It may be a surprise to learn that you need acid in your stomach, where it plays a key role in activating digestive enzymes, breaking apart protein so your body can use it and more. The problem for people with acid reflux, the backward flow of acid from the stomach to the esophagus, is usually not too much acid, but complications with the lower esophageal sphincter (LES)—a ring of muscle that sits between the esophagus and the stomach and acts like a trap door to keep acid where it belongs. (Your stomach has a mucous layer to protect its lining.)
Your doctor may suggest over-the-counter or prescription medications, which work by neutralizing acid to help reduce classic symptoms like heartburn, nausea and a bad taste in your mouth. But they do not stop the reflux from occurring; they just make it less irritating to the esophagus, which is why diet and lifestyle modifications are cornerstones of any treatment plan. These changes are so important, in fact, that they alone may be enough to keep your acid reflux in check.
See which suggestions you’re already following—and which new ones you can put to work for you.
Avoid Trigger Foods and Beverages
As you’ve probably already discovered, certain foods can aggravate acid reflux more than others. Try your best to steer clear of the following, and keep a journal of what you eat and drink and when you have symptoms—it can help you figure out what foods in particular make your acid reflux worse, so you can avoid them in the future.
- Full-fat, fried or greasy foods, such as whole milk, French fries or pizza can stimulate the production of stomach acid.
- Alcohol, carbonated drinks, chocolate, cow’s milk, tea and coffee (sometimes decaf, but more so with caffeinated) can all relax the LES.
- Citrus, spearmint, peppermint and tomato-based or spicy choices like orange juice, tomato sauce and curry dishes can further irritate an esophagus already damaged by reflux, causing pain. They can also relax or weaken the LES.
- Wheat, dairy, soy, citrus and eggs are foods that people are commonly allergic to. “Undiagnosed food allergies can present as reflux,” says Cynthia Geyer, M.D., a doctor at Canyon Ranch in Lenox, Mass. If these foods tend to trigger symptoms for you, talk to your doctor about the possibility that you have eosinophilic esophagitis, or inflammation of the esophagus, masquerading as reflux.
Eat Smaller Meals
The more food you eat at a sitting, the more pressure you put on your LES. Ensure that you’re getting a balanced diet and enough food to sustain you—just space out your eating and don’t overdo it. Try five or six mini-meals, instead of three larger ones, each day.
Make Gravity Work for You
It’s common to feel sleepy after dinner, but lounging on the couch soon after you’ve finished a meal could worsen your symptoms. Just like water pours out of a bottle more easily when it’s completely horizontal, lying down can give stomach acid a quick and easy route to your esophagus. Aim to stay upright for three hours after you eat.
Likewise, once it’s time to go to sleep, make sure the head of your bed is raised six to eight inches, to make it harder for acid to make its way upward. Try putting a brick under each leg of your bed at the head, or sleeping with a firm bed wedge. (Traditional pillows are usually not firm enough to accomplish this, and they may even position your body in a way that puts more pressure on your stomach.) Research has also shown that sleeping on your left side, which keeps your stomach below your esophagus, reduces the flow of acid into the esophagus.
Watch Your Weight
Experts have found that gaining as little as 10 to15 pounds can contribute to reflux symptoms. Talk to your doctor about an exercise plan and food choices that can help you reach a healthy weight.
Dress for Success
Tight clothes or belts put pressure on your abdomen, forcing acid out of your stomach and into your esophagus. Try wearing dresses instead of skirts, or pants that don’t require extra cinching, for example.
Commit to Quitting Smoking
Nicotine relaxes smooth muscles in the body, including the LES. Smoking is a hard habit to break, and no two people take the same road to become successful quitters, but the benefits—the least of which is reducing acid reflux symptoms—are great. Seek support from others, and ask your doctor about helpful aids.
Examine Your Medicine Cabinet
Several medications—such as some used to treat high blood pressure, depression and anxiety, as well as birth control that contains progestin—can relax your LES. And aspirin and non-steroidal anti-inflammatory (NSAIDS) can interfere with the protective mucous layer and esophageal lining. Other medications can irritate the lining in your esophagus and cause heartburn. Bisphosphonates (Fosamax, Boniva), which are typically prescribed to improve bone density, can irritate your esophagus. Never go off a medication without first consulting with your doctor, but be sure to give her a list of all of the drugs and supplements you take so that she can determine if any may be aggravating your acid reflux symptoms.
Consider Reflux Prescriptions Carefully
If none of these lifestyle or dietary changes brings relief from your acid reflux symptoms, long-term treatment with medications may be needed, but they have risks like hip fractures, risk of B12 deficiency, development of food antibodies and small intestinal bacterial overgrowth. Talk to your physician about the treatment plan that makes the most sense for you. And if you’re already on a prescription to treat your reflux and would like to wean yourself off of it, make sure that you first discuss how to do so safely and comfortably with your doctor. “Many people who have been on proton pump inhibitors (PPIs) for a long time for their reflux experience rebound hyperacidity when they stop abruptly, prompting them to go back on,” says Dr. Geyer. “Combining these lifestyle recommendations with a guided taper can enable many people to successfully get off their meds.”