Common Triggers of GERD & How to Avoid Them

Gastro-oesophageal reflux disease (GORD), or acid reflux, is a condition where the stomach contents reflux into the oesophagus (food pipe). Common symptoms include heartburn, chest pain, hoarseness, coughing, difficulty swallowing, and regurgitation.  

GORD is linked to several underlying causes. These range from a hiatus hernia, where part of the stomach lies in the chest, to pregnancy, where the pressure in the abdomen pushes the food contents back up into the oesophagus. 

Several GORD triggers increase the risk of an acid attack. These triggers either affect the muscles that prevent the backflow of stomach contents into the oesophagus or increase the production of stomach acid. Let’s take a closer look. 

Common Reflux Triggers 

Not sure if you have acid reflux? Consider if these triggers cause your symptoms to worsen: 

Spicy, Fatty, or Acidic Foods 

What you eat is almost certainly a major factor in causing acid reflux. After all, the more acid that’s present in your stomach, the more severe the symptoms will be. 

Most of these foods are either acidic or trigger the release of acid from the stomach. For example, high-fat foods, such as pizza or chips, increase the risk of acid reflux via the following mechanisms: 

• Delayed Gastric Emptying. Fatty foods linger in the stomach for longer as they’re harder to digest. Prolonged gastric retention increases the risk of backflow.

• Lower Oesophageal Sphincter (LOS) Relaxation. The LOS sits between the stomach and oesophagus, acting as a valve to prevent the stomach contents from moving backwards. Both fatty and spicy foods can relax the LOS.

• Stimulating Acid Production. Spicy foods, especially those containing chilli or pepper, can stimulate the stomach lining to produce more acid. This increase in acid can contribute to the discomfort and symptoms associated with acid reflux.

• Irritation of the Oesophagus. Both types of foods can also directly irritate the oesophageal lining if the tissue is already sensitive or damaged from existing reflux, exacerbating symptoms and discomfort. 

Acidic foods, on the other hand, simply lower the pH of your stomach. Foods to avoid include: 

• Coffee

• Citrus fruits

• Tomatoes

• Peppermint

• Caffeine

• Chocolate

• Garlic

• Onions

Smoking 

Smoking is another major trigger for GORD. It acts via several mechanisms, including reducing saliva production, which neutralises stomach acid, increases acid production, and impairs LOS function. 

However, smoking can also exacerbate the complications of prolonged reflux. Acid reflux damages the oesophagus, potentially leading to oesophageal cancer. Smoking is carcinogenic and can further increase the risk of cancer.  

Drinking Alcohol 

Alcohol is a known muscle relaxant. It causes your LOS to relax and allows acid to reflux into the oesophagus. It also irritates the stomach lining, triggering the production of more acid. The solution? We recommend the following tips: 

• Limit your alcohol consumption to a few drinks.

• Opt for white wine instead of red wine.

• Dilute your alcoholic drink with water or soda water.

• Monitor your alcohol consumption.

• Bring along a pack of antacids to counteract heartburn. 

Eating Large Meals or Too Close to Bedtime 

Perhaps the biggest mistake people with GORD make is overeating. It’s often behind GORD flare-ups and is one of the easiest GORD triggers to avoid.  

Your LOS usually stays closed due to the upward pressure against it – it works like a valve. However, if the pressure in your stomach gets high enough, it can force the LOS to open, allowing the stomach contents to move into the oesophagus. 

Eating larger meals will rapidly increase your stomach pressure. Instead of eating three big meals a day, it’s sensible to restrict your diet to six small meals – or three meals and three snacks. This prevents your stomach from becoming too full.  

Eating too close to your bedtime or too quickly is also a problem. This is likely to trigger acid production and the LOS opening just before going to be, which is likely to lead to a flare-up. Try to take smaller bites, chew your food thoroughly before swallowing, and take your time.  

Lying Down After Eating 

The only reason GORD flare-ups don’t occur all the time is due to gravity. It prevents the stomach contents from entering the oesophagus. When you lie down, the stomach contents are free to flow down towards the mouth. Plus, the stomach contents press harder against the LOS, once more forcing it open. 

We recommend: 

• Wait at least three hours after meals before lying down.

• Raise the head of your bed by 6-8 inches using blocks or a wedge pillow.

• Sleep on your left side to minimise acid reflux.

• Wear loose clothing to reduce pressure on your stomach.

Wearing Tight Clothes 

What you wear is a common reflux trigger. Remember, the more pressure in your abdomen, the greater the chance of the LOS opening. Wearing extremely tight clothing around the abdomen squeezes the stomach, forcing food and acid into the oesophagus.  

Getting Too Stressed 

You might not think of emotions as a GORD trigger. However, stress can stimulate stomach acid production, reduce LOS function, and alter your lifestyle habits. It’s not clear how stress causes greater stomach acid release or impairs LOS function, but it might be connected to cortisol levels. 

That being said, practicing mindfulness, getting enough exercise, and taking time to destress can help relieve your symptoms. Reducing stress also makes it easier to choose healthier options instead of fatty foods, which can trigger GORD. 

Testing for Acid Reflux 

Dealing with the common triggers for GORD is only part of the solution. If you suspect you’ve got acid reflux, you need to get tested to confirm the diagnosis.  

Here at The Functional Gut Clinic, we guide patients through the testing process and offer two kinds of testing: 

• 24-hour Reflux Testing monitors the presence of acid in your stomach and is used to diagnose GORD.

• Oesophageal Manometry measures pressure changes in the oesophagus, detecting if there’s a problem with the LOS or muscles used to swallow. 

Our team can help advise you on the best option for your symptoms. We’ll also talk you through your results after the test to ensure you receive the right treatment. 

It's important to remember that chronic acid reflux can also impact oral health, leading to dental erosion and other issues.