Acid Reflux Disease

About acid reflux disease - to learn more read on. Acid reflux is the regurgitation of the acidic fluid from the stomach into the lower oesophagus (the gullet - a tube that connects the throat to the stomach). This acid reflux is the result of inefficiency of the muscular valve at the lower end of the oesophagus. Also known as gastro-esophageal reflux disease (GERD), acid reflux if repeated frequently may inflame the oesophagus, resulting in heartburn (a burning pain in the chest) due to oesophagitis (inflammation of the oesophagus).

Articles about GERD and GERD diet:

GERD diet picture

Acid reflux in more detail - not technical

If you mention "heartburn" or "acid reflux" at parties or social gatherings, then everybody has heartburn or knows someone with heartburn. As you get older heartburn seems more common, especially when one is over 40 years of age, and you find that heartburn is more discussed at work, parties, social gatherings and dinner parties.

There have been studies into the emotional health of individuals with heartburn. It was found that patients with unresolved acid reflux often report worse on scores of emotional well-being than patients with high blood pressure, diabetes, heart disease, peptic ulcer disease or angina.

There is however, good news!

Acid reflux is a treatable condition. And there is more good news! Most individuals with acid reflux have a mild form of disease that is easy to treat with a GERD diet and lifestyle changes. There is also effective medication for acid reflux disease and GERD.

If you are experiencing heartburn then the first step is to consult your family doctor, GP (general practitioner) or physician. The second step is to work with your doctor to agree and follow the best treatment plan. You may only require lifestyle and dietary changes or your doctor may prescribe medication or you may even need further investigation by a gastroentererologist. The advice on this website is here to help you make the correct dietary changes, guide you in formulating a treatment plan and explain any medical investigations that may be required.

It is important to avoid unnecessary symptoms and suffering. See your doctor, and discover if you have acid reflux disease. Then get the best treatment and follow a reflux diet that leaves you feeling well and symptom free again.

How common is acid reflux?

In the United States more than 15 million people suffer with heartburn every day. It is estimated that in the US about 45 million people have heartburn at least once a month. This means that about 10% of Americans have some degree of gastro-esophageal reflux disease. Worldwide it is thought that about 7% of the global population (including men, women and children) suffer from acid reflux disease.

If I have acid reflux, what is happening inside my body?

If you experience heartburn, then acid from your stomach is flowing backwards up into your gullet or esophagus. So the word "acid" comes from the acid contents of the stomach and the word "reflux" comes from the backward flow or reflux of this stomach acid into the lower (or distal) esophagus. The problem is that this upflow of acid into your esophagus can damage, injure and hurt the lining of the esophagus and lead to unpleasant and even severe symptoms or complications. This acid reflux can keep you awake at night, make you very uncomfortable after eating, cause considerable pain and distress and if not treated properly lead to serious medical complications.

If everything is working normally in your body, then the stomach acid should never reflux up into the esophagus.This is because there is a muscular valve between the stomach and esophagus. This valve is known as the lower esophageal sphincter (LES). Normally food and drinks are only meant to pass downwards from the esophagus (gullet) into the stomach and these foods and drinks are not meant to pass upwards into the lower esophagus. If you have acid reflux disease then food and liquids spill up into the lower esophagus, because the lower esophageal sphincter relaxes too often. This is a problem because the stomach lining produces acid and the stomach contents are therefore acidic and irritant to the lining of the esophagus.

Can acid reflux disease be cured?

Acid reflux disease is a chronic (long-term) and recurring condition that does not usually resolve and disappear. There isn't a cure as such for acid reflux disease. Losing weight helps a lot though. However long term medical treatment, lifestyle changes and an effective reflux diet is usually effective. Treatment options include lifestyle changes, GERD diet, medication, surgery or a combination of these.

What is the most frequent symptom of acid reflux disease?

Heartburn is the most common symptom of GERD. After a large or heavy meal, usually some 20-40 minutes later heartburn happens. Excessive quantities of acid from the stomach reflux upwards into the lower esophagus, causing heartburn. Heartburn is usually described as a burning sensation or discomfort behind the sternum (breastbone), that spreads up towards the throat and neck. The burning sensation may last a few hours and is usually worst after large meals. If you experience only occasional heartburn then this doesn't mean you have acid reflux disease. However if heartburn is frequent, occuring at least two or three times a week then the diagnosis becomes gastro-esophageal reflux disease.

