How to naturally tackle Acid Reflux

Acid reflux, also known as heartburn and sometimes gastroesophageal reflux disease (GORD), is a common digestive disorder characterised by the regurgitation of stomach acid into the oesophagus. In 2019, 783.95 million cases were recorded globally! ( 1 ). Symptoms of acid reflux are common, but are not normal and it is important that symptoms are not ignored, to prevent any long term complications.

Written by Kayleigh Stannard, Registered Nutritional Therapist, specialising in Gut health and digestion.

Stomach acid (Hydrochloric acid or HCL), as the name precludes, is a highly acidic environment and plays a significant role in the digestive process. It helps breakdown food, plays a key role in nutrient extraction such as B12, magnesium and iron.  (7) . It impacts the movement of food through the digestive system, it influences the secretions of other digestive juices. In addition, stomach acid acts as a defence mechanism against ingested pathogens, such as bacteria, helping prevent infections and food borne illnesses (12).

Acid reflux occurs when the lower oesophageal sphincter, that acts as a gate keeper between the oesophagus (food pipe) and the stomach, relaxes abnormally or weakens, allowing stomach acid to flow back into the oesophagus. Acid reflux can affect individuals of all ages, from infants to the elderly and all sexes (1)

Symptoms of acid reflux include, Halitosis (bad breath), a burning sensation in the middle of your chest, known as heartburn or an unpleasant, sour taste in the mouth. Other symptoms such as a cough, hoarse voice, nausea and bloating may occur. (2)

There are a number of risk factors for acid reflux including:

· Obesity

· Pregnancy (due to increase intra-abdominal pressure)

· Smoking

· Alcohol

· Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAID) (4)

As well as the above risk factors, the following may contribute to the development of acid reflux:

· Stress and anxiety (2)

· Hormones, such as progesterone and oestrogen (2)

· Hiatus hernia (9)

· Stomach ulcer (2)

· Imbalances in the gut, such as bacterial overgrowth (10)

· Infection in your stomach (2)

· Issues with stomach emptying (9)

Additionally, diet and lifestyle habits can trigger or exacerbate symptoms. There is much debate on whether acid reflux is down to too much acid, too little acid or whether acid is being sufficiently produced at the right time. Regardless of the exact context – the symptoms must be addressed. If left untreated, chronic acid reflux can cause significant damage to the oesophagus, and can increase the risk of oesophageal cancer (3). It is therefore crucial to address the acid reflux as soon as possible and investigate the root cause.

Conventional treatment options will depend on the severity and the underlying driver of the acid reflux. The most common conventional treatment options for acid reflux is a proton pump inhibitor (PPI). Long-term lowering of the stomach acid can lead to increased risk of vitamin and mineral deficiencies (7).

EAT

Avoid known trigger foods and drinks. Common triggers are spicy foods, acidic fruit, fatty, greasy foods and a diet high in carbohydrates. Caffeine, fizzy drinks and alcohol can also exacerbate symptoms of reflux (5)(8). 

Caffeine stimulates stomach acid and impacts the lower oesophageal sphincters ability to remain shut (5).

Meal timings should also be considered, research suggests frequently skipping meals, eating too fast and over eating, are all correlated with reflux. (5) Be mindful of portion sizes and consider eating smaller meals, more frequently.

In addition, it is also important to stay hydrated, healthy hydration is supportive of overall digestive function, the stomach produces 3-4 litres of acid a day which requires water to be produced effectively (11).

Therapeutic teas such as ginger, chamomile and marshmallow may soothe the digestive tract and help alleviate symptoms associated with acid reflux. Consider some breathing exercises before meals to calm the nervous system and prepare the body for the incoming food, eat mindfully and chew well!

MOVE

Regular exercise can improve digestion and may therefore benefit individuals with acid reflux. Exercise can also help with maintain a healthy weight, which can reduce the risk for acid reflux. There is a lack of research on which specific types of exercise are most effective for reducing acid reflux. A study involving 10 healthy athletes found running to impact the lower oesophageal sphincter and induce episodes of acid reflux (6). Suggesting some activities like running or vigorous exercise may exacerbate acid reflux symptoms.

It may therefore be beneficial to temporarily adjust your movement to suit your individual needs, whilst addressing the underlying cause. If you are struggling with acid reflux and digestive discomfort, try moving positions as certain postures such as being hunched over can make symptoms worse. Tight clothes around the abdomen can also make things worse.

MIND

Secretions of the stomach are controlled by our para sympathetic nervous system (rest and digest) – If we are stressed or on high alert, this will significantly impact the digestive process. In addition, the first phases of digestion begins before food gets to the mouth. It starts with the look, sight and smell of food, this is called the cephalic phase of digestion (12).

During this phase around 20-30% of the acid is produced (12) Therefore if we are distracted, focused on other things or engaged in technology. This will significantly impact the digestive process. Focus on calming the mind and body to engage the para sympathetic nervous system.

Stopping smoking should also be at the top of considerations also.

SLEEP

Laying down can exacerbate symptoms of acid reflux. Consider keeping your head end of the bed raised by around 4-6 inches. Avoid large meals and be mindful of acidic and spicy food too close to bedtime (consider eating 2-3 hours before bed).

Bedtime is a perfect time to use relaxation techniques to help reduce the symptoms of stress and anxiety. Create a relaxing bedtime routine to calm the nervous system, you may want to consider, breathe work, journaling or mediation or the use of therapeutic teas as mentioned above. 

1. Global, regional and national burden of gastroesophageal reflux disease, 1990–2019: update from the GBD 2019 study - PMC (nih.gov)

2. Heartburn and acid reflux - NHS (www.nhs.uk)

3. Current Advancement on the Dynamic Mechanism of Gastroesophageal Reflux Disease - PMC (nih.gov)

4. Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis - PubMed (nih.gov)

5. Dietary and Lifestyle Factors Related to Gastroesophageal Reflux Disease: A Systematic Review - PMC (nih.gov)

6.Effect of Running on Gastroesophageal Reflux and Reflux Mechanisms - PubMed (nih.gov)

7. Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications - PMC (nih.gov)

8. The effect of dietary carbohydrate on gastroesophageal reflux disease - PubMed (nih.gov)

9. Pathophysiology of gastroesophageal reflux disease—which factors are important? - PMC (nih.gov)

10. High Prevalence of Small Intestinal Bacterial Overgrowth among Functional Dyspepsia Patients - PubMed (nih.gov)

11. How does the stomach work? - InformedHealth.org - NCBI Bookshelf (nih.gov)

12. Stomach Acid Secretion - an overview | ScienceDirect Topics