failure, heart attack, and stroke, according to the National Confectioners Association. There’s also been some initial evidence that chocolate may help improve your mood and reduce anxiety, the association reports.

But not all chocolate is created equal. That’s why it’s important to read the labels. Here are some tips to make sure you’re getting the chocolate that’s healthiest this holiday.

1) Look for the fewest ingredients. Many large chocolate-makers add soy lecithin, milk powder, and other fats to their chocolate, says Adam Kavalier, cofounder of Undone Chocolate, the District’s first bean-to-bar chocolate-maker. This process “dilutes the health properties that are inherent in the natural cocoa bean,” says Kavalier, who has a Ph.D. in plant biochemistry. Holovach recommends brands such as Equal Exchange, Theo, Pascha, Enjoy Life, and Alter Eco because they contain only four ingredients: cocoa, sugar, vanilla, and salt.

2) Eat craft chocolate. The term “craft chocolate” means it’s made from bean to bar under one roof. Craft chocolate is also usually created with cocoa beans that are lightly roasted and carefully ground, which keeps the antioxidants intact in the final chocolate bar. Local companies that follow this bean-to-bar process include Dandelion Chocolate, Madre Chocolate, DickTaylor, and Taza Chocolate. Eating craft chocolate also helps you avoid chocolate processed with alkali, which is used to tone down the bitterness of chocolate but also reduces the level of antioxidants.

3) The more cacao, the better. Most dark chocolate is 50 to 60 percent cacao, but the higher the percentage of cacao, the higher the flavanol and antioxidant content, says Holovach. “I find 70 percent is what most people enjoy,” she says. “It’s right around the range chocolate is still sweet, with just a little bitterness.”

Posted at 10:30 AM/ET, 02/12/2015 | Permalink | Comments ()
Sharon Feuer Gruber shares her strategies for ensuring her whole family eats well even on rushed days. By Tanya Pai

Sharon Feuer Gruber knows plenty about eating well even on a busy schedule, thanks to her job. As the cofounder of the consulting practice Food Works Group, Sharon examines all aspects of the food industry, including urban agriculture, nutrition education, hunger relief, and distribution of local and sustainable products. She also cofounded the Wide Net Project, an organization that supports hunger-relief and environmental conservation in the Chesapeake Bay region.

To make sure her family continues to eat well even when short on time, Sharon relies on having healthy options available at a moment’s notice. She likes to use the beginning of the week to prep meal ingredients for the days ahead, ensuring a nutritious lunch or dinner can be whipped up in less than 15 minutes. She also admits to a daily chocolate habit, which she balances with early morning walks in Rock Creek Park a few times a week with friends—in pretty much any weather. “Making it a date with friends helps get me out the door so early in these colder months,” she says.

Read on for a look at a typical day of eating for Sharon and her family.

Breakfast: “The mornings are a blur in my home—the kids need to catch the school bus, and my husband and I are consistently not the best at packing their lunches the night before. I try to remind myself that eggs take less than ten minutes and leave us all feeling ready to face the day. This morning they got a quick wrap in a whole-grain spelt tortilla and a side of salsa with a little fresh avocado for an extra boost.”

Lunch: “Nourishing meals happen at my house regularly because of two strategies in the beginning of the week: 1) chopping enough vegetables for most of the week, and 2) making a few great dips to go with them. The veggies in the morning’s scrambled eggs were in containers in the fridge and ready to go. Same for most of my lunch. I made the garlic/goat cheese spread, walnut pesto, and beet-yogurt dip a couple of days prior. I needed only to scoop the dips onto my plate, add (optional) garnish, chop up a carrot, and accompany with some crisps. This is one of my favorite lunches, and it was ready in less than five minutes today. It’s also entirely portable.”

Snack: “Late-afternoon hunger snuck up on me today, and an apple held me over just enough until dinner.”

Dinner: “We had friends over for dinner, so I made sure to have leftovers from last night on hand to fill out tonight’s meal. With multiple children and adults all at the table tonight, plus some food allergies, a make-your-own seemed the best approach. We enjoyed rice bowls stacked high with ingredients of our choosing—baked salmon, lots of vegetable options (cut in advance), baked tofu, an almond-sunflower seed mixture for extra crunch, and an Asian-inspired sauce. My favorite topping was the raw bok choy; the crispy, light stems and flavorful greens make it almost a two-in-one vegetable.”

