Are There Acid Reflux Triggers?

What triggers acid reflux? Understanding the causes and exacerbating factors is essential for managing symptoms and finding relief, mainly through lifestyle and dietary changes. Effective treatment is not a quick fix; however, identifying and addressing key triggers can significantly improve symptoms.

Acid reflux occurs when stomach contents flow back into the esophagus, often due to a combination of factors such as weakened esophageal barriers or increased abdominal pressure. Recognizing how diet and lifestyle impact these factors is crucial for effective management.

For many, the exact cause remains unclear. While occasional overindulgence in food and alcohol can trigger symptoms, some individuals experience acid reflux that worsens due to specific events like respiratory infections, some medications, or medical procedures like endoscopy.

Regardless of the initial cause, persistent symptoms are often linked to ongoing lifestyle and dietary habits. By understanding how our daily choices affect reflux physiology, we can take more control over managing the condition.

Below, we’ll explore the top five lifestyle triggers and top ten dietary reflux triggers, along with practical tips for addressing them.

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Lifestyle Triggers

1. Eating Too Late

Many people with acid reflux experience what’s known as silent nocturnal respiratory reflux – where stomach contents move into the throat and airways during sleep without the typical symptoms of heartburn or indigestion. 

Eating too late is the #1 risk factor for this condition. When you eat close to bedtime, the stomach remains full while you lie down, increasing the pressure in the stomach and making it easier for acid to flow back into the esophagus … reflux. 

Additionally, the Lower Esophageal Sphincter (LES) – the valve that prevents stomach contents from entering the esophagus – is less effective at preventing reflux when the stomach is still digesting food, and your body’s ability to clear acid from the esophagus is reduced during sleep.

2. Snacking Before Bed

Even a small bedtime snack can stimulate acid and pepsin production, increasing the likelihood of reflux during sleep. Pepsin is a digestive enzyme that normally functions in the stomach to help break down food. However, when reflux occurs, pepsin can escape into the esophagus, where it can contribute to inflammation and tissue damage. To avoid this, it’s important to avoid eating anything close to bedtime.

3. Overeating

Overeating increases pressure on the stomach, which can cause the LES to weaken or temporarily open, allowing acid to flow upward and trigger reflux. 

Large evening meals are especially problematic because they are often high in fat and paired with alcohol, both of which are significant dietary triggers. To reduce the risk of reflux, opt for smaller, well-balanced meals instead.

4. Certain Medications

Certain medications, such as ACE inhibitors, antibiotics, steroids, and newer drugs like Ozempic, can increase the risk of acid reflux in various ways. 

For example, ACE inhibitors are commonly prescribed for high blood pressure but can cause side effects like coughing, which may worsen reflux symptoms. Similarly, Ozempic, a medication used for weight management and diabetes, may slow stomach emptying, increasing the likelihood of reflux by causing food to remain in the stomach longer … causing acid reflux. Other medications may irritate the stomach lining or relax the lower esophageal sphincter, further contributing to reflux.

5. Obesity

Obesity is another important risk factor for developing reflux. Imagine lying down with a heavy weight on your abdomen—it would place significant pressure on your stomach, increasing the likelihood of reflux. This is similar to what happens when there is excess abdominal weight. 

Carrying extra weight, especially around the midsection, puts additional pressure on the stomach, which can cause stomach contents to be pushed upward into the esophagus. Achieving a healthier weight can reduce this pressure, helping to alleviate reflux symptoms and improve overall health.

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Dietary Triggers

Identifying trigger foods can be challenging, as everyone’s experience with acid reflux is unique. That said, there are certain foods and beverages that commonly worsen symptoms for many individuals.

1. Alcohol

Alcohol is a major risk factor for acid reflux. It reduces the tension in the LES, making it easier for stomach contents to flow back into the esophagus. If you fall asleep after drinking, you’re likely to experience reflux throughout the night. To effectively manage reflux, it’s important to avoid alcohol for at least two to three months.

2. Fried Foods

High-fat, fried foods, such as fast food, are among the worst offenders for acid reflux. A meal like a double cheeseburger with fries can trigger reflux in almost anyone due to its high fat and salt content. The fat in fried foods relaxes the LES, similar to the effect of alcohol, making it easier for stomach contents to flow back into the esophagus.

3. High-Fat Foods

In addition to fried foods, other high-fat items—such as cheeses, rich desserts, and buttery dishes—can exacerbate reflux. Interestingly, olive oil appears to be an exception and is generally safe for those with reflux.

4. Carbonated Beverages

Carbonated beverages should be avoided for those dealing with acid reflux. In my book Dropping Acid: The Reflux Diet Cookbook and Cure, we discovered that soft drinks are required by law to be acidified, which means they’re processed and regulated, but still, they contain substances that worsen the effects of reflux. For example, Coca-Cola contains phosphoric acid, also used as a rust remover.

Pepsin is an important digestive enzyme in the stomach that helps break down food. However, when activated outside of the stomach, such as in the throat or esophagus, it can cause inflammation and irritation. Carbonated beverages, along with fruit juices and energy drinks, are acidic and can trigger pepsin activation outside the stomach, worsening reflux symptoms.

5. Chocolate

Chocolate contains a chemical called theobromine, which can relax the LES, making it easier for stomach contents to flow back into the esophagus. It is also a high-fat food, which can contribute to reflux. While chocolate is a known trigger for some people, its effects can be idiosyncratic, meaning it may affect individuals differently. For example, when I had reflux, chocolate would dramatically worsen my symptoms.

6. High-Acid Foods (e.g., Citrus and Vinegar)

Lemons and apple cider vinegar are popular in some health trends but can aggravate reflux symptoms. As high-acidic foods, they can activate pepsin, a digestive enzyme that can contribute to inflammation and tissue damage when refluxed into the esophagus or respiratory tract.

7. Coffee

Coffee is a trigger food for some people, and it’s important to note that decaffeinated coffee can have the same effect as its caffeinated counterpart. In my case, it caused nausea and an upset stomach, so I switched to tea. For most people, one or two cups of coffee per day are tolerable.

8. Onions

Raw onions, especially those that are sharp and pungent, can trigger reflux. The more they make you cry, the more likely they are to be irritating. Sweet caramelized onions are generally less problematic and can be a great addition to many dishes.

9. Garlic

While fewer than 25% of people find garlic triggering, it’s worth monitoring if you suspect it’s contributing to your symptoms.

10. Peppers

Bell peppers and hot peppers can slow stomach emptying, increasing the likelihood of reflux. During the initial phases of treatment, it’s best to avoid any foods with “pepper” in the name.

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Practical Recommendations for Dietary and Lifestyle Changes

To effectively manage acid reflux, consider the following steps:

• Eat Early: Aim to finish meals a few hours before bedtime.
• Avoid Snacking After Dinner: Allow your digestive system to rest overnight.
• Limit Fast Food: Reduce intake of fried, fatty, and heavily processed foods.
• Minimize Carbonated Beverages: Opt for still water or herbal teas instead.
• Quit Tobacco and Vaping: Both increase reflux risk and harm overall health.
• Limit Alcohol: Eliminate it entirely during your acid reflux treatment phase.
• Identify Personal Triggers: Determine which foods exacerbate YOUR reflux.

By making these adjustments, you can take control of acid reflux and improve your quality of life. Effective management is a process, and consistency is key to seeing results.

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For more information about diagnosis and treatment of acid reflux, see two companion books on Amazon: Dr. Koufman’s Acid Reflux Diet and Dropping Acid: The Reflux Diet Cookbook & Cure. If you would like to receive personalized guidance and strategies for lasting relief, consider scheduling an online consultation.