What are the other symptoms of acid reflux disease?

Apart from heartburn, the most frequent symptoms are:

A sensation of food coming up into the mouth, associated with a bitter or sour taste.
Hoarseness
Chronic cough
Chronic asthma
Belching
Bloating

More serious symtoms include the sensation of food getting stuck on the way down to the stomach. This is known as dysphagia and always requires medical investigation. Other symptoms which require investigation include: vomiting up blood, severe chest or upper abdominal pain, weight loss, and anaemia due to chronic blood loss.

If I have occasional heartburn, how can I treat this?

For those who suffer from the occasional attack of heartburn, the quickest treatment is drinking plain water, or antacid medicine which can be bought over the counter. It also helps to make some lifestyle changes and dietary changes, such as:

Avoiding those foods and drinks which may causing or contributing to the heartburn. In other words following a GERD diet.
Stopping smoking
Losing weight if you are overweight.
Eating your last meal or snack at least three hours before you lie down in bed to go to sleep.

Does heartburn result from bad habits and lifestyle or does it have a physical cause?

Dietary choices, bad habits and eating patterns may be the cause of occasional heartburn. For example, eating large meals high in fat, over indulging in alcohol and consuming certain foods such as citrus juices, spicy tomato products, or chocolates may lead to heartburn, even in healthy individuals. However, if you suffer from frequent acid reflux and heartburn, or have other symptoms or complications of acid reflux, there is usually a physical cause.

How do I know if my heartburn is serious?

There are three aspects of heartburn symptoms that can be measured to provide an idea of the severity of acid reflux:

How long does each episode of heartburn last?
How frequently does the heartburn happen?
How intense is the heartburn when it does occur?

Pointers that it may be something serious:

Having heartburn at least twice a week
Heartburn that does not get better with over-the-counter antacid medicines
Heartburn is associated with other symptoms such as: food sticking in the gullet (known as dysphagia), weight loss, vomiting blood or low blood count (anaemia).

What about heartburn and pregnancy?

For many women their initial experience of heartburn id during the last three months of pregnancy. There is a simple explanation for the heartburn of pregnancy. The growing uterus, containing the growing fetus, presses on the stomach, which leads to backflow of acidic stomach contents up into the esophagus. This heartburn can be difficult to treat with antacids and dietary changes, and may require prescription medication. However, once the baby is born the heatburn usually goes away.

What is the most important factor in relieving the symptoms of acid reflux?

If the medical cause of many of the symptoms of acid reflux is the acidic stomach contents refluxing up into the lower oesophagus from the stomach, then suppressing that acid and preventing it from burning the oesophageal tissue is the key factor in treating acid reflux disease and relieving the symptoms of heartburn. Suppressing the acid and finding the right GERD diet is key to allowing the irritated oesophageal tissue to heal. Medication such as proton pump inhibitors are very effective at suppressing the acid and finding the ideal acid reflux diet is also critical.

When are the symptoms of acid reflux worst?

In acid reflux disease sufferers and patients with esophagitis, the symptoms are typically more frequent during the day and especially after meals. There are however heartburn sufferers who find that their symptoms are worst at night. Injury and irritation of the esophageal lining can take place shortly after meals, because it is during meals that acid is released into the stomach. It is also during and after meals that the lower esophageal sphincter tends to relax, allowing the irritant stomach acid to reflux up into the lower esophagus.

For those who experience heartburn at night, that is when all the large meals and drinks that we probably shouldn't have consumed so much of reflux up and come back to trouble us. When you lie down in bed to go to sleep, the stomach is shifted from an up-and-down position to a sideways position and suddenly the opening from the stomach to the oesophagus is level with the rest of the stomach and its acidic contents. The result is acid reflux and heartburn.

What are the treatment options for acid reflux disease?

Acid reflux disease is usually treated with a combination of lifestyle changes, acid reflux diet, over-the-counter antacids and medications and prescription medications. In severe cases of GERD the disease sometimes requires surgery. Most doctors will start with the least invasive and least expensive options, such as changing troublesome lifestyle habits, and advising on a GERD diet and over-the-counter medications. Doctors will then move on to more intensive treatments such as prescription medications which include proton pump inhibitors and finally if the symptoms remained severe and persistent, sometimes the only option is surgery.

In what ways are simple heartburn different from GERD?

