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Ultimate Guide to the GERD (Acid Reflux) Diet

Evidence Based

If you’ve found yourself eating TUMS (an antacid) like candy after a meal, then this is the guide for you!  Because in it we’re going to show you exactly how to manage your acid reflux / GERD through diet and lifestyle.  Best of all, we’ll even spend some time showing you all the unproven ideas for treating reflux, so you also know what to avoid.  Let’s go!

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What is it? Yes & No Foods Typical Meals Is It Easy To Do? Cautions Worksheet Summary & Verdict
Researched & Written by
Bailey Franzen MS, RDN
Bailey Franzen MS, RDN
Registered Dietitian Nutritionist
Carolyn Quijano MS, RDN
Carolyn Quijano MS, RDN
Registered Dietitian Nutritionist

Edited by Digest Life team

Last Updated: 7 April 2021

What is the GERD (Acid Reflux) diet?

We often think of acid reflux as one of those unfortunate facts of life. For some, the symptoms are a mild inconvenience, while for others, reflux can be debilitating.

So when acid reflux happens often, such as two or more times per week, this may point towards a bigger problem called gastroesophageal reflux disease (GERD).

GERD is a common disease affecting 13-19% of people globally.1

It’s a chronic medical problem where stomach contents flow backward from the stomach into the esophagus — the tube that connects our mouth and stomach.1

Symptoms of GERD can include:

  • burning chest pain
  • acid regurgitation
  • difficulties swallowing
  • Coughing
  • vocal changes
  • nausea.1

Even worse, uncontrolled GERD may lead to long term complications. When the esophagus is routinely exposed to damaging stomach contents, this can result in:

  • Inflammation
  • Scarring
  • Strictures
  • or even esophageal cancers.2

Obviously, for the sake of comfort and managing potential complications, getting treatment is a good idea.

First-line treatments for GERD include acid-reducing medications, diet, and lifestyle changes.1

Opting for the diet and lifestyle route may be ideal to try first. In our expert opinion, this is especially when considering acid-reducing medications, such as proton pump inhibitors (PPIs), can have side effects.3

  • Long-term use of PPIs has been associated with risks of infections such as Clostridium difficile and pneumonia, dementia, or worsened chronic kidney disease progression.3

Generally, diet and lifestyle strategies for GERD can be broken down into the following three categories:

  1. Diet composition changes
  2. Removal of trigger foods and beverages
  3. Changes to lifestyle patterns

What foods can you eat on the GERD diet?

So let’s first look at the evidence-based strategies and changes in our overall dietary composition to improve GERD symptoms.

Diet Composition Changes

Carbohydrates and Fiber

Although there have been small studies conducted in the area of GERD and carbohydrates, the good news is that they did show that the type of carb or amount of carbs you eat can make a big difference on GERD management.

So let’s break it down, there seems to be a couple of diet strategies that can be used to achieve benefits. You can either go two ways – the low to very low carb diet route or opt for a diet rich in whole-food sources of carbs and fiber.

One example of an effective diet strategy for GERD is the Meditteranean diet. The carbs included in this diet come from whole grains, fruits, vegetables, and legumes.2

Following the Med Diet pattern has been associated with a decrease in GERD symptoms in an observational study of 817 people.2 This diet has also been studied head-to-head against standard antacid therapies and has been shown to be equally effective for GERD sufferers.2

One key factor here may be that the type of carbs eaten on a Mediterranean diet come naturally packed with dietary fiber.

Fiber, both from diet sources and supplements, has been shown to be therapeutic against GERD symptoms.2 

Several other carb-altered diet strategies have also been found to be effective. These include carb limiting diets. One diet limited refined carbohydrates and sugars. Another all-liquid diet with a lower daily carb intake of roughly 85 g/day2  helped to manage GERD symptoms. While lastly, an ultra low carb diet of 20g or less per day has also shown benefits for GERD.2

