7 Dietitian Tips for Managing Acid Reflux

You used to be able to eat and drink everything, from spicy food to coffee on an empty stomach, and now you get heartburn almost every time you eat. There seems to be no obvious pattern to your symptoms and you’re tired of living in constant discomfort and pain. Even sleeping is uncomfortable, with acid waking you up at night. Does this sound familiar?

If you suffer from acid reflux or GERD (gastroesophageal reflux disease), you are not alone. 1 in 6 adults in Canada are impacted by GERD and many more experience some form of heartburn at some point in their lives. While some occasional heartburn is normal, if you’re experiencing symptoms a few times per week, it’s important you speak to your doctor for further assessment.

As a Registered Dietitian, I have worked with countless clients with acid reflux over my 10+ year career and I’ve also lived with GERD myself. I can relate to how painful and frustrating it can be and how much it can impact your quality of life, especially when it comes to navigating what to eat.

My GERD story is a long one, with my symptoms starting in high school. I will spare you the boring details, but I was eventually diagnosed with a hiatal hernia and took a proton pump inhibitor (a type of acid suppressing medication) for about 3 years. I had to taper off the medication for a test a few years ago and was able to stay off it since then, with my symptoms generally well managed through lifestyle changes. While this is my personal experience, and everyone’s health journey is unique, there are some science-backed tips that helped me and numerous clients take control of their heartburn and I’m happy to share them with you today.

Women experiencing discomfort of acid reflux

1. It’s Probably Not (Only) About the Food

You’ve probably heard about the common reflux food triggers and may have been told to avoid the following foods and beverages:

spicy & greasy foods
coffee & tea
chocolate
peppermint
alcohol
soda
tomatoes, acidic, pickled or citrus foods

It is true that these are common symptom triggers and it may be necessary to temporarily limit or modify how you consume some of them, until symptoms settle down. Some of these foods may cause a bit of irritation (since the esophageal lining may already be a bit inflamed) and others may cause more frequent reflux due to their impact on relaxing the lower esophageal sphincter - I’m looking at you, peppermint! Coffee can be especially aggravating to some individuals, so reducing caffeine intake can be helpful. At minimum, I recommend clients to try to consume caffeine after food, rather than on an empty stomach. Even eating something small like a fruit or piece of toast, can help. Alcohol is also a significant trigger and there are many health benefits of reducing your alcohol intake.

Since we are talking about food, I want to acknowledge that following a restrictive diet is not only hard but can have other unintended consequences. That’s why taking a more holistic approach can be helpful. I don’t want you eliminating a long list of foods and getting stuck in a fear-avoidance-symptom cycle with food restrictions. This can make your symptoms worse, by missing out on important nutrients that support your gut health and through an increase in stress and symptom hypervigilance. More on that later.

Therefore, I want to remind you that, as with any chronic condition, it’s complicated. The reason you have acid reflux may be multifactorial, so please don’t blame yourself or food! I would recommend talking with your primary care provider to better understand what may be contributing to your acid reflux, whether it’s a structural issue (like a hernia), functional issue (motility, a weak or inappropriately relaxed esophageal sphincter etc.) or some other reason. Further testing may be needed to investigate a possible cause. At the same time, sometimes there isn’t always a clear cause. I also want to highlight that while being at a higher weight can potentially increase the risk of GERD due to abdominal pressure, many people in smaller bodies have GERD. Weight loss may or may not improve symptoms, but there are many other evidence-based strategies that can help manage GERD, regardless of weight.

2. Under Pressure: Aim for Small, Frequent Meals

Before we dive into this one, let’s take a quick minute to briefly review some basic upper GI anatomy, related to digestion. When we eat, food starts in our mouth, then moves into the throat before entering into our esophagus (food pipe). On the way to the stomach, it must pass through a couple muscular valves, the upper and lower esophageal sphincters (UES and LES). Normally these stay closed and only open briefly to let food and fluids move down or to let gas move back up. However, the LES can also open at the wrong time – which can lead to acid coming back up. It is normal for this to happen sometimes, but it can happens more frequently in those with GERD, irritating the esophagus. If the GERD is not well controlled, it can lead to tissue changes over time – a condition called Barrett’s esophagus.

As an aside, if the UES is involved, it can lead to Laryngopharyngeal Reflux (LPR), as the acid and pepsin can travel all the way up to the throat and voice box. We won’t have time to discuss LPR in detail today, but lifestyle recommendations are typically similar to those of GERD.

You have probably heard that it’s important to eat smaller, more frequent meals, when you have acid reflux. One of the reasons for this is that larger meals can increase pressure in the abdomen and increase the risk of the LES opening at the wrong time. Larger meals also take longer to digest and can lead to more bloating, especially if you eat fast and swallow more air. This air can also contribute to increased pressure, which can also allow the LES to relax.