Everyone will experience heartburn sometimes in their life. However, if the heartburn progresses from occasional heartburn to heartburn that occurs more than twice a week or if the heartburn is associated with other more significant symptoms then it is likely that your heartburn has developed into acid reflux disease.

Which medications work best for acid reflux disease?

The most effective prescription medications for acid reflux disease are the group of drugs known as proton pump inhibitors (PPI's). These include omeprazole (Prilosec, Zegerid, Losec), lansoprazole (Prevacid, Zoton), rabeprazole (Aciphex, Pariet), pantoprazole (Somac, Pantoloc, Protium, Pantecta, Protonix, and Pantoheal), esomeprazole (Nexium). The PPI's have generally replaced older drugs such as cimetidine and ranitidine in treating acid reflux disease. It is important to remember though, that none of the current drugs used to treat GERD actually result in a cure. They are able to control the symptoms and allow the oesophagus to heal if esophagitis has developed. Even when the drugs relieve the symptoms of acid reflux completely, the condition usually recurs within months after the medication is stopped. It is therefore important to initiate lifestyle changes and find an effective GERD diet.

What do antacids and foaming agents such as alginitates do?

Antacids and foaming agents, containing alginic acid, can be bought over-the-counter. When swallowed they pass into the stomach an there they act to neutralise the stomach acid. This restores the pH of the stomach contents to a more normal level, and any stomach contents that happens to reflux into the esophagus is therefore less irritant. They also help to neutralise the acidic environment within the lower esophagus. There are antacids, such as Gaviscon, which contain a foaming agent (containing alginic acid or alginate) which produces a foam barrier that lies on top of the stomach contents. This foam barrier helps to prevent acid from refluxing up into the lower oesophagus.

It is important to note that antacids and alginates only provide short-term relief of heartburn and are not strong enough to heal esophagitis or to prevent the complications of acid reflux.

What are the problems associated with the long-term use of antacids?

Diarrhoea can be caused by some antacids. Antacids that contain magnesium tend to cause diarrhoea. The antacids that contain magnesium include magnesium trisilicate and magnesium carbonate.

Constipation may result from taking some antacids. Antacids that contain aluminium and antacids that contain calcium carbonate tend to cause constipation. Antacids that contain aluminium include aluminium hydroxide and Alu-Cap. Examples of antacids that contain calcium carbonate include Tums, Titralac and Alka-2.

Some antacids are balanced by having a mixture of magnesium and aluminium salts. The balance of magnesium and aluminium is designed to balance the constipating and diarrhoea causing effects of these compounds and reduce the likelihood of bowel and colonic problems. Examples of antacids that contain both magnesium and aluminium include: Maalox, Mylanta and Mucogel. There is an antacid that contains aluminium magnesium carbonate hydroxide hydrate. This is an aluminium magnesium complex and is called Hydrotalcite (Altacite, Altacite Plus).

There is a a potential risk of elevated levels of calcium in the bloodstream (hypercalcaemia) if very large amounts of calcium carbonate containing acids are taken daily over a long period of time. In the past it was common for acid reflux sufferers to take calcium carbonate antacids and drink milk regularly. This combination could result in a condition known as milk-alkali syndrome. A major feature of the milk-alkali syndrome was hypercalcaemia, and the symptoms associated with hypercalcaemia. Raised levels of calcium in the bloodstream are potentially serious, with kidney failure being a potential problem. , It is therefore, important not to take excessive amounts of calcium containing antacids drink excessive amounts of milk for heartburn and dyspepsia.

Taking large doses of antacids long-term can lead to kidney stones.

Some antacids containing Bismuth. Unless bismuth containing antacids are chelates, they are not recommended, because absorbed bismuth can be neurotoxic (damaging to nerve cells) and lead to encephalopathy.

If you have impaired kidney function (renal failure) then taking antacid medication can be risky. This is a complex area of medicine, and any use should be discussed with your doctor and kidney specialist.

If antacid medications are required for any length of time, then a doctor should be consulted. It is usually recommended that if antacid medications are required for at least 2 to 3 weeks then medical advice should be taken from a doctor.

What are the interactions that antacids can have with prescribed medication?

Antacids are known to reduce the absorption of certain prescribed drugs such as: tetracycline antibiotics, ciprofloxacin (Ciproxin), propranolol (Inderal), captopril (Capoten) and H2 blockers. It is therefore important to let your doctor know if you are taking antacids, even if this use of antacids is infrequent. To reduce the likelihood of absorption problems with antacids, it is recommended that you take the other drugs at least one hour before or three hours after the antacid.

