Acid Reflux isn't actually part of the IBS set of symptoms, but it's a common additional area of concern for many people I work with. This week I'm talking about

• Signs of reflux to watch out for
• How different foods affect your acid reflux
• What changes you can make to your eating pattern to improve reflux

Tune in next week for more about the use of acid suppressing medication in PPIs and H2 blockers.

Work with me

• 3 month Gut Reset - https://www.goodnessme-nutrition.com/consultations/
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The information in this podcast is not medical advice and is not designed to treat, diagnose or provide personalised health advice. This podcast content is information only and any changes you make are at the user's own risk. Please consult with your doctor or healthcare provider before implementing any new treatment.

Do

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you suffer with acid reflux?

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Maybe you wake up at night with a

burning sensation in your chest or

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you constantly get regurgitation of

food after you've eaten your meals.

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This can be an incredibly uncomfortable

condition that interrupts your sleep,

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your work and your enjoyment of food.

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This week on The Inside Knowledge,

I'll be covering acid reflux,

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including how it can be treated.

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I'll also cover some foods that you

can eat and avoid, and other kinds of

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support for reducing the symptoms of

heartburn, and regurgitation of acid.

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Welcome

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to episode 62 of the Inside

Knowledge for People with IBS.

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My name is Anna Mapson.

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This week is all about stomach acid and

reflux, and although it's not officially

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part of an IBS diagnosis, in fact it is

a separate condition, it is something

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that a lot of my clients suffer with.

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So I thought you might be

interested to hear what I've got

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to say about how to manage reflux.

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So when we're talking about acid

reflux, it's basically the regurgitation

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of the contents of your stomach.

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into the ooesophagus.

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That's the tube that runs like from

your mouth down to your stomach.

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This may be triggered in part down to

having too much acid in your stomach,

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or it may be that the sphincter at

the top of your stomach, the bottom

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of the ooesophagus, comes open.

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So this can be relaxed, this little tube.

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band of muscle that closes the tube to

stop things coming up, it gets relaxed

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and then the acid can actually start to

creep up, particularly if you lie down

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or if you bend over, and that is when

you might be getting acid in your mouth

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or even regurgitation of your last meal.

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So sort of signs of Having heartburn

or acid reflux would definitely

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be like a burning sensation in

your chest around your breastbone.

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That can be really strong, particularly

after meals, and it seems to be after

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like heavy, stodgy, fatty meals that

take a bit longer to get digested.

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I'll go through a few more other foods

that can affect acid reflux in a minute,

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but often you might also get a cough,

like a dry, tickly cough, and that

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is to do with the acid coming up and

irritating the back of your throat and

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irritating the lining of the oesophagus

so that you're constantly coughing or

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clearing your throat from a lot of mucus.

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Um, you may find you get a lot

of hiccups as well, and that can

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be down to your body's reaction

to this acid in the oesophagus.

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And that can also lead to, like,

a croaky voice, a really hoarse

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voice that just doesn't go away.

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So, sometimes it can not only be

a pain in your stomach, but also

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affecting up towards your mouth.

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I have worked with people in

the past whose acid reflux has

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been so bad that it actually has

started to erode their back teeth.

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So when they were lying down at night

to go to sleep, the acid was washing up

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and actually getting into their mouth

and degrading the back teeth overnight.

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And so other symptoms that you

might find is like, Bad breath or

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really acidy taste in your mouth

like a constant sour feeling.

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That can also be a sign of the acid from

your stomach getting into your mouth.

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And then sort of lower down in

your body you may get nausea.

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So feelings of sick, feelings

of bloating as well and like

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being a bit gassy that can also be

related to acid in your stomach.

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There is also another type of reflux

called silent reflux or the long name is

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laryngopharyngeal reflux or LPR and this

is where people don't get burning they

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don't get any of that sensation of pain.

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You might get a bit of heartburn

at night but You might not.

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But it might be more around feeling a

sensation of, a difficulty swallowing

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or like a lump in your throat.

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Particularly a hoarse and croaky

voice, that is quite common.

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And also like throat clearing, like

if you're constantly having to clear

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mucus from the back of your throat.

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But particularly around that feeling

uncomfortable about swallowing and

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feeling like there is something stuck

in your throat although there will be

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nothing there to see if the doctors

actually take a look and you might get

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like frequent burping with this as well.

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So sometimes you can have reflux but

you don't actually feel the pain and

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that's why it's called silent reflux.

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The typical treatment for acid

reflux is to take something that

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suppresses the acid for your stomach.

