What is acid reflux?
Acid reflux, often referred to as heartburn, is one of the most common digestive complaints, affecting approximately one in five UK adults. For many of these people, occasional heartburn or regurgitation is an unpleasant experience, but doesn’t progress to anything more serious. Its typically described as a pain or burning sensation in the chest which comes on after eating. A typical trigger scenario might be bending to load the dishwasher after eating a rich, heavy or spicy meal.
For those with frequent or severe heartburn, it may be the presentation of a potentially more problematic condition known as gastroesophageal reflux disease (GERD).
What are the symptoms of acid reflux?
Symptoms vary from a warm to burning pain felt in the middle of the chest, which rises up towards the throat. Some sufferers complain of an unpleasant taste in the mouth or bad breath. All of these symptoms are understandable when you consider that reflux involves the acidic contents of the stomach repeating into the gullet or oesophagus. At its mildest this is unpleasant, but can become more serious. Whilst the stomach lining protects itself against the acidity needed for digestion, if enough reflux makes its way back into the oesophagus, this may, over time, lead to inflammation and even ulcers.
How does acid reflux start?
As we age our muscles lose tone and start to function less effectively. This is relevant because there is a muscular ring, known as the lower oesophageal sphincter (LES), which separates our stomach from our oesophagus. The role of this muscle is to act as a one-way gate allowing the flow of food down the gullet and into the stomach. However, as our muscle tone weakens, the sphincter becomes less effective at doing this job and as a result, we may experience reflux.
Our dietary habits may also make us more prone to the condition. An interesting study assessing diet suggests people who eat only one or two meals a day, or drink peppermint tea daily, or eat one big meal in the evening (rather than two smaller meals), may be at greater risk of developing the condition as they age. In addition to this, some experts believe that a condition known as a hiatus hernia may promote reflux.
How does nutrition help or hinder acid reflux?
What, when and how you eat may help manage your symptoms. Eating smaller, more frequent meals throughout the day and avoiding food within three hours of bedtime appears to help some sufferers. Chewing well and eating in a slow and relaxed manner may also be a useful strategy as can reducing the fat and carbohydrate content (especially simple sugars) of your meal. It’s worth remembering that what triggers your heartburn will be personal to you which means what helps manage it will likewise depend on your own journey of discovery.
How does my lifestyle help or hinder acid reflux?
Your lifestyle may make symptoms worse, for example, those who smoke, are over-weight, suffer from high levels of stress, take certain medications including non-steroidal anti-inflammatories (NSAID) or anti-histamines or are in the latter stages of pregnancy (typically from 27 weeks onwards) are more likely to experience acid reflux. However, always speak with your GP before making any significant changes and certainly prior to altering your use of prescribed medication.
Making lifestyle modifications is the first line therapy for most sufferers. One of the most effective changes for those with night-time symptoms, is elevating the bedhead or using a wedge-shaped pillow. For most people this is an easy win – to achieve results aim to raise your bedhead by 20-28cm.
Further, benefits may be realised by avoiding tight clothing, this is especially relevant for those who carry excess abdominal obesity, as well as avoiding lying or bending too soon after eating. It’s also wise not to exercise immediately after meals but to allow 1-2 hours for digestion to progress.
What are the food triggers for acid reflux?
A food diary is an invaluable tool for working out the foods which act as your triggers – record what and when you eat and drink, what activities you were involved in after eating and what symptoms you experienced. Keeping a journal or using an app or tracker for at least a week can help identify your personal food triggers.
Typical culprits can be divided into three categories:
- Foods which are acidic in nature and cause irritation to the lining of the oesophagus such as tomatoes, onions and citrus fruits, as well as spices.
- Food and drinks which cause the stomach to distend, including carbonated drinks and large, calorie-dense meals.
- Foods which promote relaxation of the LES including caffeinated drinks like coffee, chocolate, mint, alcohol, fatty and fried foods as well as carb-rich meals.
Eating any of these foods late in the evening whether as a full meal or substantial snack may also aggravate symptoms.
Which foods may help soothe acid reflux?
Sadly, no food cures the condition, but certain foods may lessen the effects of reflux when combined with lifestyle changes. Be aware not all these suggestions work for all sufferers, so use your own experience to determine the most relevant for you.
Foods which may help include:
- Vegetables (boiled or steamed) such as green beans, potatoes, fennel, asparagus, cucumber and leafy greens including spinach and kale.
- Fruits (with the exception of citrus and tomatoes) including melon, banana, apple and pears.
- Fibrous foods including oatmeal, wholegrain rice and psyllium husks.
- Ginger, famed for its stomach calming properties and natural anti-inflammatory status. Grate the fresh root and add to meals or brew as a tea – when making tea for therapeutic purposes cover while steeping to retain the active constituents.
Although lean meat, fish and egg whites are often cited as useful food inclusions, evidence is inconclusive, with some studies reporting no difference to symptoms. Clearly, more research is needed to clarify this.
Lifestyle changes such as weight loss and stopping smoking combined with the right food and dietary habits may make a worthwhile difference for some heartburn sufferers. Although it’s worth noting that the only lifestyle recommendation which has an evidence-base is elevating the bed head for sleep.
Finally, it’s important to say – don’t ignore your symptoms and be sure to refer to your GP if you experience any of the following:
- Heartburn most days for three weeks or more.
- You’ve been taking antacids for four weeks or more.
- You have symptoms such as weight loss, nausea or difficulty swallowing in conjunction with your heartburn.
If you are considering a change in diet, please consult your GP to ensure you can do so without risk to health.
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This article was published on 5 November 2020.
Kerry Torrens BSc. (Hons) PgCert MBANT is a BANT Registered Nutritionist® with a post graduate diploma in Personalised Nutrition & Nutritional Therapy. She is a member of the British Association for Nutrition and Lifestyle Medicine (BANT) and a member of the Guild of Food Writers. Over the last 15 years she has been a contributing author to a number of nutritional and cookery publications including BBC Good Food.