An estimated 100 million Americans suffer from acid reflux, with half remaining undiagnosed. The number of people affected by this problem has risen 4 percent per year since the 1970s. This article explores the principles of a low-acid diet, often referred to as the "reflux diet," and provides a detailed food list to help manage acid reflux symptoms.
Understanding Acid Reflux and GERD
Acid reflux occurs when the acidic contents of the stomach leak backward into the esophagus, the tube connecting the mouth to the stomach. Everyone experiences heartburn now and then. In people with GERD, acidic contents leak from the stomach up into the esophagus (the tube that connects your mouth to your stomach). This condition, also known as Gastroesophageal Reflux Disease (GERD), can cause uncomfortable symptoms and, over time, irritate the lining of the esophagus, leading to further health complications. It's important to note that "silent GERD" can occur without noticeable symptoms, yet still cause damage to the esophagus.
The Role of Diet in Managing Acid Reflux
While no single food is the direct cause of GERD, certain foods and eating habits can worsen its symptoms. It's not a great idea to just omit the full list of these foods. Keeping a record of what you eat and when you experience symptoms can help identify personal trigger foods. Certain foods are more acidic and can irritate the lining of the esophagus.
Sarah Andrus, MS, RD, LDN, a Mass General Brigham outpatient dietitian in the Newton-Wellesley Hospital GERD and Heartburn Clinic, says, “Your food should be moving one way - from your mouth to your stomach - and it should be digested in your stomach within a certain period of time."
Key Principles of the Reflux Diet
The reflux diet focuses on reducing the intake of foods that can relax the lower esophageal sphincter (LES) or increase stomach acid production. The lower valve connects your esophagus to your stomach. They should remain closed until they need to open to allow food to come in. “But certain foods and drinks can relax that valve at the end of your esophagus, allowing acidic stomach contents to come back up into the esophagus."
Read also: The ultimate guide to acid reflux cooking
General Dietary Recommendations
- Eat Smaller Meals More Frequently: Instead of consuming large meals, opt for smaller, more frequent meals.
- Avoid Late-Night Eating: Do not eat during the three to four hours before you go to bed.
- Stay Upright After Eating: Do not lie down after eating. This means no naps right after lunch.
- Limit Vigorous Exercise After Eating: Avoid vigorous exercise for a couple of hours after eating.
- Increase Fiber Intake: Look at every meal for a source of fiber. If you find your diet lacking, try to start replacing simple carbs with complex forms of fiber.
- Chew Gum: Chew gum to increase saliva production.
- Eat Slowly: Eat slowly to prevent swallowing air.
"Red" Foods: Foods to Avoid or Limit
These foods are more likely to trigger reflux and heartburn. If you eat any of these foods regularly, try eliminating them to see if doing so reduces your reflux. These are generally high in fat, acidic, or contain compounds that relax the LES.
- Chocolate: Especially high-fat milk chocolate.
- Soda: All carbonated beverages. Other foods, including carbonated beverages such as sodas and seltzers can cause distention (pressure) in the stomach that forces the lower esophageal sphincter open.
- Alcohol: Any alcoholic beverages.
- Deep-Fried Foods: High in fat and difficult to digest.
- Fatty Meats: Such as high-fat hamburgers.
- Bacon, Sausage, Ribs: High in fat and often heavily processed.
- Cream Sauce: Such as Alfredo.
- Butter, Margarine, Lard, Shortening: High in fat.
- Mint: Especially peppermint and spearmint.
- High-Fat Nuts: Peanut butter.
- Hot Sauces and Pepper: Can irritate the esophagus.
- Citrus Juices/Fruits: Oranges, limes, lemons, grapefruit, pineapple.
- Tomatoes and Tomato-Based Foods: Can be highly acidic.
- Onions: Can relax muscles in your lower esophagus and worsen reflux symptoms.
"Green" Foods: Foods to Include in Your Diet
These foods are less likely to trigger reflux. When making food choices, some foods have been found to be less reflux-triggering.