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So these are either called proton pump

inhibitors that stop the cells that

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produce the acid, or there are histamine

blockers which also do something similar,

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and both I'm going to cover these next

week in a separate podcast episode,

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because I really want to get into a

little bit about how they work, how you

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should take them, and how you can start

to get off them, or steps that you could

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take in order to try to reduce your

reliance on medication for acid reflux.

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So look out for that.

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Next week, but this week.

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I just want to focus a little bit on foods

and sort of lifestyle factors That can

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also affect acid reflux and how you can

improve your symptoms If you're not on

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medication, or actually even if you are

on medication, as a first step in order

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to help you get ready to start to have

a conversation about coming off them.

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And whilst it's not possible for

everybody who's taking a PPI to stop

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taking them, because there are some

conditions where it's really essential

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to keep on top of your stomach acid,

actually there are a lot of people

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taking them long term who don't need

to be, to And PPIs are one of the most

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commonly prescribed drugs in the UK.

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There was some research saying

up to 20 percent of people

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have actually tried them.

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That was in one study.

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That was only up to 2018.

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And I think potentially

it's got more since then.

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There are a lot of people

taking them anyway.

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So next week I'm going to cover more

about the proton pump inhibitors and

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other acid suppressing medication.

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However, Today what we can do is talk

about some of the foods and how that might

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affect your digestion and your stomach.

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There are a number of different

ways that your food that you eat can

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affect your acid in your stomach.

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Sometimes the food can increase the

acid by the fact it is an acidic type

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food that you're eating, sometimes the

food can relax that sphincter at the

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top of your stomach at the bottom of

the oesophagus and allow more acid to

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creep up the oesophagus and sometimes

your eating pattern can also impact

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the way that acid is likely to get out.

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So if we think about acidic foods

that may Either irritate the mucus

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in the oesophagus, so if it's already

a bit sore and then you're eating

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something acidic, it can then burn

a little bit, or it could increase

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the amount of acid in your stomach.

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I'm talking about things like orange

juice, tomatoes, anything kind of

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citrusy, like lemon juice as well,

so just like typically acidic foods.

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And you might also find like

spicy food can also irritate this

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mucous lining of your stomach.

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So I wanted to also just jump in here

and say acid is really important.

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And if you haven't listened to my

episode about low stomach acid,

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then go back and listen to that.

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Episode 55 is all about low

stomach acid and actually why

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we need acid in our stomach.

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There is a mucus lining around your

stomach bag, which helps protect

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the stomach lining from this acid.

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It is really strong and really powerful.

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And actually, if it came into contact

with your actual cells, it would burn.

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And so we have a mucous lining around

the stomach, which helps protect

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the stomach and also keeps it more

alkaline, so your actual cells don't

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come into contact with the acid.

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some of those foods will increase the

acid, by being acidic themselves, and

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some foods will relax that sphincter

at the top of your stomach, which

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includes alcohol, coffee, chocolate,

and mint, which could include mint

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capsules that are, um, meant for IBS

if they are opening in your stomach

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or peppermint tea even, or just having

some sweets that have got mint in them.

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Try and limit those kind of foods

that also are going to maybe increase

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your heartburn symptoms and your pain.

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If we look at the research on certain

foods and whether they affect digestion

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or not, there is really variable

results with things like coffee.

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There's really mixed results in terms

of the, um, analysis, I suppose.

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There's one meta analysis of 15 different

studies show that there was no association

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between drinking coffee, And heartburn.

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However, some people really do notice it.

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As soon as they take coffee, they

feel more acid in their stomach and

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they can increase their heartburn.

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The other things that tend to

increase acid, as I said at the

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beginning of the episode, is

heavy, dense, like fatty meals.

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And this is just because food sits for

longer in your stomach when it is a

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big, It's like a stodgy, fatty meal.

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So something like fish and chips might

be particularly, heavy and greasy.

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And those are also going to reduce

the tone of that lower esophageal

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sphincter, which may affect the reflux

coming back up, and it also may slow

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down your gut motility so that food

is sitting in your stomach for longer.

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About 90 percent of your food will pass

through your stomach in about 4 hours.

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Majority of it will start to leave

your stomach within, 40 minutes to 2

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hours, but some of it will stay longer.

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But heavier, fattier meals will sometimes

sit there for longer, and that can then

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increase the chance of it popping back up.

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In terms of meal frequency and meal

timing, there are also some things

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you can put into place to try to help

your stomach and help your digestion.

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So certainly smaller, more frequent

meals can put less pressure on

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that lower esophageal sphincter.

