Food Therapy for Acid Reflux
Acid reflux, commonly known as heartburn, is the process in which acid from the stomach refluxes up into the esophagus. Occasional reflux is common, but it is estimated that 1/3 of the population suffers from chronic reflux, also known as gastroesophageal reflux disease or GERD (1). The reason this is a large health concern is because the lining of the esophagus is not designed to tolerate stomach acid, therefore it can become damaged and lead to strictures, Barrett's esophagus, and esophageal cancer (1). In addition, GERD can be very painful and undermine a person's quality of life. While frequent heartburn is the most common warning sign of GERD, some people have less common symptoms and are unaware of the damage the refluxing acid is doing to their esophagus. Less common symptoms include:
Belching
Difficulty or pain when swallowing
Waterbrash (sudden excess of saliva)
Dysphagia (the sensation of food sticking in the esophagus)
Chronic sore throat
Laryngitis
Inflammation of the gums
Erosion of the enamel of the teeth
Chronic irritation in the throat
Hoarseness in the morning
A sour taste
Bad breath
The first line of defense by most primary care physicians is to prescribe a very effective medication called a proton pump inhibitor (PPI), common brand names include Prilosec, Prevacid, Nexium, and Zegrid. These medications are also available over the counter and can be taken without the supervision of physician. Long term use of PPI's have been associated with loss of bone density, increased risk of fracture, low magnesium, iron deficiency, vitamin B12 deficiency, increased pneumonia risk, increased risk of food born illness infections, kidney disease, myocardial infarction, and dementia (2). PPI's are best used for shorter periods of time when all diet and lifestyle strategies have been exhausted, not as a bandage to cover up bad habits.
To limit the amount of medication needed to treat acid reflux, diet and lifestyle are the most effective treatments. The cause of most acid reflux is a weakening of the valve (lower esophageal sphincter or LES) that separates the esophagus from the stomach. The goal of diet and lifestyle is to reduce stress on that valve so it can do it's job of letting food through without letting acid back up. Another goal is to eat food that is easily digested and avoid foods that increase the demand for stomach acid production.
What to do:
Eat small frequent meals to avoid over stretching the stomach and LES.
Choose low fat foods. Fat requires more stomach acid and takes longer to digest.
Eat slowly and chew thoroughly. There are enzymes in your saliva that help break food down before it gets to your stomach, therefore needing less stomach acid for digestion.
Try drinking beverages between meals, instead of with meals, to reduce volume and stretching of the stomach during a meal.
Stop eating at least 3 hours before going to bed or lying down.
Elevate the head of the bed and try lying on your left side while sleeping or resting.
If overweight, weight loss can help relieve pressure on the stomach and LES.
What NOT to do:
Don't eat large meals.
Avoid high fat or fried foods.
Avoid drinking alcohol, carbonated, and caffeinated beverages.
Avoid certain foods that may irritate the LES and increase acid production: chocolate, mints, garlic, onion, cinnamon, tomato products, citrus fruit or juice, red or black pepper, and spicy foods.
Do not smoke.
Avoid NSAID medications (Aspirin, Ibuprofen, and Naproxen Sodium are most common).
There are also some specific foods that have been recognized to help with digestion and reduced acid production. There are no large bodies of research to support the effectiveness of these specific foods, but they are all healthy food choices filled with vitamins and minerals so if they don't help your reflux, they will certainly help your overall health.
Fresh papaya, pineapple, mango, kiwi, and avocado all have specific enzymes that have been linked with reducing stomach acid. If any of these foods are canned or cooked in any way, the enzymes will be killed and no longer effective.
Fresh apples are an alkaline fruit which may help with reducing the stomach's pH level. More importantly, apples are high in a fiber called pectin that has been associated with increased digestion. Cooking or canning of apples does reduce their beneficial effect.
Bananas, melon, ginger, green vegetables, and fennel or fennel seeds all have homeopathic claims to improve digestion and ease acid reflux.
Low fat yogurt contains active probiotics that can provide healthy bacteria to the gut for improved digestion. Taking a probiotic supplement is also an option, but why miss out on the tasty high quality protein and calcium the yogurt also has to offer?
Sample day menu that may ease daily heartburn:
Breakfast: 1 slice of whole grain toast topped with avocado and a poached egg
Mid-morning snack: 1/2 cup of low fat yogurt topped with fresh papaya, pineapple, mango, kiwi, or banana slices
Lunch: Fresh green salad with chopped fennel and 3 ounces grilled chicken
Mid-afternoon snack: Fresh apple slices and peanut butter
Dinner: 4 ounces baked fish, small baked sweet potato, and steamed green beans
Evening: 1 cup of decaf ginger tea
(1) https://www.aboutgerd.org/what-is-gerd/prevalence.html
(2) Brisebois S, Merati A, Giliberto JP. Proton pump inhibitors: Review of reported risks and controversies. Laryngoscope Investig Otolaryngol. 2018;3(6):457–462. Published 2018 Oct 19. doi:10.1002/lio2.187