- Bagels and Non-Fruit Low-Fat Muffins: Choose whole-grain options.
- Banana: A low-acid fruit.
- Beans: Black, red, lima, lentils, etc.
- Celery: A low-acid vegetable.
- Melon: Cantaloupe, honeydew, watermelon.
- Oatmeal and All Whole-Grain Cereal: Provides fiber and is gentle on the stomach.
- Popcorn: Plain or salted, no butter.
- Potatoes: And all root vegetables except onions.
- Rice: Especially brown rice.
- Whole-Grain Breads, Crackers, and Breakfast Cereals: Choose options with minimal added sugar.
- Lean Meats: Lean meats that are grilled, poached, broiled, or baked are your best options.
- Vegetables: Try to eat your vegetables raw.
- Unsaturated Fats: Unsaturated fats from plants and fish.
- Dairy products: Dairy products are a reliable source of alkaline foods.
The "Dropping Acid" Cookbook and Cure
Dr. Jamie Koufman and Dr. Jordan Stern, co-authors of “Dropping Acid: The Reflux Diet Cookbook & Cure,” developed a list of good and bad foods for reflux, which they call “green” and “red” foods. “I told patients not to eat anything red for the next two weeks. And to my surprise, patients responded and felt better in that short amount of time,” she said.
The book also includes 75 original low-fat recipes developed with French master chef Marc Bauer.
Sample Recipes from "Dropping Acid"
- Sautéed Shrimp with Angel Hair Pasta: A low-fat, low-acid dish.
- Ingredients: Angel hair pasta, extra virgin olive oil, shrimp, snow peas, carrots, clam juice, chicken stock, thyme, parsley, sesame seeds.
- Instructions: Cook pasta; sear shrimp, snow peas, and carrots; add clam juice, chicken stock, thyme, and parsley; toss with pasta and shrimp; sprinkle with sesame seeds.
- Pearl Barley and Vegetable Salad: A nutritious and filling salad.
- Ingredients: Barley, chicken stock, corn, butternut squash, peas, broccoli, cucumber, parsley, olive oil, ginger, green tea, peach juice, baby greens or Boston lettuce.
- Instructions: Cook barley; blanch peas and broccoli; sauté squash; combine all ingredients with a dressing made from ginger, olive oil, parsley, tea, and peach juice.
- OMG (Oh My God) Banana Oatmeal Pancakes: A healthy and delicious breakfast option.
- Ingredients: Light brown sugar, oat flour, all-purpose flour, baking powder, salt, nutmeg, non-fat sour cream or buttermilk, eggs, bananas, milk, butter, maple syrup.
- Instructions: Mix dry ingredients; whisk in wet ingredients; cook on a non-stick pan until golden brown; serve with maple syrup.
The Three Phases of Dr. Koufman’s Reflux Diet
Dr. Koufman’s reflux diet has three phases: (1) Reflux detox, (2) Transition, and (3) Maintenance. The detox program should be strictly alkaline. After detox, things can be loosened up a little.
Read also: Dr. Koufman's Reflux Diet
Reflux Detox
At the beginning of the reflux detox, strictly follow the rule to consume nothing below pH 5; this is well covered in Dropping Acid: The Reflux Diet Cookbook & Cure. You can use pH Paper to test items. FYI: You really don’t need a pH meter and it is not that easy to use properly, e.g., calibration, cleaning, etc. If your symptoms are severe, it’s well worth considering the even stricter induction phase diet for two weeks, in which you eat nothing below pH 5.
- Apples (max.)
- Pears (max.)
- Red bell peppers* (max.)
- Vegetables - raw or cooked, no onion, tomato, peppers.
- Lean preserved meats - e.g.
- Spices (not pepper or chili) - e.g.
