Learn what causes reflux to flare up…and how to stop it

Jan 22

**If you’ve ever experienced heartburn, the burning pain in your chest after eating, you know how incredibly uncomfortable, even borderline painful it is.**

This pain is caused by acid reflux—the backflow of acidic gastric juices from the acid-friendly area of the stomach into the alkaline area of the esophagus...only the stomach is suited to handle highly acidic digestive secretions. They’re detrimental to the tissue that lines our esophagus.

Reflux, heartburn, and GERD are often used interchangeably, although they differ by definition.

Reflux causes heartburn, the searing pain you feel, but it can also be silent. Although silent reflux may sound less irritating, it’s actually more dangerous because it may go unnoticed and cause severe damage to the esophagus.

Gastroesophageal reflux disease (GERD) is chronic reflux, meaning it happens regularly over a more extended period. If you experience reflux or heartburn more than twice weekly, you may have GERD, although this requires a diagnosis from your medical provider.

In this blog, I’ll discuss what causes reflux and how to stop it.
We’ll also explore lesser-known causes of reflux that you may be overlooking.
Finally, I’ll provide a list of foods that help prevent GERD and reflux and natural solutions for reflux.

What causes reflux to flare up?

If you experience only occasional reflux, you may be able to pinpoint the cause to eating certain foods.

Foods that slow down digestion or cause the lower esophageal sphincter (LES)—the ideally well-controlled opening between your esophagus and stomach—to relax too much can cause acid reflux.

Because fat slows down digestion, it can cause food to sit in the stomach longer than usual. While this can be helpful for blood sugar balance, it may also trigger reflux.

You may notice that your reflux flares up after eating extra-fatty foods like:

Pizza
Buttery sauces or gravies
Fried foods
Certain cheeses
Fatty meats like bacon and sausage

Other foods, including spicy foods and alcohol, can relax the LES, allowing the acidic contents of the stomach to backflow into the esophagus. Other than alcohol, many of these foods are otherwise considered healthy.

Foods that cause reflux may include:

Tomatoes and tomato sauce
Chocolate
Alcohol
Coffee and tea
Spicy peppers

In addition to food, a handful of lifestyle factors can cause reflux to flare up.

These include stress, lack of sleep, and overeating.

Additionally, there are a few sneaky causes of reflux that may require thorough testing and medical guidance.

These include hypermobility disorders, hiatal hernia, and bile reflux.

Let’s look at each of these in a little more detail to fully uncover what causes reflux to flare up.

Hypermobility is a hidden factor of reflux and GERD

People with joint hypermobility are much more likely to experience GERD than the general healthy population.

78% of adults with joint hypermobility were GERD suffers, compared to 23% of non-hypermobile adults, according to the results of a 2015 study (1).

Now, you may think this wouldn’t be a hidden factor—surely you would know you are hypermobile. But, it’s not uncommon for hypermobility to go undiagnosed, as many people do not experience noticeable symptoms.

Some researchers think up to 30% of the general population may have hypermobility (2).

Were you the kid in class who was double-jointed? Do you excel in sports such as ballet or yoga? Are you prone to injury while playing sports or being active? These are all signs you could be hypermobile, but it’s best to consult a skilled medical provider to know for sure.

Having a hiatal hernia causes reflux and GERD

A hiatal hernia occurs when the very top of the stomach bulges up through the esophageal hiatus, the opening in your diaphragm where the esophagus passes through to the stomach.

Credit: Harvard Health, What is a hiatal hernia?

This can happen for many reasons, but common factors include diaphragmatic muscle weakness, usually caused by age, obesity, pregnancy, abdominal injury, congenital disability, or even smoking.

Heartburn is a symptom of a hiatal hernia, as well as indigestion and feeling full very quickly while eating.

Hiatal hernias are pretty common, affecting around 20% of the general population and increasing in prevalence with age. If you are over age 50, you may have a 50% chance of developing a hiatal hernia. Depending on how severe the hiatal hernia is, you may never experience noticeable symptoms (3).

If you think a hiatal hernia is the reason behind your reflux, follow the simple steps in this video and notice if your symptoms improve.

Bile reflux could be behind chronic heartburn, indigestion, and digestive problems

Bile reflux is a lesser-known type of reflux that happens when bile from your small intestine flows backward into the stomach.

Bile is produced in the liver and used to break down fats in the small intestine so the body can absorb them. It has soap-like properties, similar to dish soap used to wash a greasy pan.

When it enters the stomach, where it does not belong, bile can cause burning and stomach ache. Eventually, bile will damage the tissue of the stomach and the esophagus. Some people with acid reflux or GERD may also have bile reflux.

Although doctors think that bile reflux is rare, the symptoms of bile reflux and acid reflux overlap, and bile can also severely damage the esophagus even though it is not an acid (4).