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So you might get on better eating

four or five small meals throughout

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the day than having three big meals.

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The way you might do that is to

have your breakfast early, say 7

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o'clock or half 7 or something.

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Then you might have another

small meal, say around half 11.

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And this doesn't need to be like a snack,

but it could be some of your lunch that

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you're just having a little bit earlier.

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And then you might have another

meal, like at around 2, 2.

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30.

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And then another meal, let's say six.

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So you're spacing out your meals to

have four or even five if you feel

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like you need to split it down more.

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And that will then allow you to eat the

same amount of foods, but eating them

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at separate times and just allowing

your stomach to do its work and sort of

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easing the pressure of a larger meal.

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Because we also know that calorie dense

meals can increase acid production

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and also Gently relax that sphincter,

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so now I said you're going to have

your dinner, say, around six o'clock.

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The reason I've said earlier

in the evening, then many of

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you may actually be eating.

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Is that actually you want to allow

a long time before bed for that

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food to try and leave your stomach.

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So if we think that 90 percent

of your food will leave

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your stomach within 4 hours.

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Normally we say like 3 hours before bed.

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So if you finish your meal by 7,

then you can hope that, say, 60 70

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percent of your food has already

left your stomach by the time you're

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going to lie down to go to sleep.

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So after each meal, you can stay

sitting upright, sit up very tall,

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keep your stomach and your torso

as, strong and upright as you can.

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And then also, moving around is really

helpful, so Get up, do the washing up,

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like keep moving after dinner, keep going.

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You could even try a little walk

gently after each meal, if that's

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possible with your schedule.

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But certainly to try and keep

upright, don't immediately go and

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lie down on the sofa after eating.

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When you do go to bed, there are

two things that can also impact

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on your reflux and heartburn.

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One is to raise your bed by 4 to

6 inches or 10 to 15 centimetres.

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And what this does is it just raises

your head up higher than your feet.

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So naturally your stomach is in a position

where things are moving downwards.

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This could just be putting a few books

under the head of your bed and that will

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help your head to be a little higher.

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Now if you sleep with somebody else and

they aren't keen on having their bed

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raised up like that, you can also try,

there are like wedge pillows that you can

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get which are for, that specific purpose.

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For raising up your head in a

gradual incline so that your top

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half is lower than your feet.

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Ideally you want to put

something under the mattress.

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It's probably more comfortable,

but you can try both ways.

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There's no harm.

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The main purpose is just that you get your

head and stomach higher than your feet.

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And that will allow things to

naturally have a downward motion.

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And the other thing that you can change

is sleeping on your left hand side.

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So, Having your left hand side on

the bed and your right hand side

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upwards and curling over in that way.

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In that position, your stomach

bag is falling downwards.

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So naturally, the way our body works

is that the stomach does go down to

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the left and so you want to be in

that position, there's less chance

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of the contents of your stomach

falling up into the oesophagus.

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That's, One of the best ways that you can

sleep, and actually if you have taken any

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medication at night, or even supplements

before you go to bed, lying on your

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left side also helps them to go down.

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Some of the other common causes

of heartburn, acid coming back

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up into the oesophagus, is

pressure within the abdomen.

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Sometimes this can come from conditions

like SIBO, where you are producing

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a lot of gas in the small intestine

and that is putting pressure on the

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whole torso, upward pressure, that

can encourage that sphincter to open.

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So, particularly, there are studies

showing that pressure Heartburn can't

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be managed with medication, sometimes

called refractory GERD, or like, GERD

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is gastroesophageal reflux disease.

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So, it's, can't be treated very well.

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Sometimes to get to the bottom of

it, they've done a SIBO test and

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realised that this person has a

high level of methane in their small

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intestine, which is causing gas.

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Causing pressure in the abdomen, and that

is pushing on the stomach and increasing

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symptoms of heartburn and reflux.

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That is particularly for people who

get a lot of frequent burping, and also

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really strong nausea, you might see

those symptoms more associated with that

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picture then also people commonly get

reflux or heartburn in Pregnancy and that

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is to do with the pressure of growing

another human inside your body and that

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is pushing upwards as well and sometimes

when people have Excess weight around

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the middle that can also affect it.

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for some people, losing a little bit

of weight can also really help with

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the downward flow of digestion, so it

can really just ease your digestion to

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have less pressure around your stomach.

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If you're a smoker as well,

then definitely stopping smoking

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can improve your digestion.

