Diet for gastro-oesophageal reflux: what to eat and what to change

Why do I have reflux?

Because something makes that valve fail to close properly or makes the stomach push upwards. It is almost never one single thing. Usually several add up, such as excess weight, smoking, alcohol, large or very fatty meals, eating in a rush and lying down soon afterwards. There is no safe amount of alcohol for health (OMS): the less, the better; and none during pregnancy, breastfeeding, childhood, if you are going to drive or if your medication does not allow it. See “Heartburn in pregnancy”.

Pregnancy also raises the pressure inside the abdomen and causes reflux without anything being broken. And there is hiatus hernia, when part of the stomach moves up into the chest through the diaphragm. It makes reflux more likely, but it is neither its only cause nor does everyone with a hernia have it.

Can reflux be cured?

Diet cannot cure reflux, but it can control it. Changes to your diet and habits reduce the symptoms and keep you away from what sets them off, and for many people that is enough. When medication is needed, your doctor manages the medication.

Before thinking any further about food, it is worth reviewing what you take. The British clinical guidelines advise going over the drugs that may be behind these symptoms, such as calcium antagonists, nitrates, theophyllines, bisphosphonates, corticosteroids and anti-inflammatories [4]. That does not mean stopping any of them on your own. You take the list to your doctor and ask.

What relieves reflux?

The measures do not all carry the same weight. The American College of Gastroenterology reflux guideline gives a strong recommendation to only one, losing weight if you are overweight or obese [1]. If that is you, the weight-loss diet is a good starting point. If it is not, the other measures are still useful to you.

The others come with a weaker recommendation and low-quality evidence [1]. They are having dinner at least two or three hours before going to bed, stopping smoking, raising the head of the bed if you have night-time symptoms and avoiding the foods that trigger your symptoms. That is why they are tried out and adjusted to each person.

Food is the same. An analysis of twenty-one studies concluded that the evidence for managing reflux with diet is limited. It also concluded that the plan has to be individual and maintained over time, removing or adding foods as the case requires [2].

Movement counts too. Active people have less reflux, and the risk falls clearly from around 150 minutes of activity a week [5]. Better away from meals and without exercises that bring on burning.

Which foods make reflux worse?

There are two groups, and they do not work the same way. Alcohol, tobacco, chocolate, mint and fatty food lower the pressure of the valve, at least in laboratory measurements [1]. Coffee, citrus fruit and spicy food barely move it, although for some people they cause trouble by another route [1]. Even so, few studies show that removing those in the first group improves symptoms [1].

There is no universal list. The British guidelines advise avoiding the foods you notice trigger your symptoms [4]. In clinic this is how we do it. The suspected foods are removed for one or two weeks, tried again one at a time, and only the ones that trigger your symptoms stay out. Removing them all just in case makes the diet less varied and does not improve heartburn. Do not restrict your diet more than necessary.

Do I have to give up coffee?

If you notice heartburn when you drink it, give it up; if not, there is no need to stop drinking it. An analysis of forty studies found slightly more reflux among those who drink coffee, 34.9% versus 30.7% [6]. It is a small difference and the authors themselves ask for more studies to clarify that association [6].

With tea, test your tolerance: if it brings on heartburn, give it up. That analysis deliberately left out the studies that mixed coffee with other drinks, tea among them [6].

How to spread out meals and dinner

In smaller portions and without rushing. We suggest four or five moderate meals, eating slowly and chewing well. Include breakfast at whatever time you can, unless it triggers your symptoms or does not fit your lifestyle. With less volume each time, the stomach puts less pressure on the junction with the oesophagus.

Dinner is the meal you notice most, because afterwards you lie down. Keep it small, because a large dinner keeps the stomach full for hours. And do not drink much right before getting into bed.

If you also have gastritis or hiatus hernia

They look alike and get confused, but it is worth knowing which is which. If what burns is the pit of the stomach, below the breastbone, and not the chest, see the gastritis diet. The advice overlaps quite a lot, but the cause and what the doctor does about it change.

If a hiatus hernia has already been found, this advice works for you just the same, because the symptoms are produced by reflux. And if you notice more bloating and wind than burning, start with the bloated tummy and abdominal distension.

What mistakes do we see in consultations?

• Having dinner late and trusting that a small dinner makes up for it. A light dinner helps, but it does not replace waiting before going to bed.
• Living on boiled rice and chicken breast for months. The diet becomes poor, the burning carries on and there is no longer any way to know which foods trigger your symptoms.
• Putting two pillows in place of raising the head of the bed. They bend the neck and do not raise the chest.
• Drinking a lot during the meal. The stomach fills up more than it should.
• Stopping your heartburn medication as soon as you feel better, without telling anyone. Your doctor manages that medication plan.
• Sticking to the food list and forgetting timings, the head of the bed and weight, which have as much backing or more [1].