Further notes on carbs

  • Small studies suggest that adjusting the amount or types of carbs we eat can play a role in GERD management. Successful strategies so far have included a low glycemic/low sugar diet, or low to very low carbohydrate diets. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6702398/
  • However, not all carbs are created equal. Complex carbohydrates high in dietary fiber may be beneficial for GERD. For example, the Mediterranean diet is rich in complex carbs and fiber from vegetables, legumes, fruits, and whole grains.
  • A cross-sectional study looking at 817 participants found that following a Mediterranean diet was associated with a decreased risk for GERD symptoms. http://saigaiin.sakura.ne.jp/sblo_files/saigaiin/image/Diet20and20Gastroesophageal20Reflux.pdf Another study comparing patients with GERD on acid-reducing therapies to those on a Mediterranean diet found both treatments to be equally effective. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6702398/
  • A Japanese study found that daily consumption of Japanese apricot — a high fiber fruit — was associated with decreased symptoms such as belching, early satiety, bloating, and heaviness. However, the fruit didn’t affect acid-related symptoms in GERD patients. http://saigaiin.sakura.ne.jp/sblo_files/saigaiin/image/Diet20and20Gastroesophageal20Reflux.pdf
  • Even fiber supplements have been used with success for GERD. In one study, 45 GERD patients were given a soluble fiber supplement for two weeks. Those taking soluble fiber experienced just as much improvement in their heartburn symptoms as a separate group prescribed an antacid. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6702398/
  • Another study looked at 36 GERD patients eating low fiber diets of less <20 g per day at baseline. Study participants were given Psyllium fiber three times per day. The Psyllium was found to reduce symptoms, and also reduced the average number of reflux episodes. This was even verified by pH testing. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5989243/
  • At a minimum, we suggest aiming for a daily intake of *** grams of fiber for women and *** grams for men per day. Of course, check with a qualified health care provider first to make sure higher fiber intakes are appropriate for your needs.

Proteins and Fats

There’s a lot of talk around high-fat diets, especially fried or greasy foods, and GERD symptoms. They’re often blamed for worsening reflux. However overall, there isn’t consistent research showing how fat impacts GERD.2

Likewise, there are only a few studies that have looked at the role of eating protein and GERD symptoms.2

With little and inconsistent information to rely on for now, we suggest that it’s best to take an individual approach and monitor how you personally respond to high fat or protein foods. Therefore, more studies are needed for us to know exactly how protein and fat might impact GERD symptoms.2

Further notes on protein

  • While the picture seems  clear on the role of carbohydrates and fiber for GERD management, that’s not the case for proteins and fats.
  • High fat diets — especially those which include fried or greasy foods — are often blamed for worsening GERD or reflux symptoms. But, overall, the research isn’t consistent about how fat may impact GERD. More research is needed.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6702398/  For now it may be best to look at how you’re personally impacted when you eat higher fat foods to gauge if dietary fat  is a problem area for you.
  • Few studies have looked at the role of eating protein when it comes to GERD. More studies are needed for us to know how protein might impact GERD symptoms. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6702398/

Quick Summary

  • Diet composition strategies that have been effective for managing GERD include:
    • Following a Mediterranean Diet
    • A low refined carb/low sugar diet
    • Low or very low carbohydrate diets
    • Increasing dietary fiber
  • More studies are needed to better understand how fat and protein might impact GERD symptoms.
  • Keeping a diet journal may help to keep track of how you’re personally affected by high fat and protein foods.

Food and Beverage Changes

After looking at overall dietary intake and composition, there are certain foods and beverages proposed to help alleviate GERD symptoms. So let’s look at several ideas about how this might happen:

Some foods may impact the band of muscles at the bottom of the esophagus called the lower esophageal sphincter (LES). Other foods and beverages cause the stomach to empty at a slower rate or acidify the stomach contents.

