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In April 2020, the Food and Drug Administration (FDA) requested that all forms of prescription and over-the-counter (OTC) ranitidine (Zantac) be removed from the U.S. market. They made this recommendation because unacceptable levels of NDMA, a probable carcinogen (or cancer-causing chemical), were present in some ranitidine products. People taking prescription ranitidine should talk with their doctor about safe alternative options before stopping the drug. People taking OTC ranitidine should stop taking the drug and talk with their healthcare provider about alternative options. Instead of taking unused ranitidine products to a drug take-back site, a person should dispose of them according to the product’s instructions or by following the FDA’s guidance.
Gastroesophageal reflux disease is a condition in which the stomach contents regularly move back up the food pipe.
This regurgitation is usually long-term, and can result in uncomfortable symptoms, including heartburn and pain in the upper abdomen. The severity of the condition often relates to diet and lifestyle.
Avoiding trigger foods and following other dietary tips may relieve the symptoms of GERD. In this article, we discuss the foods that people with GERD may wish to exclude from their diet and those that they might benefit from consuming.
Certain foods can trigger GERD symptoms.
GERD is a digestive disorder, so diet can often affect the symptoms of the condition. Making dietary and lifestyle changes can go a long way toward treating many instances of GERD.
An article published in the Gastroenterology Research and Practice Journal found a connection between reflux esophagitis, which is inflammation that is usually due to GERD, and a high intake of specific foods.
Foods that might make GERD or reflux esophagitis symptoms worse include:
- meat, as it tends to be high in cholesterol and fatty acids
- oils and high-fat foods, which may cause the sphincter in the stomach to relax
- high quantities of salt
- calcium-rich foods, such as milk and cheese, which are sources of saturated fats
A study published in Gut and Liver examined the relationship between cow’s milk allergy (CMA) and GERD symptoms in children.
The researchers found that children with CMA often experienced symptoms of GERD after consuming cow’s milk. Ongoing research is looking into whether this also applies to adults.
People who regularly experience discomfort or bloating after eating dairy products containing cow’s milk may find that eliminating them from the diet reduces these symptoms.
A study published in Alimentary Pharmacology and Therapeutics explored the relationship between cholesterol and GERD.
The results indicated that people who consumed more cholesterol and saturated fatty acids and a higher percentage of calories from fat were more likely to experience GERD symptoms.
Other food flare-ups
There are additional foods that typically cause GERD flare-ups, which doctors often recommend people with this condition to avoid. These include:
- carbonated beverages
- acidic drinks, such as orange juice and coffee
- acidic foods, including tomato sauce
There is little clinical evidence linking these foods to GERD symptoms, but the anecdotal experiences of some people with the condition suggest that these foods may worsen symptoms.
However, trigger foods can vary from person to person. People with GERD should try eliminating each food type from their diet to see if their symptoms improve. If they do not, they can incorporate the food back into their diet.
Some foods might actively improve GERD symptoms.
Until recently, researchers did not fully understand GERD, and there was a lack of scientific evidence to suggest that changing the diet could improve symptoms.
However, a 2013 study of more than 500 people found that some foods do appear to reduce the frequency of GERD symptoms.
- protein from low-cholesterol sources, such as salmon, trout, almonds, lean poultry, beans, and lentils
- certain carbohydrates that occur in fruits, vegetables, potatoes, and some whole grains
- vitamin C-rich foods like fruits and vegetables
- fruits high in fiber, magnesium, and potassium, especially berries, apples, pears, avocados, melons, peaches, and bananas
- eggs, in spite of their cholesterol content
- green vegetables, such as broccoli, spinach, kale, asparagus, and Brussels sprouts
Research also suggests that foods high in fiber, particularly soluble fiber, can help reduce the symptoms of GERD.
The trigger-food diet
The trigger-food diet involves eliminating common trigger foods, such as coffee and chocolate, to alleviate symptoms. These methods have little clinical backing and results vary between individuals.
In a set of guidelines on diagnosing and managing GERD, the American College of Gastroenterology state that they do not recommend eliminating trigger foods because the dietary connection is not straightforward.
