Blog Post

Nutrition Strategies for Addressing Reflux

GERD Reflux Mechanism

Gastroesophageal reflux disease (GORD or GERD) is a condition where stomach acid comes back up your oesophagus. This can irritate the lining of the oesophagus and result in other symptoms such as heartburn.

There are many dietary and lifestyle approaches that can be implemented to reduce the likelihood of reflux occurring.

Mechanism

Reflux Mechanism

Typically, the lower oesophageal sphincter opens to allow food to pass through and then closes tightly to prevent stomach acid from flowing back up.

If the sphincter relaxes, food can push upwards through this opening and cause acid reflux.

Two main variables involved in GERD are:

  • The amount of stomach acid produced.
  • The action of the lower oesophageal sphincter.

The types and quantities of foods we eat can influence both.

Foods to Avoid

List of Foods to Avoid with GERD
Image Credit to Integris Health

One complex thing about reflux is that there is no consistent, comprehensive list of foods to avoid that has a high likelihood of helping significantly.

A review looking at all of the research on GERD found that there was a lot more evidence for other dietary manipulations than there was for elimination-style diets.

Although there is no comprehensive list, there are common themes that have been shown to be effective.

It is worth trialling limiting the below foods. These foods have been chosen due to a combination of theoretical reasons, anecdotal evidence and research-based evidence.

  • Citrus fruits
  • Carbonated beverages
  • Caffeine
  • Alcohol
  • Chocolate
  • Peppermint
  • High-fat foods (although “healthy fats” appear to often be tolerated better)
  • Garlic and onion
  • Spicy foods

That is not a comprehensive list. But it does represent common themes that people often find effective.

Weight Loss

Excess weight, especially around the abdomen, can increase the pressure on the stomach, leading to a higher likelihood of acid reflux.

Additionally, fat tissue may affect the function of the lower oesophageal sphincter. When this sphincter is weakened or compromised, reflux is more likely to occur.

Losing weight can help reduce the pressure on the stomach and improve the function of the LES, thereby reducing the frequency and severity of reflux episodes.

A study looking at this topic found that when overweight/obese participants (based on BMI) lost an average of 13kg, there were significant improvements in symptoms on average:

  • 81% of participants had reductions in GERD symptoms.
  • 65% of participants had complete resolution of symptoms.
  • There was a significant correlation between total weight loss and reduction in GERD symptoms.

Fibre

Fibre Types

Higher fibre intakes are linked with reductions in GERD symptoms.

There are multiple explanations for this.

One simple one is that higher-fibre diets are usually lower in calories and saturated fat, which should result in lower rates of reflux.

Beyond that, fibre is involved in motility throughout the digestive tract. Improved motility typically leads to reductions in acid reflux.

Research clearly supports the idea of increasing fibre intake helps to reduce symptoms of GERD.

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 GERD from 93.3% down to 40%.

That is an easy intervention. To have such a large impact from something so small is impressive.

Beyond supplements though, it is worth adding in plenty of fruits (non-citrus, if that is a trigger), vegetables, wholegrains, nuts and seeds.

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 oesophagus.

This means that you likely do not want to eat too close to when you go to bed. The combination of the increased stomach acid from digestion and the lying down position is a big contributor to reflux.

Leaving at least 2-3 hours between dinner and bedtime is a good idea.

If you still get reflux while laying down regardless, raising the pillow height by 6-8 inches can help.

And finally, eating slower can help reduce the risk of reflux. This allows for better digestion of food and reduces the amount of food within the stomach at any given moment.

Antacids and Other Medications

Over-the-counter options such as Gaviscon (in Australia) can also be helpful for managing reflux.

There is a video below showing how it works.

Some of these options appear to have minimal downsides, for most people.

Stronger antacids and other options such as proton-pump inhibitors can be more effective but also can have more downsides.

Proton-pump inhibitors (such as Nexium) are linked with B12 deficiency. If you were to take an option like that, it is worth exploring these side effects and making an informed decision.

There are plenty of medications available. This article is focused on nutrition, but it is worth exploring all options.

Summary

There are a lot of approaches to managing reflux with nutrition. It is not guaranteed that these approaches will solve symptoms completely. Significant improvements in symptoms are often seen though. The following approaches can often help:

  • Limiting trigger foods.
  • Losing excess weight, if relevant.
  • Eating a fibre-rich diet.
  • Focusing on small, frequent meals, rather than large, infrequent ones.
  • Slowing down your rate of eating.
  • Remaining upright after eating.
By Aidan Muir

Aidan is a Brisbane based dietitian who prides himself on staying up-to-date with evidence-based approaches to dietetic intervention. He has long been interested in all things nutrition, particularly the effects of different dietary approaches on body composition and sports performance. Due to this passion, he has built up an extensive knowledge base and experience in multiple areas of nutrition and is able to help clients with a variety of conditions. One of Aidan’s main strengths is his ability to adapt plans based on the client's desires. By having such a thorough understanding of optimal nutrition for different situations he is able to develop detailed meal plans and guidance for clients that can contribute to improving the clients overall quality of life and performance. He offers services both in-person and online.