In contrast, others may cause stomach distention or irritation of sensitive tissues. All of these underlying mechanisms have been theorized to worsen GERD symptoms.2

Suggested Trigger Foods and Beverages

1.  Acidic Foods and Beverages

Have been shown to drop the pH of the stomach into a more acidic range.2 However, reported symptoms from acidic foods and beverages are inconsistent. A survey of 394 patients with heartburn found only weak associations with the acid content of foods and reflux symptoms. Some high-acid drinks such as prune juice didn’t cause symptoms, while others did (i.e., tomato juice).2

2.  Carbonation

Has been shown to change abdominal pressure, possibly leading to short-term relaxation of the LES or changes in the LES tone. However, these changes aren’t permanent. A systematic review of 17 studies did not find a connection between carbonation and GERD symptoms.2

3.  Coffee

Some research has found that coffee temporarily decreases the tone of the LES.2 Even though coffee is suggested to be a trigger beverage, a recent meta-analysis showed no association between coffee intake and GERD symptoms. This was true even for people drinking a lot of coffee; > 4 cups per day.2

4.  Chocolate

Eating chocolate has been tied to the relaxation of the LES. However, chocolate has not been associated with GERD symptoms. This seems to be the case even when large amounts of chocolate are eaten.2

5.  Mint

Is a common dietary trigger for GERD. It’s known to rapidly relax the LES. Even still, a small study looking at the mint/GERD connection found only a small number of patients (6/20) had worsened symptoms from high mint intake.2

6.  Spicy Foods

For some sensitive people, spicy foods can cause the sensation of heartburn by irritating sensitive tissues. Those who are sensitive to spicy foods may do better to avoid them.2

7.  Alcohol

Studies looking at the impact of alcohol on GERD symptoms have been mixed. The most recently published meta-analysis on this topic drew a correlation between alcohol intake and GERD symptoms. However, newer studies conducted in Asia may have skewed the association in favor of a link. This may point towards a genetic or demographic susceptibility to GERD symptoms that needs to be further explored.2

Quick Summary

  • We have theories as to why several foods and beverages might trigger GERD symptoms. There’s no consistent evidence saying that these foods and drinks cause problems across the board.
  • Trigger foods are specific to the person, so avoiding all suggested trigger foods may not be necessary or even helpful. It’s best to test foods and beverages out for yourself to determine if you should eliminate them.
  • Keeping a food diary and symptom journal may be the best way to pin down your personal diet triggers.
  • The overall goal may be to follow the least restrictive diet possible while keeping GERD symptoms under control.

Lifestyle Changes

1.  Avoiding Late Night Eating

ome small studies have shown that eating an early dinner can reduce reflux episodes while lying on our backs.2 Since reflux can be disruptive to sleep, it may not be a bad idea to pass on late night dinners and bedtime snacks. We suggest not eating within 4 hours of bedtime if possible.1  Elevating the head of the bed or sleeping on a wedge may also reduce acid exposure to the esophagus compared to lying flat.1

2.  Meal Size and Calories

Small studies and surveys have suggested that eating large, high-calorie meals may worsen GERD symptoms.2 It may be worthwhile to eat smaller meals more frequently throughout the day to keep reflux more controlled.

3.  Smoking and Tobacco Use

The use of tobacco has been tied to worsening reflux symptoms. On the other hand, stopping tobacco use has been shown to improve GERD symptoms. Other studies have shown that smoking duration has been associated with poor esophagus movement and emptying into the stomach.1

4.  Obesity and Exercise

People with a BMI above the normal range have been found to have more acid reflux and more frequent symptoms; they more commonly experience a complication of GERD called erosive esophagitis.1 Weight gain of as little as 3.5 BMI points has been tied to a three-fold increase in the risk of developing reflux symptoms.1

On the other hand, 10% weight loss has been associated with a significant decrease in reflux symptoms.1  In one study, people who reduced their BMI by 5 points were able to decrease the dose or even eradicate acid-reducing medications.1

Quick Summary

  • Aim to eat your last meal or snack 4 hours before heading to bed.
  • Consider elevating the head of your bed or sleeping on a wedge.
  • Avoid eating large high-calorie meals, and instead, opt for smaller meals eaten throughout the day.
  • Avoid tobacco use and smoking.
  • If your BMI is in the overweight or obese range, weight loss may help to reduce reflux.

What typical meals do you eat on the diet?

So, when it comes to managing GERD with diet, some overarching diet strategies emerge. Things like limiting simple sugars and refined carbohydrates or avoiding heavy meals.

