5 Common Acid Reflux Triggers

Acid reflux is a common health condition caused by gastric acid from the stomach travelling up towards the oesophagus and throat, resulting in a burning sensation in the chest. You may also experience:

• An unpleasant taste in your mouth
• A cough or hiccups that consistently come back
• Bad breath
• Nausea and bloating

There are a number of different triggers that can cause acid reflux flare ups, meaning it can often be difficult to determine what exactly has caused the symptoms.

Sleeping Position

Gravity and anatomy play an important role in allowing the digestive system to operate. You are more likely to be upright during the day, so when acid reflux occurs, gravity and saliva help return the contents to the stomach. You are also more likely to act on any symptoms during the day by swallowing saliva or taking antacids. This minimises the harmful effects that acid can have on the delicate lining of the oesophagus.

A study^[1] that set out to find the influence of sleep positions on gastro-oesophageal reflux disease (GORD, a more serious form of acid reflux), found that those who slept on their back experienced more frequent episodes of gastro-oesophageal reflux. These symptoms presented themselves within 1 minute after changing into this position 28% of the time.

The study also recommended to avoid sleeping on the right side. In this position, the stomach is above the oesophagus, which creates a ‘leaky faucet’ that spouts stomach acid into the lining of the oesophagus. This triggers more severe symptoms as the acid stays in the oesophagus for longer due to the absence of gravity.

It was concluded that sleeping on the left side was preferred. Adding in an incline can bolster the effect of this position - the oesophagus is positioned above the stomach and gravity can assist in minimising any potential incidences of acid reflux. It is recommended to use pillows to prop up your head and shoulders as you sleep.

Stress

Emotional stress can have a huge impact on your physical health. It can both increase the production of stomach acid and lower the pain tolerance of the oesophagus, making it more sensitive to irritation.

In a study^[2] that set out to find the factors that worsened the symptoms of GORD, it was found that among 12,653 patients, 45.6% reported “feelings of continued stress” as the most common lifestyle factor that contributed to symptoms.

Therefore, stress management can play a vital role in the reduction of episodes of acid reflux symptoms.

Caffeine

Caffeine can relax the lower oesophageal sphincter, meaning it becomes much easier for gastric acid to leak out of the stomach into the oesophagus. In turn, the acid damage can cause irritation to the oesophagus. Although it may be hard for some people to completely cut caffeine out of their daily routines, reducing caffeine intake may help. Additionally, when it comes to coffee, opting for a darker roast (which contains less caffeine per bean) may mean acid reflux is less likely to occur.

Smoking

It is well known that smoking poses several health risks to your body, particularly in regards to increasing your likelihood of developing certain health conditions. One of the health conditions linked to smoking is acid reflux. According to medical professionals, smoking can contribute to acid reflux by:

• Increasing gastric acid production:

When you smoke, it can signal to the stomach to produce more gastric acid. This makes your chances of experiencing acid reflux much more likely, as the acid can leak upwards into the oesophagus. In addition, smoking can promote the transfer of bile salts from the intestines to the stomach, which increases the concentration of the gastric acid. This means the gastric acid that is refluxed can cause more damage to the oesophagus due to the higher acid concentration.

• Damaging the lower oesophageal sphincter:

Nicotine, the key component in cigarettes, relaxes the ring of smooth muscles that connects the oesophagus to the stomach, known as the lower oesophageal sphincter. These muscles help to direct the passage of food you eat into the stomach, and in turn prevent gastric acid from refluxing up to the oesophagus. By relaxing the muscles involved, the sphincter has much less control when it comes to stopping the gastric acid from refluxing.

• Reducing saliva:

Saliva contains a component called bicarbonate which increases its pH and its buffering power. This means saliva becomes much more effective at neutralising acidity. People who smoke regularly have much less saliva, meaning there is a lower chance of refluxed acid being neutralised.

• Damaging esophageal lining:

Although smoking increases mucus production in the lungs, it thins the mucus membrane that lines the oesophagus. This mucus membrane protects the oesophagus from acid damage, so when it is thinned, damage to the oesophagus is much more likely to occur.

Spicy Foods

Capsaicin is the chemical compound that makes food taste spicy - this can irritate the oesophagus and trigger symptoms of acid reflux. A study^[3] in 2010 set out to find the capsaicin induction of esophageal symptoms in different phenotypes of gastroesophageal reflux disease (GERD). It found that the chemical caused esophageal and gastric symptoms in healthy volunteers and GERD patients.

Another study^[4] in 2017 set out to find the foods inducing typical gastroesophageal reflux disease symptoms in Korea. They identified foods that induced typical symptoms in 33% of the patients - this included spicy foods.

Whilst the research is not conclusive, the fact still remains that spicy food can be a trigger of acid reflux for some individuals. Steps can be taken towards prevention of episodes through a number of strategies:

• Eat smaller servings to alleviate the pressure on the lower esophageal sphincter.
• If consumed as the last meal of the day, allow a minimum of three hours before bedtime for digestion.
• Chew gum to encourage the secretion of saliva which helps to move food through the oesophagus.

Other acid reflux triggers and risk factors

In addition to the ones listed above, other factors that contribute to acid reflux and heartburn include:

• Being overweight or obese
• Pregnancy
• Eating food within 3 hours before going to bed
• Drinking certain beverages like alcohol and carbonated drinks
• Having a hiatal hernia
• Not doing regular exercise
• Acidic foods such as citrous fruits
• Foods that are high in fat
• A low fibre diet
• Large meal portions
• Consuming a high amount of table salt
• Wearing tight clothing that applies pressure to the abdomen and lower esophageal sphincter

Acid reflux treatments

Whilst making changes to your diet and lifestyle can reduce the frequency and severity of acid reflux, there are clinically proven medications that can be used to treat acid reflux. Omeprazole, Lansoprazole and Pantoprazole are recommended prescription acid reflux treatments that are known as ‘proton pump inhibitors’ (PPIs) which work effectively by disrupting the final stage of the acid reflux secretion process. PPIs inhibit the gastric proton pump in the stomach that is responsible for producing stomach acid, which means that the symptoms of acid reflux can be alleviated if the treatment is taken regularly for extended periods of time.

Antacids such as Gaviscon Tablets, Gaviscon Liquid and Gaviscon Sachets are effective treatments when it comes to relieving heartburn, one of the most common symptoms of acid reflux. They work by neutralising the gastric acid in the stomach which relieves some of the pain and discomfort caused by acid reflux.