- Butter, olive oil, whole egg, toasted nuts and seeds, salad dressings, citrus oils from zest (orange, lemon, lime), Italian Parmesan or Romano cheese, cheddar cheese extra sharp, blue cheeses e.g.
- Cream sauce e.g.
Transition
Maintenance
Understanding pH and Acidity
The pH scale, used to measure acidity, is somewhat counterintuitive. As the pH value increases, the acidity decreases: pH 7 is neutral; pH 1 is very acidic, and caustics like bleach have pH values from pH 8-14. It is also a logarithmic scale, so pH 4 is ten times more acidic than pH 5; and pH 4.8 is twice as acidic as 5.0; this explains why diluting acidic beverages doesn’t make them non-acidic.
The Importance of Individualized Dietary Adjustments
Everyone’s food triggers are different. So it’s not a great idea to just omit the full list of these foods. She suggests keeping a record of what you eat and when you experience symptoms. Some foods, such as bananas, are low in acid, but Koufman said everyone has “trigger” foods that they might always have to avoid or combine with other foods.
“If every time you have tomato sauce you are hoarse and coughing 30 minutes later, it’s a message,” she said. “We give patients permission to learn the rules and be their own detective.”
Additional Tips for Managing Acid Reflux
- Identify and Avoid Trigger Foods: Keep a food diary to track which foods worsen your symptoms.
- Consider Alkaline Foods: For active GERD symptoms, foods that are alkaline (the opposite of acidic) can help neutralize stomach acid.
- Consult a Dietitian: A dietitian can be particularly effective by helping you evaluate your overall diet and identify what triggers acid reflux for you.
The Silent Reflux Diet
The silent reflux diet is an alternative treatment that can help relieve reflux symptoms by limiting or eliminating foods known to inflame or weaken your esophageal muscles. Unlike acid reflux or GERD, silent reflux causes few or no symptoms until it has progressed to later stages. sore throat hoarseness difficulty swallowing shortness of breath or cough. This article takes a closer look at the silent reflux diet and how it may help relieve symptoms of acid reflux.
Read also: Dropping Acid: An Alkaline Diet
The muscles in your lower esophagus, also known as the esophageal sphincter, act as a one-way valve between your esophagus and stomach. They allow food to travel from your esophagus to your stomach, and they prevent stomach acid and food from traveling back up from your stomach to your esophagus. When it’s relaxed, the esophageal sphincter can’t close properly. This can cause a backward flow of food and acid from your stomach, which leads to reflux symptoms.
The silent reflux diet eliminates foods that can relax muscles in your lower esophagus and worsen reflux symptoms. Paired with medication, it can help prevent reflux symptoms and identify the trigger foods that might worsen your condition.
Foods to Avoid on the Silent Reflux Diet
If you decide to try the silent reflux diet, doctors recommend eliminating high fat foods, sugary foods, and acidic fruits and beverages from your diet.
Foods to avoid include:
- whole fat dairy products
- fried foods
- fatty cuts of meat
- caffeine
- alcohol
- soda
- onions
- kiwi
- oranges
- limes
- lemons
- grapefruit
- pineapple
- tomatoes and tomato-based foods
It’s also important to avoid chocolate, mints, and spicy foods because they’re known to weaken the esophageal sphincter. However, it’s worth noting that common trigger foods can affect people differently. Pay close attention to what foods cause you more discomfort or worsen your upper endoscopy results.
Foods to Include on the Silent Reflux Diet
- lean meats
- low fat dairy
- whole grains
- most fruits and vegetables (but avoid acidic ones like citrus, rhubarb, and pineapples)
- caffeine-free beverages
- water
- leafy green vegetables
- legumes
Important Considerations for the Silent Reflux Diet
The silent reflux diet is a food-based approach for reducing reflux symptoms. Though effective, these dietary changes may not treat the underlying cause of silent reflux. It’s best to follow traditional treatment methods advised by your doctor in combination with this diet.
Before adding the silent reflux diet to your treatment plan, discuss your options and risks with a doctor.