Signs you may have bile reflux include (5) :

Chronic indigestion (also called dyspepsia)
Gallbladder removal (cholecystectomy)
Heartburn
Nausea
Fullness
Abdominal pain

If you’ve had your gallbladder removed or have a history of peptic ulcers and can’t seem to get your heartburn or reflux controlled, ask your doctor about bile reflux.

Foods that are bad for reflux are only one part of the puzzle

In the first section, I touched on foods considered bad for reflux. Fatty and spicy foods are generally on the list of foods to avoid if you have reflux or GERD.

However, you may find that you can tolerate these foods just fine and that some other food gives you heartburn. For instance, I once had a client who only experienced heartburn after eating bananas!

For many of my clients, I find it much more effective to focus on a diet that prevents GERD, and I will discuss this in the next section.

Additionally, eating too quickly, not chewing well, overeating, and eating while stressed out can all contribute to reflux flare-ups.

So, no matter what your meal is, try to practice the following simple tips to improve your digestive function.

Allow your nervous system to relax before eating. Sitting and taking a few deep, slow breaths can help you shift out of fight-or-flight mode and into rest and digest mode.
Avoid drinking lots of liquids right before and with your meal.
Chew each bite 20-30 times until the food is the consistency of apple sauce.
Eat slowly, and stop eating when you begin to feel full.
Try to have your last meal about three hours before bedtime.
If time allows, enjoy a 10-30 minute walk after meals.

I’m honestly amazed at how effective these often overlooked tips are for alleviating heartburn in many of my clients; don’t dismiss this list. It might be the best medicine to get rid of GERD.

Check out my Goodbye Reflux cooking class if you’re ready to say goodbye to GERD for good!

Foods that help prevent GERD

Because GERD and heartburn are digestive disorders, the foods you eat can profoundly affect your ability to solve the reflux problem.

As you may have guessed, the health of your gut, particularly your lower gut, where the bulk of your gut bacteria live, is a big factor in GERD.

Because there is a link between gut bacteria imbalance (also called dysbiosis) and GERD (6), I prioritize a microbiome-supportive diet for my GERD clients.

Everyone differs a little in what foods are gut-healthy for them (this can depend on personal factors like gut inflammation, food sensitivities, and fiber tolerance). Still, there are a couple of hard and fast rules that seem to help everyone.

The first is to eat a rainbow of color daily. The colors of plant foods indicate their polyphenols—plant chemicals that are really good for you and your gut!

Because polyphenols are actually hard for your body to absorb, they stick around in your gut, and your good gut bacteria (like Lactobacillus and Bifidobacteria) chow down on them. The result is that your good bacteria thrive and also produce anti-inflammatory compounds that circulate through your entire body!

The second rule for eating to support your lower gut health is to be mindful of how many ultra-processed foods you eat. These foods contain ingredients like emulsifiers, preservatives, and artificial sweeteners, many of which are known to be harmful to good gut bacteria and even the gut tissue itself (7).

Immediate relief for reflux flare-ups

Diet and lifestyle changes are absolutely needed for long-term heartburn prevention, but sometimes, you just need a quick fix!

If you are experiencing a reflux flare-up, there are a couple of great natural supplements you can keep in your medicine cabinet.

Slippery elm: Slippery elm is a mucilaginous herb that coats the esophagus with a protective, healing barrier. This is especially helpful for immediate relief or to take before bedtime if that’s when your heartburn tends to flare.
The best way to take it is to buy the loose powder or open capsules and mix the powder with a tablespoon or two of warm water. You can also add a little honey if you’d like (a combo that is excellent for sore throats!).
Apple cider vinegar This remedy doesn’t work for everyone, and it doesn’t have any hard science to back it up. But I’m including it here because it's a miracle cure when it does work! I recommend taking it as soon as you feel heartburn beginning.

ALWAYS dilute apple cider vinegar with water—it’s very acidic and can irritate your esophagus.

To take apple cider vinegar for heartburn, mix 1-2 teaspoons with 1-2 ounces of water and drink immediately.

With tailored changes to diet and lifestyle modifications, you can say goodbye to reflux!

The changes I’ve outlined may take time, but they do make a difference. I want to emphasize the importance of taking steps to prevent reflux and GERD because acid reflux can seriously damage the delicate esophageal tissue.

I don’t say this to scare you but to empower you. In the worst-case scenario, long-term acid reflux can lead to Barrett’s esophagus, a condition in which the cells of the esophagus become inflamed and damaged. In some cases, this cellular damage can contribute to esophageal cancer (8, 9).

Again, this is rare, but it is something to be aware of if you have chronic reflux.

Click here to sign up for my Goodbye Reflux cooking class, where you can learn more about foods and herbs that prevent heartburn, reflux, and GERD.

We’ll cover even more fantastic ways to address heartburn, reflux, and GERD, plus you’ll learn easy (kid-friendly) recipes and be part of a supportive community.

References

Shannon Woodcock, FNTP