GERD Diet: Foods to Eat and Foods to Avoid for Acid Reflux
Struggling with acid reflux? Wondering if there are any foods that help heartburn? Let’s explore the GERD diet: foods to eat, foods to avoid + lifestyle choices to help you find some relief, all from a registered dietitian and best-selling author of a gut health cookbook.
As a dietitian with a focus on gut health nutrition (I even wrote a bestselling gut health book called Good For Your Gut Cookbook!) I find it curious that we don’t talk a lot about acid reflux, heartburn and GERD. Especially considering that it is one of the most common digestive diagnoses out there.
A recent meta-analysis estimates the prevalence of reflux as 15% of the North American population. In one 2018 survey of over 71,000 Americans, over 61% of respondents experienced at least one GI symptom in the past week. The most common? Reflux, at 30.9% of people. That’s almost one-third of folks!
And I was shocked by this data from my home province of British Columbia, suggesting that prescriptions for proton pump inhibitor medications for GERD have grown by 257% since 2000, even though our population has only grown by 20% in the same period.
So let’s talk about reflux, what it is and how nutrition might help.
- Heartburn vs Acid Reflux
- What is GERD?
- Acid Reflux: Foods to Eat
- Acid Reflux: Foods to avoid
- Natural remedies for reflux
- Nutrition Considerations when using Proton Pump Inhibitor medications
- GERD Diet + Lifestyle Practices
Heartburn vs Acid Reflux
Whether you call it heartburn or acid reflux, we’re talking about the same thing: the troublesome refluxing of stomach contents back into the esophagus and throat. It’s often called reflux because of the telltale burning sensation around the center of your chest…although it has nothing to do with your heart!
Your stomach is highly acidic, which is important for the proper digestion and absorption of the food you eat. At the top of the stomach is a little muscular trap door known as the lower esophageal sphicter, or LES. The LES is acid-sensing, meaning it is supposed to snap shut tightly when the stomach pH decreases but sometimes, it can falter.
Why does reflux happen? It could be because you are just too full after a feast, or because you are pregnant, and the pressure from your baby is pushing up on the stomach. It might actually happen if your stomach acid is too low (that’s a bit of a controversial statement!) or as you get older, because muscle tone decreases which can decrease pressure in the LES. If it happens every once in a while, no big deal. Use the tips below and move on! But, what if it is more than once in a while?
What is GERD?
GERD is reflux…but like ALL OF THE TIME. If you are experiencing heartburn consistently more than twice a week, you experience nausea or the Tums aren’t working, you might have GERD: gastro-esophageal reflux disease. If you experience regular reflux, get checked out to know for sure. Other conditions, such as Functional Dyspepsia, also mimic GERD, so don’t self-diagnose!
GERD Diet: Foods to Eat for Acid Reflux
There is shockingly little research to guide us in making nutrition recommendations for reflux, and at this point, there is no “GERD Diet” in terms of a dietary pattern we can prescribe to manage symptoms. However, the science does give us a few clues. And in practice? We see very clearly that improving diet, particularly adopting a more plant-based diet, helps our clients feel better.
- Ginger: Ginger is a pro-kinetic, meaning that it helps to encourage healthy movement in the gut, particularly in the stomach. Ginger hasn’t been specifically researched in GERD; however, research does suggest it’s effective for increasing motility and decreasing nausea, especially in pregnancy. But easy does it…ginger is a bit spicy!! A little goes a long way, like a cup of ginger tea.
- Psyllium: Eating high fibre foods is thought to support reflux in multiple ways: increasing motility in the gut, decreased effect of nitric oxide on the LES and potentially, decreased stomach acidity. In one 2018 trial, taking 1 teaspoon of psyllium husk 3 times a day resolved symptoms in 60% of the study subjects after just 10 days. It’s worth noting that subjects had a low baseline fibre intake…but so do most North Americans!
- Fruits + Vegetables: Non-acidic fruits and vegetables such as broccoli, spinach, berries, bananas and papaya are all rich in fibre and low in fats to minimize reflux symptoms…plus, they are nutrient-dense to help you and your gut feel your best! Whenever possible, try to make half your plate fruit and vegetables at most meals.
