Episode 115 Transcript – Nutrition for Reflux

Leah:

Hello and welcome to the Ideal Nutrition podcast. I’m Leah Heigl and I’m here with my co -host Aidan Muir and today’s episode will be all about nutrition for reflux. So let’s start by talking about the physiological mechanisms of reflux just to set a little bit of background. Normally the lower esophageal sphincter, which is in between the esophagus and the stomach, allows food into the stomach but then closes and prevents that and stomach acid from coming up back through the esophagus. But with reflux, there are two main variables we’re looking at.

So one is excessive stomach acid, and that’s coming up through the sphincter and causing that reflux or issues with the action of the lower esophageal sphincter itself also allowing that stomach acid to come up. For the management of reflux, we can focus on several things from a nutrition point of view, and we’ll go through all of those one by one.

Aidan:

So the first one that a lot of people will be looking at is what foods they should avoid. And one of the things that sucks about the research on reflux is that there is no comprehensive list of things to avoid or consume or anything like that. Like when we’re looking at other areas such as food intolerance, intolerances in relation to like IBS, like we can see stuff like the low FODMAP diet works 50 to 80 % of the time. Like there’s, there’s kind of things like that, but with reflux, there isn’t anything like that.

A research review that did look at this topic specifically found way more evidence for other dietary manipulations, which we’ll also talk about, in comparison to what they found for elimination style diets. But even though that’s kind of what the evidence shows, this not super like it’s not like this has been a very well studied area in terms of elimination style diets in relation to this. And there are a few trials, a few things that are worth trialing or trialing to limit for theoretical reasons and also anecdotal evidence.

And then there is some also research back to stuff that I’ll talk through, but quickly listing some stuff of things that are commonly recommended to be limited. You’ve got citrus fruits, carbonated beverages, caffeine, alcohol, chocolate, peppermint, garlic and onion, spicy foods and high fat foods, although anecdotally healthy fats, quote unquote, often appear to be better tolerated.

Touching on this just for one more second, when I say that kind of research -backed things, although we don’t have like research where it’s like, get me a group of people with reflux and eliminate all these foods and then show that reflux disappears, there are some hints and some things that we can learn.

For example, when we look at research on peppermint oil for people with IBS, one of the most common reasons people drop out of those studies is because they have a side effect of reflux. And therefore it can be common sense to be like, if you have reflux, maybe it’s worth trialing, limiting peppermint if you’re having that regularly. And a lot of these things are stuff like that, where we can kind of take clues from other areas and be like, maybe it’s worth trialing that. And if there’s no difference, you can just add it back in.

Leah:

Perfect. The next topic we’re going to discuss is weight loss. So excess weight, especially the weight around the abdomen can increase the pressure on the stomach, leading to a higher likelihood of acid reflux. It can also weaken the lower esophageal sphincter. So thinking back to the mechanisms, one of the mechanisms for having reflux is issues with the esophageal sphincter. And when you are a higher body weight, having more abdominal fat, there is a potential that that is weakened and then that’s what’s leading to it.

A study looking at this topic found that when overweight or obese or and obese participants lost an average of around 13 kilos, there were significant improvements in symptoms on average. So looking at specific numbers, 81 % of participants had reductions in symptoms. 81%, that’s huge.

And I think what is a better giveaway here is 65 % of the participants in this study had a complete resolution of symptoms. So it’s definitely not insignificant. That’s a really, there’s a really significant numbers. There is clearly a correlation between weight loss in overweight individuals and reduction in acid reflux.

Aidan:

And it’s, it’s a very strong correlation and it’s not a perfect correlation as you can imagine too. There are lean individuals who have reflux as well. And there are also people who are not lean, but when they previously were lean, they had the same symptoms of reflux at the same levels and everything like that. But that’s why I still go back to that point of, or the point you made about how 81 % of participants had reductions in symptoms.

One thing to consider with that study as well is it was an average of 13 kilos weight loss and there could be certain people who lost a decent amount of weight who had no reduction in their symptoms, which was the point I was going to make, but another factor in this as well is, although there was an average of that amount of weight loss, there was a lot of people who also lost significantly less than that, and that can also be another factor in why they didn’t have symptoms. But I still keep an open mind in terms of if there is excess weight to lose, there is a high likelihood that it will help with symptoms. It might not resolve it, it might not even be a meaningful improvement, but in a lot of cases it likely will be a meaningful improvement.

Another interesting topic with reflux is fibre. So higher fibre diets are linked with reductions in reflux. When I first came across this research, I thought it was a bit of a red herring in a way, and that it actually had nothing to do with the fiber, it had everything to do with everything else. A simple explanation of what I’m saying there is that high fiber diets are typically lower in things like saturated fat and calories, and they’re likely lower in a lot of those other trigger foods. Like somebody who has a high fiber diet is less likely to be consuming heaps of high fat foods or heaps of alcohol, for example. Because they have a high fiber diet, they might be more likely to be in a calorie deficit or consuming fewer calories overall, so they might be having a lower body weight, and that could play a factor.

