For some, it’s a harbinger of middle age; for others, it’s the hallmark of the later weeks of pregnancy. At some point, though, almost everyone will experience acid reflux.
With symptoms including heartburn, sour stomach, and indigestion, this burning, churning condition likely conjures up images of late-night trips to the medicine cabinet for relief. Typically episodic, acid reflux can become chronic and develop into gastroesophageal reflux disease — better known as GERD. Though they’re often confused, acid reflux is a symptom of GERD.
“Acid reflux is to GERD as bloating is to IBS,” explains licensed functional nutritionist Jesse Haas, CNS, LN. “It’s a major symptom, but it’s not the whole picture.”
Other GERD symptoms include difficulty swallowing, nausea, regurgitation, chest pain, bloating, and even the wearing away of tooth enamel.
GERD may also involve laryngopharyngeal reflux, or “silent reflux.” (Some healthcare providers consider this a separate condition, while others view it as an additional symptom of GERD.) In these cases, stomach acid travels through the esophagus and into the throat, so instead of indigestion, sufferers typically present with a hoarse voice and a sore throat.
Between 18 and 28 percent of Americans suffer from GERD, and millions routinely treat it with over-the-counter or prescription medications, including antacids, H2 blockers, and proton pump inhibitors (PPIs).
Yet, for lasting relief, a growing number of nutritionists and holistic-health practitioners are recommending starting in the kitchen rather than the medicine cabinet. “There’s a huge mind–body connection to GERD,” said Haas, who takes a food-first approach with her clients. “The question is, how do I help the stomach function more appropriately?”
Look Under the Hood
GERD is a “mechanical” problem, explains Haas. “The issue is more about the stomach not being able to contain the acid it’s producing, when it should be really well contained — there is laxity in the lower esophageal sphincter.”
Here’s where the image of a pregnant belly makes sense for understanding reflux: The growing baby pushes up on the stomach, forcing the sphincter to open and relax, spilling stomach acid back up into the esophagus.
Food can both aggravate and ameliorate acid reflux, but if yours is linked to stress, hiatal hernia, abdominal weight gain, or pregnancy, changing your diet may not be enough to relieve the burn. In these instances, Haas says, it’s best to seek support from a healthcare professional.
It’s also a good idea to visit your doctor to rule out a Helicobacter pylori infection: This bacterium causes stomach ulcers, which are a common comorbidity of reflux, she notes.
Understanding the structural issues behind some cases of reflux also reveals the shortcomings of antacids and acid reducers. Neither prescription nor over-the-counter drugs can fix a hernia or relieve stress. Worse still, when taken in excess, they may compound the problem and create others (see “The Trouble With Antacids” below).
It’s important to consider the causes of your reflux before depending on drugs for relief.
Once you’ve ruled out a structural issue, it’s time to look at food. What we eat and, just as important, how and when we eat play substantial roles in causing and correcting acid reflux. Consider these steps for addressing reflux with behavior change and diet.
1. How Can I Figure Out What Triggers My Acid Reflux?
Identifying your reflux-triggering foods starts with conducting an inventory of possible suspects. Cindi Lockhart, RDN, LD, an integrative and functional-nutrition practitioner, recommends starting with the most common culprits: caffeine, alcohol, citrus, and spicy, fried, or fatty foods.
Removing most or even one of those foods or beverages might be enough for some people, she says. Alcohol, for example, can relax the lower esophageal sphincter (as can fried foods, and even peppermint tea), while other foods may simply not agree with your stomach.
If removing these common offenders does nothing to help your reflux, it may be time to dig deeper and undergo an elimination diet. (For one such protocol, see “The Institute for Functional Medicine’s Elimination Diet Comprehensive Guide and Food Plan“.)
“Sometimes, clients don’t want to know what is triggering their reflux, because it may mean having to make a difficult change.”
