What Causes Acid Reflux Symptoms?

If you’re reading this article, you’ve likely experienced that painful burning sensation in the middle of your chest, usually after eating or drinking something. You may have felt it after enjoying those stadium jumbo cheese-soaked chili fries – or on Thanksgiving after feasting with friends and family. Maybe you encounter this pain every time that you eat or drink or when you lay down to go to bed. This uncomfortable symptom is called heartburn and it is a sign of acid reflux.

I have personally experienced acid reflux countless times: usually after a social night out enjoying cocktails with friends, or when I discovered coconut La Croix and drank it instead of regular water for several days. I’ve spent $5 on a creamy, delicious cashew milk latte only for it to result in pain and irritation in my chest. Acid reflux is not a pleasant feeling, and can be unbearable when everything that you eat causes pain. Luckily, it can be treated, especially once you identify your unique triggers, which could be caused by food, medications, a medical condition, or lifestyle choices. Typically, multiple factors are playing a role.


What is Acid Reflux?

The most basic explanation of acid reflux, is the backflow of highly acidic stomach contents into the esophagus.2

You may also hear acid reflux referred to as:

  • Gastroesophageal reflux
  • Acid reflux
  • Acid regurgitation
  • Reflux
  • Heartburn1
  • Gastric reflux
  • Indigestion2

Just as a rose by any other name would smell as sweet, acid reflux is just as painful whatever the name.

Normally when you swallow something, the food or beverage travels from your mouth, down a narrow tube called the esophagus, and into your stomach. At the bottom of the esophagus, there is a muscular ring, called the lower esophageal sphincter (LES). When functioning properly, this LES stays closed most of the time to protect the esophagus from the highly acidic contents of the stomach, but must open to allow food to pass through. If the stomach contents (specifically hydrochloric acid and the enzyme pepsin) regurgitate back into the more fragile esophagus, you experience a burning sensation near the middle of the chest called heartburn. Heartburn actually has nothing to do with the heart, but because the heart and esophagus are located close to each other, people label the sensation as heartburn.3 The heart is not seen in the graphic above, but it is located between the lungs.

Not sure if you’re experiencing severe heartburn or a heart attack?
Check out the Mayo clinic’s article: When to Worry

What Causes Acid Reflux?

The stomach secretes 1-3 liters of gastric juices daily, composed of water, mucus, hydrochloric acid, enzymes, and electrolytes. These gastric juices are crucial for for multiple reasons:

  1. Hydrochloric acid starts to unravel protein foods as they enter the stomach and activates pepsinogen into the enzyme pepsin.
  2. Pepsin further breaks down proteins into shorter chains of amino acids, making them easier to digest once they enter the small intestine.
  3. The acidic environment of the stomach kills off many microorganisms to “disinfect” the food we eat, which lessens the risk for infection.

The release of hydrochloric acid and pepsinogen are stimulated just by tasing, smelling, or even seeing food.3 Despite the term “acid reflux”, it is actually the activated pepsin enzyme that causes more damage to the esophagus than the hydrochloric acid. Pepsin is easily activated by acid in any form, so if pepsin has already been regurgitate into the throat or esophagus, highly acidic foods and beverages can perpetuate the burning sensation.4 Frequent acid reflux causes irritation to the esophagus and can lead to inflammation.

One episode of acid reflux every few months is not a big deal, but if it becomes more consistent, this could be a sign of a more serious condition. If you experience heartburn or have to take medications to treat it more than 2-3 times every week, you might have gastroesophageal reflux disease (GERD).1

If those stomach contents regurgitate to the throat and then spill into the trachea or windpipe, this is known as laryngopharyngeal reflux (LPR). LPR is less characterized by heartburn, but usually results in excessive throat clearing, coughing, hoarseness, and feeling as if there’s a lump in the throat.5

Medical Terminology Break!

  • “-itis” means inflammation of.
    • “Esophagitis” means inflammation of the esophagus.
  • “gastro-” means stomach or abdomen.
    • “Gastroesophageal reflux disease” means a reflux disease pertaining to the stomach and esophagus. “Gastritis” means inflammation of the stomach.
  • “laryng-” means pertaining to the larynx.
    • The larynx is the voice box, connected to the top of the windpipe or trachea. The larynx produces vocal sounds and prevents food or liquid from entering the respiratory tract.
  • “pharyng-” means pertaining to the pharynx.
    • The pharynx, or throat, is the passageway that leads from the mouth and nose to the esophagus and larynx.  

