We call it heartburn, even though it has nothing to do with the heart. It’s gastroesophageal reflux disease (GERD) and one in five Americans have had it at one time or another.

Although medications can help to control reflux, lifestyle changes often do the trick, says Scott Gabbard, MD, a gastroenterologist and hepatologist.

GERD affects people when the lower esophageal sphincter, which controls the opening between the esophagus and stomach, fails to close after food passes through, and stomach acids travel backward up the esophagus.

Why reflux happens, how to prevent it

Dr. Gabbard lists excess stomach weight, fatty foods, large meals, and intake of alcohol, cigarettes, caffeine, chocolate and peppermint as risk factors for GERD. He says lifestyle changes are most important to help prevent that sphincter from opening in the first place.

Here are his top recommendations to help GERD sufferers:

Lose weight. There is no other single thing you can do that can have a greater impact on your reflux, Dr. Gabbard says. Losing weight is the most important, and often the hardest thing to do — but the effort is worth it.
Eat smaller, less fatty meals, especially late in the day. “Fat causes the sphincter to open, as do large meals,” he says. ”No medicine can prevent you from getting reflux if you eat a pepperoni pizza and drink a full pitcher of beer.”
Cut alcohol and smoking to start with, and see whether you need to make other dietary changes. “Many patients with reflux tolerate coffee just fine,” Dr. Gabbard says.
Don’t eat for three hours before bed if reflux hits you hardest at bedtime — and use a 6- to 8-inch incline wedge pillow. “Those can be purchased on the Internet for $30,” he says.
Wear looser clothes that doesn’t compress your abdomen. This sometimes helps, although that hasn’t been formally studied.
Take Prilosec® or Nexium® about a half hour before eating. Some patients mistakenly take them at bedtime, which doesn’t provide any benefit. The medications reduce the amount of stomach acid but they don’t help keep the sphincter closed; there is currently no FDA-approved medication that does.

Medications such as Prilosec and Nexium are basically safe over the long term, although studies show they contribute to a slightly increased risk of osteoporosis, pneumonia and colon infections, Dr. Gabbard says. He says GERD sufferers should discuss them with their doctor. He also says to talk to your doctor if reflux symptoms don’t respond to treatment or are severe and persistent.