Using a Food-First Approach to Improve Acid Reflux
Heartburn, indigestion, regurgitation, and bloating typically go hand in hand for most people. The impact that acid reflux can have on digestion can make it difficult for people to even enjoy meals because they fear that eating certain types of meals will leave them in pain and discomfort for hours later. For most people, these symptoms are much worse in the evening and throughout the night, leading to an interruption in sleep.
You’ve probably heard the general recommendations like sleep on an incline, avoid eating within 2-3 hours of bed, and remove fried foods from your diet. These tips can be helpful but are likely to only make a small dent in symptom improvement.
Using a comprehensive nutrition approach as the first line of intervention can lead to incredible outcomes for resolving reflux and creating health. And unlike the commonly prescribed reflux medications, this approach is often free of side effects!
Stomach Acid Belongs in Your Stomach, Not Your Esophagus
The digestive process starts in your mouth and moves downward into the esophagus and then the stomach. These are two very different environments for digesting food. The stomach’s environment is incredibly acidic, due to gastric acid or stomach acid that is primarily composed of hydrochloric acid (HCl).
That acidic environment is absolutely critical for helping the body absorb vitamins and minerals such as vitamin B12, iron, zinc, calcium and magnesium. The digestion of protein also occurs in the stomach. Additionally, stomach acid neutralizes potential harmful bacteria, yeast, viruses, and other pathogens in order to protect your intestines.
Stomach acid is helpful if it stays in your stomach; but it can be harmful to other organs. Acid reflux occurs when stomach acid rises up out of the stomach back into the esophagus. Heartburn is often used interchangeably with acid reflux, but some people experience acid reflux without heartburn. You may have trouble swallowing, get a choking feel in your throat, or feel like you have food stuck in the throat.
What is Acid Reflux?
Acid reflux, sometimes called gastroesophageal reflux, runs the gamut from being occasionally unpleasant to full-blown post-meal misery. Gastroesophageal reflux disease or GERD is a stronger, chronic type of acid reflux that occurs more than twice a week. This condition is extremely common! Up to 28 percent of Americans may suffer from GERD, but that number may be even higher since a lot of people use acid-reducing medications such as antacids to cover up symptoms.
Indigestion or heartburn is a symptom of both acid reflux and GERD. So is regurgitation. But the impact can go beyond the esophagus to include:
- Chest pain
- Dental erosions
- Chronic cough
- Sore throat
Some risk factors to manage acid reflux are out of your control. Genetics plays a role. So does age. GERD traditionally impacts middle-aged and older people but researchers have found that a growing number of younger people struggle too. I attribute this to things like chronic stress and eating on the run.
That raises an important point: There are risk factors that impact reflux that are within your control. They include:
- Being overweight or obese
- Anxiety and depression
- Being sedentary
- Over-consuming alcohol
- Some medications
Side Effects of Medical Management
The most common recommendation for acid reflux in our medical management approach to health is to prescribe proton pump inhibitors (PPIs) like Prilosec and Nexium. PPIs are among the highest-selling classes of drugs in the US. In 2012, their sales were reported at $9.5 billion. But there are several concerns with this approach.
First, most PPIs simply mask unresolved problems and lead to further complications.
Second, clinical guidelines do not typically recommend prescribing these drugs for more than 8-12 weeks.
Third, this group of drugs is also suggested to be associated with a number of serious side effects including cardiovascular disease, chronic kidney disease, dementia, and more. Over time, PPIs can lower absorption of key vitamins and minerals including iron, vitamin B12, and magnesium. Long-term PPI therapy may also lower calcium absorption, leading to increased risk of fractures and osteoporosis.
The Widespread Problem of Low Stomach Acid
Traditional thinking says that too much stomach acid contributes to acid reflux. On the surface that makes sense, since excess stomach acid can rise up to the esophagus and create the burning sensation and other symptoms that characterize acid reflux. However, acid reflux and GERD become more common as you get older, when the production of stomach acid declines.