I tell clients to aim for 3 smaller meals and at least 2 snacks per day to ensure adequate nourishment. Try to aim for meals that are balanced (include protein, fibre and carbohydrates) and satisfying, while not overfilling.

Lastly, avoid wearing clothing that fit very tightly around the midsection to reduce pressure on your stomach and LES. This can also help reduce bloating. I love stretchy waistbands!

3. Time Your Food and Fluids for Success

Timing is an important aspect of acid reflux management. Allowing enough time for your food to digest and leave your stomach is key to reducing acid reflux. Avoid lying down for 3 hours after eating a meal, especially in the evening.

Try to eat an earlier supper and ensure you are eating enough through the day to help keep you satisfied and reduce hunger late at night. Eating adequate balanced snacks (include protein and fibre) at least 2 x per day can be very helpful in reducing post bed-time hunger and late-night snacking.

Another aspect of timing that I discuss with clients is separating food and fluids. Avoid having fluid within 30 minutes to 1 hour after eating (and about 30 minutes before, if possible, as well). This prevents your stomach from getting too full.

4. Make Digestion Easier

When your digestive tract is irritated or more sensitive due to GERD or IBS, it can be helpful to make some small changes to support easier digestion. This doesn’t mean you need to consume only soups or smoothies, but there are things you can do to help support motility and avoid extra “churning” of your stomach.

First off, make sure you are eating regular meals and snacks and not skipping meals. When you skip meals, you are more likely to eat larger amounts of food at once. Having your stomach empty for a long period of time can also make it a bit more “reactive” and can lead to a “sour stomach” sensation. Many people find acid reflux is worse when they haven’t eaten for several hours.

Try to eat something every 3-4 hours if you can.

It is also helpful to be mindful of the texture of food you consume. When you are experiencing an acid reflux flare, choosing cooked instead of raw vegetables can be helpful. Consider having the roasted vegetables instead of that salad. Make sure you are chewing your food well before you swallow – after all, digestion begins in the mouth!

Keep in mind that some foods take longer to digest than others. Foods higher in fibre and fats slow gastric emptying; try to spread these foods out through the day, rather than consuming a large portion at once. Add some high fibre foods to your snacks – think nuts, seeds, whole grains, fruit – to help you meet your fibre goals. Fibre is important for gut health and can support good acid reflux management long term, but spacing it out through the day will likely be the best tolerated.

5. How You Eat Is As Important as What You Eat

In our fast-paced society, it can be so hard to slow down and eat our meal mindfully, without distraction. How we eat, has an important impact on our digestion. I recommend trying your best to set aside some time to eat your meal slowly and mindfully – at least 20 minutes if you can. Try to remove distractions like your work, computer, TV and your phone (I know it’s hard!). This will help you better tune into your hunger and fullness cues and be less likely to eat past fullness, which can increase risk of heartburn.

Did you know?

Slowing down can also positively impact our digestion in other ways as well. Our gut and our brain are connected via the gut-brain axis, which is closely connected to our nervous system. The enteric nervous system (ENS) is a network of nerves that lines the entire length of the digestive tract. Because two-way communication occurs between our brain and our gut, it may come as no surprise that we experience changes in digestion when under stress. This often leads to either a speeding up or a slowing down of our motility. This is because when we are under stress our body diverts resources away from our digestive system as part of the “fight-or-flight” mode. (Digestion isn’t the priority if we are running away from a wild animal!) It is normal for this to happen occasionally, but when the body is under constant stress or experiencing frequent anxiety, these symptoms can become the default. This is well documented to occur with IBS and may occur with GERD as well, to some degree. Over time, the signals between the gut and the brain can become dysregulated leading to gut-hypersensitivity. Signals that would normally be interpreted by the brain as normal (normal sensations related to digestion) can be interpreted by the brain as pain. This doesn’t mean that the condition isn’t real or physical (it still is) but hypersensitivity can add another layer of complexity and is important to address to have the best chance of success with symptom resolution.

Mental Health and Supporting Your Gut Brain Connection

Supporting your mental health is very important for overall health and there are many tools that can help. I value the important role of interdisciplinary care and I often refer clients to my awesome mental health colleagues to address this aspect of the health journey. Gut-directed hypnotherapy has also been shown in studies to be effective for helping to improve digestive symptoms related to IBS. While more research is needed with GERD specifically, it may be worth considering as an additional therapy, especially if you are experiencing other GI symptoms as well.

