Acid Reflux Diet · What Is It, Foods to Eat, Foods to Avoid, and More

Acid reflux, also known as gastroesophageal reflux disease (GERD), is a condition where stomach acid flows from the stomach 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 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) doesn’t 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 LES decreases, 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 LES. 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 LES, like certain foods, a high-fat diet, caffeine, alcohol, and smoking.  

First-line treatment for GERD includes lifestyle changes and acid suppression therapy with antacids; histamine receptor (H2) antagonists, like famotidine; and proton pump inhibitors, such as omeprazole. In cases where conservative treatment isn’t effective, surgery may be necessary to tighten the LES. 

Acid reflux diets eliminate foods that delay stomach emptying and reduce LES tone to improve acid reflux symptoms. 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 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 LES pressure, facilitating reflux. In addition, cigarette smoking reduces the production of saliva rich in bicarbonate, which helps neutralize the acidic stomach content.