If you've ever experienced heartburn, you know how unpleasant the burning sensation in your chest and throat is. Heartburn is a symptom of acid reflux, which occurs when stomach acid bubbles up into the esophagus—the tube that connects your stomach to your throat.
A little acid reflux every now and then is usually nothing to worry about—you probably just ate or drank too much.
If your reflux becomes more frequent and severe, you may have gastroesophageal reflux disease (GERD). While this must be treated to avoid complications, you can often treat or even prevent occasional acid reflux with lifestyle changes such as eating smaller meals and losing weight.
1. Certain Foods and Drinks
Many people report having acid reflux after eating certain foods. Foods high in fat, chocolate, spicy foods, citrusy or acidic foods like oranges and tomatoes, mint, garlic, and onions, as well as carbonated drinks, are common culprits.
These foods may be more challenging to digest, resulting in an increase in stomach acid that can enter the esophagus. Fatty foods can also cause the lower esophageal sphincter (LES) to relax, which acts as a "lid" on the stomach.
2. Obesity
Obesity is a major contributor to acid reflux and GERD. It may also increase the risk of GERD complications such as Barrett's esophagus, which is characterized by precancerous changes in esophageal cells. It appears that it is not only excess fat that increases the risk. It's central obesity, which means you have more fat around your midsection.
According to experts, extra abdominal fat adds pressure to the stomach, forcing acid into the esophagus. Hormones may also be involved. Clinical obesity is associated with higher levels of circulating estrogen, which has been linked to GERD symptoms. People who use hormone therapy after menopause are also at a higher risk of reflux.
3. Hiatal Hernia
A hiatal hernia occurs when the top of your stomach bulges into your chest cavity, preventing the LES from properly closing.
Many people who have hiatal hernias have no symptoms. However, in some cases, GERD causes the hernia, while in others, GERD is a symptom of the hernia.
Hiatal hernias are more common in people over 50 and in obese people. They can also occur due to coughing, vomiting, or physical injury.
Weight loss, combined with a healthy diet, can help control reflux symptoms caused by a hiatal hernia. In addition, some people with hiatal hernias who have reflux may benefit from over-the-counter (OTC) or prescription heartburn medications. In extreme cases, hiatal hernia surgery may be required to push the stomach back down and reinforce the barrier between the stomach and the esophagus.
4. Lying Down After Eating a Big Meal
Eating a large meal at any time can cause acid reflux, but it's especially aggravating if you eat it right before going to bed or sitting on the couch.
Eating immediately before lying down causes reflux because the stomach is full while lying down, making it easier for acid to back up into the esophagus. Large meals may also breach the esophageal barrier, resulting in increased acid exposure.
5. Smoking
Smoking can harm your digestive system in the same way that it harms so many other parts of your body. Smoking and chewing tobacco can also contribute to reflux by relaxing the lower esophageal sphincter.
Both smoking and alcohol contribute to reflux by lowering LES pressure, decreasing acid clearance, and weakening protective esophageal functions.
Coughing from smoking may also contribute to reflux. Many smokers cough, and every time you cough, you increase pressure in your stomach and promote reflux.
6. Pregnancy
Acid reflux affects up to half of all pregnant women. It can begin at any point during pregnancy, but it is more common after 27 weeks.
If you've had acid reflux before or have been pregnant before, you're more likely to have it again while pregnant.
Paying close attention to your diet and eliminating trigger foods is your best bet for reducing symptoms while pregnant.
7. Stress and Anxiety
Many people who suffer from heartburn believe that stress aggravates their symptoms, and a 2013 study published in Digestive Diseases and Sciences suggests a link between stress and GERD. Anxious people may produce more stomach acid, according to experts, and GERD was linked to anxiety and depression in a 2018 study published in the Journal of Neurogastroenterology and Motility.