Many people know the pain of acid reflux. The burning pain in your throat and chest after eating, the acid taste in your mouth, and the occasional wrenching pain in your stomach. Acid reflux, one of the symptoms of which is heartburn, can seem benign, but it can drastically affect your life and keep you from your most vibrant self. And while there’s no cure for reflux, there are plenty of ways to manage the symptoms and prevent recurrence.
This Can’t Be Me!
When I was first diagnosed with GERD twenty years ago while living in England, I was handed a pamphlet from the Gastroenterologist with a picture of an obese man engaging in behaviours that are likely to cause acid reflux. Something like this photo:
Needless to say, as a 21-year-old international karate athlete, non-smoker, and healthy eater who rarely drank (maybe a few times a year after competitions), I couldn’t relate to this portrayal of the typical sufferer of this strange disease that a doctor told me I had.
Since then I’ve learned a lot more about the condition and have found that it can happen to people of all ages and sizes.
Symptoms of heartburn, also called acid indigestion, are more common in pregnant women and the elderly, but some people are just more predisposed to having a dysfunctional stomach (that’s me!).
What Is GERD?
Gastroesophageal reflux disease (GERD) is a condition in which the contents the gastroduodenal area come up into the esophagus and cause chronic symptoms. The most common symptoms are heartburn, acid regurgitation, and chest pain, and less-typical symptoms include abdominal discomfort, chronic cough, and asthma.
What Is Acid Reflux?
Most people have probably experienced the burning sensation after a big or spicy meal at some point. That feeling is acid reflux, which is your stomach acid pushing its way up into your esophagus where it doesn’t belong.
The lower esophageal sphincter (LES) is a bundle of muscles at the top of the stomach that open up to allow food to go down and then close to prevent acid from coming back up into the esophagus:
Sometimes the LES doesn’t do its job well and the acid comes up the wrong way, leading to acid reflux symptoms.
How Common Is Acid Reflux?
The American College of Gastroenterology states that more than 60 million Americans experience symptoms once a month and the worldwide prevalence of GERD, defined as at-least weekly heartburn and/or acid regurgitation, is thought to be between 10-20%.
That’s a serious problem!
Over time, acid reflux can lead to erosion of the esophagus.
My Personal Experience with Acid Reflux
After several months without an issue, I started to get a recurrence of my acid reflux symptoms about a month ago. I had visited an ENT not long before and found out that the nighttime coughing I had been experiencing was the result of acid reflux and not sinus issues, as I had believed. It was a reminder that I had to do more to manage my reflux if I was going to feel better.
As I usually do when I want to get more informed about my health or that of my clients, I did my research.
Typical Symptoms Of GERD
- acid reflux/heartburn
- burning pain in esophagus
- burning pain in throat
- acid taste in mouth
Symptoms You Might Not Have Associated With GERD
- sore throat
- lump in your throat
- frequent throat clearing
- sensation of post-nasal drip
- hoarse voice
For me, these less-typical symptoms have also been present in the past year or so and I didn’t associate them with GERD until my ENT Doctor recently pronounced my sinuses perfectly healthy through examination and CT scan.
Many people don’t realize that gastroesophageal reflux is a common cause of chronic coughing. Many people who suffer with a chronic cough but never have any digestive symptoms like heartburn won’t realize that they have acid reflux. So taking nutrition and lifestyle measures to treat GERD may help you in unexpected ways.
Nutrition Changes To Relieve GERD
The standard recommendation by National Institutes of Health and the American College of Gastroenterology is that patients with GERD reduce their intakes of chocolate, alcohol, citrus and tomato products, fat, coffee, tea, and large meals. Smoking is another risk factor so if you need another reason to quit, here it is.
While certain foods are not the cause of acid reflux, they can trigger the issue in susceptible people and make the condition worse once it’s started. It doesn’t mean that you have to give up these foods forever, but it’s a good idea to keep your intake in check to prevent a recurrence of symptoms.
Foods To Avoid
Caffeine is acidic and has been shown in research to decrease the pressure of the LES (remember those are the muscles that are supposed to keep the acid where it belongs!). I personally can’t tolerate coffee, but a cup or two of tea a day doesn’t trigger reflux symptoms for me.
Alcohol is very acidic and is a notorious LES loosener (so I guess it’s not just your tongue that loosens up when you drink!). Wine is one of the most acidic options, while tequila and vodka are a little better.
Fried & Fatty Foods
These foods cause the LES to relax, which allows stomach acid to back up into the esophagus. Most fried and fatty foods aren’t a great choice health-wise anyway, so they’re probably worth skipping most of the time.