What are H2 blockers?

H2 (histamine 2) blockers, which are also known as H2 receptor antagonists, work by reducing the acid secreted by the stomach lining. After being swallowed they take about 30 minutes to work and then last for 8 to 12 hours depending on the type of H2 blocker. Examples of H2 blockers include cimetidine, ranitidine, nizatidine and famotidine.

H2 have been around longer than proton pump inhibitors (PPI's). Doctors often prescribe H2 blockers for acid reflux disease initially, before they move on stronger medications known as proton pump inhibitors (PPI's). H2 blockers can be bought over-the-counter, where the dose tends to be lower than prescription H2 blockers. It should be noted that in treating acid reflux disease high doses of H2 blockers are more effective than the standard doses. Taking H2 blockers twice a day is more effective in treating acid reflux disease than taking them once a day. H2 blockers are generally less expensive than proton pump inhibitors.

Over-the-counter versions of H2 blockers which are available in the US include cimetidine (100mg) – Tagamet HB, ranitidine (75mg) – Zantac 75, famotidine (10mg) – Pepcid AC and nizatidine (75mg).

When doctors prescribe H2 blockers they usually prescribe larger doses than are available over-the-counter. For example in the US the usual prescribed dose of Tagamet is 300 mg three times a day. In the UK the usual prescribed doses 400 mg twice daily or 400 mg four times daily. For Zantac the prescribed dose is usually 150 mg twice daily. For those who suffer from heartburn mainly at night a single dose of Zantac 300 mg at night is usually effective.

Even though these H2 blocker drugs are available over-the-counter without a prescription, it is still important to seek medical attention for persistent symptoms of heartburn.

Side-effects of H2 blockers

Generally H2 blockers have few side-effects and are well tolerated. The commonest side-effects are mild diarrhoea and other gastrointestinal disturbances, headache, tiredness, dizziness, rash and occasionally altered liver function tests. The oldest H2 blocker cimetidine has the most side-effects and may cause tiredness and confusion, particularly in the elderly. The new H2 blockers such as ranitidine, famotidine and nizatidine have fewer side effects. There is also some concern, although this has never been proven, that long-term acid suppression with these drugs may lead to an increased risk of cancer of the stomach in those individuals who also have untreated Helicobacter pylori infections. Certainly untreated Helicobacter pylori is known to increase the risk of stomach cancer, but whether long-term acid suppression increases this risk is not known.

H2 blockers also interact with a number of common prescription medications. For example cimetidine (Tagamet) is known to interact with phenytoin, warfarin and theophylline. Other problematic side-effects with cimetidine, especially if taken in large doses long-term, include breast enlargement in men (gynaecomastia) and erectile dysfunction. Both of these problems are reversed when cimetidine is discontinued.

Ranitidine (Zantac) has very few drug interactions. The two newest H2 blockers famotidine and nizatidine are thought to have even fewer side-effects and drug interactions.

The risk of taking H2 blockers without consulting medical advice and having further investigations is, that they could be hiding a more severe disease and complications of acid reflux disease. If you have heartburn more than twice a week or heartburn associated with weight loss, food sticking or a low blood count then you should consult with your doctor immediately.

Pro-motility agents for GERD

Pro-motility agents are drugs that improve gastric emptying. In other words they improve the digestsion of food by the stomach. They improve gastric peristalsis and shorten the length of time that food remains in the stomach. All these effects have beneficial effect on acid reflux disease. Pro-motility agents are generally used for mild-to-moderate acid reflux symptoms, though occasionally they are used in severe GERD, when they are used in addition to proton pump inhibitors. Pro-motility agents also increase the muscle tone and strength of the lower oesophageal sphincter muscle and help acid reflux disease in this way as well. Examples of pro-motility agents include metoclopramide and domperidone. Metoclopramide (Maxalon) and domperidone (Motilium) are dopamine receptor antagonists which stimulate gastric emptying and small intestinal transit. The drug cisapride is an effective promotility agent but has been withdrawn from most markets because of dangerous cardiac side-effects.

Side-effects of metoclopramide include drowsiness, restlessness, diarrhoea, depression, neuroleptic malignant syndrome, rashes, pruritus and fluid retention. A problematic side-effect of metoclopramide is a side-effect known as acute dystonic reaction which is an extra pyramidal side-effect. Occasionally, tardive dyskinesia has been reported on long-term use of metoclopramide. The movement side-effects are much more common in young adults and metoclopramide should be avoided in children and used with caution in young adults.

