When people think of heartburn and acid reflux, they generally think of the same thing: that burning feeling in the throat and chest that you treat by popping a Tums. But according to Dr. Jonathan Aviv, ENT and clinical professor of otolaryngology at Mt. Sinai, misinformation about acid reflux is abundant, and that it’s far more common, and potentially serious, than you might think. In this interview, the author of The Acid Watcher Diet clears up the different types of acid reflux, how to prevent acid reflux with diet, acidic foods to avoid, and much more.
Acid Reflux vs. GERD and Types of Acid Reflux
People often use the terms acid reflux, heartburn, and GERD interchangeably, but they’re actually distinct conditions. Here’s how to differentiate:
Acid Reflux: A muscle called the lower esophageal sphincter connects your esophagus to your stomach, and it acts like a door between the two. Normally, it closes tight after food passes into the stomach, but if the muscle is weak or can’t fully tighten for other reasons, the acid from your stomach can make its way back up into your esophagus. This is acid reflux.
Heartburn: Heartburn is not really its own condition, but rather a symptom of acid reflux. When the acid creeps into your esophagus, it creates a painful sensation in the esophageal lining, which is more delicate than the stomach lining. This can feel like burning (hence the name), or like a sharp, tight pain. More than 60 million Americans experience heartburn on a monthly basis (that’s nearly 20% of the population!).
GERD (gastroesophageal reflux disease): While heartburn and acid reflux are often temporary and caused by something you ate or drank, GERD is a chronic, more serious form of acid reflux. It is diagnosed when a person experiences acid reflux more than twice a week, or when their reflux causes inflammation in the esophagus. It can lead to long-term health issues, including cancer.
But beyond those broad definitions, there are other distinctions that Dr. Aviv explains are very important to our understanding and treatment of these conditions. See, there’s more to acid reflux than heartburn and GERD, and this is where the main issue lies.
When patients come to see Dr. Aviv complaining of a hoarse throat or allergy-like symptoms, they’re often perplexed when he returns with his diagnosis: acid reflux. Not what you expect to hear from an ENT doctor right? The first misconception Dr. Aviv wants to clear up is that there are actually two types of acid reflux. There’s the one everyone thinks of, the burning feeling coming up your chest from your stomach, which is associated with GERD and heartburn.
But there’s also a type that can happen to any of us and that manifests much differently: when you eat something acidic, it can cause inflammation as you swallow, affecting the throat, sinuses, ears, lungs, and vocal cords. This second type is where people get confused, as the symptoms don’t seem to fit those of “traditional” acid reflux. Instead, you might have a cough, post-nasal drip, or a hoarse throat.
“This is what trips people up,” says Dr. Aviv. “They’ll come in and they’ll say, ‘I’ve been clearing my throat for weeks,’ or ‘My allergies are acting up and I have nasal drip and I need some antihistamines and an allergy investigation,’ when really, it’s the acidity of what they’re eating that’s triggering all these symptoms.
This confusion around the different types of acid reflux is dangerous, because it means that many cases of acid reflux go undiagnosed — and long-term untreated acid reflux of either type can lead to esophageal cancer. “You can imagine if you’re eating or drinking something acidic, the sensitive esophageal tissues get burned,” explains Dr. Aviv. “If you keep burning them, the tissues break down, and in a certain number of cases, they transform into cancer cells.”
Unexpected Causes of GERD and Acid Reflux
Esophageal cancer has been the fastest-growing cancer in the U.S. and Europe since the mid-1970’s, and this is largely due to more and more people suffering from acid reflux. So, what happened in the mid-1970’s? Well, two things:
First, in an effort to prevent botulism (food poisoning caused by improperly sterilized canned food), the government enacted a law called Title XXI, which required that every food in a can, bottle, or box needs to be acidified. The recommended pH number to protect against botulism was 4.4, but after the food producers began adding acid, they cranked things up a notch. They realized that acid could not only prevent food poisoning, but also keep the foods on the shelves for very long periods of time, so they began adding ingredients like ascorbic acid and citric acid to lower the pH even further. Suddenly, the food Americans were eating was much more acidic than they were used to or than their bodies were meant to ingest.
Second, the food industry began to shift how they added sweeteners, switching from cane sugar and beet sugar to a much less expensive sweetener derived from corn, known as high fructose corn syrup. This is a very inflammatory sweetener that can loosen the lower esophageal muscle, making it easier for the acidic cells in the stomach to make their way up.
This combination of more acidic food and looser esophageal muscles is a one-two punch that causes a lot of inflammation — or worse. “You have to think about what’s going on now. You’re eating and drinking various acidic things and you’re having sweeteners that loosen, so it’s essentially a double whammy,” says Dr. Aviv. “Acidic things this way, loosening that way, and it’s causing a lot of inflammation.”
Today, 75 million Americans have GERD, and “we’re all at risk,” according to Dr. Aviv. “The scary thing is that a lot of people don’t have the traditional symptoms.” So when patients come to Dr. Aviv complaining that they need to clear their throat all the time, they’re quite confused when he responds by asking about their diet. “They look at me like I have nine heads,” he says.