However, personal food triggers will need to be figured out on a case by case basis. This means, there’s no cookie cutter GERD diet, and a typical day of meals may look different from one person to the next. Therefore, stay aware of signs and symptoms to tailor your diet accordingly, honoring your body.

With that said, even though there isn’t a ton of evidence suggesting the majority of people are sensitive to many of the suggested trigger foods, we opted to leave those out and play it safe when creating our sample menu.

Below we broke down a sample menu into 4 smaller meals.

Make sure to test these foods out for yourself to identify your own triggers.

Remember that an early dinner may reduce reflux symptoms, so if you can manage, try eating your last meal 4 hours before bedtime.

Breakfast

Egg sandwich with 2 slices whole-wheat toast, 1 egg, arugula, 1 tbsp pesto, 1 tbsp sun-dried tomatoes
Side: Banana

Lunch

Wrap with grilled chicken, spring mix lettuce, garbanzo beans, feta cheese, cucumber, kalamata olives, sunflower seeds, bell pepper
Side: Carrots, pita chips, and hummus

Snack

Greek yogurt with strawberries and walnuts

Dinner

Grilled Mahi Mahi tacos with onion, cilantro, on corn tortillas, mild mango salsa (no tomatoes), shredded cabbage
Side: Watermelon

How easy is the diet to do?

This will all depend on your current diet, food preferences, and lifestyle.

Some simple steps and strategies to get you started:

  • You may have to make some changes to your meal pattern to accommodate smaller, more frequent meals and an earlier dinner.
  • You’ll also have to steer clear of heavier, high-calorie meals and refined sugars while adding in plenty of fiber.
  • Good record keeping is also essential to spot food sensitivities. Keeping a food journal may feel like a hassle but will provide you with great info on customizing the GERD diet to your needs. You may also have to look for alternatives to some favorite foods and beverages if you find they trigger GERD symptoms.

With the above suggestions combined, be aware that this can present a few challenges. For one, a high fiber diet that’s low in refined carbs usually means you’ll be doing a lot of food prep and cooking at home. Meal prep is time-consuming and is one area where this diet could get challenging. For example, you’ll be:

  • Eating smaller meals throughout the day (meaning preparing 4-5 meals in a day)
  • Eating more high fiber foods (plant foods may require more prep time)
  • Reducing your intake of easy but heavy/high-calorie convenience foods (pizza, burgers, fries, etc.)

Meal timing is also a part of relieving GERD symptoms. If you can manage it, your last meal will take place about 4 hours before going to bed.1 So, if your bedtime is 10pm, you’ll want to have dinner before 6pm. This means meal prep may need to start as early as 4:30pm and could get overwhelming, depending on your schedule.

Overall, following a diet designed for GERD will likely have benefits for both general health and relieving GERD symptoms. Also as an added bonus, following a tailored GERD diet may help you skip out on taking acid-reducing medications or reduce your needed dose. We feel this alone makes following a GERD diet worthwhile.

Quick Summary

  • Depending on your current diet and schedule, the GERD diet may be easy or more challenging.
  • If you love some foods that require elimination, you may have to find substitutes.
  • This diet involves meal preparation and can be time-consuming.
  • Scheduling your last meal could be tricky, depending on your personal schedule.

Any potential cautions before trying it?

Before managing reflux or GERD with diet and lifestyle, it’s best to understand which strategies are most likely to pay off.

The most effective strategies to date seem to be diet composition adjustments, changes to meal size and timing, weight loss for those who are overweight or obese, and stopping the use of tobacco or smoking.2

From there, the diet can be personalized even more by identifying any personal food triggers. Just know that avoidance of triggers typically won’t cut it alone and more broad diet strategies seem to be most effective.2

Food, Symptom & Lifestyle Logger

1.  Log your daily meals

Date Meal  Time  Food/Beverage/Amount Notes/Symptoms/

Duration

11/26/20 Breakfast 8:00 AM 1 slice whole-wheat toast

½ Avocado

2 poached eggs

1 cup coffee, black

1 cup almond milk

1   medium fresh orange

None
11/26/20 Snack 10:00 AM 1 cup nonfat greek yogurt

2 tsp honey

½ cup blueberries

1 cup water

None
11/26/20 Lunch 12:30 PM 3 slices pizza with ham, pineapple, and jalapeno slices

