Nutrition and Lifestyle Strategies for Better Digestive Health
If you're struggling with reflux and eager to enhance your quality of life, keep reading to discover actionable changes you can make today!
As a Registered Dietitian in my clinical practice, one of the most common concerns I encounter is REFLUX, or gastroesophageal reflux disease (GERD). It’s a condition that affects millions worldwide, and in Canada, it’s estimated that about 13-29% of the population experiences GERD symptoms. Our October blog is here to impart some wisdom on this very topic. Reflux can significantly impact the quality of life, but with the right nutrition and lifestyle changes, you can manage these symptoms and feel your best. We are going to dive into my top strategies to help you regain control, and share lots of other goodness below!
Reflux comes in many forms and affects more people than we might think. It’s crucial to address it early so it doesn’t persist, worsen, or interfere with your health goals. Let’s explore simple strategies to help manage reflux and keep your digestive health on track!
Ask yourself …
Do you frequently experience heartburn or indigestion that disrupts your day-to-day life?
Have meals become a source of discomfort, leaving you with lingering acid or regurgitation?
Ever feel like your reflux is worse at night, keeping you from getting a good night's sleep?
Does bending over or exercising soon after eating make you feel that familiar burning rise in your chest?
Have you noticed certain foods seem to trigger that uncomfortable acid reflux feeling more than others?
Let’s begin with some background, starting with what is reflux?
Reflux occurs when stomach acid flows back into the esophagus, leading to discomfort or a burning sensation known as heartburn. Common signs include heartburn, a sour taste in your mouth, and trouble swallowing.
Chronic reflux can lead to subsequent health problems, including poor quality of life - as persistent reflux symptoms can affect daily activities, sleep, and overall well-being. Addressing chronic reflux early can help prevent these serious complications and improve quality of life.
Subsequent health problems from chronic reflux include:
Esophagitis
Inflammation, which can cause pain and difficulty swallowing
Esophageal stricture
Narrowing of the esophagus due to scar tissue formation, making swallowing difficult
Barrett's Esophagus
Lining of the esophagus changes due to prolonged acid exposure
Dental problems
Acid exposure can erode tooth enamel, leading to cavities
Respiratory issues
Asthma, chronic cough, or laryngitis due to acid irritating the airways
Now, let’s get a better understanding of some of the causes of reflux?
Weak Lower Esophageal Sphincter (LES):
A malfunctioning LES can lead to acid leakage into the esophagus
Delayed Stomach Motility:
Slower gastric emptying increases stomach pressure, contributing to reflux
Excess Weight:
Carrying excess weight can increase abdominal pressure, pushing stomach contents up into the esophagus
Dietary Factors:
Certain foods and beverages, such as spicy foods, caffeine, chocolate, and alcohol, can trigger reflux symptoms
Smoking:
Tobacco use can weaken the LES and increase acid production
Hiatal Hernia:
This occurs when part of the stomach bulges through the diaphragm, leading to reflux symptoms
Pregnancy:
Hormonal changes and increased abdominal pressure during pregnancy, especially during the second and third trimester, can cause reflux
Now for my FAVE part, let’s talk about 10 LIFESTYLE changes to improve reflux.
Managing reflux involves a combination of dietary changes, lifestyle adjustments, and mindful habits.
Here are some effective strategies to help alleviate reflux symptoms:
Eat smaller meals more frequently – Large meals can increase stomach pressure, which may lead to acid reflux.
Avoid lying down after eating – Wait at least 2-3 hours after a meal before lying down to allow digestion to occur properly.
Elevate the head of your bed – Raising the upper body while sleeping can reduce nighttime reflux. Consider using a wedge pillow or elevating the bed frame.
Avoid trigger foods – Common culprits include spicy, fatty, or fried foods, caffeine, alcohol, chocolate, and citrus fruits.
Limit late-night eating – Avoid meals or snacks within 3 hours of bedtime to reduce pressure on the lower esophageal sphincter.
Maintain a healthy weight – Excess weight, particularly around the abdomen, can increase pressure on the stomach, pushing acid into the esophagus.
Wear loose-fitting clothing – Tight clothes, especially around the abdomen, can exacerbate reflux by adding pressure to the stomach.
Stay upright after meals – Sitting or standing after eating helps prevent acid from moving up the esophagus.
Chew food thoroughly and eat slowly – This can reduce overeating and give your digestive system time to work efficiently.
Consider a low-FODMAP diet – For some people, reducing fermentable carbs (FODMAPs) can reduce reflux symptoms, especially if linked to IBS.
These habits can improve symptoms over time and help manage reflux long-term.
My heart just skipped a beat hearing about caffeine reduction! What’s the deal with caffeine, and how can we have SOME caffeine just to function?
Caffeine is a known trigger for acid reflux because it can relax the lower esophageal sphincter (LES), which normally keeps stomach contents from rising into the esophagus. Reducing or moderating caffeine intake can be a helpful strategy for managing reflux symptoms.
How Much Caffeine to Reduce?
To manage reflux, it’s recommended to reduce caffeine intake gradually and monitor how your body responds. Some people find complete elimination necessary, while others can tolerate small amounts without issues.