And I do think that is a factor, but it’s not the only factor because another thing that is an aspect as to why fiber matters for this is that fiber helps with motility in the digestive tract, which is basically how quickly food moves through the entire system and improved motility typically helps reflux because you could obviously think that’s going to be, like the food is going to be in the stomach for less long, so it’s less likely to be leading to this buildup of stomach acid.

One key study that is way more impressive than I’ve made it sound so far is that they got a group of participants who had quite low fiber intakes. So less than 20 grams per day. Although I say that’s quite low, I would say the average population level data is below 20 grams of fiber per day. It’s just that we should theoretically be aiming for significantly more. So they got people with baseline fiber intake of less than 20 grams per day. And the only intervention, the only thing they changed was they added five grams of psyllium husk per day, which is a form of fiber. It’s a specific form of soluble fiber, but this single addition of five grams of psyllium husk, which is not a massive amount, led to a reduction in the prevalence of heartburn. So not specifically reflux, but this is a symptom of reflux, led to a reduction in the prevalence of heartburn from 93 .3 % down to 40%. It’s a huge difference. Such a small intervention.

So massive from such a small intervention and it raises more questions than answers as well. Like the answer is obviously like adding five is probably a good thing. But the questions it raises is like, what if you added 10 grams instead of five? What if you did that through Whole Foods instead of psyllium husk? Like there’s so many more questions that come alongside that. But I point to that specific study because it just stands out so much. And it’s like, if we can get such a huge difference from one small thing, how many other potential easy wins are there out there for reflux as well?

Leah:

One of the last things we’re going to touch on from a nutrition perspective is looking at meal frequency, timing, and rate of eating. So we do know that eating smaller, more frequent meals can reduce the risk of reflux. This is because it reduces how full the stomach is after eating. So we have an overall reduction or smaller amount of pressure on the esophageal sphincter, potentially less stomach acid in the system at any one time. So less chance of reflux occurring.

It is also beneficial to stay upright after eating. So that’s a really common suggestion for people with reflux is to basically don’t lay down after eating because laying down can make it easier for acid to travel up the esophagus. This means you probably want a gap between eating and going to bed. So if you have a very large dinner and then you’re going to bed right away, you definitely have a higher chance of having acid reflux as opposed to if you left a couple of hours between having a meal and going to bed.

Another option is also elevating your pillow six to eight inches and that can help as well. Yeah, I’ve recommended that a few times and have had clients do that and always surprises me when people do that. But it’s like, this is the pillow thing. Yeah. Yeah. It’s also like, this is how important solving this reflux is. Like, yeah, it would be uncomfortable for sure. Yeah. Cause you’ve slept one way for however many years of your life. Yeah. I don’t know. But like it also has worked quite effectively as well.

Aidan:

So the next one we’re going to talk about is antacids and other medications. So this is obviously outside of the nutrition space, but I just wanted to touch on it very briefly. One reason for touching on it is because there’s an over -the -counter option in Australia called Gaviscon. And this is an antacid which basically puts a protective lining at the top of your stomach acid, which is something that prevents it from coming back up.

It has minimal downside for most people from everything I’ve seen. Obviously, I encourage speaking to your doctor and everything like that to confirm that, to confirm it’s safe for you to use, et cetera. But I’d like to start with that because to the best of my knowledge, it has minimal downside for most people and it can dramatically help improve symptoms.

Outside of that, there are a bunch of prescription medications which you might want to speak to your doctor about, such as proton pump inhibitors. Once you’re looking at those prescription ones like every medication often comes alongside some form of downside and that’s obviously worth being aware of weighing up the pros and cons and everything like that. But although this stuff is outside of scope and why I’m like, hey, you still should probably have a chat to your doctor is beyond the discomfort of reflux. There are also clear downsides to unmanaged reflux as well.

Barrett’s esophagus, I believe, is one thing that could occur just due to the burning of the cells of your throat while you have this unmanaged reflux. So even if you did come across a medication that might have some side effects or anything like that, it’s worth weighing up the pros and cons because if you didn’t manage to reflux, whether that’s through nutrition, lifestyle, medication, whatever it takes to kind of get it done, there are still downsides of it occurring beyond the discomfort.

Leah

So a little bit of summary on these kinds of things for reflux that you can do to manage it is of course, like you just said, using certain medications or things like Gaviscon, but also reducing body weight if it is high, reducing intake of certain foods, including things like spicy, high fat foods and alcohol. Obviously that’s going to be on an individual basis, but potentially looking at that list.

And also increasing fiber intake, particularly if it is low, so like that under 20 gram per day mark, and maybe even utilizing the same intervention as that study of that five grams of Cillian husk can be a really easy win.

Aidan

This has been episode 115. We really do appreciate when you guys leave reviews. It is a massive help for the podcast. It boosts up the rankings. We get more listens and everything like that when people do that. And hopefully we can try and spread our good nutrition messages to more people. So if you haven’t already and you would like to leave a rating review, we would massively appreciate it.