Nutrition and reflux – The Food Medic

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September 26, 2022

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This article was written by registered dietitian – Maeve Hanan

What is reflux?

Reflux goes by many names, including:

Heartburn
Acid reflux
Gastro-oesophageal reflux disease (GORD or GERD)
Indigestion (although this can be just one symptom if indigestion)

This occurs when stomach acid moves up into your oesophagus leading to a burning sensation in the chest and/or throat and often a sour or bitter taste in the mouth. This is often related to issues with the functioning of the lower oesophageal sphincter (LOS), which should prevent stomach contents from moving back into the oesophagus.

Over time this can lead to inflammation or damage to the oesophagus and is a risk factor for oesophageal cancer (1).

Reflux can impact all ages, from babies to older adults. There isn’t always a clear cause for this, although it can be impacted by a variety of factors.

Certain medications like antacids or proton pump inhibitors (PPIs) can be advised for the management of reflux. Food and lifestyle changes can also play an important role which is what we will cover in this article.

Trigger food and drinks

Many people notice that particular foods or drinks can trigger reflux for them.

Common reflux triggers include (2, 3, 4, 5):

spice
mint
citrus foods like oranges and tomatoes
salty food
chocolate
coffee
alcohol
fatty or greasy food
meat
fizzy drinks

A few studies have found that certain types of FODMAPs found in food may be a reflux trigger (6, 7). FODMAPs are a group of carbohydrates that are poorly digested and are linked with gut and IBS symptoms. High FODMAP foods include: wheat, dairy, beans, peas, onion, garlic, cashews, pistachios, cauliflower, mushrooms, apples, pears, dried fruit and sugar alcohol sweeteners. You can find out more information about high and low FODMAP foods here. Important: a low FODMAP diet should only be undertaken with support from a FODMAP-trained Dietitian.

However, evidence is very limited related to FODMAPs and reflux overall. A 4-week study from 2021 that compared a low FODMAP diet to usual reflux dietary advice, such as a lower fat intake and raising the head in bed, found no significant difference between groups as both approaches had a similar but small beneficial effect (8).

Plant-based diets, Mediterranean diets, and lower-carbohydrate diets have been linked with reduced reflux risk (2, 3).

As this can be very individual, it can be helpful to keep a food and symptom diary to help identify possible triggers. A Registered Dietitian can support you with this.

Eating pattern and habits

How and when food is eaten can have a significant impact on reflux symptoms.

The following eating patterns have been linked with increased reflux (2, 9):

skipping breakfast
eating a large meal in the evening (rather than smaller, more regular meals and snacks)
a gap of less than three hours between dinner and bedtime

The fact that irregular eating is associated with reflux may be related to consuming a larger amount in one go, which could lead to a higher intake of trigger foods and the overall volume could put pressure on the lower oesophageal sphincter.

For example, in a small study which compared 3 x 600ml liquid meals for breakfast, lunch, and dinner compared with 300ml 6 times per day (3 meals and 3 snacks) the larger meal size led to more reflux which lasted a longer time (10).

Eating a meal close to bedtime may also be impacted by positioning, as lying or bending after eating has been seen to worsen reflux, whereas raising the head in bed by 20cm is associated with reduced reflux (2, 11).

Eating habits such as eating quickly and beyond comfortable fullness are also known reflux triggers (2).

Other contributing factors

Many factors beyond nutrition impact reflux risk.

The following have been associated with an increased risk of reflux (12, 13, 14):

medical issues such as having a hiatus hernia or a weakened sphincter muscle between the oesophagus and stomach
being pregnant – due to increased pressure from the baby and hormonal changes
having a higher body weight
taking certain medication like NSAIDS [e.g.ibuprofen]

Certain lifestyle factors are also linked with a higher likelihood of reflux, such as (2):

smoking
high stress levels
lack of sleep
low quality sleep
wearing tight clothes
a low level of movement – whereas being active for at least 30 minutes at least 3 times per week may reduce reflux risk

Nutrition advice for reflux

Taking all of the this into account, nutrition advice for managing and reducing reflux includes:

establishing a regular meal pattern that includes 3 meals and a few snacks in the day (rather than fewer, larger meals)
not skipping breakfast
trying not to eat a large meal within a few hours of bed time
eating slowly
eating to a level of comfortable fullness, most of the time
identifying and limiting individual trigger food and drinks – keeping a food and symptom diary may help with this
consuming an overall balanced and varied diet

Lifestyle changes may also be helpful, such as:

avoiding or quitting smoking
not wearing clothes that are too tight around the stomach
raising the head in bed by 10-20cm i.e. using an extra pillow or putting this under the mattress
regular movement
stress management
sleep hygiene

Important: Please speak with your doctor if you are struggling to control reflux, especially if you struggle with this most days, if you need to rely on antacids regularly, or if you are being sick, unintentionally losing weight or getting food getting stuck in your throat.