- Whole grains: Whole grains such as oats, wheat berries, quinoa and millet are also rich sources of fibre and help support healthy movement of the digestive tract. What’s more, soluble fibre-rich foods such as rolled oats feel especially soothing to the troubled gut. Eating a more plant-based diet is a smart approach to better overall digestive health. If you’re ready to get started, consider picking up Good For Your Gut to help show you just how delicious a gut-friendly plant-based diet can be!
GERD Diet: Foods to avoid for Acid Reflux
It’s important to note that dietary triggers are individualized in reflux, so don’t consider this a cut-and-dried list of what everyone needs to avoid. Instead, listen to your body: which foods cause symptoms for you? Consider keeping a food and symptom journal for a couple of weeks to see if any patterns emerge. A couple of these bear some explanation, but the others are pretty standard – and you might find they are causing symptoms for you too!
- High fat meals: fat can increase pressure in the stomach, making reflux more likely. Healthy plant fats from nuts, seeds, olive and avocados are super important…so don’t eliminate them! Instead, eat fewer deep fried foods. Eat fewer cheesy, creamy sauces. Use a little drizzle of oil when cooking, instead of covering the bottom of the pan.
- Carminative Herbs (Peppermint, Cinnamon): carminatives help relax the smooth muscle of the gastrointestinal tract, which sometimes (like in IBS) you want, but you definitely do NOT want that in reflux.
- Acidic Foods (Citrus, Tomatoes, Soda)
- Spicy foods
Natural Remedies for Reflux
Adopting a more GERD-friendly diet is all about prevention. But when heartburn strikes? I get that you want it to go away, FAST. Here are a couple of things to try:
- Calcium is very soothing in reflux. Pop a Tums, which are just calcium. If reflux is only occasional, there is nothing wrong with doing this! Or try a glass of plant-based milk, which is a great calcium-rich food.
- Chew (non-mint, non-cinnamon) gum to help dilute acid
- Try a couple of pieces of black licorice, or with your doctor’s approval, try DGL, deglycyrrhizinated licorice extract. Warning: it can interact with blood pressure meds.
- Go for a gentle walk. Movement begets movement.
Nutrition considerations when using Proton Pump Inhibitor medications
Proton pump inhibitor (PPI) medications are widely prescribed for reflux and considered very safe. While not originally intended for long term use, many clients that come into our practice have been taking them for years. Sometimes, these clients are still suffering from reflux despite using the medications. Medication decisions are between you and your physician. If you choose to use them, it is worth noting a couple of nutritional considerations to keep in mind.
- Risk of C.diff infection: proton pump inhibitors may alter the gut microbiome with long term use, increasing risk for infection with Clostridioides difficile, an antibiotic resistant species of bacteria. Ask your doctor about using probiotics with long term PPI use.
- Vitamin B12 deficiency: your body requires intrinsic factor to help you digest and absorb vitamin B12. Intrinsic factor is released in the stomach secretions, which PPI medications reduce (but do not eliminate). Ask your doctor whether you need to monitor your B12 levels and consider taking a B12 supplement, which is harmless and recommended for anyone over 50 or on a plant-based diet anyways.
- Low magnesium: low magnesium levels have been noted with PPI use…and magnesium is already a mineral that many of us do not get enough of! Consider taking additional magnesium to offset this, and enjoy more magnesium-rich foods such as legumes, nuts and hemp hearts.
GERD Diet + Lifestyle Practices for Reflux
Managing GERD isn’t just about avoiding triggers. Consider these lifestyle approaches to help you find relief.
- Try smaller, more frequent meals: this will help you avoid over-filling the stomach and increasing pressure on the LES
- Raise head of bed 4-6 inches with a block under the mattress: this helps gravity minimize reflux overnight
- Finishing eating 3-4 hours before bedtime: this will help minimize food in the stomach when you lie down
- Gentle walks: gentle movement helps increase gut movement, while vigorous workouts slow it down. Ensure you do intense activity at least 2 hours after a large meal.
- Wear loose clothing: it will help reduce the upwards pressure on the stomach
- Quit smoking: easy to say…tough to do. But very helpful in alleviating reflux.
- Manage stress: through meditation, breath work, time in nature…whatever it takes! Stress can alter gut motility, stomach secretions and even sensations of pain.
I hope that you found some information here to help you find relief! If you’re looking for more guidance on gut health, pick up a copy of Good For Your Gut, or consider getting some one-on-one care from one of our registered dietitians.