How many times have you been advised to “just change your diet and all your reflux will go away”? It’s true that avoiding certain “trigger foods” can sometimes help reduce reflux. However, how you eat can have a greater impact on your ability to control your acid reflux at night. To understand why, let’s start with an anatomy lesson:
When you eat, food travels down your esophagus through your lower esophageal sphincter (LES) and into your stomach where digestion begins. Your LES is a valve that controls the flow of contents between your esophagus and your stomach and vice versa. The LES will occasionally relax to release gas, aka a burp. When the LES relaxes too much, stomach acid can escape up into the esophagus and beyond.
Technically known as transient lower oesophageal sphincter relaxations (TLOSR), these LES relaxations are the main cause of reflux symptoms in both healthy individuals and GERD patients1 and can be directly affected by how you eat.
Here are a couple tips to help reduce the frequency of these LES relaxations or TLOSRs:
#1: Eat smaller meals.
Filling your stomach to the brim can cause more frequent LES relaxations resulting in painful reflux symptoms. A 2015 study showed that when the upper stomach is distended (or enlarged) due to being really full, the LES relaxes more frequently.2 In fact, many researchers believe that the main determinant of reflux is the amount of food that you eat (or your stomach volume), not the number of calories3 or fat grams4 in the meal itself.
We all overindulge from time to time, especially during the holidays, but keep in mind the more you do, the less likely your LES will function properly to keep your reflux under control. Eating smaller, more frequent meals should result in fewer reflux episodes, less esophageal acid exposure, and fewer reflux symptoms overall5.
#2: Dinner time matters.
Sometimes late night meals are unavoidable. In general, the more time between when you eat dinner and when you go to bed, the better. It has been shown that most reflux episodes occur within 3 hours of eating6 so going to bed within 3 hours of eating can significantly increase the likelihood of refluxing at night7. To minimize nighttime reflux, try to align your meal times with when you normally head to bed.
You may find that minor adjustments to your meal sizes and meal times can go a long way towards reducing your acid reflux by helping your LES keep stomach acid where it belongs…in your stomach.
1. Holloway RH, Hongo M, Berger K, McCallum RW. Gastric distension: a mechanism for postprandial gastroesophageal reflux. Gastroenterology 1985; 89: 779 84.
2. Randhawa MA, Mahfouz SA, Selim NA, Yar T, Gillessen A. An old dietary regimen as a new lifestyle change for Gastro esophageal reflux disease: A pilot study. Pak J Pharm Sci. 2015 Sep;28(5):1583-6.
3. C Pehl, A Pfeiffer, A Waizenhoefer, B Wendl, W Schepp. Effect of caloric density of a meal on lower oesophageal sphincter motility and gastro-oesophageal reflux in healthy subjects. Aliment Pharmacol. Ther., Feb. 2001; 15 : 233-9
4. Pehl C., Waizenhoefer A., Wendl B., Schmidt T., Schepp W., Pfeiffer A. Effect of low and high fat meals on lower esophageal sphincter motility and gastroesophageal reflux in healthy subjects. Am J Gastroenterol. 1999; 94: 1192–1196.
5. Wu, K., Rayner, C., Chuah, S., Chiu, Y., Chiu, K., Hu, T. et al. Effect of liquid meals with different volumes on gastroesophageal reflux disease. J Gastroenterol Hepatol. 2014; 29: 469–473.
6. Dent, J., Dodds, W., Friedman, R., Sekiguchi, T., Hogan, W., Arndorfer, R. et al. Mechanism of gastroesophageal reflux in recumbent asymptomatic human subjects. J Clin Invest. 1980;65: 256–267.
7. Kang JH, Kang JY. Lifestyle measures in the management of gastro-oesophageal reflux disease: clini- cal and pathophysiological considerations. Ther Adv Chronic Dis. 2015; 6(2):51–64. Epub 2015/03/03.