Moderate intake: Limiting caffeine to 200-300 mg per day (about 2 cups of coffee) can be a reasonable target for individuals sensitive to caffeine.
Sensitive individuals: For those with more severe reflux symptoms, it might be beneficial to keep caffeine intake under 100 mg per day, or avoid it altogether.
Caffeine Content in Various Foods and Drinks
Here’s an overview of caffeine content in common sources:
Coffee
Brewed coffee (8 oz): 80-100 mg of caffeine
Espresso (1 oz shot): 60-70 mg of caffeine
Instant coffee (8 oz): 60-80 mg of caffeine
Decaf coffee (8 oz): 2-5 mg of caffeine
Teas
Black tea (8 oz): 40-70 mg of caffeine
Green tea (8 oz): 30-50 mg of caffeine
Oolong tea (8 oz): 30-50 mg of caffeine
Herbal tea (8 oz): 0 mg of caffeine (herbal teas are naturally caffeine-free)
Soft Drinks
Cola (12 oz can): 30-40 mg of caffeine
Diet cola (12 oz can): 30-50 mg of caffeine
Energy drinks (8 oz): 70-100 mg of caffeine (some can contain much more, so check labels)
Chocolate and Other Foods
Dark chocolate (1 oz): 20-30 mg of caffeine
Milk chocolate (1 oz): 5-10 mg of caffeine
Hot chocolate (8 oz): 5-10 mg of caffeine
Chocolate-flavored snacks (varies by serving): 5-15 mg of caffeine
Additional Tips for Reducing Caffeine
Gradual reduction: Cutting down in caffeine slowly can help avoid withdrawal symptoms like headaches and irritability.
Switch to decaf: Decaffeinated coffee and tea can be good substitutes with a much lower caffeine content.
Herbal teas: Consider herbal teas such as peppermint or chamomile, which are naturally caffeine-free (though peppermint may worsen reflux for some individuals).
Monitor other foods: Be mindful of hidden sources of caffeine in foods and drinks like chocolate, some protein bars, and sodas.
By keeping caffeine intake within these limits and tracking your reflux symptoms, you can find the balance that works best for your digestive health.
OKAY, another BIG question is CITRUS foods - what’s the DEAL?
Citrus foods are well-known triggers for acid reflux because of their high acid content, which can irritate the esophagus and worsen symptoms.
What Makes a Food Citrus?
Citrus fruits belong to a family of fruits that are typically tart, juicy, and high in citric acid.
Common citrus fruits include:
Oranges
Grapefruits
Lemons
Limes
Tangerines
Mandarins
Pineapple
These fruits have high levels of natural acids, particularly citric acid and ascorbic acid (vitamin C), both of which can aggravate reflux symptoms by increasing acidity in the stomach and weakening the lower esophageal sphincter (LES).
How to Recognize Citrus in Foods
Citrus is easily recognizable by its flavor—fruits that taste tart, sour, or tangy are usually high in acid. However, citrus flavor is also often added to various foods, drinks, or dressings in the form of lemon or lime juice.
If you're avoiding citrus for reflux management, be cautious with the following:
Fruit juices (especially orange, grapefruit, and lemon juice)
Salad dressings (with lemon or lime juice as ingredients)
Marmalades or jams (often made with citrus)
Baked goods (containing lemon or orange zest)
Is There a Scale of Acid Content in Foods?
Yes, foods have different levels of acidity, which are often measured by pH, with lower pH values indicating higher acidity. The pH scale ranges from 0 to 14, where 7 is neutral, below 7 is acidic, and above 7 is alkaline. Citrus fruits generally fall within the pH range of 2-4, which makes them highly acidic.
Here are the typical pH values for common citrus fruits:
Lemon juice: pH 2.0-2.6
Lime juice: pH 2.0-2.4
Grapefruit juice: pH 3.0-3.4
Orange juice: pH 3.3-4.0
While there isn't a specific "scale" used to rate the acid content of foods for reflux management, generally, foods with lower pH values (below 4) are more likely to trigger reflux symptoms.
What About Vinegar?
Vinegar is not a citrus food, but it is highly acidic. Vinegar is made from fermented ethanol and contains acetic acid, which is different from the citric acid in citrus fruits. Though it's not citrus-based, vinegar can still exacerbate reflux due to its acidity (pH levels range from 2.5-3.5 depending on the type).
Vinegar is commonly found in:
Salad dressings
Pickles
Condiments like mustard, ketchup, and some sauces
Just like with citrus fruits, individuals with acid reflux should monitor their intake of vinegar, as it can also irritate the esophagus and trigger reflux symptoms.
As a part of a balanced lifestyle, how does ALCOHOL fit into reflux management?
Alcohol can worsen acid reflux by relaxing the lower esophageal sphincter (LES) and increasing stomach acid production.
Here are some tips to help manage reflux when drinking alcohol:
Limit intake: Stick to 1-2 drinks and avoid drinking frequently.
Choose lower-acid options: Opt for lighter drinks like white wine or clear spirits (vodka, gin) mixed with non-acidic options like water.