While food and digestion play a significant role in causing and perpetuating acid reflux, other factors need to be considered. Various medications and medical conditions can cause acid reflux, esophagitis, or GERD. Different lifestyle factors may also contribute. More than likely, it is a combination of these factors that are contributing to your acid reflux. It is important to find out what specifically is triggering your acid reflux so that you can directly treat the cause. Check out these common triggers and see which apply to you:

Foods that Cause Acid Reflux

Foods can cause acid reflux several different ways: by increasing production of stomach acid, by weakening the pressure of the lower esophageal sphincter, and then aggravating esophagitis.

Some foods encourage the stomach to increase gastric acid production:

  • Black and red pepper
  • Coffee (both caffeinated and decaf)
  • Alcohol3

Other foods are more likely to weaken the lower esophageal sphincter (LES), causing it to relax, which prevents it from staying tightly closed.

  • Chocolate
  • Mint
  • High fat foods: fried foods, meals with a lot of grease, oil, cheese, meat, avocado, nuts or nut butters
  • Overeating3
  • Carbonated beverages6

Other foods that have potential to aggravate acid reflux, especially if your esophagus is already inflamed:

  • Highly acidic foods and beverages with a pH less than 5: tomatoes and tomato products, citrus fruits and juices2
  • Spicy foods3
  • Foods or beverages served at hot temperatures
  • Onions and garlic are highly fermentable food that can also cause belching7-9
  • People with lactose intolerance should avoid most dairy products: cow’s milk, regular ice cream, cream cheese, sour cream, cottage cheese
  • People with an allergy or intolerance to gluten should avoid: wheat, rye, barley, farro, couscous, whole grain breads, and many baked goods made from wheat

Medications that Commonly Cause Acid Reflux

Medications that are likely to inflame the esophagus, when taken by mouth:4, 10-13

  • Antibiotics: clindamycin (Cleocin), doxycycline, tetracycline
  • Aspirin
  • Biphosphonates: used for osteoporosis – alendronate (Binosto, Fosamax), ibandronate (Boniva), risedronate (Actonel)
  • Iron supplements: ferrous sulfate, ferrous glucinate, ferric citrate, ferric sulfate
  • Quinidine: used to treat arrhythmias
  • Non-steroidal anti-inflammatory drugs: ibuprofen (Advil, Mortin), naproxen (Aleve)
  • Potassium chloride: often prescribed to people taking a diuretic

Other medications known to cause acid reflux and worsen GERD:4, 10, 13-17

  • Antihistamines: used to treat allergies
  • Anticholinergics & antispasmodics: used to treat Parkinson’s, depression, and irritable bowel syndrome – propantheline (Pro-Banthine), dicyclomine (Bentyl, Dibent, Dicyclocot), levodopa, carbidopa
  • Some Antidepressants: amitriptyline (Elavil), norotriptylene (Pamelor)
  • Benzodiazepines: often used to treat anxiety – diazepam (Valium), temazepam (Restoril), alprazolam (Xanax)
  • Calcium channel blockers: used to treat high blood pressure – diltiazem (Cardizem), nifedipine (ProCardia), verapamil (Verelan, Calan)
  • Opioids impair the ability of the esophagus to efficiently move food into the stomach, and delays gastric emptying, meaning more food sits in the stomach for a long period of time – codeine, fentanyl, hydrocodone, methadone, morphine, oxycodone
  • Progesterone: oral supplementation often used for postmenopausal hormone therapy
  • Theophylline: used to treat chronic obstructive pulmonary disease (COPD), emphysema, bronchitis, and asthma – Theo-Dur, Theophyl, Bronkodyl