While supporting the gut-brain connection can take some time, one simple strategy that I often recommend is diaphragmatic (deep belly) breathing. Start and end each meal with taking 3-5 slow, deep breaths, to help engage the parasympathetic nervous system (“rest and digest” mode) and support your digestion. There is also some evidence that diaphragmatic breathing can help reduce reflux symptoms due to its positive impact on the diaphragm muscles. While more research is needed in this area, it’s a small daily habit worth trying due to the many possible benefits.

A women eating mindfully, enjoying a new view — A women eating mindfully, enjoying a nice relaxing view of a lake

6. Exercise and the Post-Meal Walk

We all know exercise is important for our physical and mental health and it can have specific benefits for our digestive health. One of the mechanisms by which it can benefit acid reflux is supporting good motility. Constipation can also be a driver of acid reflux and bloating and while this can be a topic on its own, it is important to note that movement helps with gut motility. Post-meal walking specifically can be helpful for reducing acid reflux as it can help reduce gas and bloating. I find it especially helpful in the evening after supper. Try to aim for at least a 10 minute walk after your meals, as often as you are able.

One caveat with exercise is that certain types of movement may temporarily worsen reflux, especially if done after meals. Avoid bending after eating and try to maintain an upright posture after meals. Even sitting can be aggravating for some – try to get up and move around right after you have finished your meal.

7 . Tips For A Good Night’s Sleep

Sleep and GERD have a complicated relationship. Poor sleep can worsen digestive issues but individuals may also experience poor sleep due to symptoms. As mentioned earlier, it can be helpful to allow enough time, ideally 3 hours, between your last food intake and your bedtime. Here are a couple other tips that can help reduce the likelihood of reflux overnight.

The first one is to elevate the head of your bed 4-6 inches. This can be done using bed risers (elevate the feet at the head of the bed only) or a wedge pillow that is large enough to elevate your entire upper body (not just your head and neck – this won’t help reflux and can cause neck pain). There are also large wedges that can go under the entire length of the mattress – this is an expensive option but can be more comfortable than the smaller, top of mattress options. If you have other medical conditions or back pain, please speak to your doctor first to ensure these options are right for you.

Secondly, the position you sleep in can also have an impact on nocturnal acid reflux. Sleeping on your left side has been shown to be effective for reducing acid reflux symptoms at night.

The Bottom Line

In this article we covered quite a few different strategies that can be very beneficial for managing heartburn and acid reflux. It’s important to keep in mind that symptom improvement can take time and progress probably won’t be linear. It’s also important to remember that it’s normal to have flares – the goal is to feel good more often and have the tools to handle flares when they come. I also want to acknowledge that while these strategies focused on lifestyle aspects, other treatments including medication may also be needed for symptom management, either in the short or long term, for some individuals. It is good to know your options and discuss them with your health care team. Coming off a medication can also be challenging and getting the right support is essential.

When living with digestive issues, food can get complicated. Eating enough to nourish your body while managing symptoms can be challenging without the right support. If you are located in Alberta and looking for a digestive health dietitian, I would love to help - feel free to reach out or book a free discovery call! Let’s get you on the right track and feeling like yourself again.

In health,

Anna Maria

Information provided on my website is for general advice only and is not intended to be a substitute for consultation with your health care provider.

References:

1. Fedorak, R. N., Veldhuyzen van Zanten, S., & Bridges, R. (2010). Canadian Digestive Health Foundation Public Impact Series: Gastroesophageal reflux disease in Canada: Incidence, prevalence, and direct and indirect economic impact. Canadian Journal of Gastroenterology, 24(7), 431–434. https://doi.org/10.1155/2010/296584

2. Katz, P. O., Dunbar, K. B., Schnoll-Sussman, F. H., Greer, K. B., Yadlapati, R., & Spechler, S. J. (2022). ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. The American journal of gastroenterology, 117(1), 27–56. https://doi.org/10.14309/ajg.0000000000001538

3. Eherer, A., Netolitzky, F., Högenauer, C., Puschnig, G., Hinterleitner, T., Scheidl, S., Kraxner, W., Krejs, G., & Hoffmann, K. (2012). Positive effect of abdominal breathing exercise on gastroesophageal reflux disease: A randomized, controlled study. American Journal of Gastroenterology, 107(3), 372–378. https://doi.org/10.1038/ajg.2011.420

4. Abureesh, O., Qaqish, F., Abu-Shaban, M., Lahoud, C., Habib, T., Sleiman, J., Moussa, E., El Douaihy, Y., Chalhoub, J., & Andrawes, S. (2026). Efficacy and safety of diaphragmatic breathing exercises for gastroesophageal reflux disease: A systematic review and meta-analysis. Journal of Clinical Medicine, 15(9), 3406. https://doi.org/10.3390/jcm15093406

5. Research and resources on gut-directed hypnotherapy: https://www.nervahealth.com/research