Reflux (Gastro-oesophageal Reflux Disease)

Gastro-oesophageal reflux disease (GORD, or GERD if you are from North America) is extremely common in Western populations. Approximately 10–20% of adults experience reflux, and in Australia alone around 15% of the population is prescribed reflux medication. Most commonly these medications are proton pump inhibitors (PPIs), which work by suppressing gastric acid production.

While these drugs can reduce symptoms, they also substantially reduce stomach acid, which plays an essential physiological role in digestion. Gastric acid is required for effective protein digestion, absorption of certain nutrients, and suppression of microbial overgrowth in the upper gastrointestinal tract. Long-term suppression of stomach acid may therefore contribute to intestinal microbial imbalance, including overgrowth of methane-producing organisms, which has itself been associated with increased reflux symptoms. It also results in reduction of protein digestion and absorption, which has multiple downstream consequences.

Physiological contributors to reflux

Several physiological mechanisms contribute to reflux. One of the most important is delayed gastric emptying. When food remains in the stomach for prolonged periods, pressure within the stomach increases, promoting the backflow of gastric contents into the oesophagus.

Another contributing factor is reduced salivary production, which tends to decline gradually with age, potentially beginning as early as the third decade of life. Saliva helps neutralise acid and clear refluxed gastric contents from the oesophagus, so reduced production can worsen symptom severity.

A number of medications can also promote reflux by relaxing the lower oesophageal sphincter, the muscular valve separating the stomach from the oesophagus.

Certain foods and lifestyle factors are also known to exacerbate reflux, including:

• Alcohol

• Chocolate

• Coffee

• Peppermint essential oil

• High-fat meals

Alcohol has a dose-dependent relationship with reflux: the more consumed, the greater the likelihood of symptoms. Fatty meals are particularly problematic because they slow gastric emptying, significantly increasing reflux risk. Research suggests reflux is approximately seven times more likely following a high-fat meal.

Eating behaviour and reflux risk

Eating patterns and meal timing also influence reflux risk.

Evidence suggests that reflux is:

• 7 times more likely after a fatty meal

• 5 times more likely when eating late at night

• 7 times more likely when food is consumed within three hours of bedtime

• 4 times more likely when meals are eaten quickly

Eating slowly and chewing thoroughly appears protective. In fact, increasing chewing significantly reduces reflux scores in clinical studies.

Humans have historically eaten earlier in the day, typically finishing meals before darkness due to the absence of artificial lighting. Returning to this pattern—finishing the final meal before nightfall (and ideally even by sunset)—may reduce reflux symptoms while also supporting metabolic health and body weight regulation.

Importantly, low stomach acid is not considered a primary cause of reflux. Interestingly, some evidence suggests that Helicobacter pylori infection may even be protective against reflux disease in certain populations.

Additional risk factors

Other recognised contributors to reflux include:

• Coeliac disease

• Overweight or obesity

• A non-Mediterranean dietary pattern

• High intake of animal protein

• High intake of simple sugars

Conversely, diets rich in complex carbohydrates and fibre appear to be associated with lower reflux risk. So don't cut out the carbs (the right ones).

Non-pharmaceutical therapeutic options

A number of botanical and nutritional interventions have shown evidence of benefit for reflux symptoms. These include:

Demulcent and soothing botanicals

• Marshmallow root

• Slippery elm

• Meadowsweet

• Aloe vera

• Chamomile

• Calendula

• Quince

These herbs are traditionally used to soothe and protect gastrointestinal mucosa and are often most effective when taken as powders, teas, or syrups rather than capsules.

Adaptogenic and nervine botanicals

• Lavender

• Passionflower

• Kava

• Rhodiola

• Panax ginseng

• Withania (Ashwagandha)

• Schisandra

• Motherwort

• Vervain

• Green milky oats

These herbs may help modulate the stress response, which can influence digestive motility and symptom perception.

Other botanicals

• Hawthorn berry

• Liquorice

• Mastic gum

A 2010 randomized trial found that 350 mg of mastic gum three times daily for three weeks improved reflux symptoms in approximately 90% of participants.

Nutritional interventions

Several nutrients have demonstrated benefit in clinical studies:

• Melatonin – 6 mg nightly has been shown to improve reflux symptoms and may be comparable to PPIs in some trials.

• Curcumin – 2 g daily improved symptoms substantially in clinical research, with around 80% of participants becoming asymptomatic within two weeks in one study.

• D-limonene – a citrus-derived compound that may improve gastric motility and reflux symptoms.

• Coriander triphala – approximately 1 g three times daily was shown in a randomized controlled trial to produce symptom improvement comparable to 20 mg omeprazole.

• In patients with Barrett’s oesophagus, a serious complication of chronic reflux, a 2012 study reported that consuming the equivalent of 250 mL of carrot juice daily for six months resulted in complete regression in approximately one-third of participants.

Dietary fibre and the microbiome

Increasing dietary fibre intake appears to reduce reflux symptoms, likely through improvements in gastrointestinal motility and microbiome composition. This is something I plan to address in a further blog.

In contrast, low-FODMAP diets, while sometimes used for irritable bowel syndrome, have been shown to reduce beneficial gut bacteria and may negatively impact microbiome diversity. They are therefore not generally recommended as a long-term strategy for reflux management.

Practical strategies to reduce reflux

In many cases reflux symptoms can be substantially improved through dietary and lifestyle changes:

• Eat slowly and chew food thoroughly

• Aim for approximately 50 chewing strokes per mouthful

• Avoid eating within three hours of bedtime

• Finish the final meal before evening where possible

• Prioritise a Mediterranean-style diet rich in whole plant foods

• Increase intake of dietary fibre and diverse plant foods

• Limit high-fat meals

• Avoid ultra-processed foods and refined sugars

A predominantly plant-based, whole-food Mediterranean diet combined with purposeful eating behaviours appears to offer one of the most effective non-pharmacological approaches to reducing reflux symptoms while simultaneously supporting broader metabolic and gastrointestinal health.

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