And no, the same rule doesn’t apply to healthy fats like avocado or olive oil. Eating smaller amounts of fat at one time is probably helpful. Fat takes a longer time to digest than protein or carbs and the longer food is in the stomach the more likely it is to reflux back upwards.
Citrus fruits and Tomatoes
Limit your intake of lemons, oranges, and grapefruit, as well as tomatoes and their sauces. Highly acidic, these foods are more likely to cause a burning sensation.
Foods that are very spicy can irritate the stomach, so if you already know you have a reflux problem you might want to be more careful.
Not only are soft drinks full of sugar, but they’re also extremely acidic. Either citric (found in citrus fruits), carbonic, and/or phosphoric acid can be contained in these drinks, even those drinks that are labelled “Diet”. The carbonation itself (bubbles!) can cause digestive issues for some people.
Vinegar isn’t on the official “ban list” from most gastroenterologists, but it may be something to be wary of. A few “natural health gurus” advocate apple cider vinegar for just about everything. Most evidence points to vinegar (even apple cider vinegar!) being acidic and actually causing problems for people with GERD.
Not only is vinegar aciditic, but it also activates pepsin, a digestive enzyme that can damage the lining of the esophagus.
My personal favourite food is a bad choice for reflux so these days I try to minimize it when I’m having symptoms. It contains methylxanthine, a stimulant which loosens the LES and increases HCL production.
Although mint is generally considered good for digestion, it can irritate the esophagus and make acid reflux worse.
Garlic and Onions
Both garlic and onions can loosen the LES. Raw garlic and onions tend to be worse, but many people with acid reflux (myself included!) don’t tolerate cooked garlic or onions either.
Foods That May Help Acid Reflux
This is where most of your protein should be coming from. Choose chicken breasts, lean turkey, pork, fish, and cut down on processed meat and fatty cuts of meat, which can exacerbate your reflux symptoms.
Bananas, melons, papaya, guava, watermelon, cantaloupe and pears are good choices for acid reflux sufferers.
Oatmeal is high in fibre, which helps your digestion, and may help neutralize acid.
Although they’re not always an awesome choice for other people, whole grains or even plain, processed, dry crackers can be a good choice for “soaking up” some of the acid from the stomach in GERD sufferers.
Yes, the yolk is awesome and contains tons of nutrients, but if you have GERD it’s more likely to trigger symptoms. Have the occasional egg, but have egg whites more often.
This is a tricky one.
While dairy delays gastric emptying, and the longer the food is in your stomach the more likely it is to move back up the esophagus, dairy products can actually help to neutralize acidity. Whether dairy products are helpful or harmful depends on how YOUR body responds to it.
Pay attention to symptoms to see if dairy is right for you.
What Am I Supposed To Eat?!
I don’t blame you if you’re thinking that there aren’t many options left. There are, but if the foods you regularly eat fall into the “avoid” categories above then the first couple of weeks of following a GERD nutrition plan can be really hard.
Since you also want to make sure that you’re eating enough protein because it’s best for maintaining muscle and staying lean, eating to prevent acid reflux can be tricky.
Meal Ideas For Acid Reflux
It can be a struggle to put together healthy meals with adequate protein that are tolerable when my reflux symptoms are raging. I usually keep things simple for a few days until the burning sensation subsides and then gradually increase the variety of food that I’m eating as my symptoms improve.
Here are a few meal ideas for you to try:
One egg, egg whites, with mushrooms, avocado buckwheat toast and raw pea shoots
Chicken breast with roasted carrots and zucchini
Wild haddock with roasted carrots and coriander
Chicken breast with sweet potatoes, broccoli, parsley, and mushrooms
Egg whites with avocado quinoa toast and a banana
Salmon with herbs, roasted potatoes in olive oil, and broccoli
Oatmeal with macadamia nuts and blueberries in almond milk with whey protein
Remember, how you eat is as important as what you eat. Eat slowly, chew thoroughly, and take your time. Eating on the run, or having a meal and then running to catch the train to work, is going to make your reflux worse.
Lifestyle Changes For GERD
Lifestyle modifications are the first point of call for reducing symptoms. Although scientific evidence isn’t conclusive on how much nutrition and lifestyle changes can actually improve GERD, it’s worth making a few adjustments and seeing whether they help you. Everyone is different in their response to these changes.
Chewing gum after meals was shown in a study to reduce the amount of acid that refluxes up the esophagus. The study used a one hour period after meals to reduce acid.
Walk After Meals
Although it’s not always possible to walk after meals, it’s a good idea to do it after your larger meals. The same study that tested gum after eating also showed a slight (albeit small) decrease in acid reflux when walking for one hour after a meal.
Eat Smaller Meals Regularly
Although frequent meals don’t “stoke your metabolism” and get you lean, for GERD sufferers they can be helpful for reducing the pressure on the LES. Small, frequent meals are best because they’re less likely to release the LES.
