Introduction: Acid Reflux and Stomach Acid
Welcome to episode 62 of the Inside Knowledge for People with IBS. My name is Anna Mapson. This week is all about stomach acid and reflux, and although it’s not officially part of an IBS diagnosis, in fact it is a separate condition, it is something that a lot of my clients suffer with. So I thought you might be interested to hear what I’ve got to say about how to manage reflux.
So when we’re talking about acid reflux, it’s basically the regurgitation of the contents of your stomach into the oesophagus. That’s the tube that runs from your mouth down to your stomach. This may be triggered in part down to having too much acid in your stomach. Or it may be that the sphincter at the top of your stomach, the bottom of the oesophagus, comes open.
What causes acid reflux?
This can be relaxed, this little tube, band of muscle that closes the tube to stop things coming up. It gets relaxed and then the acid can actually start to creep up, particularly if you lie down or if you bend over. That is when you might be getting acid in your mouth or even regurgitation of your last meal.
Signs of having heartburn or acid reflux would definitely be a burning sensation in your chest around your breastbone. That can be really strong, particularly after meals. It seems to be after like heavy, stodgy, fatty meals that take a bit longer to get digested.
Symptoms of acid reflux
I’ll go through a few more other foods that can affect acid reflux in a minute, but often you might also get a cough. A dry, tickly cough. That is to do with the acid coming up and irritating the back of your throat. And irritating the lining of the oesophagus so that you’re constantly coughing or clearing your throat from a lot of mucus.
You may find you get a lot of hiccups as well. And that can be down to your body’s reaction to this acid in the oesophagus. That can also lead to, like, a croaky voice, a really hoarse voice that just doesn’t go away. So, sometimes it can not only be a pain in your stomach, but also affecting up towards your mouth.
The impact of acid reflux on teeth and oral health
I have worked with people in the past whose acid reflux has been so bad that it actually has started to erode their back teeth. So when they were lying down at night to go to sleep, the acid was washing up. Actually getting into their mouth and degrading the back teeth overnight. And so other symptoms that you might find is like, bad breath or really acidy taste in your mouth, like a constant sour feeling.
That can also be a sign of the acid from your stomach getting into your mouth. And then sort of lower down in your body you may get nausea. So feelings of sick, feelings of bloating as well and like being a bit gassy that can also be related to acid in your stomach.
Silent reflux: Symptoms and differences
There is also another type of reflux called silent reflux or the long name is laryngopharyngeal reflux or LPR, and this is where people don’t get burning, they don’t get any of that sensation of pain.
You might get a bit of heartburn at night but you might not. But it might be more around feeling a sensation of difficulty swallowing or like a lump in your throat. Particularly a hoarse and croaky voice, that is quite common. And also like throat clearing. If you’re constantly having to clear mucus from the back of your throat.
But particularly around that feeling uncomfortable about swallowing and feeling like there is something stuck in your throat. Although there will be nothing there to see if the doctors actually take a look. You might get like frequent burping with this as well. So sometimes you can have reflux but you don’t actually feel the pain and that’s why it’s called silent reflux.
Treatment options for acid reflux
The typical treatment for acid reflux is to take something that suppresses the acid for your stomach. So these are either called proton pump inhibitors that stop the cells that produce the acid. Or there are histamine blockers which also do something similar. I’m going to cover these next week in a separate podcast episode, because I really want to get into a little bit about how they work, how you should take them. And how you can start to get off them. Or steps that you could take in order to try to reduce your reliance on medication for acid reflux.
Lifestyle changes to help manage acid reflux
So look out for that next week, but this week I just want to focus a little bit on foods and sort of lifestyle factors that can also affect acid reflux. How you can improve your symptoms if you’re not on medication, or actually even if you are on medication. As a first step in order to help you get ready to start to have a conversation about coming off them.
And whilst it’s not possible for everybody who’s taking a PPI to stop taking them, because there are some conditions where it’s really essential to keep on top of your stomach acid, actually there are a lot of people taking them long term who don’t need to be, too. And PPIs are one of the most commonly prescribed drugs in the UK.
The impact of food on acid reflux
There was some research saying up to 20 percent of people have actually tried them. That was in one study. That was only up to 2018. And I think potentially it’s got more since then. There are a lot of people taking them anyway. So next week I’m going to cover more about the proton pump inhibitors and other acid suppressing medication.
However, today what we can do is talk about some of the foods and how that might affect your digestion and your stomach. There are a number of different ways that your food that you eat can affect your acid in your stomach.
- Sometimes the food can increase the acid by the fact it is an acidic type food that you’re eating.
- Sometimes the food can relax that sphincter at the top of your stomach at the bottom of the oesophagus. And allow more acid to creep up the oesophagus and sometimes your eating pattern can also impact the way that acid is likely to get out.
Acidic foods to watch out for
So if we think about acidic foods that may either irritate the mucus in the oesophagus. If it’s already a bit sore and then you’re eating something acidic, it can then burn a little bit. Or it could increase the amount of acid in your stomach. I’m talking about things like orange juice, tomatoes, anything kind of citrusy, like lemon juice as well, so just like typically acidic foods. And you might also find like spicy food can also irritate this mucous lining of your stomach.
