Pharmacist on treating acid reflux with diet and lifestyle

Deborah Grayson said that people are hooked on medication to manage acid reflux, but they could resolve their symptoms with diet and lifestyle alone.

Proton pump inhibitors (PPIs) are one of the UK’s most widely used drugs, with 73 million NHS prescriptions dispensed in England in 2022-23, at a cost of £190m. Long-term use comes with worrying side-effects from dementia to osteoporosis.

Ms Grayson believes doctors are overprescribing PPI medication, such as omeprazole and lansoprazole, as a ‘panacea for varied digestive symptoms, without a clear clinical need to suppress acid production’. 

And she claims there is no clear ‘exit strategy’, meaning many patients with acid reflux - where stomach acid painfully flows back up into the oesophagus, the tube connecting the mouth and stomach - can be ‘hooked’ on the drugs for life.

Ms Grayson, the nutritional therapist in residence for Heartburn Cancer UK, wants to better educate doctors and patients on the appropriate use of PPIs and effective management of ‘coming off’ the medication via her work through Digestion With Confidence.

She said: “We are sleepwalking into a significant culture of PPI addiction due to over-prescribing without clear reason and failure to give patients a clear exit strategy from the treatment.

“It only takes three days’ use of PPIs to be at risk of rebound heartburn, which can be five times worse than normal reflux. This can mean patients inappropriately assume that the medication is essential as excess acid must have been the issue. 

“It is this rebound that leads to the inability to stop taking a PPI in many patients, effectively leaving them hooked on PPI medication.

“Whilst simple reflux symptoms can be successfully managed by diet and lifestyle it is important to consult your doctor if you have issues with persistent symptoms, issues with swallowing, burning or gnawing pain, fatigue, weight loss, or blood in stools or vomit.” 

Ms Grayson says the following can help to manage acid reflux without medication:

Manage stress to improve your digestion:

Control of digestion is managed by the autonomic nervous system, which has two sides - the fight or flight system and the rest and digest system. When one is dominant the other is suppressed. This means that we cannot have effective digestion if we are under a high amount of stress. 

Making sure that we are as relaxed as possible at meal times is really important. Eating at your desk while checking your emails or scrolling on social media can effectively switch off the digestion process. 

Taking time to eat at a dining table away from distractions can really help with the digestion process. If particularly stressed doing a few minutes of alternate nostril or box breathing can help to calm the fight or flight response and do wonders for your digestion.

How you are eating wrong – eating mindlessly

Digestion starts in the brain with 20 per cent of stomach acid being produced in anticipation of food being consumed, according to Grayson.

“This is known as the cephalic response,” she says, explaining that before the invention of fast-food, the preparation and cooking of meals triggered the same process, kick-starting the digestive system. 

“Modern lifestyles have resulted in many people deciding they are hungry, dashing into the nearest food outlet and eating food within minutes,” Grayson adds. “This means that the body has to play catch up. If you are stressed this is even worse.”

She advises – even if too busy to cook - to start the ‘anticipation process’ some 20-30 minutes before grabbing something to eat. 

“Think about what you are going to have, how it tastes and how it smells can trigger this response in the same way that preparing it yourself would have done.”

Chewing is of equal importance. Each mouthful of food should be chewed until it's soft - while putting down your knife and fork between mouthfuls gives the stomach a much better chance of digesting the food you have eaten.

How foods affect reflux

There are many foods that make reflux worse - such as coffee, alcohol, chocolate, peppermint, tomatoes and citrus fruits. “These foods relax the oesophageal sphincter making reflux of stomach contents more likely,” Grayson explains.

Spicy meals, fatty foods and large portions also cause the muscle to not function properly. “If you have severe reflux symptoms, avoiding these foods can play a key role in calming them down,” she advises.

“As you work on your digestion, your tolerance to these foods may improve and avoiding these foods within three-to-four hours before bedtime can help massively.”

Start a meal with something bitter, such as rocket or salad leaves, which helps the production of stomach acid, digestive enzymes and bile, to help your digestion function better. “If done 20-30 minutes before the full meal, it can help with the stimulation of the cephalic response,” she says.

It’s crucial to work out which foods trigger reflux, and eliminate those from your diet; it will help to reduce the symptoms and reduce the risk of damage to the oesophagus and further complications.

Herbs that may help

Herbs can act as a stimulant for digestion, as well as protecting the system from damage from acid and bile, according to Grayson.

“Drinking chamomile or artichoke tea can help stimulate the digestive process in a similar way to bitter leaves whilst fennel can have a calming impact on digestion too,” she explains.

“Drinking tea containing marshmallow root or slippery elm can help to protect the digestive system from acid and bile and help to calm digestive symptoms.”

These two teas should be consumed one hour after medication to reduce the risk of impacting the absorption and function of your medication.

Boost your body’s vitamins

Patients taking PPIs may have trouble obtaining sufficient vitamins and minerals from their food - so Grayson suggests taking a multivitamin supplement.

“Of particular concern are magnesium and vitamin B12. You can ask your GP to perform a blood test to check the need to supplement with these,” she says. “Key signs of issues with these two nutrients are fatigue, muscle spasms, pins and needles and headaches.”

A digestive bitter - which works in the same way as rocket - can be used when out and about. 

As with all supplements, it is important to check they are appropriate for you with a suitably qualified nutritional professional, your doctor or your pharmacist.