Jonathan Wright, MD, pioneered the theory that low stomach acid – not excess stomach acid – can create acid reflux in his book Why Stomach Acid is Good For You. He found that when you give people with low stomach acid supplements that contain HCl and pepsin, their condition often improves.
PPIs also suppress stomach acid, which is usually not a good idea! Without enough HCl, protein metabolism becomes inhibited. The stomach continues to produce stomach acid, which can build up and increase acid reflux over time. Low stomach acid – called hypochlorhydria – means that food sits in your stomach longer, increasing the possibility that the food will regurgitate into the esophagus.
Over time, hypochlorhydria can create imbalances in the microbiome, called dysbiosis, where unfavorable bacteria dominate the gut and create havoc. One study looked at the microbiome of 1,815 people and found that PPI users had a less healthy gut, which may explain their increased risk of stomach infections.
Left unchecked, low stomach acid can be the source of so many other health issues including:
- Thyroid problems
- Yeast overgrowth and candidiasis
- Bacterial infections
- Leaky Gut
- Rheumatoid arthritis
Conventional medicine approaches the situation by trying to fix one issue, like reflux, by taking a PPI that further lowers stomach acid and could lead to even poorer health outcomes.
One study even demonstrated that esophageal damage from GERD may be driven by inflammation rather than even being directly related to acid levels in the stomach.
That’s why I use food as the first line of intervention for reflux. It’s possible for many people to manage their reflux with their diet and lifestyle. This route takes time and energy but the benefit is that you don’t necessarily have to rely on pharmaceutical interventions that can create poorer health outcomes than you started with.
Managing Acid Reflux with Your Diet
What you eat and don’t eat can play a significant role in managing acid reflux and GERD. I customize an eating plan based on the individual’s symptoms with a focus on improving digestive health.
Research shows that focusing on overall macronutrients in your diet, in addition to removing problematic foods, can be beneficial. That means:
- Decreasing or eliminating sugary, processed foods as well as unhealthy or damaged fats
- Increasing nutrient-dense plant foods
- Incorporating sufficient amounts of protein and healthy fats
- Remove foods from your diet that are personal triggers for your reflux
There are several common food triggers for acid reflux. But this will look different for everyone. The most common triggers include tomatoes, onions and garlic, chocolate, coffee, alcohol, fried foods, spicy foods, citrus, dairy foods, and carbonated beverages.
Remember that nutrition is always personal. But generally speaking, I recommend removing provoking foods from the system short-term while relying on a nutrient-dense diet. That means plenty of organic leafy and cruciferous vegetables as well as low-sugar fruits such as berries and avocado.
With acid reflux, how you eat can also be as important as what you eat.
- Slow down, be mindful, and enjoy your meals. Be sure to chew your food thoroughly.
- Be aware of meal size and when you eat.
- Pay attention to eating patterns, such as eating too late or on the run.
- Especially if acid reflux occurs in the evening, close the kitchen at least three hours before bedtime.
A food symptom journal can help tremendously here.
Lifestyle Modifications to Reduce Acid Reflux
Beyond food, I focus on these factors to effectively manage acid reflux:
Obesity is a significant risk factor for the development of GERD. When people gain weight, they sometimes develop symptoms of GERD. For many people who have excess weight to lose, a weight loss program can resolve many GERD symptoms.
Feeling nearly chronically stressed out can increase acid reflux, and it can make your life miserable in a lot of other ways too. Learn ways to reduce the impact of stress here.
Acid reflux can become worse at night and create sleep disturbances. People who get acid reflux at night are more likely to struggle with insomnia, sleep apnea, daytime sleeplessness, and more. Sleeping on your left side and keeping the head of the bed (not just the pillows) elevated can help here. So can maintaining good sleep hygiene, such as keeping a consistent bedtime and avoiding stimulants like caffeine after 12pm that can impede sleep.
Physical activity can help you manage your weight and improve digestion, both of which are associated with a reduction in acid reflux.
