Reflux is not only about too much acid. A loose valve, a stomach that is too full, the kind of food you eat, posture, sensitivity and very hot drinks all play a part. Here is how to tackle each one.
Many people with acid reflux think the problem is simply too much acid. In clinic I find it more useful to look at six separate things that push acid up, or make the food pipe (oesophagus) feel it more. These factors add up. One on its own may or may not cause trouble, but when several come together, reflux is almost certain. Most people have two or three of them, and fixing those often helps as much as medicine.
1. A loose valve at the top of the stomach
Where the oesophagus joins the stomach (the gastro-oesophageal junction, or GEJ) there is a ring of muscle that acts as a one-way valve. When it relaxes too easily, acid flows back up. Alcohol, chilli and spicy food, coffee and tea all loosen this valve. Cut down on the ones that affect you, and avoid them in the evening.
2. A stomach that is too full
The fuller the stomach, the more pressure on the valve. A stomach gets too full when food goes in faster than it leaves. Eating too fast or eating too much are the commonest causes. Some people also have a stomach that empties slowly, and oily food, bloating and constipation slow it further. Eat smaller meals, slow down, go easy on fried and fatty food, and treat constipation if you have it.
3. The kind of food you eat
Simple carbohydrates such as porridge, white bread and starchy gravy are digested quickly. A few hours later many patients notice acid or a gnawing hunger. Swapping to slower carbohydrates such as brown rice, and eating meals on time so the stomach is not left empty for long, often helps. If that acid or hunger feeling comes, eat something rather than wait.
4. Physics: posture and gravity
When you are upright, gravity helps keep acid in the stomach. Lying down or bending soon after a meal removes that help, and anything that presses on the stomach pushes acid up.
- Do not lie down for 2 to 3 hours after eating, so have dinner earlier
- If you have night-time symptoms, raise the head of the bed by 15 to 20 cm (extra pillows are less effective)
- Avoid bending over or tight belts straight after meals
5. Sensitivity
Once acid has irritated the oesophagus, it becomes more sensitive, so the same amount of acid can feel much worse on some days than others. Poor sleep and stress make the oesophagus more sensitive, so symptoms flare during busy or anxious periods. Good sleep, ways to manage stress and regular exercise all reduce this sensitivity. Avoid hard exercise straight after a meal, though. Abdominal breathing is a simple exercise that can help.
6. Food and drinks that are too hot
Soup or drinks hotter than 50°C can scald the lining of the oesophagus, which is already irritated in people with reflux. Over many years, very hot drinks are also linked to a higher risk of oesophageal cancer. Let hot soup, tea and coffee cool for a few minutes first.
When medicine is needed
If symptoms continue despite these changes, acid-reducing medicines such as proton pump inhibitors work well. They are best used at the lowest dose that controls symptoms, and reviewed with your doctor rather than taken indefinitely on your own. More on treatment is in the acid reflux guide.
When to see a doctor
- Difficulty or pain when swallowing, or food sticking
- Vomiting, black stools, weight loss you cannot explain, or anaemia
- New reflux symptoms after the age of about 50
- Symptoms that come back whenever you stop medicine, or have lasted many years
A gastroscopy can check for inflammation, a hiatus hernia or Barrett’s oesophagus.
General information only. Reviewed by Dr Chia Chung King, 2026-11-07. Book a consultation.