Acid Reflux – What is it and how can you reduce occurence?

Acid reflux happens when acid from the stomach escapes up the oesophagus giving the feeling commonly referred to as heartburn.  When this happens repeatedly GORD (or GERD with the American spelling) may be diagnosed – gastro-oesophageal reflux disease.

There are many causes of acid reflux, and if you suffer from it regularly it is important to consult your doctor to check that there is no medical issue causing the problem.  Your doctor can also check if the reflux is contributing to any longer-term health issues such as Barrett’s Oesophagus.  Some possible causes of reflux are:

• Diet: the type of food you eat, or the quantity, may trigger attacks if you have sensitivities
• Being physically active too soon after eating
• Hiatus hernia
• Being overweight
• Pregnancy
• Eating too late at night
• Some medications
• Stress
• Stomach ulcers
• Gastroparesis (paralysis of the stomach)
• Stomach infections
• Problems with your intestines, such as IBS or constipation
• Hormonal balance
• Aging

Interestingly, although the mainstream belief is that reflux is triggered by an excess of stomach acid, it can also be caused by too little acid.  This is because with less acid, food takes longer to digest in the stomach causing a range of digestion-related symptoms.  There appears to be little recognition of this in the NHS (the medical term of hypochlorhydria doesn’t even show results on their website) and treatments for reflux are designed to reduce the acid – if you use these treatments (along with diet and lifestyle changes) but the problem continues or worsens, it is worth asking your GP to investigate further.

Symptoms of acid reflux may include:

• Heartburn (burning feeling in chest, spreading to mouth
• Sour taste in the back of the mouth
• Hiccups or burping
• Coughing
• Hoarse voice
• Feeling of fullness or lump in throat
• Aggravation of asthma symptoms
• Nausea or vomiting

There is also a condition called silent reflux (or airway reflux), a problem affecting the upper part of the oesophagus.  Some symptoms are similar but may also include:

• Snoring
• Throat clearing
• Post-nasal drip
• Breathing difficulties
• Choking
• Chronic cough

Silent reflux is common in children, who may show symptoms of sinusitis, middle ear problems or other ear pain, sleep disordered breathing, feeling like they have a lump in their throat, or dental erosion.

In young children, especially babies, reflux may be triggered by a sensitivity to milk protein such as cows’ milk protein allergy* (this is different to lactose intolerance, which is an inability to digest the sugar in milk); tongue-tie due to the child swallowing more air due to a poor latch during feeding; or weak muscles which are likely to strengthen as the child develops.  Infants with reflux may bring up small amounts of milk after feeding, or may be ‘fussy’ or have a tendency to cry during feeding due to the discomfort.  Breastfed babies may comfort feed to ease their discomfort.  They may also cry when lying down.  This article provides more information about babies and reflux: https://abm.me.uk/breastfeeding-information/reflux/  Although the article is based on breastfeeding mothers, much of the advise can be applied to bottle-feeding too.

*This can occur in breastfed babies due to the dairy milk proteins that the mother has consumed passing through her milk to the child.  If the mother stops all dairy products, including as an ingredient in other foods, it can take 6-8 weeks for an improvement in the child’s symptoms to be seen.

As mentioned above, due to the many causes of reflux, you should consult your doctor to establish the cause of your issue.  This way, you can establish a treatment and/or management method that is appropriate for you long-term.  Do not rely on antacid medication long-term, without medical guidance, whatever the adverts suggest!

In terms of reducing diet and lifestyle contributors to the problem, here are a few things you can try:

• Do not eat until you are completely full – you don’t have to clear your plate! Of course, I don’t like food waste but eating until you are only 80% full can reduce the occurrence of reflux.  It may be better for you to eat smaller meals, more often.
• Eat at least 2 hours (3-4 if possible) before you go to bed. When we lie down to sleep our muscles relax, and this may contribute to the release of the acid.
• Keep a food diary to help identify your triggers. Typical triggers include: coffee, chocolate, spicy foods, carbonated drinks.
• Reduce the amount of fat in your meals – some dietary fat is important for our health, but meals that are particularly high in fat may trigger reflux.
• Allow more time between eating and intensive exercise or activity involving a lot of bending and/or lifting.
• Stop smoking – it reduces the pressure on the ring of muscle at the bottom of the oesophagus/top of the stomach allowing acid to escape; and smoking reduces the acid-neutralising property of saliva.
• Reduce your alcohol consumption – there have been small studies which have found that beer and wine in particular increased the occurrence of acid reflux. Alcohol may relax the ring of muscle at the top of the stomach enabling the acid to escape.
• Find ways to manage your stress, such as regular exercise, a healthful diet, exposure to sunlight, or relaxation techniques.
• Drink apple cider vinegar if you have confirmed that you have low stomach acid.
• Make sure you keep yourself sufficiently hydrated, and try drinking plain water when you get reflux.

You may not need to apply more than one of these ideas, try them for a week or so in turn to see which ones make a difference to you.

If you experience reflux at night, try propping yourself up.  You could also raise the head of your bed 10-20cm/4-8 inches (make sure it is secure!) or try a wedge shaped pillow.  Note: you may find propping yourself up with pillows causes you to scrunch your stomach up more making reflux worse.  You could also try sleeping on your left-hand side (changing the angle of the stomach opening) – this was a trick I learned during pregnancy.

• Gastroesophageal Reflux Disease (GERD) – Clarrett and Hachem (2018) – https://pmc.ncbi.nlm.nih.gov/articles/PMC6140167/
• Laryngopharyngeal Reflux – Brown and Shermetaro (2022) – https://www.ncbi.nlm.nih.gov/books/NBK519548/