Have you been chomping down on Tums, seeking relief for the constant burning in your chest, the sour taste in the back of your throat? Acid reflux strikes again: ack! Here’s the scoop from a functional nutritionist: you need to understand the root cause of your acid reflux (it may be different for each person) so that you can get to the bottom of it. Hopefully, before you get to the bottom of your Tums bottle or need to refill your next acid reflux prescription.
Acid reflux is common. Getting down to the root cause of acid reflux is less common – we can help you stop acid reflux in its tracks.
But first – what is acid reflux, exactly?
Overview of acid reflux
Acid reflux is an uncomfortable condition where the contents of your stomach flow backward into your esophagus. The digestive tract is intended to be a one-way path, with muscles that act as doors to prevent backward movement.
The stomach contents are very acidic. But, our body has protective mucus in place to prevent that acid from harming the stomach while it is doing the important work of digesting your food.
In the case of acid reflux, the acid has gone backward. This rogue acid damages your esophagus by eroding the protective mucus layer, which can cause pain.
Now before you assume all acid deserves a bad reputation, know that an acidic stomach environment is crucial for normal digestion. But, that acid must be kept securely in your stomach. And if your acid is starting to erode your stomach, that is called an ulcer, which is a topic for another blog post.
Not having enough stomach acid is actually a recipe for other icky conditions – we’ll cover that in the PPI section of this article.
And you may be wondering, are acid reflux and Gastroesophageal reflux disease (GERD) the same thing? Almost. Acid reflux is having the acid brush back into your esophagus less frequently. Your doctor may diagnose you with GERD if your acid reflux symptoms occur more than twice per week.
Symptoms of acid reflux
What does acid reflux feel like? Symptoms of acid reflux vary by person and in intensity, but no matter what, they’re not fun. They may include:
- Pressure in the chest (heartburn)
- Burning in the esophagus
- Regurgitating food
- Sour or bitter taste in the back of your throat
Symptoms might be worse at night or after big meals. More uncommon (and surprising) root causes of acid reflux are covered in the next section.
Common root causes of acid reflux
Here’s the bad news: it isn’t just spicy food that causes acid reflux; there can be a lot more root causes.
The good news? Once you know what is causing your acid reflux, you get to make a plan to make things better. And, that is exactly what we help our clients with: getting down to root causes and making an evidence-based plan to feel better and prevent relapse!
Weakened LES sphincter
The lower esophageal sphincter (LES) is a muscle that “closes the door” between the stomach and the esophagus. When all is well, that sphincter opens to allow your food and beverages to enter your stomach and then closes behind them.
The LES keeps the acidic stomach contents from flowing back into your esophagus. But, if that muscle is weakened, or if the pressure is too great, it might be unable to keep up with its job. And the acid escapes!
Certain foods and drinks are more likely to stress the LES – more about that in a bit.
We can increase the pressure in our stomach, putting additional stress on the LES, if we gain weight.
This also happens during pregnancy; the sphincter is being put to the test! In addition, during pregnancy, hormonal changes can relax the LES, increasing risk of acid reflux, regardless of weight gain.
Bloating from food sensitivities or digestive conditions can cause increased abdominal pressure, which can lead to acid reflux. More on that below.
Certain medications can increase the risk of acid reflux, including:
- Certain pain medication
- Certain antidepressants
- Potassium supplements
If you’re taking any prescription medication and struggling with acid reflux, be sure to speak with your doctor and check if acid reflux might be a side effect of that medication (1).
Of course, you already know that smoking is not a healthy habit, increasing your risk of lung cancer.
What most people don’t know is that smoking increases your risk of acid reflux. How? The nicotine relaxes the LES muscle, making it easier for the stomach contents to back up into the esophagus (2).
Your diaphragm is the thin muscle that runs below your lungs, helping you to breathe. Your stomach should be below your diaphragm, with your esophagus running through it.
In the case of a hiatal hernia, part of your stomach has bulged through the diaphragm. This can increase pressure on the stomach contents, causing acid reflux (similar to the weight gain and pregnancy, mentioned above).
Not everyone with a hiatal hernia has symptoms, but for those who do, they may be the same symptoms of acid reflux (3).
Surprising root causes of acid reflux
While you may have been familiar with all or some of the above root causes of acid reflux, these next few may come as a surprise.
SIBO & IBS
Acid reflux is very common for our clients with SIBO or IBS (and many folks have both, did you know that?).
The issue is that both SIBO and IBS can cause bloating. And the bloating in the abdomen changes the pressure and forces the contents of the stomach upwards.
Why Are You Still Stuck With SIBO?
If your body is having a histamine reaction or a food allergy, the symptoms might present themselves as acid reflux. You may be familiar with histamine reactions as allergy symptoms, such as runny nose and watery eyes with seasonal allergies. What you may not realize is that you can have a host of symptoms with histamine reactions such as bloating, reflux, diarrhea, heart palpitations, migraines, and more.
You can have a histamine reaction either to foods that are high in histamines, or if your body is having a hard time clearing the histamine. Read more on histamine intolerance on this blog post.
Stress and anxiety
This one is probably going to surprise you, but stress and anxiety can make your heartburn worse – dang!
Being in a stressed state of mind changes your digestion – your body is in fight or flight mode, not “rest and digest.” This increases pressure on your stomach and therefore risk of acid reflux.
Other types of reflux
There are a few other players to introduce you to: two other kinds of acid reflux and one player who acts a lot like acid reflux.
Like “regular” acid reflux, silent acid reflux is a condition where the stomach contents back up into the esophagus. Small molecules of acid and the enzyme pepsin may reach the back of your throat, which helps to explain some of the unique symptoms of this pedigree of acid reflux.