Domperidone (Motilium) works in a similar way to metoclopramide but domperidone has far fewer side-effects. It can rarely cause gastrointestinal disturbances and rarely cause hyperprolactinaemia (raised prolactin levels). Extrapyramidal effects and rashes are extremely rare. Domperidone does not pass into the brain because it does not cross the blood brain barrier. This is in contrast with metoclopramide which does pass into the brain because it crosses the blood brain barrier. This is the probable explanation for the much greater risk of side-effects with metoclopramide. Domperidone is a much safer drug and is available over-the-counter.

Proton pump inhibitors (PPI's) for GERD

Proton pump inhibitors are newer drugs than the H2 blockers. Proton pump inhibitors inhibit gastric acid secretion by blocking the hydrogen–potassium adenosine triphosphatase enzyme system. This is known as the "proton pump" of the gastric parietal cell. Proton pump inhibitors are very effective short-term treatments for gastric and duodenal ulcers. They are also used in combination with antibacterials to eradicate Helicobacter pylori infections.

Proton pump inhibitors are very effective drugs for treating gastro-oesophageal reflux disease and dyspepsia. They can also be used to prevent and treat non-steroidal anti-inflammatory drug associated ulcers.

Cautions with proton pump inhibitors

Proton pump inhibitors should be used with caution in patients with liver disease, in pregnancy and women who are breastfeeding. Proton pump inhibitors may mask the symptoms of gastric cancer.

Side-effects of proton pump inhibitors

Side-effects of proton pump inhibitors include gastrointestinal disturbances (including nausea, vomiting, abdominal pain, diarrhoea, constipation and flatulence), and headache. Less frequent side-effects of PPI's include dry mouth, peripheral oedema (fluid retention), dizziness, sleep disturbances, fatigue, pins and needles (paraesthesiae), joint pains (arthralgia), muscle pains (myalgia), rash and itching (pruritus). Other side-effects that are reported rarely with PPI's include taste disturbance, stomatitis, hepatitis, jaundice, hypersensitivity reactions (allergic reactions including anaphylaxis and bronchospasm), fever, depression, hallucinations, confusion, gynaecomastia, interstitial nephritis, hyponatraemia, blood disorders (including leucopenia, leucocytosis, pancytopenia and thrombocytopenia), visual disturbances, sweating, photosensitivity, alopecia, Stevens-Johnson syndrome and toxic epidermal necrolysis.

There has also recently been concern about PPI is causing hypo-magnesium (low levels of magnesium in the blood).

What effect do PPI's have?

Proton pump inhibitors are able to maintain a stomach acid level with a pH greater than four (in other words a more alkaline environment) for longer periods of time than H2 blockers. Proton pump inhibitors are the gold standard for treating gastro-oesophageal reflux disease and oesophagitis. They are the most effective drugs for healing esophagitis and preventing the complications of acid reflux disease. This is something that the other drugs are not very affective at doing. Proton pump inhibitors also provide rapid relief of acid reflux disease symptoms such as heartburn.

Proton pump inhibitors have been extensively studied in the use of treating gastro-oesophageal reflux disease (GERD). Studies have shown that PPI's lead to symptom relief and healing of the esophagus in at least 80% of acid reflux disease sufferers.

What do PPI's not do?

Even though they are very effective drugs in relieving the symptoms they probably have little effect on the actual reflux and regurgitation of stomach contents that is taking place. They are also often disappointingly ineffective in controlling asthmatic symptoms associated with GERD, although they can be good at treating the cough which may be induced by acid reflux disease.

Which medications can make gastro-oesophageal reflux disease worse?

Some prescription medications can actually aggravate acid reflux disease. It is therefore important to discuss with your doctor whether any of the medications that you are taking might be making your gastro-oesophageal reflux disease worse.

For example, some drugs are known to cause the lower oesophageal sphincter to relax. Examples of these include: calcium channel blockers (such as nifedipine, amlodipine), anticholinergic drugs, dopamine, sedatives, alph-adrenergic agonists and common pain relievers.

Some drugs can weaken the lower esophageal sphincter action of the esophagus and can slow down gastric emptying. Examples of these include: anticholinergic drugs and calcium channel blockers.