Dessert: “Whether after dinner or earlier in the day, I eat a little chocolate pretty much daily. Two or three squares usually does the trick. Life without chocolate would be so much less pleasant!”

Posted at 12:13 PM/ET, 02/10/2015 | Permalink | Comments ()
My injuries have healed, but questions about my accident continue to haunt me. By William O'Sullivan
Photograph by Pictures by Rob/Alamy.

Lights flashed, hands were all over me, and I was hoisted onto a stretcher. The last thing I remembered—as “memory” itself haltingly reformed—was leaving work, walking my bike across L Street, and turning onto the bicycle lane. But that’s all that’s come back to this day, a year later.

Most people assume it was a collision. It could have been: Bicyclists whiz by without calling out, “On your left!” Rush-hour car traffic around 19th and L is aggressive—and inches away. But there was no police report, no evidence any vehicle was involved.

Friends kept asking if I’d found out what caused the accident—which, because I was wearing a helmet, only broke my elbow, knocked out two teeth, cut up my face, and detached a retina. My standard reply became “No, and I’m not sure I need to. What I imagine might have happened is bad enough.” Privately, I decided that a cyclist sped past, close enough to knock me off balance. But the questions haunted me.

I’d been told GW hospital’s records office could provide emergency-services and doctors’ reports from that February night. I wasn’t convinced that seeing the trauma described in black and white would do me good, even if it solved a puzzle, so I procrastinated. But several weeks later, my sister-in-law was driving me back from the doctor and encouraged me to seek out answers, if only to help me move on.

So we swung by the hospital, and a short time later I was reading the EMS account: “Patient fell off his bicycle, striking his face on the ground. Does not remember falling and states he does not even ride a bicycle. . . .” And the physician record: “Patient presents with major trauma and bicycle accident. . . . Fell off, hit his head with facial injuries, amnesia of events.”

Fell off. That was all.

I found out I could request the 911 calls. As soon as an e-mail arrived containing two audio files, I realized I couldn’t listen: Strangers describing me bloody and motionless? No, thanks. But my partner did. He told me one call was from a hotel clerk saying pedestrians were reporting someone had fallen from his bike out front. Another was from a driver who saw me on the ground.

As I related this non-news to my brother—who’d been the first to arrive at the ER—he reminded me that when he retrieved the bike, the chain was jammed between the frame and the gear teeth. When he’d mentioned this months before, I’d assumed it had come off track as a result of the crash. Now my brother, a biker himself, said the chain was stuck so tight that it probably came loose first and I pedaled it into its jam—and went down with it.

So, a mechanical failure? A likely scenario anyway.

Still, I’m spooked by the amnesia. Would I rather remember the tumble of flesh, bone, and metal on pavement? No—my protective lapse is a blessing in that regard. The truth is I feel compassion for the guy lying tangled on the ground, and my memory blank gives me the strange sensation of having abandoned him that night.

A year later, after two surgeries, months of physical therapy, and dozens of doctors’ appointments, my elbow and face have healed, I have new teeth, and my eyesight is almost what it was. I no longer bicycle to work—illogically or not, it feels like tempting fate—but last summer I took a rental bike for miles-long rides on an open trail. I was surprised by the outcome: It was a kind of balm. On those sun-warmed days, my body finally began to shoulder the mystery, to balance the weights of what I’ll never know and what I can’t forget.

William O'Sullivan is the senior managing editor of Washingtonian. This article appears in the February 2015 issue.

Posted at 10:10 AM/ET, 02/09/2015 | Permalink | Comments ()
Healthy snack options that don't fall flat on flavor. By Ryan Weisser

Super Bowl celebrations are normally centered on a smorgasbord of pizza, wings, barbecue, and other foods you can cover in cheese or dunk in sauce. But if you want to watch the game without blowing your diet, here are some delicious, crowd-pleasing recipes that are festive, not fattening.

Chips and Dips

Baked Zucchini Chips

If you're making your Super Bowl dishes ahead of time, try out this light and crispy take on chips.

Photographs by Ali Eaves.

Heirloom Tomato and Avocado Salsa

There is nothing tastier than fresh, homemade salsa. Plus—it only takes a few minutes to whip up.

Make-Ahead Cheesy Spinach-Artichoke Dip

Yes, there is cheese in this, but it is a bit healthier than your typical restaurant-style or store-bought dip. With only 162 calories per serving, you won't feel guilty about seconds—or thirds.