Unfortunately, the symptoms of silent acid reflux may be more vague and difficult to diagnose (5). It is typically diagnosed by an Ear, Nose and Throat doctor. I can speak from personal experience with silent reflux; I call it the bane of my existence for two years.
In the case of silent reflux – otherwise known as Laryngopharyngeal Reflux (LPR) – the symptoms can be surprising. The symptoms of silent acid reflux may include:
- Constant cough
- Excessive throat clearing
- The sensation of having a lump in the throat (aka globus)
- Chronic post nasal drip
The worst symptoms for me, were constant throat clearing and globus (along with good old-fashioned reflux). What finally helped me clear it was to remove all triggers and irritants – even supplements that I thought were helping.
Bile acid reflux
Bile acids are digestive fluids made by your liver and stored in the gallbladder. They are intended to be doled out into the small intestine, to further digest your food as it slowly is released into the stomach. But as with acid reflux, a weakened sphincter muscle may not be up to the task.
In the case of bile acid reflux, the bile acids can wash backward into your stomach, or in rare cases, all the way back to the esophagus (6).
Similar to acid reflux, bile acids are the right digestive fluid in the wrong place. We need bile acids, they’re crucial for digestion, but they can cause issues when they’ve gone rogue and are not where they should be.
Symptoms of bile acid reflux can be similar to acid reflux, which makes it tricky to diagnose. And even more fun: you can have both acid reflux and bile acid reflux at the same time. Ack!
Eosinophilic Esophagitis (EOE)
Eosinophilic Esophagitis, abbreviated EOE – is not actually a type of acid reflux but can feel like it. In the case of EOE, your body’s normal white blood cells that are living in your esophagus are having an abnormal reaction to food and causing inflammation, heartburn and difficulty swallowing.
Food and environmental allergens are often associated with EOE but often don’t show up on allergy tests. A short-term elimination diet designed by a nutritionist (ahem, that’s us) may help identify your triggers.
EOE can happen in children and adults. What may be a clue in the proper diagnosis of EOE is that your symptoms are not responsive to antacids or other acid reflux medications (7).
How is acid reflux diagnosed?
Your doctor may diagnose your acid reflux based on medical history and symptoms. But in order to know for sure, an endoscopy is the best way to diagnose acid reflux disease.
An endoscopy involves inserting a small tube down your throat that has a tiny camera on the end. The camera will allow your doctor to look at your esophagus and stomach, look for inflammation and even take a sample of esophageal tissue for further testing in a lab (8).
Acid reflux treatment
The most common treatment offered by your doctor is a prescription of Proton Pump Inhibitors, abbreviated PPIs. Example brands of PPIs include Prilosec, Prevacid and Nexium. These medications reduce acid reflux symptoms by blocking your body’s ability to make so much acid. Less acid should mean a reduction in symptoms (9).
The trick is, PPIs are not intended to be a long-term solution: they’re not addressing your root cause of acid reflux, they’re simply managing symptoms.
The best practices for PPIs are to take them if needed and to have a tapering protocol with your doctor. It is really common for our clients to have been on PPIs for far too long. And unfortunately, long-term use of PPIs comes with risk.
Long-term risks of taking PPIs may include (10):
- Nutrient deficiencies (including calcium and magnesium)
- Kidney disease
It is important to have tools that help you to feel better, and we are not against medications. But we like it even better when we help our clients understand what is causing reflux to begin with so we can help alleviate symptoms and help stop it from coming back! We always recommend addressing the root cause for long-term relief.
Risk factors for long-term PPI use
Here is where use of PPIs becomes a little less appealing. Long-term use of PPIs includes risk of SIBO and IBS (and those two conditions also are a risk factor for acid reflux – dang!).
Let’s get off of this merry go round and address the root cause of acid reflux, for you, so that you can move on with a symptom-free future. Bye-bye, Tums!
What can you do?
Avoid any known triggers
While you may not know all of your triggers yet, avoid anything that is known to cause your acid reflux to worsen. This can include foods, drinks and even medications (or nicotine) that can loosen the LES muscle.
Common acid reflux triggers can be abbreviated CRAP. Stop the CRAP to avoid feeling like crap, shall we?
- C – Cola/soda/carbonation, chocolate, coffee, caffeine (We’re sorry!)
- R – Refined carbohydrates – cookies, muffins, crackers, pastries and doughnuts.
- A – Acidic foods that aggravate reflux (citrus, tomatoes, vinegar) and alcohol
- P – Peppermint, prescription or over-the-counter medications like aspirin, NSAIDs and processed food (especially sugary carbohydrate and high-fat carbohydrate foods)
Avoid eating at least 3 hours before bed
A big meal and lying down are not a good mix with acid reflux. Plan to have your largest meal at lunch and a lighter dinner. Or, plan to have an early dinner so that your digestive system has time to digest your delicious meal long before bed.
Stay upright after eating
Same as above – we need to give our digestive system an opportunity to digest our food. How about a walk after dinner instead of Netflix?
Opt for light exercise after eating
While exercising is an important part of having a happy, healthy life and managing stress, it does matter what kinds you’re doing.
Having a vigorous workout right after a meal might make your acid reflux worse. An after-dinner stroll might be preferred by your digestive system to a Peloton ride or Zumba class.
Acid Reflux: Key takeaways
The root cause of acid reflux might be elusive to you and your doctor. But getting to the root cause (or root causes) of your acid reflux is an important step to being able to stop those symptoms in their tracks. Remission is possible – believe us!
Sara Kahn, MS, CNS, CDN is a board-certified nutritionist specializing in digestive health conditions like SIBO, IBS, acid reflux and more. She’s the founder of Belly Bliss Nutrition and the Solving SIBO Program.