Some prescription medications can damage the lining of the oesophagus. Examples of these include bisphononate drugs that are used for treating osteoporosis such as alendronic acid (Fosamax), disodium etidronate (Didronel) and risedronate (Actonel).

It is also known that some prescription medications when they lodge in the lower oesophagus can be extremely corrosive and result in ulcers in the lower oesophagus. Examples include potassium tablets (in particular slow K - potassium tablets) and iron tablets.

It is thought that some antibiotics may make the mucous membrane lining of the oesophagus more vulnerable to stomach acid.

Non-steroidal anti-inflammatory drugs (NSAID is) are well known to cause ulcers in the stomach. Medical studies have also found that non-steroidal anti-inflammatory drugs also increase the risk of acid reflux disease and increase the risk of acid reflux disease complications. In particular the risk of oesophageal strictures and Barrett's oesophagus. If you been taking non-steroidal anti-inflammatory drugs, this may increase your risk of acid reflux by a factor of two. It is thought these drugs may contribute to acid reflux by relaxing the lower oesophageal sphincter muscle and allowing the stomach contents more easily to reflux up into the oesophagus. There are a large number of non-steroidal anti-inflammatory drugs which are available.: Examples include aspirin, ibuprofen, naproxen, piroxicam, indomethacin, ketoprofen, diclofenac, diflunisal, ketorolac, flurbiprofen and meloxicam.

A good alternative to non-steroidal anti-inflammatory drugs is acetaminophen (paracetamol in the UK). Acetaminophen (Tylenol) is known to be safe in gastro-oesophageal reflux disease.

Other drugs that may lodge in the oesophagus and irritate the oesophageal lining include aspirin, vitamin C supplements and antibiotics such as tetracycline.

In summary:

If you have acid reflux disease, you should stop taking any drugs that may be worsening your symptoms, follow your doctor's advice regarding prescription medication for your acid reflux disease and make the necessary lifestyle changes.

It you are overweight, then try to trim down your weight. Obesity may well be contributing to the acid reflux. This is because the extra weight being carried around your abdomen can put pressure on the stomach contents, which in turn then pushes the stomach acid up into the esophagus.

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GERD Diet

When you eat, avoid those foods that reduce the tone of the lower esophageal sphincter. This means cutting down or avoiding fatty food and chocolate. Other foods and drinks that relax the lower esophageal sphincter include coffee (this includes decaffeinated coffee, which is known to increase the acid content in the stomach) caffeinated tea and cola drinks, alcoholic beverages, peppermint and spearmint, garlic and onions. Foods that increase the acid content in the stomach and which should be limited or consumed in small portions include all caffeinated drinks (tea, coffee, soda drinks with caffeine), coffee (including decaffeinated coffee).

Foods that can irritate a damaged esophageal lining and which should be avoided or eaten in small portions include citrus fruits and juices, tomato products, chilli peppers and pepper. Foods that bloat up the abdomen causing pressures that force acid to back up into the esophagus such as carbonated beverages should also be avoided. It is also sensible to avoid foods and drinks which may damage the lining of the oesophagus such as citrus juice and tomato juice and pepper.

If you eat large heavy meals then you are at an increased risk for having attacks of heartburn, especially if you follow the large heavy meal with a lie down.

GERD Diet – What to Eat, What to Avoid

If you are unlucky enough to have acid reflux disease then the acid from your stomach is refluxing up into your lower esophagus. This refluxed acid leads to a burning sensation in your chest which is called heartburn. The foods that you eat can cause your stomach lining to produce an excessive amount of acid. People with acid reflux disease have learnt from experience that some foods cause heartburn and should be avoided.

There are however some foods that can actually relive your acid reflux and heartburn. By using this knowledge you can alter your diet to avoid those foods that cause heartburn and eat those foods that actually help heartburn.

Those foods to avoid if you have heartburn

There are some foods that tend to cause the gastric mucosa (stomach lining) to produce more acid. Some of the worst foods to eat with acid reflux disease include:

Fatty Foods

These are foods that have a high fat concentration. Any foods that are fried in fat or oil, or those that naturally contain a high concentration of fatty acids are harder and slower to digest by the stomach. Therefore more acid is produced to digest these high fat foods. So, by avoiding fried and high fat foods it is possible to reduce the amount of acid produced by the stomach and relive the symptoms of heartburn.