Photographs by Ali Eaves.

Salt-Free Baked Chipotle Tortilla Chips

Don't blow your daily sodium intake with store-bought chips. They are easy to make at home, and are flavorful and salt-free.


Photograph by Melissa Romero.

10-Minute Pita and Pepper Pizza

Use pita, naan or flatbread as your pizza dough, and you'll have a healthier, and just as tasty, option for snacking.

Photograph by Melissa Romero.

Feta-Stuffed Buffalo Chicken Bites

These delicious poppers can be made ahead of time and can save you a lot of messy eating while trying to keep an eye on the game.

Gluten-Free Baked Chicken Fingers

Crunchy, protein-packed snacks are the way to go if you want to make it through the game. Try out this healthier version, which forgoes frying.

Photographs by Ali Eaves.

Old-Fashioned Popcorn With Pizza or Curry Spices

Try out this recipe for perfect popcorn, or create your own flavors—sans butter and salt, of course.

Photograph by Ali Eaves.

Vegetarian Chili

This warm and comforting dish has a good amount of veggies, protein, and spice. Try it on top of homemade tortilla chips for guilt-free nachos.

Photograph by Ali Eaves.

Vegetarian Pizza With Sautéed Fennel, Mushrooms, and Cherry Tomatoes

Get a few servings of veggies into your diet with this satisfying, low-calorie pie.


Photograph by Melissa Romero.

Lemon-Orange Sports Drink

No judgments here if you knock back a few while watching the game. Just be sure to replenish those lost electrolytes with this tasty, low-sugar drink.


No-Bake Cherry Almond Bites

These super easy treats are made with only three ingredients—dried cherries, dates, and almonds—but experiment with flavors! Add a little bit of dark chocolate or oats and you'll have an antioxidant-rich, guilt-free treat.

Photograph by Melissa Romero.

Low-Fat Chia Seed Brownies

This brownie recipe is just as good as the homemade, butter-laden original. We just made a simple swap to replace not-so-healthy fats with omega-3 fatty acids.

Posted at 04:18 PM/ET, 01/30/2015 | Permalink | Comments ()
Balance is the name of the game for this healthy-living entrepreneur. By Tanya Pai

Are you a local health, nutrition, or fitness expert with a love of food? Keep a food diary for us! E-mail for details.

In 2013, Hillary Lewis founded Lumi Juice, a line of small-batch, cold-pressed juices, in Charlottesville, Virginia. The former Wall Streeter created the company—the full name is “Love You, Mean It”—with the goal of providing products that make it easy for people to make healthier choices. Each 16-ounce Lumi juice contains nearly two pounds of fresh, organic produce with no additives or preservatives, and Lewis relies on them to keep herself healthy and energized throughout the day. She also admits to having a “ridiculous sweet tooth,” so she tries to balance her indulgences with healthy habits. Read on for a look at a typical day of eating for Lewis, which begins with a 5 AM run and ends with a homemade brownie à la mode.

Early morning: “I woke up at 5 AM, went on a three-mile run in Charlottesville, and refueled with a Lumi Minted Greens, which is full of spinach, cucumber, mint, orange, and lime. It’s full of vitamin K, which is important for bone health.”

Breakfast: “By 7:15, I’m ready to head to Lumi facility to start production. I normally choose to drink tea over coffee—there are countless interesting teas out there. Today, I chose Get Burning from the Republic of Tea, which is spicy with cinnamon and ginger. I also had a packet of Quaker instant oatmeal. Every day, I drink about a gallon of water, which helps with fatigue and keeps me hydrated.”

Lunch: “This week, the flu has been sweeping through Charlottesville. I haven’t been feeling 100 percent and leave for a big trip tomorrow, so to strengthen my immune system I made a juice shot with turmeric, ginger, pear, lemon, and cayenne.”

Snack: “I rounded out my lunch with a mid-afternoon snack of a Lumi Belmont Beet and a handful of almonds. I find eating raw food makes it much easier for your body to digest and extract much-needed nutrients.”

Dinner: “For dinner, I made a delicious quinoa salad with feta, tomatoes, romaine lettuce, and grilled shrimp. I like to incorporate a mix of flavors and textures in my meals to keep it interesting. This was light and packed with protein from the quinoa and shrimp.”