Wear Loose Clothing
If you put pressure on your stomach area from the outside, in the form of tight and restrictive clothing, you can aggravate acid reflux.
So skip the Spanx or skintight jeans and wear more comfortable clothing most of the time.
Avoid Lying Down 2-3 Hours After Eating, Especially Before Bed
Lying down with a full stomach causes food to push up against the lower esophageal sphincter and can significantly up your chances of experiencing acid reflux. Those holiday post-meal naps can be particularly harmful for GERD sufferers. Extra food in the lying position means that acid is more likely to get pushed up.
Obesity is a known risk factor for GERD. This association is not causal, so it doesn’t mean that everyone who is obese has GERD or that everyone with GERD is obese. Many behaviours associated with obesity, however, like overeating, eating large quantities of food, and eating fried and fatty foods, can exacerbate the symptoms of GERD.
That stereotypical beer-bellied guy IS more likely to suffer from reflux, partly because of what he eats and also because of how much he eats. The tools you use to lose weight will help you with GERD. Both obesity and GERD can cause sleep disturbances so treating both root causes can improve your sleep.
Elevate The Head Of Your Bed
Having your body in a slightly inclined position while you’re sleeping makes it more difficult. Putting 4×4 blocks at the head of your bed is recommended, or just find something (I’ve been using a large pillow underneath the top of my mattress) that will elevate the upper part of your bed a bit.
Don’t try to cheat with a big pillow right under your head. The angle won’t be better for your stomach and you’ll probably just end up with a sore neck!
Exercise Guidelines For Acid Reflux
Avoid High-Impact Activities
While exercise is usually helpful for reflux symptoms, certain kinds of exercise can actually make your symptoms worse. Any high-impact exercise (like running, skipping, jumping, plyometrics) can force acid upwards through the esophagus. Imagine holding a glass of almost-full water while doing your activity and think about your stomach acid splashing up the same way.
When my GERD was at it’s worst in my 20s when I was an international karate competitor, I had to leave many sparring classes because of terrible stomach pains. I finished a couple of karate tournaments feeling like I was going to throw up.
Weight Training Guidelines
Even weight training, which I rely on as the mainstay of my program, can be a challenge for GERD. Bentover positions put the stomach in a disadvantageous position and the intra abdominal pressure created from heavier lifts can be stressful. Do your exercises in a standing or seated position and breath slowly and carefully to avoid putting excess pressure on the stomach.
That’s not to say that you need to give up your favourite high impact activities, but when your symptoms are starting to appear it’s best to change your workout to prevent more serious development.
Walk, rather than jog or run. As much as I enjoy my HIIT, skipping, and sprint training, I know it’s not helpful for my reflux symptoms when they’re playing up.
Stress Management With Meditation
The most ignored method of treatment can make a huge difference, but because it’s so difficult to define progress. We all have stress in our lives, but it effect everyone differently. A simple 5-Minute Meditation routine can be a good way to start your stress reduction practice. You can increase your time as you get more committed to the practice.
Acid Reflux Treatments That May Work
PPIs (Proton Pump Inhibitors)
PPIs are the standard medical treatment for acid reflux and GERD. They work by reducing the amount of acid in the stomach and tightening the LES. Unfortunately, they don’t work for everyone and long-term use may have side effects.
I’ve used this traditional Chinese modality in conjunction with chiropractic treatment to good effect over the years. Although the scientific evidence for acupuncture for acid reflux isn’t completely convincing, I think the relaxation that I experience during treatment contributes to its effectiveness.
Do What You Can To Help Yourself…And Get Medical Help, If Necessary
Remember, I’m not a doctor. I’m a nutrition and lifestyle coach and I’ve suffered from GERD for twenty years. Although I’m not not qualified to diagnosis and treat any illness, if you’ve been diagnosed with GERD or just have acid reflux issues that you’d like to relieve, these guidelines are likely to follow what you’ll hear from most Gastroenterologists and ENT specialists.
Living With GERD
I’m not going to have a life without chocolate and a cup or two of tea. I’m just not. But when my symptoms are bad I know that I’m overdoing it.
A couple of pieces of chocolate may be ok, if you’ve been following the nutritional guidelines for a while and your symptoms have resolved. The occasional glass of wine when you’ve been symptom-free for a while, is probably not going to hurt you. As with all of life, it’s about finding the right balance between enjoying the foods/drinks you love and the effect they have on your body.
Acid reflux can have a big effect on your enjoyment of life and it doesn’t pay to ignore the symptoms. When you manage reflux effectively, you’ll feel a lot better. And that’s what true health is about.