The incidence of Gastroesophageal Reflux Disease (GERD) has dramatically increased over the last few decades. I know I see a lot of it in my practice. This blog post will help you to understand the most common causes of reflux, dietary factors that contribute to symptoms, and some helpful tips for management and prevention.
GERD is most often caused by the flow of gastric juices (stomach acid) up the esophagus, which can result in a burning sensation, pain, or discomfort often referred to as heartburn. The condition typically intensifies following a meal and when lying down. While some individuals may suffer from occasional cases of heartburn that are easily resolved with over the counter medications such as antacids, GERD is more of a chronic condition. GERD can place individuals at a higher risk for swallowing difficulties, esophageal inflammation, ulcers, and certain cancers.
GERD is frequently associated with abnormalities or a decrease in pressure of the lower esophageal sphincter (LES). Your LES is a valve that controls the flow of food from your esophagus into your stomach. Normally this valve should close tightly, keeping hydrochloric acid and gastric juices in their rightful place – your stomach – so that they can help you digest your food properly. When the LES is compromised, the valve does not close fully, or it opens too often, and stomach acid will creep up into the esophagus as foods are being digested.
GERD can also be associated with muscle contractions known as gut motility. In a healthy gut, foods are normally pushed through the GI tract from the esophagus into the stomach, from the stomach into the small intestine, and from the small intestine into the colon. However, when the gut is impaired, these contractions can become compromised and cause a disruption in the digestive process.
Another factor to consider is hypochlorhydria or low stomach acid. While it may sound counterintuitive, having too little stomach acid can disrupt natural digestion, causing food to remain in the stomach longer then it should. This can cause major discomfort for many individuals including reflux-like symptoms.
Consuming foods that weaken the LES (see list below), along with increased stress, anxiety, and gut dysfunction, can make the symptoms associated with GERD occur more frequently and at a higher intensity.
Common causes of GERD include:
Overeating / Obesity (puts pressure on the stomach)
Smoking (relaxes the LES)
Ingestion of the following trigger foods (weakens the LES):
- Soda / Carbonated beverages
- Coffee / Caffeine
- Fatty / Greasy / Fried foods
- Spicy foods
- Acidic foods (tomatoes, orange juice, citrus fruit)
- Peppermint / spearmint
- Onions / garlic
Stress (impairs gut motility)
Use of certain medications (NSAIDS, calcium channel blockers, Bisphosphonates)
Additional considerations include:
- Bacterial overgrowth such as H. pylori, SIBO or yeast
- Celiac Disease
- Hiatal Hernia (stomach pushes up through the diaphragm muscle)
- Food sensitivities / Allergies
- Chronic constipation
- Micronutrient deficiencies (from use of GERD medications) such as zinc, B12
When reviewing this list, you may find that few or many of these items pertain to you. The list of trigger foods is a general one, and not all foods listed will trigger symptoms in all individuals with reflux. But it is important to know which ones exacerbate your particular symptoms and to avoid those whenever possible. This will allow your esophagus to heal and will help to avoid the pain and discomfort associated with this condition.
Conventional treatment and management of GERD often involves:
- Weight loss (when appropriate)
- Continual avoidance of trigger foods
- Eating smaller meals
- Raising the head of the bed
- Use of certain medications such as antacids and acid-blocker drugs such as Proton Pump Inhibitors (PPIs)
- Avoidance of eating within 2-3 hours of lying down or going to bed
- Avoidance of tight clothing that can put pressure on the LES
- Avoidance of certain exercises that can put pressure on the LES such as sit-ups, inverted yoga poses, and certain forms of heavy lifting
Additional recommendations that can help include:
- Slowing down at meals
- Sitting at meals (avoid standing)
- Taking smaller bites
- Chewing food thoroughly. This can actually increase saliva production which can help support the integrity of the esophageal mucosal barrier, which is often impaired in reflux patients.
- Consume meals that are lower in fat
- Consume meals that are lower in carbohydrates (to help maintain a healthy weight)
- Consume fermented foods (to support a healthy microbiome)
- Avoid consuming large amounts of fluids with meals
- Begin a routine of gargling at night to stimulate the vagus nerve (supports healthy digestion)
- Stress reduction / Lifestyle change
- Regular exercise
There are several types of supplements that can support GERD naturally and can help avoid the harmful side effects of PPIs. These include:
- Deglycyrrhizinated licorice(DGL)
- Limonene (extracted from citrus fruit peel)
- Zinc Carnosine
- Magnesium Citrate or Glycinate
- Aloe Vera
- Slippery Elm
- Glutamine (to heal)
- Probiotics (to balance the microbiome)
- Digestive Enzymes
- Iberogast (for motility)
It is always important to work with a qualified healthcare practitioner to receive a proper diagnosis for reflux and to identify the root cause.
In addition, many people find it valuable to work with a dietitian to help control their diet, which will make it easier to manage reflux and its related symptoms.
Common dietary approaches that I recommend in practice:
- Identify and avoid trigger foods
- Avoid processed foods and those high in refined sugar that can impair gut integrity and motility
- Identify and support any nutrient deficiencies
- Practice the key principles of eating properly (slow down, chew your foods, do not overeat)
- Dietary support of Hypochlorhydria if present
- Dietary support of bacterial infections if present
- Incorporation of fermented foods and probiotics to heal the gut and support your microbiome
- Stress reduction each day
Gaby, Alan R., MD. Nutritional Medicine. Alan R. Gaby, M.D., 01/2011. VitalBook file.
Murray, M. T., & Pizzorno, J. (2012). The Encyclopedia of Natural Medicine, 3rd Edition. New York, New York: Atria paperback.
University of Wisconsin School of Medicine and Public Health. An Integrative Approach to GERD (Gastroesophageal Reflux Disease). (2018)
Mullin, G. E., & Swift, K. M. (2011). The Inside Tract: Your good gut guide to great digestive health. New York, New York: Rodale.
Rishikof, D. Health Takes Guts Ebook, 2018.
Hyman, M. 7 Steps to Reduce Acid Reflux. 2018.