Using Food & Nutrients to Manage Acid Reflux
What goes on the end of your fork can tremendously impact acid reflux and GERD. At the same time, a few well-researched nutrients can complement what you eat and provide therapeutic relief. There is no one size fits all approach but here are some foods and nutrients that may improve reflux:
Ginger can soothe irritation in the gut lining. Its ability to lower inflammation can reduce the esophageal inflammation that characterizes acid reflux. I recommend trying whole ginger root and adding to smoothies, hot water, or even zesting on a salad!
Apple Cider Vinegar
Apple cider vinegar can help some people but make reflux worse for others. Those that experience improvements likely have low stomach acid. We don’t have any substantial research to support those claims, although anecdotally, many people with GERD swear by apple cider vinegar. If you try apple cider vinegar, start very slowly with no more than one teaspoon of apple cider vinegar, diluted with 6-8 fl oz of water, before meals. If you do not experience issues, work up to 1 tbsp two times per day. If you experience heartburn, stop immediately.
Deglycyrrhizinated Licorice (DGL)
Deglycyrrhizinated licorice (DGL) solves many reflux problems. Licorice has long been used in Chinese and herbal medicine to soothe and heal the gut lining. Glycyrrhizin, which gives licorice its sweet taste, is amazing! It has anti-ulcer and anti-inflammatory that can help heal the gastric mucosa to create a barrier that may protect the esophagus.
L-glutamine can strengthen the LES, reducing the likelihood of acid reflux. This amino acid is a precursor for the antioxidant glutathione, which helps fight the oxidative stress that can lead to acid reflux. L-glutamine can help repair cells that line the gut as well as the mucous membranes that line the esophagus, which could be damaged by frequent exposure to stomach acidity. L-glutamine can also improve the intestinal permeability or leaky gut.
Melatonin has long been regarded as a sleep hormone, but it is also a free radical scavenger. Studies show melatonin can protect the esophagus against acute reflux esophagitis as well as the chronic inflammation that leads to GERD and Barrett’s esophagus. Melatonin can protect the esophagus against potentially damaging factors including acidic stomach enzymes as well as alcohol, non-steroidal anti-inflammatory drugs (NSAIDs), and stress. I generally recommend Melatonin-SR by Klaire Labs.
Probiotics, the live microorganisms that support gut health, can also benefit acid reflux. One review of 13 prospective studies looked at how probiotics may help manage the frequency and severity of GERD symptoms. Seventy-nine percent reported positive benefits and 45% stated benefits that were specific to reflux symptoms, including reduced regurgitation, abdominal pain, heartburn, and other symptoms. You can take a probiotic supplement or benefit from fermented foods like yogurt and kefir that are rich in beneficial microorganisms.
Digestive Enzymes can be used when the body is not producing sufficient amounts in order to break down food, making it more digestible.
Betaine Hydrochloride (betaine HCl) is often paired with digestive enzymes and helps break down protein. This is only safe if you are not on a PPI medication. If you are not on a PPI, one way to determine whether you have low stomach acid is to take a digestive enzyme supplement with betaine HCl when you eat a meal containing protein. If you don’t feel discomfort, you may not be creating enough stomach acid. I have clients gradually increase the amount of betaine hydrochloride until they get a warm feeling after they use it. At that point, they taper back until they find the right dosage to provide sufficient stomach acid.
While PPIs and other medications can provide temporary relief, shifting the focus to digestive health is a much safer and more effective strategy for acid reflux. Optimal consumption of foods, nutrients, and lifestyle factors can often dramatically improve this condition.
Many of my clients are able to completely eliminate acid-suppressing medications when they use a food-first-approach. They are able to enjoy food without the fear of post-meal acid reflux symptoms. Now, that to me is a win!
This article is not intended to provide medical advice. Rather, it provides general tips for changing your diet. But nutrition and health is always individual. Prior to making changes on your own, work with your doctor and a dietitian.