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Q: I’ve been diagnosed with gastroesophageal reflux disease and would like to manage it naturally, without medication. Which foods are no-nos for reflux? Do some foods prevent symptoms?

Many of us have experienced occasional heartburn or an acid taste in our mouth after eating a large meal. These symptoms are caused by gastroesophageal reflux, which occurs when the stomach’s acidic contents flow back into the esophagus, the muscular tube that connects the throat to the stomach.

For some people, though, these uncomfortable symptoms persist and result in gastroesophageal reflux disease (GERD). If left unmanaged, constant acid reflux can damage the lining of the esophagus and cause inflammation.

Foods don’t cause GERD to develop in the first place, but some can trigger symptoms or make them worse.

What causes GERD?

It’s estimated that GERD affects up to 40 per cent of North Americans. Heartburn, ranging from mild to severe, is the most common symptom, but others include bad breath, nausea, hoarseness, sore throat, chronic coughing, difficulty swallowing and unexplained chest pain.

GERD is caused when the lower esophageal sphincter, a bundle of muscles that act as a one-way valve between the esophagus and the stomach, becomes weak or relaxes. This allows acid to backflow into the esophagus.

Other factors that contribute to persistent reflux include delayed stomach emptying, pregnancy, cigarette smoking and hiatal hernia, a hernia that results from part of the stomach bulging through the diaphragm.

Anti-reflux diet strategies

Diet and other lifestyle changes are recommended to help prevent acid reflux and its damage to the esophagus. For people with mild GERD symptoms, lifestyle modifications alone may eliminate symptoms. Medication, however, is required to heal an inflamed esophagus.

Lose excess weight

Obesity, defined as having a body mass index (BMI) of 30 or greater, is associated with having more severe and more frequent acid reflux symptoms. Even moderate weight gain in women of normal weight has been shown to cause or worsen symptoms.

Carrying extra weight around the middle creates abdominal pressure that can disrupt the lower esophageal sphincter, facilitating reflux. Abdominal pressure can also lead to a hiatal hernia.

Research conducted among obese individuals found that achieving a 10-per-cent weight loss led to a significant reduction of symptoms, including heartburn, regurgitation, chest pain and belching.

Manage meal size and timing

Avoid eating large calorie-dense meals. Eating smaller meals, more often, can help reduce acid reflux into the esophagus.

Eat your last meal of the day at least three hours before bedtime. Doing so allows time for food to empty from the stomach. (It can take up to four hours for a solid meal to move out of the stomach.)

Limit fatty foods

Fried foods, high-fat baked goods , ice cream, sausage, bacon, potato chips and other fatty foods can worsen reflux symptoms by causing the esophageal sphincter to relax. As well, bile salts that are required to digest fat could irritate the esophagus if reflux occurs.

Control carbohydrates

If you eat large portion sizes of starchy foods such as rice, pasta, cereal and bread, cutting back may help. Undigested starch is fermented by bacteria in the colon, a process which can lead to the release of chemicals that cause the esophageal sphincter to relax.

Reducing added sugar intake has also been shown to help resolve reflux symptoms.

Avoid triggers

Limit alcohol and coffee, both of which can increase reflux. Compounds in coffee, regular and decaffeinated, cause esophageal muscles to relax.

Chocolate, cocoa, peppermint, spearmint, mint teas and carbonated drinks may also trigger reflux by reducing the pressure in the lower esophagus.

Spicy foods, black pepper, citrus fruit, pineapple, tomatoes and tomato products can cause further irritation to an inflamed esophagus. Avoid them if they bother you.

Increase fibre

Research has linked a higher fibre intake to fewer heartburn symptoms. One study found that taking psyllium, a soluble fibre, three times a day reduced heartburn and reflux episodes. How fibre improves heartburn is unknown.

Other sources of soluble fibre include oatmeal, barley, sweet potato, kidney beans, green peas, carrots, pears and apples.

Leslie Beck, a Toronto-based private practice dietitian, is director of food and nutrition at Medcan.

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