How to Prevent Acid Reflux Naturally
On top of that, the traditional acid reflux “solutions” we turn to (we’re looking at you, Tums) aren’t solutions at all. In fact, when it comes to how to prevent acid reflux, the most effective treatment involves — you guessed it — diet and lifestyle. In Dr. Aviv’s book, The Acid Watcher Diet, he explains exactly what to eat and not eat to prevent and heal acid reflux, without any drugs. “The idea is to create a diet that replaces medication,” he says.
Dr. Aviv is laser-focused on how diet and lifestyle affects the acid response, and he should know — he has personal experience. When he was at Columbia, he woke up in the middle of the night and couldn’t breathe. Eventually he realized that it was because of what he was eating. “You know, that 32 big ounce, Big Gulp of, I don’t know how many milligrams of caffeine were in this thing,” he says. “My diet was giving me symptoms and it took a long time because the science really wasn’t there.”
Today, he asks all his patients detailed questions about their diets, and he recommends that if your doctor isn’t asking you these questions, you should volunteer the information — or better yet, bring in a food diary, including not only what you ate (and drank) but when. This latter part is important because if you’re lying down shortly after eating, you take away gravity, and acidic enzymes make their way up into your esophagus. By providing this information, Dr. Aviv says, “You’re giving your clinician the keys to a lot of these symptoms.”
Addressing the issues in your diet is incredibly important, because eating acidic foods causes a body-wide inflammatory response — which means it can affect a lot of things besides acid reflux. This is pretty sobering, but on the flipside, it means that switching to an anti-inflammatory diet can help a whole bunch of other things as well as acid reflux.
“Initially I thought of it as just for acid reflux disease,” says Dr. Aviv. “But as more and more science is coming out, we’re realizing that this diet is really an anti-inflammatory diet for everyone.” After putting patients on his acid watcher diet, Dr. Aviv has had patients come back reporting that conditions like IBS, psoriasis, and Crohn’s disease have improved.
The Acid Watcher Diet: Acidic Foods to Avoid
Dr. Aviv’s professional and personal experience has shown him, firsthand, the ways in which diet can both cause and heal problems like acid reflux, heartburn, and GERD. His book goes into detail on how to treat acid reflux naturally by using diet to replicate acid-reducing medication. This is important not only because it relies on lifestyle adjustments that are good for your health in general, but also because a lot of those medications have some serious side effects.
One of the main areas of focus is acidic foods to avoid. Here’s a quick primer on the 12 worst offenders when it comes to acid reflux (the “Dirty Dozen” as Dr. Aviv calls them):
The 12 Most Acidic Foods to Avoid
6 foods that loosen the muscle that separates the acidic stomach from the non-acidic esophagus:
6 extremely acidic foods/food groups:
sugary or diet soda
sugar or diet bottled iced tea (According to Dr. Aviv, even having these first two items once or twice a month isn’t okay. He equates it to “pouring battery acid down my throat twice a month.”)
tomato sauce (not tomatoes)
In terms of what you should eat, he recommends organic, non-GMO produce, non-dairy milks, cucumber, watermelon, flax seeds and lots of whole foods: “The more whole, natural foods you have, the better it is for your body, meaning fewer chemicals, less inflammation.” Coincidentally, these foods are similar to what we recommend in The WellBe Gut Health Guide, which is now live (go grab it!) and chocked full of information on improving and healing your gut, and in effect, your whole body.
Conclusion: What To Remember About How to Prevent Acid Reflux
Many people dismiss acid reflux as a pesky condition that you treat by popping a Tums or another heartburn medication. But, as Dr. Aviv explains, that’s not the case. It takes on different forms, is incredibly common, and can lead to really serious health issues down the line. Here’s what to remember about acid reflux:
Acid reflux occurs when the lower esophageal sphincter doesn’t tighten properly, allowing acid from the stomach to make its way up into the esophagus. Heartburn is a symptom of acid reflux, and GERD (gastroesophageal reflux disease) is a chronic and more serious form of acid reflux.
There are two different types of acid reflux. The one most of us think of is the burning sensation in the chest. With the other type, acidic food causes inflammation in the throat, sinuses, and vocal cords, which can manifest as cold- or allergy-like symptoms.
Untreated acid reflux can lead to esophageal cancer, because the delicate cells of the esophageal lining get burned by acidic foods, and then these damaged cells can turn into cancer cells.
Esophageal cancer has been on the rise in the U.S. since the mid-1970s, when two shifts increased the rate of acid reflux: first, a new policy required that food producers acidify packaged goods; and second, food producers switched from cane sugar to high fructose corn syrup, which can loosen the lower esophageal sphincter.
Heartburn and acid reflux medications don’t treat the root cause of acid reflux, and come with some serious side effects. If you want to know how to prevent acid reflux effectively, you need to turn to diet.
The Acid Watcher Diet includes details on acidic foods to avoid, and what to eat instead, but here are Dr. Aviv’s 12 most acidic foods to avoid: coffee, chocolate, alcohol, mint, raw onion, raw garlic, sugary or diet soda, sugary or diet iced tea, citrus, tomato sauce, vinegar, and wine.