Acid Reflux: The Best Ideas To Calm Your Tummy

Effectiveness Rating +++++

Downsize to Smaller Portions +++++

The smaller the portion size of food; the less your stomach needs to expand to accommodate it. Conversely, when the stomach is distended after a large volume of food &/or fluid it can induce transient lower esophageal sphincter relaxation (TLESR) which results in stomach acid traveling back into the esophagus. 

Tip: Instead of eating three main meals a day (breakfast, lunch, and dinner), divide them up into six smaller meals. Trying swapping to smaller plates and bowls will prevent you from filling your plate. 

Stay Upright After Eating +++++

Instead of slouching on the couch after a meal try to sit up straight. Gravity will play a role in keeping stomach acid down.

Tip: Keep your back straight when you sit and stand - remember just avoid reclining or slouching.

Follow a Mediterranean Diet +++++

In an observational study of 817 people, following the Mediterranean diet was associated with a decrease in reflux. This diet has also been studied head-to-head against standard antacid therapies and is equally effective for reflux sufferers. One key factor here is the type of carbs eaten on a Mediterranean diet come naturally from whole food sources like grains, fruits, vegetables, and legumes.

Tip: Include more whole grains, legumes, vegetables and fruit in the diet. Choose lean protein sources like fish 3x/week, eggs and poultry, while keeping red meat to a minimum 1-2x/week. Limit intake of processed foods with refined fats; instead increase fat sources from olive oil, nuts and seeds. 

Weight Control +++++

Carrying extra weight increases pressure on your abdomen, and is one of the most common causes of reflux. Research shows that people who are overweight or obese have a 2-3x higher chance of having reflux. The good news is that a structured weight loss program can lead to the complete resolution of reflux in most people. (Singh) 

Tip: Waist measurement is a simple check to tell if you're carrying excess body fat around your middle. The American Heart Association, National Heart, Lung, and Blood Institute define abdominal obesity as women > 88cm (35 inches) and men >102cm. (40 inches) If your waist measurement exceeds these values then consider consulting with a dietician specialized in weight loss. 

Avoid Eating Too Close to Bedtime +++++

Hitting the sack right after eating is not ideal for someone with reflux for a few reasons: 

#1 Without the force of gravity, stomach contents can creep up the esophagus in someone with a weakened lower esophageal sphincter. 

#2 Eating stimulates gastric acid production which will further exacerbate the problem

#3 Saliva plays a role in neutralizing stomach acid. When we sleep our body produces less saliva and we swallow less. This means less saliva reaches the stomach to neutralize stomach acid. 

Tip: If you can manage it, your last meal will take place about 4 hours before going to bed. So, if your bedtime is 10 pm, you'll want to have dinner before 6 pm. This means meal prep may need to start as early as 4:30 pm and could get overwhelming, depending on your schedule. 

Avoid Strenuous Activity After Eating +++++

Some people with reflux may experience worsened symptoms during or immediately after exercise. This is typically the case for more strenuous exercise as opposed to low-intensity workouts like yoga. Certain exercises like weightlifting can put pressure on the stomach and inhalation of air after sprinting can relax the lower esophageal sphincter.

Tip: Adopt better habits before exercising to prevent reflux. Reconsider energy drinks and exercise gels that contain caffeine and avoid eating within 1-2 hours of exercising. 

Sleep On An Incline +++++

Sleeping on an incline takes advantage of gravity and helps keep stomach acid where it belongs. Elevating your upper body to a 30-45 degree angle or at least 6-8 inches (15-20 centimeters) will help relieve reflux when you sleep.

Tip: To avoid causing tension in the head and neck, look for ergonomic sleeping aids like ‘wedge pillows’ and ‘elevated sleep systems’. This will offer more support than simply propping up your pillows. 

If You Smoke - Stop +++++

Smokers are more likely to have reflux than non-smokers. Nicotine is known to reduce lower esophageal sphincter pressure and increase secretions of acid and pepsin in the stomach. Research has also found that coughing or deep inspiration during smoking rapidly increases intra-abdominal pressure which can overpower a weakened sphincter. (Kahrilas)

Tip: Ready to quit smoking? Nicotine replacement therapy, smoking cessation apps, government health resources, and speaking with a person trained in quitting will provide you with the tools to get started. 

Importance of Hydration +++++

Frequent sips of water help to lubricate the food we swallow and increase the clearance of esophageal secretions. This is particularly helpful for people with abnormal esophageal motility who experience coughing with their reflux. 

Tip: Maintaining hydration is a fine balance. Keep in mind that drinking water with food will fill up the stomach faster and increase pressure which in turn reduces lower esophageal sphincter tone. Try to meet the majority of your hydration needs between meals and enjoy a few sips with meals. 

Low to No Citrus +++++

Citrus fruits contain high amounts of natural citric acid that directly cause esophageal mucosal irritation. Foods with the highest amounts include oranges, lemons, limes, grapefruit, pineapple, strawberries, and tomatoes. 

Tip: To ensure that you still get enough vitamin C and fiber in the diet, opt for low citrus-based produce. Mango, apples, pear, and stone fruit are considered moderate citrus fruits. Papaya, guava, banana, coconut, avocado, green leafy vegetables, and broccoli have very low to no citrus and would be an ideal choice for someone with reflux. 