Medical Conditions that Commonly Cause Acid Reflux

  • Vomiting (the forceful release of stomach contents through your mouth) can cause acid reflux. Vomiting can be a result of many things, often including food poisoning, morning sickness, chemotherapy or radiation, excessive alcohol consumption, etc.
  • Certain autoimmune disorders* such as scleroderma, polymyositis and dermatomyositis, rheumatoid arthritis, and Sjögren syndrome.18
  • Hiatal Hernia3 in which part of the stomach bulges through an opening in the diaphragm.
  • Medical conditions directly impacting the stomach:
    • Gastroparesis – a disorder in which the stomach slows or stops moving food from the stomach to the small intestine. You are more likely to be struggling with gastroparesis if you have had diabetes for many years, radiation to your stomach or chest, take certain medications, or if you’ve had surgery to your esophagus, stomach, or small intestine.19
    • Gastritis – inflammation of the stomach lining, often as a result of frequent vomiting, Helicobacter pylori, infections, or peptic ulcers. 20
    • If the stomach produces too little or no hydrochloric acid, you may experience symptoms like acid reflux including nausea, burping, heartburn, upset stomach. This lessened stomach acid production is usually secondary to another underlying medical condition or treatment, such as pernicious anemia, acute H. pylori infection, vasoactive intestinal peptide (VIP), hypothyroidism, stomach cancer, gastric bypass or radiation to the stomach. 21
  • One study of 1,419 patients found that  63.6% of people with IBS also qualified for a GERD diagnosis. 22

Lifestyle Factors that Cause Acid Reflux

  • Wearing tight-fitting clothes2
  • Smoking or being around second hand smoke
  • Being overweight or obese4
  • If you eat very quickly or do not chew your food thoroughly
  • High stress or anxiety23

Have you identified any factors that cause your acid reflux?
Share your knowledge in a comment below!

What Can You Do About Your Acid Reflux?

  1. Start by talking with your health care providers, especially if you experience acid reflux more than 3 times per week and if medications do not help your symptoms. Talk to your doctor before changing any of your medications or supplements.
  2. You can also start logging what you eat, drink, and the severity of your acid reflux using an app or journal. Check out this food & symptom diary designed to help you record what you consume, how you feel, and the level of your symptoms: Download your FREE food & symptom diary here! Record everything that you eat and drink, any medications or supplements you take, and your symptoms for at least 2 weeks. Then go back and review what you consumed just before your acid reflux started. What trends do you notice? Are there any foods, beverages, or medications that you took just before the acid reflux? If you notice your medications are causing your acid reflux, talk to your doctor or healthcare team before you stop taking them.
  3. Avoid foods & beverages known to cause acid reflux from the list above. Sip on plain water and herbal tea instead of alcohol, coffee, or sodas. Eat less acidic fruits and vegetables with a pH greater than 5 (see list here). Consume more whole grains like brown rice, quinoa, oats, millet, corn, or buckwheat, and select products made from these flours. Choose lean cuts of meats that have less fat, like chicken, turkey, round roast or sirloin, fish, or shellfish. Eat more eggs, beans, or tofu for protein.
  4. Eat small, frequent meals. If you only eat 2-3 times per day, you might be overeating and putting too much food in your stomach at one time. Split these portions in half to eat 4-6 times daily instead.
  5. Avoid laying down for 2-3 hours after you eat. Staying upright will help gravity do its job to keep food contents in the stomach rather than easily regurgitating back up into the esophagus.

I have suffered from gastroesophageal reflux disease (GERD) before. I understand the mental struggles that come from eliminating foods, and feeling like you’re at a loss for what to eat or drink. The process of healing takes time, but it is possible! For me personally, it took about 3 months of consistently avoiding the foods listed above to completely heal my esophagus. While that period of time came with challenges, the result of knowing what my triggers were and eliminating daily pain was so worth the time and effort.  I no longer need any medication (unless I really overdo it)!

If this feels a bit overwhelming, help is available! As a Registered Dietitian, I provide online nutrition counseling to help you feel better, manage your acid reflux, identify your triggers, and gain confidence with meal planning. If you need accountability, support, or advice, please reach out!

Schedule a FREE strategy session to chat more about your health goals
and how nutrition counseling can help.
Phone (206)414-8762
Email nicole@renewtritiononline.com

Download your FREE food & symptom diary here!