References

NHS Website (2020) “Oesophageal Cancer” [accessed August 2022 via: https://www.nhs.uk/conditions/oesophageal-cancer/causes/]
Zhang, M., Hou, Z. K., Huang, Z. B., Chen, X. L., & Liu, F. B. (2021). Dietary and lifestyle factors related to gastroesophageal reflux disease: a systematic review. Therapeutics and Clinical Risk Management, 17, 305. [accessed August 2022 via: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055252/]
Surdea-Blaga, T., Negrutiu, D. E., Palage, M., & Dumitrascu, D. L. (2019). Food and gastroesophageal reflux disease. Current medicinal chemistry, 26(19), 3497-3511. [accessed August 2022 via: https://pubmed.ncbi.nlm.nih.gov/28521699/]
Newberry, C., & Lynch, K. (2019). The role of diet in the development and management of gastroesophageal reflux disease: why we feel the burn. Journal of thoracic disease, 11(Suppl 12), S1594. [accessed August 2022 via: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6702398/]
Heidarzadeh-Esfahani, N., Soleimani, D., Hajiahmadi, S., Moradi, S., Heidarzadeh, N., & Nachvak, S. M. (2021). Dietary Intake in Relation to the Risk of Reflux Disease: A Systematic Review. Preventive Nutrition and Food Science, 26(4), 367. [accessed August 2022 via: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8747955/]
Plaidum, S., Patcharatrakul, T., Promjampa, W., & Gonlachanvit, S. (2022). The Effect of Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAP) Meals on Transient Lower Esophageal Relaxations (TLESR) in Gastroesophageal Reflux Disease (GERD) Patients with Overlapping Irritable Bowel Syndrome (IBS). Nutrients, 14(9), 1755. [accessed August 2022 via: https://pubmed.ncbi.nlm.nih.gov/35565722/]
Geysen, H., Gielis, E., Deloose, E., Vanuytsel, T., Tack, J., Biesiekierski, J. R., & Pauwels, A. (2020). Acute administration of fructans increases the number of transient lower esophageal sphincter relaxations in healthy volunteers. Neurogastroenterology & Motility, 32(1), e13727. [accessed August 2022 via: https://pubmed.ncbi.nlm.nih.gov/31633262/]
Rivière, P., Vauquelin, B., Rolland, E., Melchior, C., Roman, S., Bruley des Varannes, S., … & Zerbib, F. (2021). Low FODMAPs diet or usual dietary advice for the treatment of refractory gastroesophageal reflux disease: An open labeled randomized trial. Neurogastroenterology & Motility, 33(9), e14181. [accessed August 2022 via: https://pubmed.ncbi.nlm.nih.gov/34051134]
Jarosz, M., & Taraszewska, A. (2014). Risk factors for gastroesophageal reflux disease–the role of diet. Gastroenterology Review/Przegląd Gastroenterologiczny, 9(5), 297-301. [accessed August 2022 via: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4223119/]
Wu, K. L., Rayner, C. K., Chuah, S. K., Chiu, Y. C., Chiu, K. W., Hu, T. H., & Chiu, C. T. (2014). Effect of liquid meals with different volumes on gastroesophageal reflux disease. Journal of Gastroenterology and Hepatology, 29(3), 469-473. [accessed August 2022 via: https://pubmed.ncbi.nlm.nih.gov/24712047/]
Khan, B. A., Sodhi, J. S., Zargar, S. A., Javid, G., Yattoo, G. N., Shah, A., … & Khan, M. A. (2012). Effect of bed head elevation during sleep in symptomatic patients of nocturnal gastroesophageal reflux. Journal of gastroenterology and hepatology, 27(6), 1078-1082. [accessed August 2022 via: https://pubmed.ncbi.nlm.nih.gov/22098332/]
NHS Website (2020) “Heartburn and acid reflux” [accessed August 2022 via: https://www.nhs.uk/conditions/heartburn-and-acid-reflux/]
Valezi, A. C., Herbella, F. A., Schlottmann, F., & Patti, M. G. (2018). Gastroesophageal reflux disease in obese patients. Journal of laparoendoscopic & advanced surgical techniques, 28(8), 949-952. [accessed August 2022 via: https://pubmed.ncbi.nlm.nih.gov/30004267/]
Corley, D. A., & Kubo, A. (2006). Body mass index and gastroesophageal reflux disease: a systematic review and meta-analysis. Official journal of the American College of Gastroenterology| ACG, 101(11), 2619-2628. [accessed August 2022 via: https://www.researchgate.net/publication/6838247_Body_Mass_Index_and_Gastroesophageal_Reflux_Disease_A_Systematic_Review_and_Meta-Analysis]