The importance of stomach acid
So I wanted to also just jump in here and say acid is really important. And if you haven’t listened to my episode about low stomach acid, then go back and listen to that. Episode 55 is all about low stomach acid and actually why we need acid in our stomach. There is a mucus lining around your stomach bag, which helps protect the stomach lining from this acid. It is really strong and really powerful. And actually, if it came into contact with your actual cells, it would burn.
And so we have a mucous lining around the stomach, which helps protect the stomach and also keeps it more alkaline. Your actual cells don’t come into contact with the acid. Some of those foods will increase the acid, by being acidic themselves. Some foods will relax that sphincter at the top of your stomach, which includes alcohol, coffee, chocolate, and mint.
Research on foods and their impact on digestion
There isn’t a lot of conclusive evidence on certain foods for acid reflux. But where we do know is that everybody’s different. It’s really important to try and figure out what your personal triggers are. So for example, some people find spicy food affects their stomach acid or their acid reflux. Others may find it doesn’t make any difference at all. It really depends on your own body and how sensitive your stomach is.
Another thing to consider is that high-fat meals can really slow down the digestion of food. So things like fried foods, crisps, pastries, creamy sauces. These kinds of things take a lot longer to break down in your stomach. And the longer the food sits in your stomach, the more acid your stomach produces in order to digest it. So that means you’re more likely to experience reflux.
Eating patterns and portion control
In terms of eating patterns, it’s also important to consider portion sizes. If you eat a really big meal, your stomach has to work harder to digest all of that food. And that means it produces more acid to break down everything. That’s why you might find that after a big meal, particularly late at night, you get more reflux symptoms.
And so a simple step is to try and eat smaller portions more frequently, rather than large meals that could lead to discomfort. Try to avoid eating too close to bedtime, because when you lie down, the acid has more chance to travel back up into your oesophagus.
Importance of posture after eating
In fact, if you’re prone to reflux, it’s a good idea to stay upright for a few hours after eating to give your body time to digest your meal before you go to bed. Some people find that propping up the head of their bed by a few inches can help reduce night-time reflux as well. And that’s because gravity can help keep the acid in your stomach, rather than it travelling upwards.
So that’s another really practical tip, particularly if you’re finding reflux a problem at night. Just a couple of blocks under the head of the bed can really make a difference.
Carbonated drinks and acid reflux
In terms of drinks, carbonated drinks can also be a big issue for some people. Fizzy drinks like soda or sparkling water can introduce gas into your stomach, which increases the pressure and can push acid back up into your oesophagus. So if you’re someone who suffers from reflux, it might be worth avoiding fizzy drinks and sticking to still water or herbal teas instead.
Smoking and its effect on reflux
Another thing that has a big impact on acid reflux is smoking. Smoking weakens the valve that keeps stomach acid from travelling back into the oesophagus. So quitting smoking can be a really important step in managing reflux symptoms. It’s one of the key lifestyle factors that can really make a difference.
The role of stress in acid reflux
Something else that often gets overlooked is the role of stress in acid reflux. Stress can increase stomach acid production. It can also make you more sensitive to the pain of acid reflux. So finding ways to manage stress is really important if you’re struggling with reflux symptoms. Whether that’s through relaxation techniques like meditation, yoga, deep breathing exercises, or just finding some time to unwind, reducing stress can help a lot.
Foods that may help alleviate acid reflux
On the flip side, there are some foods that may actually help with reflux. For example, foods that are high in fibre, like whole grains, fruits, and vegetables, can help move food through the digestive tract more quickly and reduce the chances of acid building up.
There’s also some evidence that ginger can help soothe the stomach and reduce acid reflux. You could try adding fresh ginger to your cooking or drinking ginger tea if you’re dealing with reflux symptoms.
Managing weight to reduce reflux symptoms
Another factor that can play a big role in acid reflux is your weight. If you’re carrying extra weight, particularly around your middle, it can put pressure on your stomach and make reflux more likely. So losing weight, even just a small amount, can help reduce reflux symptoms.
Even if you’re not overweight, eating too much at once can increase pressure in your stomach and push acid back up, so portion control is really key here.
Final thoughts: Practical steps to manage reflux
So in summary, if you’re dealing with acid reflux, there are a number of practical steps you can take to try and reduce your symptoms. That includes making sure you’re eating smaller meals, avoiding trigger foods like spicy or fatty foods, and staying upright for a few hours after eating. You can also try to cut back on alcohol, chocolate, and caffeine, as these can relax the valve at the top of your stomach and allow more acid to escape.
If you’re taking medication for acid reflux, like a proton pump inhibitor or a histamine blocker, it’s worth discussing with your doctor whether you could reduce your dose or try to come off it, especially if you’ve been taking it for a long time. But this is something that should be done under medical supervision, because stopping medication suddenly can lead to a rebound increase in acid production.
Looking ahead: Next week’s episode on acid suppression medication
And like I mentioned earlier, I’ll be going into more detail next week about how these medications work, why they’re prescribed, and some steps you can take if you’re looking to reduce your reliance on them. So make sure to tune in next week if that’s something you’re interested in.