Nicole Lyon, RDN, CD, LD, RYT has been a Registered Dietitian since 2015. After struggling with acid reflux since college, Nicole was diagnosed with gastroesophageal reflux disease (GERD) in 2019 after an episode of food poisoning while traveling in Brazil. She was able to heal her gut and eliminate her daily symptoms after changing her diet and learning to better manage her stress. She is passionate about helping people understand their bodies and the impact that food has on health. She provides online nutrition counseling through her private practice, Renewtrition.

Sources:

  1. Definition and facts for GER and GERD. (2014). https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/definition-facts
  2. Stern, J., Koufman, J. (2012). Dropping Acid: The Reflux Diet Cookbook & Cure. United States: Katalitix.
  3. Wadsworth. (2011). Nutrition Therapy & Pathophysiology (2nd ed.). Belmont, CA.
  4. Yale Journal of Biology and Medicine (1999). Pepsin and the esophagus. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579005/?page=1
  5. International Archives of Otorhinolaryngoly (2014). Laryngopharyngeal Reflux: Diagnosis, Treatment, and Latest Research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4297018/
  6. Indian Journal of Gastroenterology (2012). Ingestion of a Carbonated Beverage Decreases Lower Esophageal Sphincter Pressure and Increases Frequency of Transient Lower Esophageal Sphincter Relaxation in Normal Subjects. https://pubmed.ncbi.nlm.nih.gov/22791463/
  7. American Gastroenterological Association Gastroenterology (2002). Colonic fermentation influences lower esophageal sphincter function in gastroesophageal reflux disease. DOI https://www.gastrojournal.org/article/S0016-5085(03)00073-8/abstract
  8. National Center for Complementary and Integrative Health (2016). Garlic. https://www.nccih.nih.gov/health/garlic
  9. American Journal of Gastroenterology (1990). The Effect of Raw Onions on Acid Reflux and Reflux Symptoms. https://pubmed.ncbi.nlm.nih.gov/2327378/
  10. Picco, Michael. May Clinic (2020). GERD: Can certain medicaitons make it worse?https://www.mayoclinic.org/diseases-conditions/gerd/expert-answers/heartburn-gerd/faq-20058535
  11. Mayo Clinic Proceedings (2009). Adverse Effects of Bisphosphonates: Implications for Osteoporosis Management. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704135/
  12. American College of Gastroenterology Care Report Journal (2013). Iron pill-induced gastritis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4435261/
  13. NIH Publication No. 95-3421 (1992). Harmful effects of Medicines of the Adult Digestive System. https://www.endo-world.com/resources/e-learning-patient-education/general-guides/harmful-effects-of-medicines-on-the-adult-digestive-system/
  14. American Journal of Gastroenterology (1992). Effect of Alprazolam (Xanax) on Esophageal Motility and Acid Reflux. https://pubmed.ncbi.nlm.nih.gov/1553935/
  15. British Journal of Clinical Pharmacology (2007). Do calcium antagonists contribute to gastro-oesophageal reflux disease and concomitant noncardiac chest pain? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2000612/
  16. Gastroenterology Hepatology (2016). Effects of Opioids on Esophageal Dysfunction. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4973563/
  17. Archives of Internal Medicine (2008). Postmenopausal hormone use and symptoms of gastroesophageal reflux. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2761884/
  18. Maedica (2011). Gastrointestinal Manifestations in Systemic Autoimmune Diseases. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150032/
  19. Definition & Facts for Gastroparesis. (2018). https://www.niddk.nih.gov/health-information/digestive-diseases/gastroparesis/definition-facts
  20. Definition & Facts for Gastritis. (2019). https://www.niddk.nih.gov/health-information/digestive-diseases/gastritis-gastropathy/definition-facts
  21. Fatima R, Aziz M. Achlorhydria. [Updated 2020 May 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507793/
  22. Yarandi, Shadi-Sadeghi et al. “Overlapping gastroesophageal reflux disease and irritable bowel syndrome: increased dysfunctional symptoms.” World journal of gastroenterology vol. 16,10 (2010): 1232-8. doi:10.3748/wjg.v16.i9.1232 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2839176/
  23. Song EM, Jung HK, Jung JM. The association between reflux esophagitis and psychosocial stress. Dig Dis Sci. 2013;58(2):471‐477. doi:10.1007/s10620-012-2377-z https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576549/

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