Avoid Carbonated Beverages ++++

Fizzy drinks contain carbon dioxide which causes your stomach to stretch when consumed. This increase in intra-abdominal pressure triggers a reflex that relaxes the lower esophageal sphincter. Gas can then travel back up your esophagus which sets off another reflex that causes the upper esophageal sphincter to relax and contributes to reflux. (Newberry)

Tip: Swap sparkling water and carbonated beverages for flat water to optimize hydration without aggravating reflux. 

Wear Loose Clothing ++++

Wearing loose-fitting clothes reduces the pressure on your stomach and may help relieve reflux symptoms. 

Tip: Avoid tight-fitting clothes around your stomach; this includes belts, pantyhose, and shapewear. What better excuse do you need to wear comfy loungewear all day?

Review Current Medications ++++

Several medications are known to contribute to reflux by directly causing mucosal damage, reducing lower esophageal sphincter pressure, or by affecting motility between the esophagus and stomach. Some of these include; Ibuprofen, aspirin, anti-anxiety drugs, tricyclic antidepressants, antibiotics, bisphosphonates (osteoporosis drugs), and some high blood pressure medications. Other supplements to be aware of include Vitamin C, iron coenzyme Q10, and St John’s wort. 

Tip: If you suspect constipation is medication-induced then speak to your healthcare provider about strategies to minimize associated reflux. 

Soothing Sips of Herbal Tea ++++

Caffeine-free herbal tea blends like chamomile, licorice, slippery elm, marshmallow can help with soothing the esophagus and stomach lining. Benefits also extend to their anti-inflammatory and antioxidant properties. 

Tips: Get the maximum benefit from your cuppa by choosing loose leaf tea over tea bags. Not only is it better for the environment, but loose-leaf also is of better quality and comes without the added chemicals coated on teabags. Avoid tea blends containing peppermint and spearmint. These two are known to worsen reflux. 

Not All Herbs Are Equal ++++

Ginger has been used for thousands of years as an effective treatment for disorders of the gastrointestinal tract. Gingerols and shogaols are the active compounds in ginger that have anti-inflammatory actions which are thought to reduce gastric contractions and relieve irritation.  

One herb to pass on is mint. It is a common dietary trigger for reflux because it is known to rapidly relax the lower esophageal sphincter.

Tip: Peel ginger before slicing or grating. You can add it stir-fry, soup, salads, marinades, or steep in a mug of water for ginger tea. 

 

Limit Onion & Garlic  ++++

Onion and garlic can stimulate gastric acid and exacerbate reflux.

Tip: Swap red and brown onions for green spring onions and shallots which are generally better tolerated. Instead of raw garlic, use garlic-infused olive oil to enhance the flavor of a dish. Alternatively, cooking the onion and garlic may help lower irritation in some people as opposed to consuming it raw. 

Avoid Spicy Foods ++++

For some, spicy foods can irritate esophageal tissues. This includes foods such as black pepper, chili, curry, hot peppers, and salsa.

Tip: Those who are sensitive to spicy foods are best to avoid completely. Instead try flavoring dishes with fresh herbs like parsley, coriander, basil, and dill.

Cut Back on Alcohol ++++

Alcohol consumption can worsen reflux through; direct esophageal mucosal damage, dysfunction of the lower esophageal sphincter, abnormal gastric motility, and inhibition of gastric emptying. Total alcohol consumption has been shown to be significantly associated with GERD. 

Tip: Consume alcohol in moderation or cut it out altogether and monitor symptoms. 

----> These strategies have less weight/research to them

Limit High Fat Foods +++

There’s a lot of talk around high-fat diets, especially fried or greasy foods, and reflux. They’re often blamed for worsening reflux. This is based on how high-fat foods take longer to digest; which means they sit in your stomach for a greater period. However, overall, there isn’t consistent research showing how fat impacts GERD.

Tip: With little and inconsistent information to rely on, for now, we suggest that it’s best to take an individual approach and monitor how you personally respond to high fat or protein foods. Keeping a diet journal may help to keep track of how you’re personally affected by high fat and protein foods. 

Go Easy on Caffeine +++

Some research has found that coffee temporarily decreases the tone of the lower esophageal sphincter.  Even though coffee is suggested to be a trigger beverage, a recent meta-analysis showed no association between coffee intake and GERD symptoms. This was true even for people drinking a lot of coffee; > 4 cups per day.

Tip: The jury appears to still be out on reducing caffeine intake for reflux. However, there is no harm in swapping some coffee for one of the beneficial herbal blends listed above.

Curb Chocolate Intake +++

Chocolate contains a compound called theobromine from cacao seeds, which acts as a mild stimulant. Along with trace amounts of caffeine also found in chocolate; both are implicated in the relaxation of the lower esophageal sphincter.

Despite this, there is limited evidence to support that chocolate is actually associated with reflux symptoms. This seems to be the case even when large amounts of chocolate are eaten. More studies are needed to better understand how varying amounts of theobromine and caffeine in different types of chocolate may contribute to the relaxation of the lower esophageal sphincter. 

