Episode 115 – Nutrition for Reflux

Key Topics Covered

GERD Reflux Mechanism

 

For some background, it’s important to explore the physiological mechanisms of reflux.

Normally, the lower esophageal sphincter (which is between the esophagus and the stomach), allows food into the stomach, then closes and prevents stomach acid from coming back up.

With reflux, there are two main variables: 

1) Excessive stomach acid AND/OR

2) Issues with the action of the lower esophageal sphincter.

For the management of reflux, we can focus on many things from a nutrition point of view, which are explored below.

Lists of Foods to Avoid

  • There is no comprehensive list or approach that is research-backed. 
  • A research review looking at this specifically found way more evidence for other dietary manipulations than it did for elimination-style diets. 
  • It is worth trialing limiting the below options, for theoretical reasons and anecdotal evidence: 
    • Citrus fruits.
    • Carbonated beverages.
    • Caffeine.
    • Alcohol.
    • Chocolate.
    • Peppermint. 
    • Garlic and onion. 
    • Spicy foods. 
    • High-fat foods (although “healthy fats” appear to often be tolerated better).

Weight Loss 

Scale weight

  • Excess weight, especially around the abdomen, can increase the pressure on the stomach, leading to a higher likelihood of acid reflux
  • It could also weaken the lower esophageal sphincter.
  • A study looking at this topic found that when overweight/obese participants lost an average of 13kg, there were significant improvements in symptoms on average:
    • 81% of participants had reductions in symptoms. 
    • 65% of participants had complete resolution of symptoms. 
    • There was a significant correlation between total weight loss and reduction in symptoms

Fibre 

  • Fibre is linked with reductions in reflux.
  • One simple explanation is that higher fibre diets are typically lower in things like saturated fat and calories. 
  • But a more interesting one is that fibre helps with motility in the digestive tract. Improved motility typically helps reduce reflux
  • In one study, participants that had a baseline fibre intake of <20g per day were selected. The only intervention was to add 5g of psyllium husk per day. This led to a reduction in the prevalence of heartburn from 93.3% down to 40%. 
  • That is an easy intervention. To have such a large impact from something so small is impressive. 

Meal Frequency, Timing and Rate of Eating

  • Eating smaller, more frequent meals can help reduce the risk of reflux. 
  • This reduces how full the stomach is after eating, reducing the amount of pressure on the lower oesophageal sphincter. 
  • It is also beneficial to stay upright after eating. Laying down makes it easier for acid to travel up the esophagus. 
  • This means you probably want a gap between eating and going to bed. Elevating your pillow 6-8 inches also can help. 

Antacids and Other Medications

Gaviscon medication

  • One over-the-counter option in Australia is Gaviscon. This antacid basically puts a protective lining at the top of your stomach acid. It also has minimal downside for most people. 
  • Outside of that there are a bunch of medications such as PPIs.  
  • While medications are outside of our scope, they are worth considering if you can’t address this with lifestyle. Beyond discomfort, there are clear downsides to unmanaged reflux. 

Summary 

Overall managing/reducing reflux could include:

  • Using certain medications.
  • Reducing body weight if it is high.
  • Reducing intake of certain foods including spicy, high-fat foods and alcohol.
  • Having smaller more frequent meals, staying upright when you eat and not eating too close to going to bed.
  • Increasing fibre intake, particularly if it is low.

Relevant Links / Resources

Blog Posts 

Studies Mentioned