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Your digestion so any acid reflux people

should really Another reason to consider

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giving up smoking because smoking dries

out your saliva which can also increase

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your stomach acid so really helpful to

try and cut down at least or stop smoking.

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The next bit of advice you've probably

heard me say tons of times if you

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are a regular listener to the podcast

and that is about chewing your food

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really really well and also what

I want you to do is start thinking

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about stomach acid production or

start thinking about your food around

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30 minutes before you actually eat.

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This is helpful because it engages your

brain in acid production and some of the

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ways that acid is produced is down to the

vagus nerve, which connects your brain and

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your thoughts to your digestive function.

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What we want to do is get our body

into eat mode, which is rest and

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digest, which is feeling relaxed.

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So first of all, we need to

think about food in order to

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stimulate acid production.

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Now, if you're someone who

suffers from excess acid or acid.

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burning you, you may feel like

I don't want any more acid, but

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actually we do want acid at the

right time, which is Eating.

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We want acid produced at the mealtime.

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And one of the best ways to do this is

to engage your brain a little bit in

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the function of food by thinking about

the food that you're going to eat.

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So thinking about what it's going to

taste like, the smells, the textures.

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If you're preparing the food, this is

much easier for you, but if you're someone

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who gets food cooked for you, or perhaps

you're eating out quite a lot or buying

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ready meals, then you don't get that

sensation because you're not preparing it.

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However, it is helpful just to start

thinking about it, what you're going to be

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having before the food arrives that helps

to engage your brain and helps to keep you

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mentally engaged in what you're eating.

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Just before I finish this episode,

I am going to talk about treatment

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options properly next week.

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But the one thing I did want

to cover this week is Gaviscon.

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Gaviscon is basically a tablet that you

can have or a liquid that you will drink.

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And it forms like a little barrier

raft over the top of your stomach.

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So you can imagine it almost like

a little umbrella that covers

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the stomach and forms a barrier.

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So nothing can go back up

that hole for the oesophagus.

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This is really helpful because it pushes,

um, the acid down or it just, it holds

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it down and doesn't let anything through.

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If you then start to eat, it

breaks that barrier because

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it's all churning up again.

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So you have to do it after

a meal or in between meals.

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But, Not right before a meal because

then it's not going to have its effect.

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Gaviscon is not absorbed into the body

and it literally just passes through you

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and isn't absorbed So it doesn't really

affect your the rest of your digestion.

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It's helpful because it keeps a

barrier between the food and the

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acid coming up and can just ease

your symptoms so that you can get on

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with your day, you can sleep better.

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And if acid reflux is something that's

keeping you up it's okay to use these kind

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of supplements or additional supplemental

medicines to help you get better rest.

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I know some people worry about taking

it because it's not natural, it's a

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medicine and you'd rather just

do things naturally through food.

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That's all okay and fine to have

as your kind of driving force that

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you want to do things naturally.

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However, if you are getting ongoing

acid regurgitation into your oesophagus

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that's not well managed, then that

can lead to other conditions like

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Barrett's oesophagus, which is

where you're getting damage to the

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cells of the esophageal lining.

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Because of acid, and that can lead to pre

cancerous signs in the esophageal cells.

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So, it's not without consequence to

have acid constantly washing up into

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your oesophagus or into your mouth even.

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It definitely should not be there

because it is really strong.

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And so, if Gaviscon is one of the ways

that you manage to keep it down, then that

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is much more preferable than having acid

damaging your cells on an ongoing basis.

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In summary then for this episode, just

really think about your eating patterns.

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So maybe having smaller meals if that

helps, sitting upright, chewing your food,

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like really focusing on the gut brain

connection and doing everything you can

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to manage your stress levels, getting into

rest and digest state before each meal.

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Also thinking about particular

foods, whether they increase

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acid in your stomach, like for

example orange juice or tomatoes.

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or are they foods like mint or

coffee which might relax that

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lower esophageal sphincter and

actually let the acid back up.

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You might be experimenting with

certain types of foods to see if

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they do actually have an impact.

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Otherwise you just google online what

are bad foods for acid reflux and you

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come up with a huge list of things.

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Maybe actually coffee and orange juice.

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Aren't your big triggers.

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It is good to test taking all of them out

first and then slowly reintroducing them

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to notice if it is a problem for you,

because everybody's body is different.

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Okay, I'm gonna leave it there

for this week, but tune in

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next week for the low down on.

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Proton pump inhibitors and other

acid suppressing medication.

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I'll see you then.

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Thanks for listening to this

episode of The Inside Knowledge.

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For people with IBS, better

digestion for everyone.