Acid reflux and gastritis: what to eat, what to avoid and which habits help

Acid reflux and gastritis: what they are and why they are not the same

Although people use the words interchangeably, they are two different problems that often overlap. Gastro-oesophageal reflux is the backflow of stomach contents into the oesophagus; when it causes symptoms at least once a week or damages the oesophagus it is called gastro-oesophageal reflux disease (GERD). It is very common: between 8.8% and 25.9% of adults in Europe, according to the population studies reviewed by El-Serag (2014). Gastritis is inflammation of the stomach lining. Unlike reflux, most people with gastritis have no symptoms, and the cause is usually specific: the bacterium Helicobacter pylori (in 2015 an estimated 4.4 billion people worldwide carried it, according to Hooi, 2017), long-term use of non-steroidal anti-inflammatory drugs, alcohol or, less often, an autoimmune problem. So the diet advice overlaps, but the weight of each factor is different: in reflux, habits rule; in gastritis, the cause rules.

What does have evidence: habits

The 2022 American College of Gastroenterology guideline grades each recommendation by the quality of the evidence. Only one is “strong”: losing weight. The rest are suggestions with low-quality evidence, but they are cheap and have no relevant side effects:

The suspect foods and what is known about each one

Almost every list of “forbidden foods” repeats the same names. The evidence behind them is thinner than it looks: for several there is a plausible mechanism, but no trials showing that cutting them out improves reflux.

What does point clearly in one direction is the overall pattern. In 42,955 US nurses followed for 10 years, those who met five habits (normal weight, never having smoked, at least 30 minutes a day of moderate or vigorous physical activity, no more than 2 cups a day of coffee, tea and soft drinks combined, and a prudent-style diet) had half the risk of developing reflux symptoms of those who met none. The authors estimated that 37% of cases could have been prevented with all five, and weight was the factor that counted most (Mehta, 2021). It is an observational study in women, but it fits the guideline: the overall pattern matters more than any single food.

What to eat with acid reflux or gastritis: a sample day

There is no evidence-based “reflux diet”, so the idea is to eat a varied diet, in moderate portions and with simple dishes, and to cut out only what bothers you. A day that is usually well tolerated:

• Breakfast: porridge made with milk or a plant drink, sliced banana and a few walnuts.
• Lunch: rice with grilled chicken and courgette or green beans sautéed with a little oil.
• Snack: a plain yoghurt with a pear or an apple.
• Dinner, 3 hours before bed: baked hake with boiled potato and steamed vegetables.
• Drinks: water; if you drink coffee or tea and they do not give you heartburn, there is no need to drop them.

Notice what is missing: fried food, heavy sauces and huge portions, which are what show up most often in the food diaries of people with reflux. Portion size matters as much as the food: the same dish feels different as a normal portion than as a double one. If it helps, bake, grill, steam or boil, and keep fat for dressing food raw.

Weight, tobacco and alcohol

Weight is the most powerful lever. In 10,545 women from the Nurses’ Health Study, the odds of frequent reflux symptoms rose step by step with BMI: they were 2.2 times higher with a BMI of 25 to 27.4 and 2.9 times higher with a BMI of 35 or more, compared with a BMI of 20 to 22.4; even in women of normal weight, gaining more than 3.5 BMI points almost tripled the odds (Jacobson, 2006). And losing weight works the other way, according to the HUNT study. You can check your starting point with the BMI calculator. For tobacco, the data are more modest than people usually say: quitting smoking was linked to less severe reflux only in people of normal weight who took reflux medication every week. Alcohol lowers sphincter pressure and, in large amounts, can damage the stomach: cutting down helps reflux, gastritis and weight all at once.

Gastritis: diet matters less than people think

With gastritis there is a widespread misunderstanding: the idea that a strict bland diet cures it. According to the NIDDK, diet does not play an important role in most cases of gastritis. What causes it is usually a specific factor that needs to be looked for: Helicobacter pylori infection, which is diagnosed with simple tests and treated with a course prescribed by a doctor; long-term use of non-steroidal anti-inflammatory drugs, which is worth reviewing with your doctor; or alcohol, which in large amounts can cause acute damage. In practice, eat what you tolerate, in moderate portions, cut down on alcohol and, if the discomfort continues, get it checked: removing foods without a diagnosis can impoverish your diet without touching the cause.

Find YOUR triggers (do not cut foods because of fads)

Because problem foods vary so much from person to person, what helps is not cutting a long list all at once but personalising. Keep a record of what you eat, at what time and when symptoms appear for 2-3 weeks: clear patterns usually emerge. Maybe you tolerate coffee well but not tomato, or the same dinner only bothers you when it is late and large. Also note whether episodes coincide with periods of stress or eating in a rush. And for packaged products, learning to read labels helps you spot the very fatty ones. That tailored approach is what the ACG guideline means when it talks about “trigger foods”.

When to see a doctor

Occasional heartburn can be handled with the changes in this guide, but some situations need assessment: frequent symptoms that do not improve with the changes, needing antacids almost every day, or any warning sign. The ACG guideline calls for an endoscopy as soon as feasible when there is trouble swallowing, weight loss, bleeding, vomiting or anaemia. A doctor can also test for Helicobacter pylori and review your medicines. Do not self-medicate long term without a diagnosis.

Finding out what sets off your reflux is, above all, a matter of watching your meals methodically. With Renzy you take a photo of your plate and it is saved with an estimate of calories and macros that you can correct: after a few weeks you have a record of what you ate and when, which you can match against your symptoms to see whether the problem is a food, the portion size or the time of your dinner.