Tip: Avoiding chocolate altogether is not an appealing option for all the chocolate lovers out there. Instead, limit yourself to smaller portions and monitor your symptoms. Also, try experimenting with different types of chocolate to see whether dark chocolate triggers reflux less than milk chocolate. 

Betaine HCl ++

One theory is that low stomach acid levels may be a contributing factor for reflux. Some small studies have found that Betaine HCl can temporarily lower the pH in the stomach. This is important because an acidic environment is necessary to support the digestion of nutrients. However, there is little evidence to show that low stomach acid levels specifically cause reflux. Therefore more research is needed to measure the effectiveness of betaine HCL for treating reflux. 

Tip: Supplementing with Betaine HCl with added pepsin and ox bile can help protein and fat digestion in the stomach. Formulas that contain digestive bitters can also help to stimulate the body’s own body production of stomach acid, enzymes, and bile. Keep in mind that the jury is still out on whether taking Betaine HCl can help relieve reflux. 

Melatonin ++

Melatonin, when used alone or in combination with omeprazole (a proton pump inhibitor used to treat reflux disease) is effective in relieving reflux. However, only a few studies on the role of melatonin in gastrointestinal issues have been carried out in humans. 

Tip: Melatonin is sold over the counter at drug stores. However, it is recommended you speak with a health professional first before commencing to assess whether this approach is suitable for your needs. 

 

Add Fennel Seeds ++

Fennel (Foeniculum vulgare) is a herb that belongs to the Apiaceae family. It has been used in traditional medicine to treat various ailments due to its anti-inflammatory and antioxidant properties. The calmative effects of fennel, when combined with curcumin, have been shown to significantly improve symptoms of IBS, which include abdominal distension. More research is needed to evaluate the effectiveness of fennel for relieving reflux. 

Tip: Fennel makes a great addition to dishes like risotto, pasta, pizza, soup and as a stuffing. Alternatively, crush fennel seeds and steep in hot water for a soothing tea. 

Buffer with Milk ++

Non-fat milk may temporarily buffer symptoms of reflux. This is thought to be due to the acid-neutralizing effect of calcium and the ability of protein to stimulate lower esophageal sphincter contractions. Conversely, the high-fat content of regular milk can actually make your reflux worse.

Tip: Milk provides an important source of calcium, protein, Vitamin D and Vitamin B12. Opt for mom-fat or skim milk but keep in mind that this will only offer temporary relief.

Drink Aloe Vera Before Meals ++

Aloe vera juice has been shown to effectively reduce reflux. Less adverse side effects have also been found when treated with 10ml once a day of aloe vera juice compared to omeprazole and ranitidine medications. More research is needed to investigate the impact of treatment with higher doses. 

Tip: Not all forms of aloe vera juice are equal- stick to decolonized and purified forms. Aloe vera juice is contraindicated in pregnancy and should be avoided. 

 

Drink Diluted Apple Cider Vinegar +

ACV is a popular home remedy for managing reflux. It is thought that diluting a teaspoon of ACV in a cup of warm water helps to balance acid levels in the stomach. Despite widespread anecdotal tales, there is limited research supporting ACV as an effective natural remedy for reflux.

Tip: Relying on ACV to alleviate your reflux may be a long shot; which is why we recommend sticking to its use as a salad dressing or a sweet and sour marinade. 

 

Licorice +

Licorice root is derived from the plant Glycyrrhiza glabra. It has long been used in botanical medicine for the treatment of gastric conditions like reflux. Importantly, licorice contains an active chemical called glizzyrizin, which is what gives it a distinct black color. When consumed in high doses it can cause serious complications such as a drop in blood potassium levels, high blood pressure, sodium retention, and swelling. That is why most licorice supplements contain a safer form of deglycyrrhizinated licorice (DGL) which is safer for long-term use. 

Tip: Ingesting licorice is not recommended for people taking medications that lower your body’s potassium like diuretics and corticosteroids. In its supplemental form, DGL is not regulated by the FDA. It is known to interact with some medications and should be avoided in pregnant women due to an increased risk of preterm labor.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928719/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498851/

Alkaline Water +

The theory behind alkaline water is that it can help neutralize stomach acid and relieve symptoms of reflux. Compared to regular tap water that has a neutral pH of around 7; alkaline water has a higher pH between 8-9. There is little evidence to support the buffering effect of alkaline water. After all, our body is well equipped with regulating pH levels in the body 

Tip: If drinking alkaline water helps meet your hydration goals, then go for it! But if you are looking to introduce it as an alternative treatment for reflux, then save your pennies.

Zinc Supplementation +

Zinc is an essential mineral for many important processes in the body, such as; immune function, wound healing, and assisting in thyroid function. One study in rodents found that oral supplementation with zinc was effective in inhibiting gastric acid secretion and it was postulated that it may provide a new prolonged therapy for those who suffer from disorders like reflux. However, no improvement in the severity of  reflux has been found in human subjects supplemented with zinc.

Tip: Zinc supplementation should be considered if a person has an underlying deficiency for overall health. However, there is no evidence to suggest that it will improve reflux in humans.