Dessert: “I followed my salad with a homemade brownie with a scoop of vanilla ice cream. I have a ridiculous sweet tooth! With that in mind, to me it’s all about balance and making smart decisions to maintain a healthy lifestyle.”

Lumi Juice products can be found at Whole Foods, Safeway, and Glen’s Garden Market.

Posted at 10:48 AM/ET, 01/27/2015 | Permalink | Comments ()
Expert advice to make those long workdays less taxing on your body. By Torie Foster
Image via Shutterstock.

It can have serious ill effects on your health, and yet almost all of us have succumbed to it: poor posture.

Bad posture can lead to a higher risk of arthritis, faster joint deterioration, and decreased lung capacity. Those who sit at a desk and on a computer all day—a.k.a. most of us—are particularly at risk, since your head is tilted, you’re leaning over, and you’re sitting, which strains your head and back muscles. Bad posture can also impair your sleeping patterns, your ability to exercise healthily, and your mood.

“Everything comes from your spinal column,” says Sheila Amon, a chiropractor in Kensington who has more than 29 years of experience. “You get fatigued because your muscles are holding you up in the wrong posture.”

Here are Amon’s tips for keeping your posture aligned throughout the workday—even while at a desk.

1. Replace your office chair with an exercise ball.

It might sound a little silly, but it works wonders, says Amon. Sitting on a ball requires a tight core and straight posture. If using one, be sure to avoid sitting “Buddha style” with your thighs spread out. Instead, make sure both knees are directly in front of you, and keep the ball from moving by tightening your stomach muscles.

2. Perform a few simple exercises at your desk throughout the day.

Amon recommends doing the “chicken wing,” which involves putting your arms parallel to the floor and doing a rowing movement while squeezing your shoulder blades. “The turkey” is another suggested exercise—jut your head forward, keeping your jaw parallel to the floor, and then bring your head back. This exercise “re-educates and strengthens the neck and upper back muscles to proper posture,” Amon explains. A third exercise to open up your chest cavity is to bring your arms behind your back, grab one wrist, squeeze your shoulder blades, and then move your arms away from your back.

3. Make sure your desk is set up properly.

Place your monitor at eye level to align your head with your shoulders, and adjust your chin so it’s parallel to the floor. Keep your knees at hip height and a 90-degree angle to your thighs, and both your feet on the ground. Place your mouse close to you to avoid problems in your shoulders, wrist, and neck. If you use a standing desk, elevate one foot about six inches, using a phone book or a box, to take pressure off your lower back.

4. Get up every 45 to 60 minutes.

Whether it’s to step outside, walk down to a colleague’s office, or make a quick trip to the water fountain, it’s a good idea to take a break from sitting. Keep Amon’s analogy in mind: “The body is 80 percent water. Moving water is healthy water; we’re not stagnant water with mosquitos running all over it.”

5. Practice confidence.

When we feel good about ourselves, we open up our chests, sit up straighter, and breathe more deeply, Amon says. To keep these practices top of mind, she recommends using an egg timer, an alarm, or sticky notes. She also suggests putting reminders in other places, such as on the refrigerator door and TV remote, to prompt yourself to sit up, even after you’ve clocked out for the day.

Posted at 10:47 AM/ET, 01/26/2015 | Permalink | Comments ()
Don't let cold weather resign you to the treadmill. By John Scarpinato
Image via Shutterstock.

With winter temperatures officially upon us, it’s important to take all the necessary steps to ensure your outdoor workout isn’t doing more harm than good. We talked with a few local running coaches for tips to running in the frigid weather.

Wear the right ensemble

The base to any winter workout is clothing. Most runners know that layering is important, but it is possible to overdo it. According to George Buckheit of Capital Area Runners, “The best approach is to accept the fact that you’re going to be cold for the first five to ten minutes of your run and to make sure you’re wearing enough layers to keep you warm mid-run, but not so many that you’re drowning in sweat.” Most technical running gear proves to be the perfect option as it is designed to wick away sweat and keep you warm without being bulky.

Terry Weir, head cross-country and track coach at George Washington University, says long sleeves, a jacket, and leggings may be obvious, but it’s just as important to cover your feet with the right gear. “Compression socks are big these days and are great for the winter,” he says. American University’s head track and cross country coach, Matt Centrowitz, suggests mittens rather than gloves, as they allow your fingers to stay warmer.

