Diet, lifestyle and acid reflux

Pain, discomfort and disruption to sleep caused by the unpleasant symptoms of acid reflux can seriously impact on quality of life and cause anxiety around consuming certain foods or drinks. In this informative article, the first of a series on the condition, Professor Stuart Bloom, a highly respected consultant gastroenterologist, answers commonly asked questions about acid reflux and sheds light on lifestyle changes which can help to improve symptoms.

How is acid reflux defined?

When defining acid reflux, it must first be considered that the main source of acid is in the stomach and its contents are extremely acidic. The stomach is well adapted to deal with this and the problem comes when the acid refluxes and enters other areas where it shouldn’t be. In this case, the acid refluxes into the oesophagus, or gullet. The oesophagus is not adapted to respond to acid and as such, troublesome symptoms arise.

Most people therefore would define acid reflux clinically, according to its symptoms. Although it’s important to say that some people experience significant reflux with variable or no symptoms at all. In the laboratory, scientists who measure acid reflux would have their own laboratory definitions. For the lay reader, however, the definition is clinical, meaning it is derived from symptoms of heartburn, feelings of acid or discomfort in the epigastric area just at the bottom of the breastbone.

What are the main causes of the condition?

The major problem behind acid reflux is a failure of the muscle at the lower end of the oesophagus, called the lower oesophageal sphincter, which sits at the gastro-oesophageal junction. Normally, the body is very clever and this sphincter stays tightly closed unless food or drink is taken, when the sphincter opens up to allow the contents to pass through. The muscle then contracts again once the food or drink has passed so that if you stand on your head, the acid in your stomach doesn’t come up into the oesophagus.

However, in around five per cent of people the muscle at the lower end of the oesophagus relaxes inappropriately or doesn’t have correct tone which can cause a tendency for acid to come up from the stomach into the oesophagus. This may be aggravated by a condition such as a hiatal hernia where a little bit of the stomach comes through the hole in the diaphragm, which normally transmits the oesophagus.

How does acid reflux cause disruption to daily life and wellbeing?

Acid reflux can cause a variety of disruptions to normal life. At perhaps the simplest level, it can cause pain and heartburn after particular foods. Sometimes at night, when people lie down to go to sleep, this discomfort worsens because this position can cause acid to leave the stomach and come up into the oesophagus so reflux is nearly always worse at night.

Similarly, patients very often learn that sometimes their favourite foods can aggravate reflux especially alcohol, caffeine and rich and spicy foods, which can limit people’s diets and their enjoyment of food. The third way that acid reflux can disrupt daily life is its disruption sleep patterns because it is often worse at night. Additionally, acid reflux can sometimes lead to more serious complications, mainly because of the inflammation at the lower oesophageal sphincter.

Which foods can worsen or relieve acid reflux symptoms?

This is a very important area. Some foods have pharmacologically active compounds within them; most commonly alcohol, caffeine and nicotine. A coffee late at night will aggravate reflux, as will an alcoholic drink. Nicotine also acts to relax the lower oesophageal sphincter as do alcohol and caffeine.

In addition, if there is significant reflux or sensitivity of the lower oesophagus, rich or spicy food, such as curries, or acidic foods, such as lemon juice or citric fruits, can aggravate reflux symptoms. There are no foods which are specifically good for reflux although sometimes alkaline foods, such as milk or similar bland foods, can coat the stomach and provide some temporary relief. In general, we would advise people to avoid rich or spicy foods but otherwise most foods will not worsen their condition.

What lifestyle changes can alleviate acid reflux symptoms?

The initial phase of treatment for acid reflux involves some lifestyle measures. Although some authorities are rather sceptical of this, some changes can be very useful to patients and offer good results. The first of these is to avoid eating late at night and to go to bed with an empty stomach. This is because late night eating can stimulate gastric acid and therefore we normally advise patients to eat their evening meal at least four hours before going to bed. It’s also important to avoid night time snacking, even with something that is said to settle the stomach, such as an antacid or a milky drink. These stimulate acid secretion and can make acid reflux worse.

The second solution that can be used at home is to elevate the head of the bed. Many people attempt to do this just by using a pillow or two but isn’t effective as it tends to elevate only the neck. A wedge pillow slipped under the top of the mattress can work as a compromise, so that the whole of the upper body is at a slight angle. By far the best solution, however, is to elevate the head of the bed by around three or four inches, perhaps with a brick or a couple of books. This does not cause either the patient or their sleeping partner to fall down the bed and on the same principle as guttering, it encourages the acid to go down towards the feet rather than to reflux upwards.

Another mechanism to improve symptoms is to lose weight. Of course, this is easier said than done but there’s no question that in patients who are overweight, the pressure on the stomach from the abdomen predisposes them to reflux and weight loss, even of a relatively modest amount, such as half a stone to a stone, can result in significant benefit to reflux symptoms.

The only other lifestyle measure is to avoid precipitating foods as previously mentioned, such as those which contain caffeine or are acidic, rich or spicy.

If you are concerned by symptoms of acid reflux and wish to discuss treatment options, you can book a consultation with Professor Bloom by visiting his Top Doctors profile.