Acid Reflux Diet
What Is It, Foods to Eat, Foods to Avoid, and More
Author:Anna Hernández, MD
Editors:Alyssa Haag,Józia McGowan, DO,Kelsey LaFayette, DNP, RN, FNP-C
Illustrator:Jessica Reynolds, MS
Copyeditor:David G. Walker
What is acid reflux?
Acid reflux, also known as gastroesophageal reflux disease (GERD), is a condition where stomach acid flows back into the esophagus. The esophagus is a long tube that allows food and liquid to pass from the mouth into the stomach. At the top and bottom of the esophagus there are two ring-shaped muscles called the upper and lower esophageal sphincters, respectively. Both sphincters relax during swallowing to allow the passage of food or liquids into the stomach, while the lower esophageal sphincter closes between meals to prevent the backflow of gastric acid. Acid reflux occurs when the lower esophageal sphincter (LES) does not close completely, allowing gastric acid to enter the esophagus and damage the esophageal mucosa.
Some degree of acid reflux is normal, especially after meals. However, when the pressure of the lower esophageal sphincter decreases, gastroesophageal reflux disease (GERD) can occur. Common symptoms of GERD include heartburn and regurgitation of stomach contents that mostly occurs after eating, when lying down, or when bending over. Other symptoms include retrosternal chest pain, difficulty swallowing, persistent coughing, voice changes, and dental erosions. Over time, the presence of acid in the esophagus may damage the esophageal lining and lead to Barrett esophagus: a serious complication of GERD that increases the risk of esophageal cancer.
GERD may be caused by a hiatal hernia, which is where part of the stomach and lower esophagus move from the abdomen into the chest through an opening in the diaphragm, thereby decreasing the pressure of the lower esophageal sphincter. Hiatal hernia is more common in individuals who are overweight or obese as well as in pregnant individuals due to increased pressure in the abdomen from the growing fetus. Risk factors for developing GERD also include those that weaken the lower esophageal sphincter, like certain foods, a fat-rich diet, caffeine, alcohol, and smoking. Finally, there are certain medications that can worsen acid reflux, such as antihistamines and calcium-channel blockers.
First-line treatment for GERD includes lifestyle changes and acid suppression therapy with antacids and proton pump inhibitors, such as omeprazole. In cases where conservative treatment is not effective, surgery may be necessary to tighten the lower esophageal sphincter.
What is an acid reflux diet?
An acid reflux diet is an eating plan aimed at reducing the symptoms of acid reflux by changing one’s diet and eating patterns.
How does an acid reflux diet improve acid reflux?
Acid reflux diets eliminate foods that delay stomach emptying and reduce lower esophageal sphincter tone in order to improve symptoms of acid reflux. In addition to avoiding certain foods, individuals with acid reflux are advised to make some changes in their eating patterns that are just as important in order to reduce symptoms of GERD.For example, eating smaller portions of food throughout the day instead of large meals creates less gastric distention and improves digestion. Other helpful measures include keeping the head elevated during sleep and not lying down immediately after a meal as gastric acid is more likely to flow back into the esophagus when lying down. Finally, individuals who smoke may be advised to quit smoking as cigarette smoking is one of the factors that reduces lower esophageal sphincter pressure, facilitating reflux. In addition, cigarette smoking reduces the production of saliva rich in bicarbonate, which helps neutralize the acidic stomach content.
What foods are best on an acid reflux diet?
The best foods to eat on an acid reflux diet include high-fiber foods that provide a good source of complex carbohydrates, including whole-grain cereals, oatmeal, brown rice, and root vegetables (e.g., potatoes, beets, carrots). Non-citrus fruits, like apples, pears, and bananas as well as other vegetables are also recommended as part of a balanced diet. High-protein foods, such as lean meats, fish, eggs, tofu, and legumes increase the pressure of the lower esophageal sphincter and are recommended to increase satiety and prevent acid reflux symptoms. Finally, healthy fats, such as avocado, olive oil, nuts, and seeds can also be consumed in moderation.
What foods should be avoided on an acid reflux diet?
Individuals with acid reflux should avoid foods that are high in fat as these tend to reduce lower esophageal sphincter pressure and delay stomach emptying, thereby increasing the symptoms of acid reflux. Examples of fatty foods include certain cuts of meat (e.g., bacon, burgers, sausages, steak); fried foods; and full-fat dairy products, such as butter, ice-cream, or cheese. Other foods, like chocolate, coffee, and carbonated beverages (like sodas) may also trigger heartburn by reducing lower esophageal sphincter pressure. Alcohol also has a direct harmful effect on the esophagus, which predisposes to acidic injury and can trigger episodes of heartburn. Finally, acidic foods, like citrus fruits and tomatoes; spicy foods; onions; and garlic can worsen the symptoms of GERD due to irritation of the esophagus and are typically not recommended for an individual with acid reflux.
What are the most important facts to know about an acid reflux diet?
An acid reflux diet is an eating plan that can help individuals decrease the symptoms of acid reflux, a condition where stomach acid flows back into the esophagus. Acid reflux diets focus on eliminating foods that trigger heartburn, such as coffee, chocolate, alcohol, and spicy or fatty foods as well as modifying any eating patterns that may worsen acid reflux.
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Resources for research and reference
Kahrilas PJ, Shaheen NJ, Vaezi MF. American Gastroenterological Association medical position statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135(4):1383-1391.e5. doi:https://doi.org/10.1053/j.gastro.2008.08.045
Kaltenbach T, Crockett S, Gerson LB. Are Lifestyle Measures Effective in Patients With Gastroesophageal Reflux Disease? Archives of Internal Medicine. 2006;166(9):965. doi:https://doi.org/10.1001/archinte.166.9.965
Ness-Jensen E, Lagergren J. Tobacco smoking, alcohol consumption and gastro-oesophageal reflux disease. Best Practice & Research Clinical Gastroenterology. 2017;31(5):501-508. doi:https://doi.org/10.1016/j.bpg.2017.09.004Newberry C, Lynch K. The role of diet in the development and management of gastroesophageal reflux disease: why we feel the burn. Journal of Thoracic Disease. 2019;11(S12):1594-1601. doi:https://doi.org/10.21037/jtd.2019.06.42