5 Common Acid Reflux Triggers

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

• An unpleasant taste in your mouth due to the stomach acid
• 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 influx of 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 act to return the contents to the stomach. You’re also more likely to act on any symptoms during daytime - by staying upright, swallowing saliva, or taking antacids. This minimises the harmful effects that acid can have on the delicate lining of the oesophagus.

A study that set out to find the influence of spontaneous sleep positions on nighttime recumbent reflux in patients with gastroesophageal reflux disease (GERD, a more serious form of acid reflux), found that those who slept on their back experienced more frequent episodes of gastroesophageal reflux. These symptoms usually presented themselves within 1 minute after changing into this position 28% of the time.

The study also recommended avoiding 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 and effects of acid reflux. It is recommended to try using some 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 that set out to find the factors that worsened the symptoms of GERD, 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.

In order to effectively manage stress and reduce the likelihood of symptoms, it is recommended to take steps towards managing and relieving stress.

Caffeine

Caffeine can relax the lower esophageal sphincter, meaning it becomes much easier for gastric acid to leak out of the stomach into the oesophagus. In turn the acid damage causes irritation to the oesophagus. Although it may be hard for some people to completely cut caffeine out of their daily routines, cutting down the level of caffeine you 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.

• Damaging the lower esophageal sphincter:

Nicotine, the key component in cigarettes, relaxes the ring of smooth muscles that connects the oesophagus to the stomach, known as the lower esophageal 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 the pH of saliva 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 and protects it from acid damage. When this mucus membrane is thinned, damage to the oesophagus is much more likely to occur as its protective barrier no longer functions.

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 in 2010 set out to find the capsaicin induction of esophageal symptoms in different phenotypes of gastroesophageal reflux disease (GERD). It was found that the chemical induced esophageal and gastric symptoms in healthy volunteers and GERD patients.

Another study 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 just 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.