Rethink your warmup

When approaching a new routine for the winter, the biggest change to keep in mind is the warmup. Spending a few extra minutes on it will help prepare your muscles for the cold and get your respiratory system acclimated to the cold air. Weir suggests a routine that keeps you constantly moving: “You don’t want to stretch cold muscles and should keep moving the whole time. Try faster repeats just to get warmed up.” If you prefer to warm up indoors, jumping jacks or a jump-rope routine can also help prepare your muscles before heading out.

Plan your route

Thankfully, the District doesn’t get hit too hard with frigid sub-zero temperatures—but the wind can still make running outside uncomfortable. Centrowitz suggests never starting with the wind at your back on an out-and-back run. Instead, go into the wind to start so that it’s at your back on the return, when you’re more fatigued.

When it comes to top routes, every coach we asked suggested running along the covered portion of K Street under the Whitehurst Freeway. There will never be snow, and the length makes for good speed workouts. Rock Creek Park is another top spot. “Beach Drive in Rock Creek Park is closed to traffic on the weekends, and the roadway is very well-maintained and kept clear of snow and ice, so it’s a good go-to location for weekend runs in the winter,” says Buckheit. The trees also serve as a good barrier to the wind. Weir suggests trying out West Potomac Park and Hains Point; he says it’s usually one of the first areas to get plowed and doesn’t have much traffic.

Bring a friend

Staying motivated is one of the toughest obstacles when confronting winter running. Grab a workout buddy who can help keep you accountable for a regular schedule (and vice versa).

Posted at 09:00 AM/ET, 01/21/2015 | Permalink | Comments ()
Think you have acid reflux? You may not. Plus—the latest on treating chronic heartburn. By Robin Tricoles

Millions of Americans take over-the-counter medications for acid reflux. The problem is many don’t have acid reflux.

Photograph by BSIP SA/Alamy.

According to Caren Palese, a gastroenterologist in DC, more than half of the patients who are referred to her with acid-reflux symptoms that haven’t improved with proton-pump inhibitors such as Prilosec and Nexium—which reduce acid production—don’t have the condition at all.

Acid reflux occurs when stomach contents flow back into the esophagus, causing heartburn, coughing, trouble swallowing, chest and throat pain, and the feeling of a lump in your throat, says Dr. Palese, director of the Center for Gastrointestinal Motility and Heartburn at MedStar Georgetown.

According to the National Institutes of Health, 20 percent of adult Americans experience reflux symptoms weekly. Persistent reflux, also known as gastroesophageal reflux disease, or GERD, can lead to inflammation, ulceration, and cellular changes in the esophagus, increasing the risk of esophageal cancer.

People who don’t have acid reflux but share many of the symptoms of those with GERD may actually have non-acid reflux. Determining which type a patient suffers from can require tests, such as esophageal pH monitoring. Knowing the kind of reflux someone has is key to coming up with an effective treatment, ranging from medication to surgery.

When symptoms persist, doctors look for an underlying cause, such as a weak lower esophageal sphincter (a ring of muscle that acts as the gatekeeper between the stomach and esophagus) or a hiatal hernia.

In rare cases, when anatomical abnormalities are present and medication and lifestyle changes—such as eating smaller meals and not lying down within two to three hours of eating—fail, surgery may be an option. One surgery, fundoplication, involves wrapping the top of the stomach around the esophagus. The procedure is usually effective and can be performed with minimally invasive surgery, says gastroenterologist Marie Borum, a professor at George Washington University School of Medicine & Health Sciences. The downside is that fundoplication may have to be repeated as tissue shifts with time, weakening the lower esophageal sphincter.

Another operation, recently approved but not yet widely used, involves placing a ring of magnetic titanium beads around the lower esophageal sphincter. The beads’ magnetic force is strong enough to keep the sphincter closed and reflux at bay but is weak enough to allow the sphincter to open when a patient eats. Like fundoplication, the device can be implanted using minimally invasive surgery.

“I don’t want to tell people to run out and get surgery if we can get good medication control, because there can be complications,” says Dr. Borum. “But there are now surgeries that can be done laparoscopically, which have helped people who may have been reluctant to undergo open surgery.”

Robin Tricoles ( currently writes about science for the National Institutes of Health.

This article appears in the January 2015 issue of Washingtonian.

Posted at 12:07 PM/ET, 01/13/2015 | Permalink | Comments ()