Food
Acid and Alkali foods
The acidity or alkalinity of what we consume actually has little or no bearing on the acid production of the stomach.
Stomach acid is produced by the parietal cells in the stomach in response to action of neurotransmitters histamine and acetylcholine, as described in the chapter "How the Stomach makes acid". It is highly concentrated hydrochloric acid that can dissolve metal.
If you pour vinegar (an acid) on your hand, it will feel wet. Pour battery acid on your hand and it will cause damage. Pour vinegar on the damaged area and it will hurt; it's not the vinegar that's caused the problem but the concentrated acid. (See the chapter on "Heartburn".)
Despite the many articles on "health" websites extolling the values of alkaline diets, they do nothing to reduce stomach acid.
Acidity is measured in terms of pH. pH7 is neutral: anything below is acid and anything above is alkaline.
Stomach acid "at rest" is usually pH4 but can reach pH1 when "active". (Vinegar is pH4.)
You can measure pH values using indicator papers but, whereas saliva or urine may be easily measured, stomach acid cannot.
Foods that may cause reflux
It is suggested that some drugs (like caffeine and alcohol) may cause the muscles of the lower oesophageal sphincter to relax which could exacerbate reflux. However, for those experiencing frequent reflux, their sphincter is obviously malfunctioning anyway and the drugs' actions may make little difference.
Anything causing a build up of gas in the stomach may cause reflux.
This includes beans, brassicas (cabbage, cauliflower, etc), salad vegetables (cucmbers, radishes etc), fruits, grains, dairy products, breads and cereals etc.
Perhaps sounding counter-intuitive, sipping plain soda water can help by permitting a controlled burp to release the gas. (See the chapter on "Sphincters and Burps".)
Know your triggers
Some acid refluxers may be affected by some foods that exacerbate their heartburn. They are their trigger foods. However, as everyone is different, not everyone is affected in the same way by the same foods. We don't know why some foods act as a trigger for some and not others. It could be to do with the foods we were weaned on, our environment or even the food choice of our mothers whilst we were still in the womb. A snap poll of members of the BarrettsEsophagusAwareness Facebook group, found, out of 130 respondents, about 30% of refluxers have not experienced heartburn. This may be due to the protection afforded by Oestrogen.
To determine your food triggers, you should keep a food diary writing down the components and times of meals and recording any possible consequences. Analysing your log after a week or two may identify common elements that caused your reflux. These foods only need to be avoided whilst your oesophagitis heals.
These items are frequently found on people's trigger foods lists but they may not affect you. If unaffected, you don't need to avoid them:
Spicy Foods, Citrus fruits, tomatoes, dairy products, fatty foods, soda, coffee.
Some food myths
The plethora of largely false advice and information regarding beverages prompted the creation of separate pages to look at some of them:
The common belief is that coffee, being acidic and containing the drug caffeine may promote or exacerbate acid reflux, particularly as it is often cited by patients experiencing heartburn. However, the balance of research does not appear to support this. (See this chapter for a full evaluation of the science.)
Alcohol is associated with various types of cancer but what is the risk for acid reflux, Barrett's and Oesophageal Adenocarcinoma?
Cancer Research UK identified 7 types of cancer lined to alcohol: "Drinking alcohol increases the risk of mouth cancer, pharyngeal (upper throat) cancer, oesophageal (food pipe) cancer, laryngeal (voice box) cancer, breast cancer, bowel cancer and liver cancer."
N.B. the "oesophageal cancer" listed above is Squamous Cell Carcinoma (ESCC) affecting the upper oesophagus, rather than the adenocarcinoma (EAC) connected to acid reflux and affecting the lower oesophagus.
"Squamous cell carcinoma is associated with black race, alcohol and smoking, while adenocarcinoma is related to higher body mass index, white race and Barrett's esophagus." (Epidemiological features of esophageal cancer. Squamous cell carcinoma versus adenocarcinoma. 2014)
(See this chapter for evidence for and against alcohol as a risk.)
Heavily promoted by those who hope to profit from its sale, alkaline water has been shown to have none of the claimed beneficial properties and is nothing but a hoax as this chapter exposes.
The link takes you to a chapter with the research links.
As with Alkaline Water above, Alkaline Diets propagate myths with no basis in scientific fact. Often promoted by those hoping to make money from those gullible enough to believe their pseudoscience.
The link takes you to a chapter with the research links and also looks at supplements.
How we eat is important
It's not so much what we eat as how we eat that's important. The main problem with "Fast Food" is the speed rather than the content.
Our modern lifestyle is much to blame for an increase in acid reflux and its associated problems.
We are prone to eat too much and too quickly and probably the wrong foods, too. (For instance fatty or processed meats need longer to break down in the stomach so should not be eaten in a rush, "on the go".)
When we eat, we need to eat small portions to avoid over-filling the stomach. We should eat slowly to permit each food bolus to enter the stomach and start being processed before the next is sent on its way.
Chewing each mouthful well will stimulate secretion of saliva and mucous to protect and lubricate the oesophagus to facilitate peristalsis to the stomach.
Keeping upright whilst eating is important for gravity to help.
A 1999 study on The role of diet and lifestyle measures in the pathogenesis and treatment of gastroesophageal reflux disease [fd-viii] stated, "A general consensus on the control of GERD through alterations in diet and lifestyle factors could hardly be based on the results of clinical or outcome studies."
This was further supported by a 2017 study Diet and GERD: Role in Pathogenesis and Management [fd-ix] stating, "Although anecdotal evidence has suggested associations with certain foods (fats, nonvegetarian, fried foods, and beverages) with reflux symptoms, objective evidence based data in this field remain unclear. Recent evidence points to the increasing importance of lifestyle in disease development as well."
And this item [fd-x] said, "It's Not Food Causing Your Heartburn—Here Are The 5 Real Culprits"
Exercise after food
After eating, the stomach should be allowed to empty before any activity which would result in it being squeezed, tilted or shaken.
It is probably best to abstain from activities like sit-ups, heavy lifting, bending down, running, swimming etc for an hour after eating.
However, gentle upright exercise is encouraged like walking which will help the food move from the stomach into the duodenum quicker.
Page updated 23 January 2023