Finding the ideal diet for silent reflux involves trial and error, as how people react to different foods can be very individual.
However, some foods are powerful reflux triggers and are problematic for nearly everybody.
1. Deep-fried food
Fried food contains an awful lot of fat, and fat is known to cause reflux on its own. It slows down gastric motility and also causes relaxation of the esophageal sphincters.[1],[2] Sphincters are like valves that prevent reflux from rising, so if they open more often, you get more reflux.
That said, I don’t think it is the fat alone that is the problem. I’m going to talk about personal experience here and do not have research data to back it up. When I eat the same amount of fat in a healthier form, let’s say something that I cooked on low heat, it gives me far less reflux than if I had eaten the same amount of fat in a deep-fried meal. Quick Thai-style stir-frying also seems to be less of an issue for me.
Many people get better by reducing fat in their diet, but some kinds of fat seem to be fine. Fried food seems to be pretty much universally bad for reflux, though.
What I assume is that deep frying might produce substances that promote reflux. It is known that inflammation-causing agents develop when frying with vegetable oils.[3],[4] Maybe some substances are formed that also promote reflux. Again, I do not have scientific data to back this up, but I see that for a lot of people, eating deep-fried food is far worse than just eating high-fat but otherwise healthy meals.
2. Sodas
Sodas such as lemonade and coke are acidic. Acid activates previously refluxed pepsin in the mucous membranes of the throat.[5] Pepsin is an enzyme from the stomach that causes the actual damage in silent reflux.
Among drinks, sodas are especially deceptive because they do not taste sour. They contain so much sugar that you would typically not suspect that they are as acidic as they are. Acid is responsible for the fresh taste of soda. Without it, they would taste like bland sugared water with a bit of flavor.
Besides being acidic, sodas are also carbonated. The drinks release gas inside the stomach, which increases the stomach volume. The pressure in the stomach then rises, causing reflux.
3. Fruit juices
Like sodas, almost all fruit juices are very acidic.
The reason I mention fruit juices as a separate item is because they are generally seen as healthy. I want to clarify that they are just as bad as other acidic drinks. Even more misleading is that fruits are often mentioned as being alkaline. This is because of the so-called “alkaline diet” trend, where acidity does not refer to the actual pH of food, but to acids that form inside the body during the digestive process.
When I talk about acid, I always mean the pH of food before being digested. I’ve written a separate article about this confusing topic.
4. Chocolate
Chocolate contains not only one, but multiple reflux-causing agents.
Among other substances, it contains theobromine, which relaxes the lower esophageal sphincter (LES), thereby promoting reflux.[6],[7] Chocolate also contains some caffeine, which favors reflux.
Furthermore, chocolate contains a lot of fat, and for these reasons combined, chocolate is a common reflux trigger.
5. Alcohol
Alcohol affects the sphincter and promotes reflux.[8] By the same token, most alcoholic drinks are acidic and carbonated, further worsening silent reflux. Alcohol itself can also irritate the already sensitive tissues of the throat.
Most people find it difficult to abstain from alcohol, but it would at least make sense to limit its consumption. Furthermore, when people get drunk, they also often eat late, e.g., after going out. This is a problematic combination, considering that they will now sleep with a full stomach and an impaired lower esophageal sphincter, leading to heavy reflux all night long.
6. Coffee
There is no question that coffee is a strong promoter of reflux, and there have been a number of studies on the subject. It is not well understood, however, why coffee causes reflux.
Caffeine is often mentioned as the reason that coffee causes reflux. However, this does not add up. Studies have shown that even decaf coffee causes reflux, although to a lesser extent. Tea, on the other hand, even if you drink more of it to get the same amount of caffeine, causes no, or at least much less, reflux – so it must be some other substance in coffee that is triggering reflux.[9],[10],[11]
If you need caffeine in the morning, you should drink tea instead of coffee. You should at least reduce the amount of coffee you drink per day.
What else you can do?
Does this mean you can never eat or drink the things on the list above? Not at all. But if you have silent reflux, reducing them will most likely improve your symptoms over time. Then later, when your reflux is better, you can try reintroducing them to see how much you can tolerate.
It is worth noting that the above-mentioned foods are just a few examples of strong triggers for reflux, but there are more. Be assured, though, that there are recommendations about the things you can eat or drink instead that will help you get better.
Diet for avoiding silent reflux is a very complex topic. That is why it is one of the main focuses of our online course on silent reflux treatment. The course covers in detail how to improve silent reflux with dietary changes.
References
[1] McSwiney BA, Spurrell WR. The effect of fat on gastric motility. J Physiol. 1935;84(1):41–49.
[2] Nebel OT, Castell DO. Lower esophageal sphincter pressure changes after food ingestion. Gastroenterology. 1972;63(5):778-83.
[3] Dobarganes C, Márquez-Ruiz G. Possible adverse effects of frying with vegetable oils. Br J Nutr. 2015;113(2):549–57.
[4] Lopez-Garcia E, Schulze MB, Meigs JB, Manson JE, Rifai N, Stampfer MJ, Willett WC, Hu FB. Consumption of trans fatty acids is related to plasma biomarkers of inflammation and endothelial dysfunction. J Nutr. 2005;135(3):562–6.
[5] Koufman JA. Low-acid diet for recalcitrant laryngopharyngeal reflux: therapeutic benefits and their implications. Ann Otol Rhinol Laryngol. 2011;120(5):281-7.
[6] Murphy DW, Castell DO. Chocolate and heartburn: evidence of increased esophageal acid exposure after chocolate ingestion. Am J Gastroenterol. 1988;83(6):633–6.
[7] Wright LE, Castell DO. The adverse effect of chocolate on lower esophageal sphincter pressure. Am J Dig Dis. 1975;20(8):703–7.
[8] Chen SH, Wang JW, Li YM. Is alcohol consumption associated with gastroesophageal reflux disease? J Zhejiang Univ Sci B. 2010;11(6):423–428.
[9] Zhang Y, Chen S. Effect of coffee on gastroesophageal reflux disease. Food Sci. Technol. Res. 2013;19(1):1–6.
[10] Pehl C, Pfeiffer A, Wendl B, Kaess H. The effect of decaffeination of coffee on gastro-oesophageal reflux in patients with reflux disease. Aliment Pharmacol Ther. 1997;11(3):483–6.
[11] Wendl B, Pfeiffer A, Pehl C, Schmidt T, Kaess H. Effect of decaffeination of coffee or tea on gastro-oesophageal reflux. Aliment Pharmacol Ther. 1994;8(3):283–7.