Side salad:

romaine lettuce tomatoes

Olives

Feta cheese balsamic vinaigrette

16 oz. Coke

Heartburn, acid regurgitation x 3 hours
11/26/20 Dinner 8:30 PM 4 oz baked chicken

Seasoned with rosemary, garlic, pepper, salt, and lemon

1 small baked potato with a pat of butter and 2 tbsp of sour cream

1 cup sauteed broccoli with garlic and olive oil

16 oz unsweetened black tea

Heartburn x 4 hours

 

2.  Carefully log any of the following

 

Food/Beverage/ Medication/ Substance Time/Meal What/Amount Symptoms (Yes/No)
Spicy Foods
Acidic Foods
Carbonated Beverages
Chocolate
Mint
Fatty or Heavy Meal
Refined Sugars and Carbohydrates
Alcohol
Tobacco Products
Antacid Medication
Other Medications or Supplements 

(over the counter or prescription)

 

3.  Log any Other Suspected Food or Lifestyle Triggers:

 

4.  Morning Log:

(Example)

I went to bed last night at: 10:00 PM
I got out of bed this morning at: 7:15 AM
Head of the bed was elevated (yes/no) No
Last night I fell asleep: ⬜ Easily

⬜ After some time

⬜ With difficulty

I woke up during the night: # of times:  2 times

# of minutes: 20 minutes each

My sleep was disturbed by: Drinking caffeine with dinner and acid reflux
Notes: I ate dinner 2 hours before bedtime

 

5.  Evening Log

 

Approximately 2-3 hours before going to bed, I consumed:

 

Reflections/ Trends

 

 

Summary & Verdict

  • Med Diet: Several carb-altered diet strategies may help to keep reflux under control. Our personal favorite, the Meditteranean diet. We like how this diet has shown substantial evidence for GERD management while also not being overly restrictive. As an added bonus, this diet pattern is naturally rich in fiber, which has shown benefits for GERD management — win, win!
  • Low-Carb: If you instead opt to cut back on total carbs — another strategy with demonstrated success — be sure to not skip out on the fiber. We suggest aiming for a minimum of 25 g of fiber per day for women and 38 g/day for men. If you aren’t quite hitting this fiber mark with diet alone, studies suggest that fiber supplements may help GERD symptoms too.2
  • Early Eating: Aim for an earlier dinner, and ideally shoot to not eat anything 4 hours before heading to bed. Consider elevating the head of your bed, or even easier, purchase a wedge to help keep nighttime reflux under control.
  • Meal Frequency: Remember that you’ll likely do best to avoid large high-calorie meals in favor of smaller meals dispersed throughout the day.
  • Lifestyle Factors: Be particularly mindful of vices such as tobacco use and smoking as these things are known to worsen reflux.
  • Weight Management: If you have a BMI in the overweight or obese range, it may be beneficial to work towards weight loss to improve reflux symptoms.
  • Personalization: Be on the lookout for your personal diet triggers. A food diary and symptom log could be your best friend when it comes to pinning down your specific triggers. Just remember that no GERD diet triggers are shared across the board, so what works for you personally may or may not work for someone else.

References

  1. Sajiv Sethi; Joel E. Richter. Diet and Gastroesophageal Reflux Disease: Role in Pathogenesis and Management. Curr Opin Gastroenterol. 2017; 33 (2): 107-111. URL Access date: 11/26/2020
  2. Carolyn Newberry; Kristle Lynch. The role of diet in the development and management of gastroesophageal reflux disease: why we feel the burn. J Thorac Dis. 2019 Aug; 11 (Suppl 12): S1594–S1601. doi; URL Access date: 11/26/2020
  3. Megan Jaynes; Avinash B. Kumar. The risks of long-term use of proton pump inhibitors: a critical review. Ther Adv Drug Saf. 2019, Vol. 10: 1-13 URL Access date 11/26/2020