Instead, they believe that the primary aim of treatment should be to heal the digestive system.
When a person swallows, food passes down the food pipe to the stomach. A ring of muscle tissue called the lower esophageal sphincter contracts after allowing food into the stomach. This prevents the food from returning into the food pipe.
If the esophageal sphincter does not close correctly, the contents of the stomach can leak back up into the food pipe, causing GERD.
If GERD symptoms occur more than twice a week for a period longer than 3 weeks, doctors will define the condition as chronic.
People sometimes refer to GERD as acid reflux or heartburn, but these are technically symptoms of the disease rather than conditions in their own right.
Without treatment, GERD can lead to severe health problems, such as Barrett’s esophagus. In this condition, the cells lining the food pipe become abnormal and have the potential in some people to develop into cancer.
The primary symptom of GERD is heartburn, a painful sensation that ranges from a burning feeling in the chest to a sensation of food sticking in the throat. It is also relatively common to experience nausea after eating.
Some less common symptoms of GERD include:
- wheezing or weak coughing
- a sore throat
- changes to the voice, including hoarseness
- food regurgitation
Lying down immediately after eating can make symptoms worse. People sometimes find that their symptoms are also worse during the night. If this is the case, it is often possible to find relief by elevating the head while sleeping and avoiding eating eat least 2 hours before going to bed.
The symptoms of GERD are highly treatable.
People can purchase over-the-counter (OTC) medications to treat GERD. These include antacids, such as Gaviscon, which neutralize stomach acid.
People can also buy H2-receptor blockers, which may decrease the production of stomach acid for up to 12 hours. OTC proton-pump inhibitors (PPIs) have a similar effect.
Prescription medications might include stronger antacid, or acid-blocking, drugs. Although these are effective, they reduce the level of stomach acid. This acid is responsible for most vitamin B-12 absorption from food during digestion, so the frequent use of antacids, PPIs, or H2-receptor inhibitors can lead to vitamin B-12 deficiency.
Baclofen is a drug that can help to control symptoms by reducing the relaxation of the lower esophageal sphincter. However, baclofen can cause adverse effects, including fatigue and confusion.
Holistic dietary strategies for GERD
A comprehensive GERD treatment plan must consider additional factors beyond basic dietary changes.
For many people with digestive issues, restoring balance to the bacterial flora in the intestines may be beneficial. Eating fermented and pre-biotic foods might help to achieve this.
People call the bacteria in these foods probiotics. Probiotics may reduce digestive issues by balancing the digestive system as a whole. Prebiotics are foods that are rich in fibers that selectively grow beneficial bacteria.
Foods that contain natural probiotics include:
- raw sauerkraut
- raw kimchi
- raw fermented pickles and vegetables
- kombucha, a fermented tea drink
Prebiotic-rich foods include:
- Jerusalem artichokes
- chicory root fiber or inulin
- greener bananas
People with GERD might find that probiotic and prebiotic foods can reduce symptoms. Probiotics help to fight a bacterial strain known as Helicobacter pylori, which some scientists believe might relate to GERD. More research is necessary to confirm this.
Other natural treatments that may relieve GERD symptoms include deglycyrrhized licorice, ginger and slippery elm bark, which may reduce symptoms, relieve nausea, and improve gastric emptying.
Research from 2010 in BMC Gastroenterology suggests that an oral melatonin supplement might also help treat GERD symptoms. However, the researchers only recommend this as one aspect of treatment, and further studies are necessary to confirm these results.
An article published in the Archives of Internal Medicine suggests that losing weight and keeping the head raised during sleep can minimize the symptoms of GERD.
Although people typically consider GERD to be a chronic disorder, it does not have to be permanent.
Changes to the diet, lifestyle, and integrative treatments can help alongside medication. If this treatment does not work, surgery can be an option to strengthen the lower esophageal sphincter.
The appropriate treatment should prevent GERD from affecting quality of life. It is vital to always talk to a doctor before making any changes to a treatment plan.
Some of the medications and home remedies listed in this article are available for purchase online.