“Sometimes, clients don’t want to know what is triggering their reflux, because it may mean having to make a difficult change,” Haas says. But chronic reflux can damage the delicate mucosal membranes in the esophagus, which is painful. Most sufferers will eventually have to choose between the discomfort of giving up a favored food and increasingly painful reflux.
Lockhart often suggests trying one of two healing diets — an elimination diet or a low-histamine protocol (histamines are chemicals used by the immune system to help protect the body from allergens) — for one month, while keeping a journal.
These restrictive diets are meant to be followed short-term, allowing the gut to heal and repair. Then, when foods are re-introduced, triggers tend to be easier to spot. (To learn more about certain elimination diets, see ELmag.com/fodmaps; for more on histamines, see “What You Need to Know About Histamine Intolerance“.)
“When you add in foods one by one, you should see patterns with your reflux,” Lockhart says.
2. How Do Eating Behaviors Trigger Acid Reflux?
Just as important as food triggers are behavioral triggers. Both Haas and Lockhart advise clients with reflux to sit down for meals, eat more slowly, and chew their food until it’s liquid.
“Eating in a relaxed state, so the parasympathetic state is turned on, is so important,” says Haas. “And I recommend thorough chewing to every client with digestive symptoms. Chewing our food well dramatically improves the ability of organs to do their job. Your teeth are the only part of your body that can chew.”
It may also be helpful to reduce meal size to avoid overloading the digestive system. Too much food at one sitting can cause pressure on the stomach’s sphincter, forcing it open and triggering symptoms.
Haas and Lockhart both suggest being moderate with beverages at meals, too — no guzzling. “I encourage people to drink less than 4 ounces during a meal,” says Lockhart, as liquids add volume to the stomach, and this added pressure can cause reflux symptoms.
Lockhart notes that being mindful of meal timing is helpful for people with GERD. “Digestion is strongest in the first half of the day and weakest in the second half of day. The old saying ‘Eat breakfast like a king, lunch like a prince, and dinner like a pauper’ is really helpful for reflux.”
“The old saying ‘Eat breakfast like a king, lunch like a prince, and dinner like a pauper’ is really helpful for reflux.”
Lockhart recommends eating your last meal or snack of the day no less than three hours before you go to bed, to leave plenty of time for digestion. Food that remains in the stomach when you lie down is more likely to create spillover that irritates the esophagus. “If you eat heavy and late, you’re going to have an uncomfortable night.”
It’s helpful to cut back on distractions while you eat, including phones, computers, and TVs. Sit down, take all the time you need to chew your food, and do your best to give your plate your full attention. For some people, just allowing for more relaxed mealtimes can be enough to reduce reflux.
Finally, Lockhart suggests a postmeal stroll. A 10- to 15-minute leisurely walk can do wonders to aid digestion, move food through the system, and help us relax. Any other daily practices that support stress relief, such as meditation, can also help in controlling reflux.
3. How to Eat for Better Digestion
Once you’ve identifed your trigger foods and adjusted any reflux-related eating behaviors, it’s time to add foods to your diet that can improve digestion. Lockhart says these will replace the highly palatable processed carbohydrates and convenience foods of the typical American diet, which she notes contains “few actual plants.”
The diet Lockhart recommends contains plenty of them. “A lot of colorful vegetables, clean protein, healthy fats, some fruit, and single whole grains” are the focus, she explains. She offers clients an easy visual for trying to improve digestive health: Always fill half your plate with colorful plants. For fruits, aim for less acidic options, such as bananas.
Haas says fiber is usually her first recommendation for any client looking to improve digestive health, including reducing reflux. “Soluble fiber slows down transit time in the stomach and helps to increase the time the stomach has to access nutrients in the foods,” she says. Fiber also keeps you satiated longer. (See “Fiber: Why It Matters More Than You Think” for more.)
Lockhart believes that eating between meals may aggravate reflux because it may keep certain aspects of the digestive process active.