Dairy Products and Whole Fat Milk Products

It is usually alright to eat fat free or low fat dairy products if you have acid reflux disease. It is sensible to avoid whole fat dairy products because these are much harder for the stomach to digest.

Greasy Foods

Grease is basically fat and is extremely hard for the stomach to deal with. Grease leads to increased acid production by the stomach. This can then lead to acid reflux and heartburn. Therefore it is best to choose foods that are broiled, grilled or baked.

Very Spicy Foods

Foodstuffs that are spicy, such as curries and Mexican dishes can cause indigestion, gastritis and heartburn in anyone. Spicy foods can really cause and acid reflux disease patient to really suffer. Therefore keep spices and chillies to a minimum or avoid altogether if you suffer from GERD.

Carbonated Drinks

Beverages which are carbonated obviously contain more gas in the form of tiny air bubbles. This excess gas then bloats the stomach and may also produce more acid. Carbonated drinks can lead to acid reflux and heartburn and it is sensible to avoid these if you have acid reflux disease.

Citrus Fruits and Tomatoes

Tomatoes, citrus fruits and citrus drinks contain a lot of inherent acid, which when added to the acid in the stomach can make eating these foods and drinks a major problem for heartburn sufferers.

If you are prone to acid reflux and acid indigestion, it does not make sense to make your gastric environment more toxic and acidic by adding extra acid in the foods that you eat or by consuming high fat foods which create more stomach acid.

Fortunately, there are loads of other types of foods and drinks which you can enjoy, and which help to reduce your heartburn and stomach acid problem.

Foods that you can enjoy with Acid Reflux Disease

If you have heartburn, you will discover that most vegetables and fruit are gentle on the stomach and esophagus.

Fruit

Try to choose non-citrus fruits such as apples, bananas, melon, apricots, stewed apples, raisins, plums, dates, figs, mango, papaya, passion-fruit, pear, prunes and sultanas.

Vegetables

Vegetables which are safe include: Artichoke, asparagus, aubergine, bamboo shoots, baked potato, boiled potatoes, butter-nut squash, French beans, beans sprouts, Brussels sprouts, cabbage, cauliflower, Chinese leaves, courgettes, cucumber, fennel, mashed potato, broccoli, cabbage, carrots, green beans, peas, kale, lettuce, mange-tout peas, mushrooms, parsnips, pumpkin, rocket, salad leaves, spinach, spring greens, sweetcorn, sweet potato, turnips, watercress. Various beans and peas such as: broad beans, butter beans, chickpeas, haricot beans, lentils, red kidney beans, soya beans, quorn chunks and tofu.

Meat, Fish and Protein containing foods

It is possible to enjoy meat if you have acid reflux disease. However it is important to choose your meat products wisely. Try to choose the leanest cuts of meat available and ask your butcher to remove any fat when you buy your meat. Avoid frying meat and try to avoid those recipes that involve the meat remaining in its own fat.

Fish is a great choice if you have GERD. Most types of fish are OK for the acid reflux sufferer provided that the fish is not fried (particularly avoid fish deep fried in batter). So when cooking or choosing fish dishes select fish that is poached, baked, broiled or grilled but not fried.

Dairy Products

Many people with acid reflux avoid dairy products. The problem with this is that you are cutting out a major source of calcium, and increasing your risk of osteoporosis (thin or brittle bones). It is important to consume sufficient calcium and no fat or low fat dairy products are generally safe for GERD patients. So choose skimmed milk, fat-free cream, low fat yoghurt’s, and low fat cheese. Choose dairy alternatives such as feta or goats cheese, soya milk, egg substitute and fat-free sour creams

Sleep problems with acid reflux disease

For those who have acid reflux disease, going to bed can be a living nightmare. This has a lot to do with the act of physically lying down. When you lie down the stomach contents have easy access to the opening of the oesophagus. There are several things that GERD sufferers can do to make heartburn less likely at night time. Leave at least 3 to 4 hours after eating your last meal or snack before going to bed. Elevate the head of the bed by about 6 inches. This can be done by placing blocks under the legs at the head of the bed or using an under-mattress foam wedge to raise the head about 6 to 10 inches. This has the effect of slightly raising the level of esophagus when compared with your stomach. This means that the stomach contents are less likely to splash out into the lower oesophagus when you are lying down . It is also been found that lying on the left side reduces acid reflux when compared with lying on the right side. Medical studies have shown that patients sleeping on their right sides suffered most acid reflux and heartburn.