Avoid triggers: Stay away from beer, red wine, and carbonated mixers, as they can increase reflux.
Drink slowly: Sip your drink and avoid gulping to reduce the risk of reflux.
Avoid alcohol near bedtime: Give your body at least 3 hours to digest alcohol before lying down.
Stay upright: Sit up or stand while drinking to prevent acid from rising.
Moderation and choosing the right drinks can help reduce reflux symptoms related to alcohol.
Switching gears to SLOW STOMACH MOTILITY … What should we do for this?
For individuals with delayed stomach motility (gastroparesis or slow digestion), managing food intake and meal planning can help reduce symptoms like bloating, nausea, and reflux. Here are tips and foods to be mindful of:
Foods That Can Delay Stomach Emptying
High-fat foods: Fat slows down digestion, so avoid:
Fried foods
Creamy sauces
Fatty meats (bacon, sausage)
Full-fat dairy
High-fibre foods: Fibre can be harder to digest, especially insoluble fibre:
Raw vegetables (especially fibrous ones like broccoli, cabbage)
Whole grains (brown rice, quinoa)
Nuts and seeds
Legumes (beans, lentils)
Tough or fibrous meats: Red meats and fatty cuts can delay emptying.
Tips for Managing Delayed Stomach Motility
Eat small, frequent meals: Stick to 4-6 small meals a day instead of large meals to ease the burden on your stomach.
Focus on low-fat, soft foods: Choose easy-to-digest options like:
Lean proteins (chicken, fish, eggs)
Cooked vegetables (carrots, zucchini, peeled potatoes)
Low-fibre grains (white rice, pasta)
Blend or puree foods: Smooth soups, smoothies, or mashed vegetables are gentler on the stomach and easier to digest.
Stay hydrated: Drink fluids between meals, not with them, to avoid feeling overly full.
Chew food thoroughly: Take your time with each bite to break down food and support digestion.
Avoid lying down after eating: Stay upright for 1-2 hours after meals to allow gravity to help move food through the digestive tract.
By modifying your food choices and eating habits, you can help manage symptoms of delayed stomach motility and promote better digestion.
Last but not least, let’s get into the nitty-gritty of FODMAP - what is it, and why will it help with REFLUX?
FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) are a group of short-chain carbohydrates that are poorly absorbed in the small intestine. For some people, these carbohydrates can cause bloating, gas, and digestive discomfort.
A low-FODMAP diet is often used to manage irritable bowel syndrome (IBS) and can help with reflux because FODMAPs can increase gas and bloating, which may put pressure on the stomach and exacerbate acid reflux symptoms. By reducing foods high in FODMAPs, digestive symptoms like bloating and reflux can improve.
FODMAP-Friendly Chart: Foods to Avoid vs. Foods to Choose
Food Group | Avoid (High FODMAP Foods) | Choose (Low FODMAP Foods) |
Fruits | Apples, pears, watermelon, stone fruits (peach, plum), cherries, mango, figs, blackberries | Bananas (firm), strawberries, oranges, blueberries, grapes, kiwi, cantaloupe, pineapple, raspberries |
Vegetables | Garlic, onions, cauliflower, broccoli, cabbage, asparagus, mushrooms, snow peas, artichokes | Carrots, spinach, zucchini, bell peppers, green beans, cucumbers, lettuce, eggplant, potatoes (white/sweet), tomatoes, bok choy, squash (butternut, spaghetti) |
Grains | Wheat, rye, barley (in bread, pasta, cereal), couscous, bulgur | Rice, oats, quinoa, gluten-free bread, gluten-free pasta, polenta, corn tortillas |
Dairy | Milk, soft cheeses (ricotta, cottage cheese), yogurt, ice cream, cream cheese | Lactose-free milk, hard cheeses (cheddar, parmesan), lactose-free yogurt, butter, ghee, coconut milk |
Legumes | Lentils, chickpeas, beans (black beans, kidney beans, soybeans), split peas | Firm tofu, canned lentils (rinsed), small amounts of peanuts, edamame (limited), tempeh, small amounts of canned chickpeas (rinsed) |
Sweeteners | Honey, high-fructose corn syrup, agave syrup, sorbitol, mannitol, xylitol, maltitol | Maple syrup, stevia, small amounts of sugar, brown sugar, glucose |
Nuts & Seeds | Cashews, pistachios | Almonds (limit to 10), peanuts, walnuts, macadamia nuts, chia seeds, sunflower seeds |
Beverages | Apple juice, pear juice, soda, alcohol (especially beer, cider), coconut water | Water, herbal teas (peppermint, ginger), cranberry juice (small amounts), decaf coffee, green tea (small amounts), lactose-free or almond milk |
Condiments & Sauces | Ketchup, BBQ sauce, relish, chutneys, gravies with garlic/onion | Mustard, mayonnaise, vinegar (white, balsamic), soy sauce, homemade sauces with garlic-infused oil, tamari |
Well, that’s a WRAP for our October newsletter - and a very quick reminder - it's about one step at a time and one change at a time. Focus on small, manageable adjustments rather than overwhelming resets. Thanks for following along, and here’s to better digestive health!
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