Acid reflux is a common issue among the American population, with an estimated 14-20% of adults suffering from a condition called gastroesophageal reflux disease (GERD). Following a GERD diet may help to control this condition and generally help to reduce symptoms of acid reflux in those who experience it less frequently.
The difference between GERD and occasional acid reflux is the frequency at which symptoms are experienced. GERD patients experience reflux more than twice a week, as well as symptoms including regurgitation of food or sour liquid, difficulty swallowing properly, loud breathing or wheezing, coughing, and heartburn. These symptoms are often particularly bad at night, which can interrupt sleep.
We’ve spoken to medical doctors to get their advice for managing GERD, the best GERD diets and which foods you should be eating and avoiding to keep your symptoms under control. It is also worth noting that GERD is sometimes called GORD.
What foods can cause heartburn?
Dr Deborah Lee, a medical doctor at Dr Fox Online Pharmacy, explains that gastric reflux is caused by the stomach contents passing backwards from the stomach into the esophagus (throat). “In normal circumstances, food is kept inside the stomach due to a valve at the lower end of the esophagus called the lower esophageal sphincter (LES),” she says. “If there is too much pressure on the LES, it becomes leaky and incompetent, and the partially digested food, mixed with stomach acids, is propelled upwards into the lower oesophagus. Certain foods and drinks can worsen gastric reflux. They may do this by stimulating excess gastric acid secretion or causing relaxation of the LES.”
Having worked for many years in the NHS, initially as a GP, and then as Lead Clinician for an integrated Community Sexual Health Service, Dr Deborah Lee now works as a health and medical writer, with an emphasis on women’s health. She is a menopause specialist.
A review in the Journal of Current Opinion in Gastroenterology indicates that dietary changes are considered the first-line treatment of GERD, with more attention being paid to medication overuse. Nonpharmacological therapies, such as dietary management, are currently considered the best way to manage GERD.
“Enzymes are specific substances found in your gut that are essential for breaking down food into tiny particles,” adds Lee. “These can then be absorbed into the bloodstream.”
Enzymes that break down carbohydrates include amylase, maltase, lactase and sucrase. Lipase is responsible for breaking down fats and converting fat into fatty acids and glycerol. Proteases break down protein into separate amino acids.
A 2019 review in the journal of Current Medicinal Chemistry indicates that high fat intake, coffee, chocolate, spicy foods and alcohol all increase reflux, although there is less data around fried food or carbonated beverages and their links to GERD.
Dr Tariq Mahmood, MD, medical director of Concepto Diagnostics, says: “Heartburn is a burning sensation felt in the chest area when stomach acids travel back up the throat. When swallowing, a muscle at the bottom of the esophagus relaxes to allow food or drink into your stomach. However, if the muscle doesn’t relax or weakens over time, stomach acid can flow back into the esophagus, which causes irritation and inflammation.
“The causes of heartburn can differ from person to person, but common foods and drinks reported to make it worse are alcohol, chocolate, coffee, spicy foods and tomatoes. Additionally, foods high in fats and salts, such as fast food, fried food, pizza and processed snacks can trigger heartburn.”
Dr. Tariq Mahmood has nearly 30 years of experience in ultrasound, paediatrics, general medicine/surgery, radiology, orthopaedics and obstetrics. He earned his bachelor's degree in Medical and Surgery from the Nishtar Medical College Multan in Pakistan in 1988 and spent seven years as a trainee radiologist after graduation before embarking on a career as a sonologist, sonographer, and ultrasound practitioner in the U.K.
What foods can prevent acid reflux?
The Current Medicinal Chemistry review vouches for the Mediterranean diet and the low carb diet as ways to manage GERD. The review also recommends leaving longer periods between eating and sleeping, with dinner at least four hours before bedtime to lower your risk of experiencing GERD symptoms overnight.
