Acid reflux is the most common upper gastrointestinal problem in people across the world. It occurs when the acidic stomach juices flow upwards into the food pipe (esophagus) and sometimes even as high as the throat, mouth or even nose. We all may experience acid reflux every now and then in life especially after overeating and heavily indulging in alcohol or spicy foods. But sometimes the condition is chronic meaning that it occurs non-stop or recurs on a very frequent basis. Acid reflux is more correctly known as gastroesophageal reflux disease. This means that it is a disease where the stomach (gastro-) contents flows backwards (reflux) into the food pipe (esophagus).
What causes reflux?
Acid reflux is a result of a dysfunctional lower esophageal sphincter (LES). This is a collection of muscles that helps regulate the movement of food between the esophagus and stomach. When you swallow food, it travels down the esophagus and the LES opens for a short time to allow the food to pass into the stomach. The LES stays closed at all other times to prevent the acid and digestive enzymes from spilling into the esophagus. In gastroesophageal reflux disease, the LES is either dysfunctional, defective or forced open. This allows the stomach juices to rise up the esophagus.
The stomach has various mechanisms to contend with the acid. In this way the stomach can hold the acid within it but not be irritated, damaged or digested by the stomach acid and enzymes. The esophagus, however, is not able to handle the acid for long. When stomach acid enters the esophagus, copious amounts of alkaline saliva are released from the mouth to neutralize the acid and the esophagus starts contracting strongly to push out the acid back into the stomach. However, this is not always sufficient and the acid can cause inflammation of the esophagus, known as esophagitis.
How foods cause acid reflux?
Various factors can compromise the function of the lower esophageal sphincter (LES) and lead to acid reflux. Food and drinks are some dietary triggers or exacerbating factors. In chronic cases, the problem lies with the LES, either the muscles it is comprised of or the nerves supplying these muscles. It is unable to close fully as it should either all of the time or during certain times. Food and drink can worsen the situation but is not necessarily the cause of the LES dysfunction. Similarly in acute cases, the consumption of certain foods and beverages can worsen acid reflux. It is not only about the type of food and drink but also about the quantity that is consumed in one sitting.
Coffee and Caffeine
Coffee is known to be one of the major triggers for acid reflux as is the case with other caffeinated beverages. But this does not mean that you cannot drink coffee. Rather it is about the quantity and frequency. A single cup of coffee early in the day may not pose a major problem but drinking coffee throughout the day and just before bedtime can worsen acid reflux. Similarly other caffeinated beverages such as sodas with caffeine and even tea can pose a problem in aggravating acid reflux.
Sodas and Gassy Drinks
Sodas and gassy drinks are other beverages that are known to worsen acid reflux. Even varieties without caffeine can be a problem. It is believed to be related to the stomach distension that occurs with consuming carbonated drinks. These beverages may also cause a short term increase in the acidity of the stomach juices. However, there have been some studies into the effects of carbonated beverages on gastroesophageal reflux disease that has revealed the contrary. As with caffeinated beverages like coffee, drinking soda and other carbonated drinks may play a role in worsening acid reflux particularly when consumed in large amounts or just before sleeping.
Chocolate and Cocoa
Chocolate and cocoa products are one of the major foods that aggravate acid reflux. Chocolate specifically is the bigger problem food among cocoa products due to having several ingredients that all contribute to acid reflux. Firstly chocolate is primarily made from cocoa, a known factor that contributes to reflux. It also has other compounds like caffeine and theobromine which worsens the condition. But if you are looking at white chocolate then you need to be aware that this can also be a problem. Chocolate has a high concentration of fats, primarily dairy fats. All fats pose a problem in acid reflux so you may not be able to avoid the problem by opting for white chocolate.
Alcohol weakens the muscle tone of the LES thereby promoting acid reflux. It can occur even in a person with no prior history of reflux. The degree to which the LES is affected depends on the quantity of alcohol consumed. Some types of alcoholic drinks appear to be worse than others. Beer being “gassy” is considered to be worse and you should avoid alcoholic drinks with carbonated beverages or acidic juices as mixers. However, any alcohol can pose a problem particularly when consumed in large quantities. Coupled with overeating when inebriated or during festivities, alcohol can be a major problem for GERD patients.
Fatty and Fried Foods
All fats pose a problem in acid reflux. Whether the food contains fats or is prepared in fats does not really matter. Fatty foods like full fat dairy and high-fat meat should be substituted for low fat and lean options. But even if you looking to avoid these foods, the preparation of other foods and even the simple potato can be a problem. French fries that are fried are another major contributor to acid reflux but there is no need to skip the fries if you are prepared to bake rather than fry them.
Vegetables and Fruits
There is no group of foods that can be said to be entirely “safe” when it comes to acid reflux. Vegetables and fruits which are thought to be the healthier food option in general can also pose a problem in reflux. Some are known to be more of a problem than others. These includes :
- Bell peppers (capsicum)
- Citrus fruits
- Horse radish
Even herbs like mint can be a problem. It is not only eating these vegetables and fruits whole that can exacerbate reflux. Tomato sauce and fruit juices may also trigger or worsen acid reflux despite being somewhat processed.
Most people suffering with heartburn know that spicy foods are probably one of the worst meals for acid reflux. But not every person seems to have a problem with spicy foods. It really depends on the individual as some people may be able to tolerate milder spicy foods while others can go much hotter without a problem. Although it is mainly the hot varieties of foods laden with pepper and chilli that are the problem, many other heavily-spiced foods can also be a problem despite not being hot to the taste buds. As with all drinks and foods causing acid reflux, spicy foods that are eaten in moderation occasionally may not trigger or exacerbate reflux.
Article reviewed by Dr. Greg. Last updated on February 8, 2013