“We are not set up to graze all day long,” she adds. “Every time you eat, you turn on the digestion process, with no time to rest and repair. With enough protein, fat, and fiber, we should be able to make it four or five hours between meals.”
4. What Foods, Herbs, and Supplements Can Reduce Reflux?
Certain foods, herbs, and supplements also offer safe, long-term support for reducing reflux.
Probiotics, which help support intestinal flora, are also key for some people, and eating fermented foods, such as kimchi, miso, and sauerkraut, can support better digestion and help reduce reflux symptoms.
Haas also recommends supplements: Zinc carnosine, glutamine, and magnesium can aid general digestion, ensure regular bowel movements, and reduce systemic inflammation.
Another option is adding acid to your diet.
Another option is adding acid to your diet. Haas says that some of her patients with reflux benefit from this practice, usually in the form of drinking a small amount (a tablespoon or so) of pickle brine or apple-cider vinegar before meals.
If you try this and it aggravates your symptoms, then this approach is not for you. If it helps, your reflux symptoms may be triggered by low levels of hydrochloric acid (HCL) in the stomach, a condition called hypochlorhydria. Confusingly, this condition feels like too much stomach acid, because you still feel that burn in the esophagus.
Adequate HCL is crucial for proper digestion, and levels drop as you age, as well as when you take some medications, including oral contraceptives. There are HCL tablets that you can take before meals, but only if recommended by your healthcare practitioner.
5. What Are Some Natural Remedies to Soothe Reflux Flare-Ups?
If reflux still crops up occasionally when you eat a trigger food or dine late, you might seek out herbs and foods that can help soothe the burn when needed. But even natural remedies are just symptom management and not treatment, Haas explains: “You still have to remove the offending factors.”
On-the-spot, nondrug remedies can help you break the antacid habit, though. Most antacids are reasonably safe, but using them routinely can inhibit healthy digestion. (See “The Trouble With Antacids,” below.)
Marshmallow root and slippery elm are two of Haas’s favorite supplements to help manage reflux symptoms. Aloe-vera juice and licorice tea or lozenges can also calm a fiery gut. These compounds all have soothing qualities, creating a viscous solution in the gut that coats the membranes in the stomach and esophagus. This reduces irritation and inflammation.
Lockhart suggests a quick fix that your grandmother would recognize: a teaspoon of baking soda in water. “It’s a tried-and-true quick solution for heartburn,” she says. “It works!”
The Trouble With Antacids
Over-the-counter antacid tablets, which are typically chewable or effervescent, contain calcium, magnesium, and aluminum salts that quickly neutralize stomach acid.
Though convenient, cheap, and relatively safe, antacids are not meant to be taken multiple times per day for days on end. Chronic use can create problems, such as constipation or diarrhea.
These drugs can also interact dangerously with other medications. People taking calcium or those with high blood pressure should be cautious about regular antacid use.
Others may seek relief from reflux with H2 blockers and proton pump inhibitors (PPIs). Both medications are available over the counter or by prescription, and both reduce the body’s production of stomach acid.
Although PPIs are useful for treating peptic ulcers, they are also commonly prescribed for long-term use for GERD — yet they weren’t meant to be used this way.
“The FDA recommends PPI use for four to eight weeks, but many people take them daily for years,” explains functional nutritionist Jesse Haas, CNS, LN.
Long-term use of acid blockers can lead to other uncomfortable digestive symptoms, like bloat. “PPIs and other types of acid blockers change the pH of your stomach from acid to alkaline, turning it into a nice, friendly place for bacteria to settle and multiply — and produce lots of bloat-causing hydrogen and methane gas,” explains integrative gastroenterologist Robynne Chutkan, MD. “If you’ve been taking acid-suppressing drugs for more than a few months, it could be the reason you’re bloated.”
Seeking a quick fix makes sense: GERD and reflux are uncomfortable. But if you can figure out the root cause, treating that is the best bet for long-term relief.
This article originally appeared as “Reflux Remedies” in the March 2023 issue of Experience Life.