Lee says that a high fiber diet can also help with GERD management. “Sufferers are likely to benefit from increasing the fiber content of their diet. Foods such as oatmeal, which is high in fiber, have been shown to reduce the concentration of gastric nitrites,” she says. “Nitrates, often taken by those with heart disease, are known to worsen reflux symptoms. Fiber rich foods include those made from unrefined grains: brown bread, brown rice and brown pasta.
It is also important to increase your fruit and vegetable intake. However, opt for non-citrus fruits such as bananas, melon, peaches, and pears, and root vegetables such as sweet potato, carrots, and beetroot. Full fat cow’s milk has been shown to worsen reflux, so semi-skimmed or skimmed is preferable. Plant-based milk is a low-fat alternative. Drinking coconut water may also be helpful, says Lee.
Dr Mahmood agrees that a high-fiber diet is best for GERD, and that alkaline fruits and vegetables can be helpful.
“There are a range of foods that you can eat to prevent heartburn. Foods which are packed full of fiber make you feel full, meaning that you’re less likely to binge eat unhealthy snacks or overeat. Green vegetables (asparagus, broccoli and green beans), root vegetables (beets, carrots and sweet potatoes) and whole grains (brown rice, couscous and oatmeal) are great high-fiber foods,” he says.
Dr Mahmood would also recommend alkaline foods and watery foods for someone who struggles with heartburn. Fruits and vegetables that are less acidic are less likely to cause reflux, including bananas, cauliflower and melons. Foods with a lot of water can dilute a strong stomach and weaken its acid – so you’ll want to eat plenty of celery, cucumber and lettuce.
Tips for managing GERD symptoms
A review in the JAMA Surgery journal indicates that the best treatments for GERD include lifestyle changes, as well as the use of proton pump inhibitors and laparoscopic fundoplication (a keyhole procedure). Endoscopic treatments have been shown to be less effective.
Mahmood says there are some over-the-counter treatments that can help with GERD symptoms, but that diet and lifestyle changes are the most effective tools. “One over-the-counter solution to heartburn is digestive enzyme supplements to aid digestion and help the body break down food,” he says. “A good digestion process is key, otherwise the body isn’t able to take all of the key nutrients it needs from the food you eat and subsequently your body isn’t properly energized.”
Other tips include:
- Not eating late at night (especially within three or four hours before going to bed)
- Optimizing your diet to avoid foods and drinks known to trigger acid reflux
- Wearing looser clothing so that pressure isn’t applied to your stomach
- Raising your head when sleeping by up to eight inches
Another risk factor for GERD is the presence of a hiatal hernia, where the entrance of the esophagus is abnormally shaped or misplaced in the thoracic cavity, according to a study in the Expert Review of Gastroenterology and Hepatology. A hiatal hernia can be diagnosed with an endoscopy and is often discovered when investigating the source of upper abdominal pain and chronic problems with acid reflux. If you know you have a hiatal hernia, it may be worth considering a GERD diet.
“If you have troublesome reflux symptoms, see your doctor to be sure you have an accurate diagnosis,” adds Lee. “This may mean you are referred for tests, likely to include an endoscopy and pH testing from the esophagus. Once the diagnosis is confirmed, there are a lot of things you can do to help yourself:
- Eat a healthy, balanced, low-fat diet with plenty of fiber – the Mediterranean Diet is a good option.
- Lose weight – obesity puts extra pressure on the LES.
- Stop smoking – smoking is closely linked to acid reflux. Nicotine relaxes the LES, plus smokers have alterations in their saliva.
- Reduce your alcohol intake – alcohol intake is strongly linked to acid reflux.
- Get regular physical exercise – exercise can help reflux so long as it is the right type of exercise, and don’t exercise within two hours of a meal. Exercise in which you are upright, for example, walking, jogging, or cycling are the best options. Avoid exercise that means bunching up your abdomen, such as gymnastics or weightlifting, or high-intensity exercise, such as sprinting or cycling fast.
This article is for informational purposes only and is not meant to offer medical advice.
